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Academy of Nutrition and Dietetics: Revised 2018 Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners

Published:December 19, 2018DOI:https://doi.org/10.1016/j.jand.2018.10.014

      Abstract

      Registered dietitian nutritionists (RDNs) engaged in education of nutrition and dietetics practitioners facilitate meaningful learning of required knowledge and supervised practice competencies in nutrition and dietetics curricula and proactively support all facets of the learning environment. Addressing the unique needs of each educational situation and applying standards appropriately is essential to providing evidenced-based, learner-centered, up-to-date education for future nutrition and dietetics practitioners. The Academy of Nutrition and Dietetics (Academy) leads the profession by developing standards that can be used by RDNs for self-evaluation to assess quality of practice and performance. The Standards of Professional Performance consist of six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how the standard can be applied to practice. The Academy's Revised 2018 Standards of Professional Performance for RDNs in Education of Nutrition and Dietetics Practitioners provide standards and indicators for three levels of practice—competent, proficient, and expert—which are used to gauge and guide an RDN’s performance in nutrition and dietetics practice in educational settings.
      Editor’s note: Figure 1 that accompanies this article is available at www.jandonline.org.
      Approved October 2018 by the Quality Management Committee of the Academy of Nutrition and Dietetics (Academy) and the Nutrition and Dietetic Educators and Preceptors (NDEP) Council of the Academy. Scheduled review date: March 2025. Questions regarding the Standards of Professional Performance for Registered Dietitian Nutritionists in Education of Nutrition and Dietetics Practitioners may be addressed to Academy Quality Management Staff—Dana Buelsing, MS, manager, Quality Standards Operations; and Karen Hui, RDN, LDN, scope/standards of practice specialist, Quality Management, at [email protected].
      All registered dietitians are nutritionists—but not all nutritionists are registered dietitians. The Academy's Board of Directors and Commission on Dietetic Registration have determined that those who hold the credential Registered Dietitian (RD) may optionally use “Registered Dietitian Nutritionist” (RDN). The two credentials have identical meanings. In this document, the authors have chosen to use the term RDN to refer to both registered dietitians and registered dietitian nutritionists.
      The Nutrition and Dietetic Educators and Preceptors (NDEP) Council of the Academy of Nutrition and Dietetics (Academy), under the guidance of the Academy Quality Management Committee, has revised the Standards of Professional Performance (SOPP) for Registered Dietitians in Education of Dietetics Practitioners originally published in 2009.
      • Anderson J.A.
      • Kennedy-Hagan K.
      • Stieber M.R.
      • et al.
      Dietetics Educators of Practitioners and American Dietetic Association Standards of Professional Performance for Registered Dietitians (Generalist, Specialty/Advanced) in Education of Dietetics Practitioners.
      The revised document, Academy of Nutrition and Dietetics: Revised 2018 Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners (EONDP), reflects advances in education during the past 9 years and replaces the 2009 Standards. This document builds upon the Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice (SOP) in Nutrition Care and SOPP for RDNs.
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      The Academy of Nutrition and Dietetics/Commission on Dietetic Registration’s (CDR) 2018 Code of Ethics for the Nutrition and Dietetics Profession,
      Academy of Nutrition and Dietetics, Commission on Dietetic Registration
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      along with the Academy of Nutrition and Dietetics: Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and Revised 2017 Scope of Practice for the RDN,
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
      guide the practice and performance of RDNs in all settings.
      Scope of practice in nutrition and dietetics is composed of statutory and individual components, includes codes of ethics (eg, Academy/CDR, International Code of Ethics and Code of Good Practice for Dietitians and Nutritionists [http://www.internationaldietetics.org/international-standards/international-code-of-ethics-and-code-of-good-prac.aspx], other national organizations, and/or employers code of ethics), and encompasses the range of roles, activities, practice guidelines, and regulations within which RDNs perform. For credentialed practitioners, scope of practice is typically established within the practice act and interpreted and controlled by the agency or board that regulates the practice of the profession in a given state.
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
      An RDN’s statutory scope of practice can delineate the services an RDN is authorized to perform in a state where a practice act or certification exists. For more information see https://www.eatrightpro.org/advocacy/licensure/licensure-map.
      The RDN’s individual scope of practice is determined by education, training, credentialing, experience, and demonstrating and documenting competence to practice. Individual scope of practice in nutrition and dietetics has flexible boundaries to capture the breadth of the individual’s professional practice. Professional advancement beyond the core education and supervised practice to qualify for the RDN credential provides RDNs practice opportunities, such as expanded roles within an organization based on training and certifications (eg, CDR Board-Certified Specialists, such as Renal Nutrition or Pediatric Nutrition), if preferred or required; or additional credentials (eg, Certified Nutrition Support Clinician [CNSC], and Certified Diabetes Educator [CDE]). The Scope of Practice Decision Tool (www.eatrightpro.org/scope), an Academy online interactive tool, guides an RDN through a series of questions to determine whether an activity is within his or her scope of practice. The tool is designed to assist an RDN to critically evaluate his or her personal knowledge, skill, experience, judgment, and demonstrated competence using criteria resources.
      Academy of Nutrition and Dietetics Quality Management Committee and Scope of Practice Subcommittee of the Quality Management Committee
      Academy of Nutrition and Dietetics Scope of Practice Decision Tool: A self-assessment guide.

