From competent to proficient; nutrition education and counselling competency dilemmas experienced by Australian clinical dietitians in education of individuals

Aim: To critically examine Australian dietitians' experiences of nutrition education and counselling dilemmas arising from their training, competence and experience in education of individual clients. Methods: Participants were a self-selected sample of Australian dietitians who were working with clients in community, hospital, private practice or other employment. They responded to a researcher-developed Web-based questionnaire asking about skills required for education and counselling of individual clients in 2006. Data were collected electronically and descriptive statistics used to compare response distributions, and open-ended responses were examined by content and thematic analysis. Results: Of 258 respondents, half-qualified to enter dietetics since 1998. There was a change in the focus of practice from information-giving (as taught 30 years ago) to use of two-way communication. Dietitians aimed to use counselling, together with discussion and instruction, as methods for educating and interacting with clients. Four-fifths of dietitians recently qualified (1998–2006) were satisfied with their initial preparation for nutrition education and counselling roles. However, many commented that training courses were too focused on knowledge acquisition rather than skills development in nutrition counselling. Planned skill development in employment was described and dietitians were in favour of a system of mandatory counselling topics within continuing professional development CPD in order to improve counselling skill proficiency and aim for expert skills. Conclusion: Practising dietitians' perceptions indicated a need for greater focus on development of expert nutrition education and counselling skills, both in initial training and in the workplace, because these were seen as key skills for practice in the 21st century.