      Academy Quality and Practice Resources

      The Academy’s Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      reflect the minimum competent level of nutrition and dietetics practice and professional performance. The core standards serve as blueprints for the development of focus area SOP and SOPP for RDNs in competent, proficient, and expert levels of practice. While this document addresses the SOPP only, each RDN educator and preceptor needs to be aware of the minimum competent level of practice for the core SOP in Nutrition Care applicable to RDNs providing direct care to patients/clients and relate its quality indicators within student/intern activities by drawing upon one’s own practice experience and knowledge. The SOP in Nutrition Care is composed of four standards consistent with the Nutrition Care Process (NCP) and clinical workflow elements, as applied to the care of patients/clients/populations in all settings.
      • Swan W.I.
      • Vivanti A.
      • Hakel-Smith N.A.
      • et al.
      Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.
      The SOPP consist of standards representing six domains of professional performance: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. The SOP and SOPP for RDNs are designed to promote the provision of safe, effective, efficient, and quality food and nutrition care and services; facilitate evidence-based practice; and serve as a professional evaluation resource.
      These focus area standards for RDNs in EONDP provide a guide for self-evaluation and expanding practice, a means of identifying areas for professional development, and a tool for demonstrating competence in delivering identified outcomes in the EONDP. They are used by RDNs to assess their current level of practice and to determine the education and training required to maintain currency in their focus area and advancement to a higher level of practice. In addition, the standards can be used to assist RDNs in transitioning their knowledge and skills to a new focus area of practice. Like the Academy’s core SOP in Nutrition Care and SOPP for RDNs,
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      the indicators (ie, measurable action statements that illustrate how each standard can be applied in practice) (see Figure 1, available at www.jandonline.org) for the SOPP for RDNs in EONDP were revised with input and consensus of content experts representing diverse practice and geographic perspectives. The SOPP for RDNs in EONDP were reviewed and approved by the NDEP Council and the Academy Quality Management Committee.

      Why Were the Standards Revised?

      It is critical that RDNs in EONDP reflect current practice environments with respect to most recent research, evidenced-based practices, and related laws and regulations in health care and other practice segments. Changes in the practice environment for RDNs and nutrition and dietetics technicians, registered (NDTRs) can impact course content and supervised practice experiences provided by nutrition and dietetics education programs. In addition, enhanced knowledge and skills training in decision making, using evidenced-based resources, and autonomous practice will be required of educators and preceptors to execute these changes. Examples of significant changes are:
      • The Scope of Practice for the RDN
        Academy of Nutrition and Dietetics Quality Management Committee
        Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Registered Dietitian Nutritionist.
        and the Scope of Practice for the NDTR
        Academy of Nutrition and Dietetics Quality Management Committee
        Academy of Nutrition and Dietetics: Revised 2017 Scope of Practice for the Nutrition and Dietetics Technician, Registered.
        were revised and published in the Academy’s Journal in January 2018 and February 2018, respectively. The RDN Scope reflects changes impacting practice, such as the Centers for Medicare and Medicaid Services (CMS) updates; national efforts to address malnutrition; and sections on coaching, global health, and telehealth, among other updates. The NDTR Scope also includes revisions, such as updated practice areas, and a new individual scope of practice figure.
      • The CMS, Department of Health and Human Services, Hospital,

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed November 19, 2018.

        and Critical Access Hospital

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 183, 10-12-18); § 485.635(a)(3)(vii) Dietary Services; § 458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed November 19, 2018.

        Conditions of Participation now allow a hospital and its medical staff the option of including RDNs or other clinically qualified nutrition professionals within the category of “non-physician practitioners” eligible for ordering privileges for therapeutic diets and nutrition-related services if consistent with state law and health care regulations.

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. 42 CFR Parts 413, 416, 440 et al. Medicare and Medicaid Programs; Regulatory provisions to promote program efficiency, transparency, and burden reduction; Part II; Final rule (FR DOC #2014-10687; pp 27106-27157). http://www.gpo.gov/fdsys/pkg/FR-2014-05-12/pdf/2014-10687.pdf. Accessed November 19, 2018.

        For more information, review the Academy’s practice tips that outline the regulations and implementation steps at www.eatrightpro.org/dietorders. For assistance, refer questions to the Academy’s State Affiliate organization.
      • The Long-Term Care Final Rule published October 4, 2016, now “allows the attending physician to delegate to a qualified dietitian or other clinically qualified nutrition professional the task of prescribing a resident’s diet, including a therapeutic diet, to the extent allowed by state law” and permitted by the facility’s policies.

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872)–Federal Register October 4, 2016; 81(192):68688-68872; §483.30(f)(2) Physician services (pp 65-66), §483.60 Food and Nutrition Services (pp 89-94), §483.60 Food and Nutrition Services (pp 177-178). https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed November 19, 2018.

        The CMS State Operations Manual, Appendix PP-Guidance for Surveyors for Long-Term Care Facilities contains the revised regulatory language.

        US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed November 19, 2018.

        CMS periodically revises the State Operations Manual Conditions of Participation; obtain the current information at www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/som107Appendicestoc.pdf.
      • The 2015 report from the Institute of Medicine, now the National Academies of Sciences, Engineering, and Medicine, provides evidence linking interprofessional education to patient, population, and health system outcomes.
        Institute of Medicine
        Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes.
        Interprofessional education endeavors to gather different professionals, including RDNs in EONDP, to learn with, from, and about one another in order to collaborate more effectively in the delivery of safe, high-quality care for patients/clients.
        • Reeves S.
        • Fletcher S.
        • Barr H.
        A BEME systematic review of the effects of interprofessional education: BEME Guide No 39.
        The Institute of Medicine report recommends actions that a diverse group of interprofessional stakeholders, including RDNs in EONDP, can take to better measure the impact of interprofessional education beyond the classroom, and in actual clinical practice.
        • Davis A.
        • Affenito S.
        Practice applications: Interprofessional education to create and sustain high-performance teams to support our transforming health care system and future educational model: How nutrition and dietetics can “weigh-in”.
        • Eliot K.A.
        • Kolasa K.M.
        The value in interprofessional, collaborative-ready nutrition and dietetics practitioners.
      Other significant changes impacting nutrition and dietetics practice are highlighted in both the Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and the Revised 2017 SOP in Nutrition Care and SOPP for NDTRs.
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice and Standards of Professional Performance for Nutrition and Dietetics Technicians, Registered.

      Three Levels of Practice

      The Dreyfus model
      • Dreyfus H.L.
      • Dreyfus S.E.
      Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer.
      identifies levels of proficiency (novice, advanced beginner, competent, proficient, and expert) (refer to Figure 2) during the acquisition and development of knowledge and skills. The first two levels are components of the required didactic education (novice) and supervised practice experience (advanced beginner) that precede credentialing for nutrition and dietetics practitioners. Upon successfully attaining the RDN credential, a practitioner enters professional practice at the competent level and manages his or her professional development to achieve individual professional goals. This model clarifies the levels of practice described in the SOPP for RDNs in EONDP. In Academy focus areas, the three levels of practice are represented as competent, proficient, and expert.
      Figure 2Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners.
      The Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Education of Nutrition and Dietetics Practitioners (EONDP) are authoritative statements that describe behavior in the professional role, including activities related to Quality in Practice; Competence and Accountability; Provision of Services; Application of Research; Communication and Application of Knowledge; and Utilization and Management of Resources (six separate standards).
      The SOPP, along with the Standards of Practice (SOP) in Nutrition Care, applicable to practitioners who provide direct patient/client nutrition care services, are complementary standards and serve as evaluation resources. All indicators may not be applicable to all RDNs’ practice or to all practice settings and situations. RDNs operate within the directives of applicable federal and state laws and regulations, as well as policies and procedures established by the organization in which they are employed. To determine whether an activity is within the scope of practice of the RDN, the practitioner compares his or her knowledge, skill, experience, judgment, and demonstrated competence with the criteria necessary to perform the activity safely, ethically, legally, and appropriately. The Academy’s Scope of Practice Decision Tool, an online interactive tool, is specifically designed to assist practitioners with this process (www.eatrightpro.org/scope).
      The term customer is used in this evaluation resource as a universal term. Customer could also mean nutrition and dietetics student/intern, preceptor, client/patient, participant, consumer, or any individual, group, or organization to which the RDN provides services. These services are provided to individuals of all ages. These Standards of Professional Performance are applicable to all settings. In addition, it is recognized that faculty, preceptors, academic institution administrators, and supervised practice setting liaisons play critical roles in the education of nutrition and dietetics students/interns and are important members of the team throughout the educational experience. The term appropriate is used in the standards to mean: Selecting from a range of best practice or evidence-based possibilities, one or more of which would give an acceptable result in the circumstances
      Each standard is equal in relevance and importance and includes a definition, a rationale statement, indicators, and examples of desired outcomes. A standard is a collection of specific outcome-focused statements against which a practitioner’s performance can be assessed. The rationale statement describes the intent of the standard and defines its purpose and importance in greater detail. Indicators are measurable action statements that illustrate how each specific standard can be applied in practice. Indicators serve to identify the level of performance of competent practitioners and to encourage and recognize professional growth.
      Standard definitions, rationale statements, core indicators, and examples of outcomes found in the Academy of Nutrition and Dietetics: Revised 2018 Standards of Professional Performance for RDNs have been adapted to reflect three levels of practice (competent, proficient, and expert) for RDNs in Education of Nutrition and Dietetics Practitioners (see image below). In addition, the core indicators have been expanded to reflect the unique competence expectations for the RDN in Education of Nutrition and Dietetics Practitioners.

      Competent Practitioner

      In nutrition and dietetics, a competent practitioner is an RDN who is either just starting practice after having obtained RDN registration by CDR or an experienced RDN recently transitioning his or her practice to a new focus area of nutrition and dietetics. A focus area of nutrition and dietetics practice is a defined area of practice that requires focused knowledge, skills, and experience that apply to all levels of practice.
      Academy of Nutrition and Dietetics
      Definition of terms.
      A competent-level practitioner who has achieved credentialing as an RDN and is starting in professional employment consistently provides safe and reliable services by employing appropriate knowledge, skills, behavior, and values in accordance with accepted standards of the profession; acquires additional on-the-job skills; and engages in tailored continuing education to further enhance knowledge, skills, and judgment obtained in formal education.
      Academy of Nutrition and Dietetics
      Definition of terms.
      A competent-level RDN in EONDP can apply knowledge and skills in several areas of practice, including but not limited to: incorporation of evidenced-based practice examples in both the classroom and supervised practice experiences, use informatics to assess student learning outcomes, contribute to curriculum design, and participate in research projects.

      Proficient Practitioner

      A proficient practitioner is an RDN who is generally 3 or more years beyond credentialing and entry into the profession and consistently provides safe and reliable service; has obtained operational job performance skills; and is successful in the RDN's chosen focus area of practice. The proficient practitioner demonstrates additional knowledge, skills, judgment, and experience in a focus area of nutrition and dietetics practice.
      Academy of Nutrition and Dietetics
      Definition of terms.
      A proficient RDN in EONDP may obtain advanced training in education pedagogy (the art or science of teaching, education, and instructional methods) and can facilitate the design of high-quality courses using the latest approaches and technologies.

      Expert Practitioner

      An expert practitioner is an RDN who is recognized within the profession and has mastered the highest degree of skill in, and knowledge of, nutrition and dietetics. Expert-level achievement is acquired through ongoing critical evaluation of practice and feedback from others. The individual at this level strives for additional knowledge, experience, and training. An expert can quickly identify “what” is happening and “how” to approach the situation. Experts easily use nutrition and dietetics skills to become successful through demonstrating quality practice and leadership, and to consider new opportunities that build upon nutrition and dietetics.
      Academy of Nutrition and Dietetics
      Definition of terms.
      An expert practitioner may have an expanded or specialist role, or both, and may possess an advanced credential(s). Generally the practice is more complex and the practitioner has a high degree of professional autonomy and responsibilities. An expert RDN in EONDP may develop and oversee an advanced-practice residency in a specialized area or lead a team on-campus to create a center for interprofessional skill training.
      These Standards, along with the Academy/CDR Code of Ethics,
      Academy of Nutrition and Dietetics, Commission on Dietetic Registration
      2018 Code of Ethics for the Nutrition and Dietetics Profession.
      answer the questions: Why is an RDN uniquely qualified to provide EONDP? What knowledge, skills, and competencies does an RDN need to demonstrate for the provision of safe, effective, and quality nutrition and dietetics education, customer-centered care, and service at the competent, proficient, and expert levels?

      Overview

      Nutrition and dietetics education and preparation for practice is a multifaceted educational structure composed of education, supervised practice, applying or producing research, and professional growth. These include Accreditation Council for Education in Nutrition and Dietetics (ACEND)
      Academy of Nutrition and Dietetics
      ACEND.
      nutrition and dietetics education programs designed to prepare students for entry-level practice as an RDN or NDTR. RDN faculty and preceptors engage in closely related but distinct activities, are role models, and use active and collaborative learning techniques to engage students/interns. RDNs in EONDP design relevant courses based on ACEND program standards,
      Academy of Nutrition and Dietetics. accreditation standards, fees and policies.
      and for post-professional practice advancement needs (eg, Continuing Professional Education, residencies, specialty certifications). Course design includes identification of 1) student/intern learning outcomes, 2) appropriate feedback and assessment procedures, 3) effective teaching/learning activities, and 4) course mode of delivery (online, in person, or hybrid). Also, RDNs in EONDP engage in educator–student interactions as the learning activity is implemented. Educator-student/-intern interaction may include leading discussions, role playing, simulation, managing research laboratories, advising, providing critical feedback, precepting, and mentoring.
      RDNs in EONDP must remain up-to-date in the knowledge, delivery, and assessment of nutrition and dietetics education-related services to reflect changes in the field of nutrition and dietetics.
      • Kicklighter J.R.
      • Cluskey M.M.
      • Hunter A.M.
      • et al.
      Council on Future Practice Visioning Report and Consensus Agreement for Moving Forward the Continuum of Dietetics Education, Credentialing, and Practice.
      Although there are a variety of instructional and training methods that educators can apply in delivery of nutrition and dietetics education, the primary focus remains on the learner-centered paradigm, where the educator serves to facilitate and guide learning.

      Overview of learning theories. http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/learning-overview/. Berkeley Graduate Division website. Accessed November 19, 2018.

      It is necessary that RDNs in EONDP remain current with new methods and utilize technological advancements when interacting with all learning, such as the use of student-centered learning methods,
      • Kicklighter J.R.
      • Cluskey M.M.
      • Hunter A.M.
      • et al.
      Council on Future Practice Visioning Report and Consensus Agreement for Moving Forward the Continuum of Dietetics Education, Credentialing, and Practice.

      Overview of learning theories. http://gsi.berkeley.edu/gsi-guide-contents/learning-theory-research/learning-overview/. Berkeley Graduate Division website. Accessed November 19, 2018.

      person-centered training models, interactive and applied lessons and assignments, and/or distance education formats/platforms.
      • Gilboy M.B.
      • Heinerichs S.
      • Pazzaglia G.
      Report: Enhancing student engagement using the flipped classroom.
      • Hark L.
      • Deen D.
      Position of the Academy of Nutrition and Dietetics: Interprofessional education in nutrition as an essential component of medical education.

      Background Information on Distance and Correspondence Education. Higher Learning Commission website. http://www.hlcommission.org/Accreditation/distance-delivery.html. Accessed November 19, 2018.

      Distance Education Certification Standards. International Distance Education Certification Center website. https://www.idecc.org/Downloads/I_DistanceEducationStandards.pdf. Published 2017. Accessed November 19, 2018.

      As life-long learners, RDNs in EONDP maintain a CDR professional development portfolio. The Professional Development Portfolio allows RDNs in EONDP to identify learning needs, create a plan based on those needs, and carry out that plan by participating in a wide variety of activity types that cater to many different learning styles in all areas of practice.

      Professional Development Portfolio. Commission on Dietetic Registration website. https://www.cdrnet.org/pdp/professional-development-portfolio-guide. Accessed November 19, 2018.

      It is imperative that RDNs in EONDP remain abreast of their specific practice or expertise area. Examples include:
      • understanding the Nutrition Care Process and clinical workflow elements
        • Swan W.I.
        • Vivanti A.
        • Hakel-Smith N.A.
        • et al.
        Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management.

        Electronic Nutrition Care Process and Terminology. Academy of Nutrition and Dietetics Nutrition Care Process web site. https://www.ncpro.org/. Accessed November 19, 2018.

        ;
      • recognizing emerging trends;
      • understanding and using current evidence-based concepts in medical nutrition therapy and nutrition informatics; and
      • recognizing emerging trends in clinical, community and public health nutrition, food science, nutrigenomics, food security, foodservice management, sustainability, and practice management to deliver quality and appropriate patient/client care and student/intern education and training.
      For more EONDP resources see Figure 3.
      Figure 3Resources for registered dietitian nutritionists in education of nutrition and dietetics practitioners (not all inclusive).
      ResourceAddressDescription and Application
      Academy of Nutrition and Dietetics (Academy)
      Academy Coding and Billing Handbook: A Guide for Program Directors and Preceptorswww.eatrightstore.org/product/72D93968-26F0-44BB-AE78-C9D2AD2C8ABDThis Academy publication provides information on coding and billing for nutrition services for program directors and preceptors to use when teaching nutrition and dietetics students/interns. This resource is free to members, and is available in the Academy store for non-members.
      Academy Certificate of Training: Informatics in Nutrition: Spanning all Areas of Practicewww.eatrightstore.org/cpe-opportunities/certificates-of-training/informatics-in-nutrition-module-1A series of 5 modules that apply the definition and historical background of Nutrition Informatics content of the Nutrition Informatics Surveys (2008, 2011, and 2014), National Delphi Study on Nutrition Informatics, Academy's Evidence Analysis Library, and the upcoming release of an Electronic Health Record (EHR)/Personal Health Record Nutrition Best Practices Implementation Guide. EHR Toolkit is now provided per subscription to the electronic Nutrition Care Process Terminology.
      Academy Dietetic Practice Groupswww.eatrightpro.org/resources/membership/academy-groups/dietetic-practice-groupsEducators and preceptors may choose to belong to practice groups that relate to their area of nutrition and dietetics expertise in addition to being an educator or preceptor.
      Academy Nutrition and Dietetics Career Development Guidewww.eatrightpro.org/practice/career-development/career-toolbox/dietetics-career-development-guideThe Academy’s Nutrition and Dietetics Career Development Guide is based on the Dreyfus model
      • Dreyfus H.L.
      • Dreyfus S.E.
      Mind over Machine: The Power of Human Intuition and Expertise in the Era of the Computer.
      of knowledge and skill acquisition. “This guide is designed to provide students, educators and practitioners the tools to assist in career development and advancement.”
      Academy Position and Practice Paperswww.eatrightpro.org/resources/practice/position-and-practice-papersThe Academy position and practice papers are resources that assist in promoting optimal nutrition, health, and well-being for the public in addition to guiding critical thinking. These are helpful documents for educators in providing evidence-based nutrition information to nutrition and dietetics students/interns.
      Academy Practice Resourceswww.eatrightpro.org/practice#dietetics-resourcesThe Academy of Nutrition and Dietetics offers members many resources to manage their practice and career, from standards of practice tools to marketing resources.
      Nutrition and Dietetic Educators and Preceptors (NDEP), an Academy organizational unitwww.ndepnet.org/NDEP provides several resources for educators and preceptors. NDEP members access webinars, the NDEP portal with a library of resources, and a mentoring program.
      Advanced Practice
      The Accreditation Council for Education in Nutrition and Dietetics (ACEND) Advanced Practice Residency (APR) Programwww.eatrightpro.org/acend/about-acend/advanced-practiceThe ACEND APR Program Guidelines were established to foster the development of APR programs for registered dietitian nutritionists (RDNs) across the spectrum of nutrition and dietetics practice.
      Commission on Dietetic Registration (CDR) Advanced Practice Certification in Clinical Nutrition (RDN-AP)www.cdrnet.org/board-certification-in-advanced-practiceThe CDR offers an Advanced Practice Certification in Clinical Nutrition. Certification is granted in recognition of an applicant's documented practice experience and successful completion of an examination.
      Non–Academy-Based Pedagogical Resources
      Competency Assessment Field Guide: A Real World Guide for Implementation and Application by D. Wright, Creative Health Care Management, Minneapolis, MN (2015)https://books.google.com/books/about/Competency_Assessment_Field_Guide.html?id=pyhzDgAAQBAJ&printsec=frontcover&source=kp_read_button#v=onepage&q&f=falseThis book is a competency-based assessment field guide and reviews the misconceptions of competency-based assessment while providing information on what every educator needs to know.
      Health Care Provider Preceptor Training Program–California Community Collegeswww.sdnsec.org/forms/PreceptorModelCurriculumObjectives-RHORC.pdfThis resource is a health care provider model preceptor training curriculum. It could be used as an educational tool for training preceptors in a group setting, and provides examples of pedagogy, worksheets, and guidelines for a facilitator in a health care setting.
      How Learning Works: 7 Research-Based Principles for Smart Teaching by S. Ambrose and colleagues, Jossey-Bass, San Francisco, CA (2010)www.wiley.com/en-us/How+Learning+Works%3A+Seven+Research+Based+Principles+for+Smart+Teaching-p-9780470484104This book addresses how students learn and provides evidence-based principles, such as student motivation and how students develop mastery for effective teaching.
      Interprofessional Education Collaborative (IPEC)www.ipecollaborative.orgIPEC is an organization that works in collaboration with academic institutions to support efforts to prepare future health care professionals. The IPEC provides resources, such as Core Competencies for Interprofessional Collaborative Practice and learning modules.
      Interprofessional Education Development: A Road Map for Getting Therewww.scirp.org/journal/PaperInformation.aspx?PaperID=34953This journal article describes the benefits of interprofessional education (IPE) and how to get started implementing IPE, and describes the cultural changes that may need to occur.
      Guidelines for the Evaluation of Distance Education (Online Learning)http://download.hlcommission.org/C-RAC_Distance_Ed_Guidelines_7_31_2009.pdfThe Guidelines for the Evaluation of Distance Education (Online Learning) were developed by the Council of Regional Accrediting Commissions for institutions to use as a resource when planning distance education. The guidelines provide an assessment framework for institutions already involved in distance education.
      Mastering Simulation: A Handbook for Success by Beth Ulrich and Beth Mancini, Sigma Tau Theta International, Indianapolis, IN (2014)www.nursingknowledge.org/mastering-simulation-a-handbook-for-success.htmlThis book provides information on using simulation as an effective teaching tool and how to respond to changing technology. Topics covered include creating simulation scenarios, designing program evaluations, managing risk, and quality improvement.
      National Center for Interprofessional Practice and Educationhttps://nexusipe.org/The National Center is charged to provide the leadership, evidence, and resources needed to guide the nation on interprofessional education and collaborative practice. The Resource Center houses a digital library of interprofessional practice and education-related content.
      Quality Matterswww.qualitymatters.org/Quality Matters is an organization that promotes and certifies quality design for online courses through training and review.
      Resources for Preceptors
      ACEND Preceptors and Mentors websitewww.eatrightpro.org/preceptorsACEND offers information on how to become a preceptor in addition to resources for preceptors and mentors, such as a preceptor training program.
      CDR Campus websitewww.cdrcampus.comThis website offers continuing professional education activities for RDNs and Nutrition and Dietetics Technicians, Registered and also provides a link to a free Dietetics Preceptor Training Program (provides 8 Continuing Professional Education Units).
      Mastering Precepting: A Nurse's Handbook for Success by Beth Ulrich, Sigma Tau Theta International, Indianapolis, IN (2012)www.nursingknowledge.org/mastering-precepting-a-nurse-s-handbook-for-success.htmlThis book gives detailed information about the role of a preceptor, provides information on creating a preceptor development plan, and describes the preceptor’s role as a health care leader. It can be used by both program directors and preceptors for planning and improving preceptor training.
      Faculty in nutrition and dietetics education programs must play integral roles in the planning and defining of educational goals and both program and student outcomes. Preceptors in supervised practice settings provide guidance, practical experience, and training to nutrition and dietetics students/interns. Degree requisites for faculty among institutions vary, though regional higher-education accrediting organizations may outline compulsory education requirements. According to the Higher Education Commission, guidelines state that faculty should be academically prepared one level higher than the courses being taught or developed.

      Determining Qualified Faculty through HLC’s Criteria for Accreditation and Assumed Practices. Higher Learning Commission website. http://download.hlcommission.org/FacultyGuidelines_2016_OPB.pdf. Accessed November 19, 2018.

      The RDN, PhD, or equivalent preparation level is usually required in regionally accredited colleges and universities to qualify for clinical or tenure track teaching appointments. All program directors of ACEND-accredited nutrition and dietetics education programs are required to hold the RDN credential. RDNs and NDTRs serve as valuable faculty members and preceptors, with expertise in nutrition and dietetics research and practice. Therefore, it is essential that programs make every effort to include credentialed practitioners (RDNs, NDTRs) in their program faculty.
      The SOPP for RDNs in EONDP is a tool to assist RDN educators, faculty preceptors, and preceptors in supervised practice settings. The SOPP can be utilized as a guide for self-evaluation and to determine the education and skills needed to advance an individual's level of practice. RDN educators and preceptors who are employed in health care or community health settings might use the SOPP for RDNs in EONDP to demonstrate to nutrition and dietetics students/interns examples of the range of nutrition and dietetics knowledge, application skills, and education delivery that may be of value in their practice setting.
      Nutrition and Dietetic Educators and Preceptors (NDEP), an organizational unit of the Academy comprising more than 1,400 members who are educators and preceptors, is a valuable resource for nutrition and dietetics practitioners in EONDP. NDEP’s mission is to “advocate for and empower educators to lead the profession of nutrition and dietetics.”

      Nutrition and Dietetic Educators and Preceptors—Same name, even greater commitment. http://www.ndepnet.org. Accessed November 19, 2018.

      NDEP works towards this mission by providing resources for educators and preceptors, such as regional meetings, opportunities for continuing education and leadership, ongoing support via shared resources, communication, and networking.

      Academy Revised 2018 SOPP for RDNs (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners

      An RDN can use the Academy Revised 2018 SOPP for RDNs (Competent, Proficient, and Expert) in EONDP (see Figure 1, available at www.jandonline.org, and Figure 2) to:
      • identify the competencies needed to provide EONDP;
      • self-evaluate whether he or she has the appropriate knowledge, skills, experience, and judgment to provide safe, effective, and quality nutrition and dietetics education for their level of practice;
      • identify the areas in which additional knowledge, skills, and experience are needed to practice at the competent, proficient, or expert level of nutrition and dietetics education;
      • provide a foundation for public and professional accountability in nutrition and dietetics education;
      • support efforts for strategic planning, performance improvement, outcomes reporting, and assist management in the planning and communicating of nutrition and dietetics education and resources (see Figure 3);
      • enhance professional identity and skill in communicating the nature of nutrition and dietetics education;
      • guide the development of nutrition and dietetics education programs and related continuing education opportunities, job descriptions, practice guidelines, protocols, clinical models, competence evaluation tools, and career pathways; and
      • assist educators and preceptors in teaching knowledge, skills, and competencies needed to work in nutrition and dietetics education, and the understanding of the full scope of this focus area of practice.

      Application to Practice

      All RDNs, even those with significant experience in other practice areas, must begin at the competent level, when practicing in a new setting or new focus area of practice. At the competent level, an RDN in EONDP is incorporating the principles that underpin this focus area and is developing knowledge, skills, and judgment, and gaining experience for safe and effective practice. This RDN, who may be new to the profession or may be an experienced RDN, has a breadth of knowledge in nutrition and dietetics and may have proficient or expert knowledge/practice in another focus area. However, the RDN new to the focus area of EONDP must accept the challenge of becoming familiar with the body of knowledge, practice guidelines, and available resources to support and ensure quality evidence-based EONDP-related practice.
      At the proficient level, an RDN has developed a more in-depth understanding of nutrition and dietetics practice and is better equipped to adapt and apply evidence-based guidelines and best practices than at the competent level. This RDN can modify practice according to unique situations. The RDN at the proficient level may possess a specialist credential(s). RDNs in EONDP manage and direct nutrition and dietetics education programs; monitor and evaluate student/intern learning outcomes; take necessary action for performance improvement; apply and utilize nutrition informatics; and engage in scholarly work.
      At the expert level, the RDN thinks critically about nutrition and dietetics education, demonstrates a more intuitive understanding, displays a range of highly developed education, clinical and/or technical skills, and formulates judgments acquired through a combination of education, experience, and critical thinking. Essentially, practice at the expert level requires the application of composite nutrition and dietetics knowledge, with practitioners drawing not only on their practice experience, but also on the experience of the expert-level RDNs in various disciplines and practice settings. Expert RDNs, with their extensive experience and ability to see the significance and meaning of nutrition and dietetics education within a contextual whole, are fluid and flexible, and have considerable autonomy in practice. They develop nutrition and dietetics education curricula, and deliver evidenced-based information in a problem-solving, learner-centered format; conduct and collaborate in research and advocacy; accept organization leadership roles; guide interprofessional teams; and lead advancement of nutrition and dietetics education and the profession.
      Indicators for the SOPP for RDNs in EONDP are measurable action statements that illustrate how each standard can be applied in practice (Figure 1 SOPP, available at www.jandonline.org). Within the SOPP for RDNs in EONDP, an “X” in the competent column indicates that an RDN in EONDP who is responsible for instruction in a didactic and/or practice setting is expected to complete this activity and/or seek assistance to learn how to perform at the level of the standard. A competent-level RDN in EONDP could be an RDN starting practice after registration or an experienced RDN who has recently assumed responsibility to deliver instruction to nutrition and dietetics students/interns.
      An “X” in the proficient column indicates that an RDN who performs at this level has a more in-depth understanding of educational theory, course design, instructional techniques, and student/intern evaluation; and can modify or guide the instruction/learning activity to meet the needs of the student/intern in various situations.
      An “X” in the expert column indicates that the RDN who performs at this level possesses a comprehensive understanding of nutrition and dietetics education and the practice of RDNs and NDTRs and a highly developed range of skills and judgments acquired through a combination of experience and education. The expert RDN builds and maintains the highest level of knowledge, skills, and behaviors, including leadership, vision, and credentials.
      The EONDP SOPP standards and indicators presented in Figure 1 (available at www.jandonline.org) in boldface type originate from the Academy’s Revised 2017 SOP in Nutrition Care and SOPP for RDNs
      Academy of Nutrition and Dietetics Quality Management Committee
      Academy of Nutrition and Dietetics: Revised 2017 Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists.
      and should apply to RDNs in all three levels. Additional indicators not in boldface type developed for this focus area are identified as applicable to all levels of practice. Where an “X” is placed in all three levels of practice, it is understood that all RDNs in EONDP are accountable for practice within each of these indicators. However, the depth with which an RDN performs each activity will increase as the individual moves beyond the competent level. Several levels of practice are considered in this document; thus, a comprehensive view of the SOPP for RDNs in EONDP is warranted. It is the totality of individual practice that defines a practitioner’s level of practice and not any one indicator or standard.
      RDNs should review the SOPP in EONDP at determined intervals to evaluate their individual focus area knowledge, skill, and competence. Consistent self-evaluation is important because it helps identify opportunities to improve and enhance practice and professional performance. This self-appraisal also enables RDNs in EONDP to better utilize these Standards as part of the Professional Development Portfolio recertification process,
      • Weddle D.O.
      • Himburg S.P.
      • Collins N.
      • Lewis R.
      The professional development portfolio process: Setting goals for credentialing.
      which encourages CDR-credentialed nutrition and dietetics practitioners to incorporate self-reflection and learning needs assessment for development of a learning plan for improvement and commitment to lifelong learning. CDR’s updated system implemented with the 5-year recertification cycle that began in 2015 incorporates the use of essential practice competencies for determining professional development needs.
      • Worsfold L.
      • Grant B.L.
      • Barnhill C.
      The essential practice competencies for the Commission on Dietetic Registration’s credentialed nutrition and dietetics practitioners.
      In the new three-step process, the credentialed practitioner accesses an online Goal Wizard (step 1), which uses a decision algorithm to identify essential practice competency goals and performance indicators relevant to the RDN’s area(s) of practice (essential practice competencies and performance indicators replace the learning need codes of the previous process). The Activity Log (step 2) is used to log and document continuing professional education over the 5-year period. The Professional Development Evaluation (step 3) guides self-reflection and assessment of learning and how it is applied. The outcome is a completed evaluation of the effectiveness of the practitioner’s learning plan and continuing professional education. The self-assessment information can then be used in developing the plan for the practitioner’s next 5-year recertification cycle. For more information, see www.cdrnet.org/competencies-for-practitioners.
      RDNs are encouraged to pursue additional knowledge, skills, and training, regardless of practice setting, to maintain currency and to expand individual scope of practice within the limitations of the legal scope of practice, as defined by state law. RDNs are expected to practice only at the level at which they are competent, and this will vary depending on education, training, and experience.
      • Gates G.R.
      • Amaya L.
      Ethics opinion: Registered dietitian nutritionists and nutrition and dietetics technicians, registered are ethically obligated to maintain personal competence in practice.
      RDNs should collaborate with other RDNs in EONDP as learning opportunities, to promote consistency in practice and performance, and for continuous quality improvement. See Figure 4 for role examples of how RDNs in different roles, at different levels of practice, may use the SOPP for RDNs in EONDP.
      Figure 4Role Examples of Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) (Competent, Proficient, and Expert) in Education of Nutrition and Dietetics Practitioners.
      RoleExamples of use of SOPP documents by RDNs in different practice roles
      For each role, the RDN updates professional development plan to include applicable essential practice competencies for EONDP roles and activities.
      Director, ACEND nutrition and dietetics programThe nutrition and dietetics education program director uses the Revised 2018 Standards of Professional Performance (SOPP) for Registered Dietitian Nutritionists (RDNs) in Education of Nutrition and Dietetics Practitioners (EONDP) as a guiding document along with the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Standards of Education
      Academy of Nutrition and Dietetics
      Definition of terms.
      to assure academic courses and supervised practice experiences provide the students/interns with the necessary core knowledge and practice competencies for supervised practice that leads to entry-level practice. The program director collaborates with and mentors other nutrition and dietetics faculty, other health professions’ faculty, and supervised practice preceptors on the purpose and expectations of the Revised 2018 SOPP for RDNs in EONDP. In addition, the nutrition and dietetics education program director provides guidance to faculty and preceptors on the value and application of using the Revised 2017 SOP in Nutrition Care and SOPP for RDNs and Revised 2017 Standards Of Practice (SOP) in Nutrition Care and SOPP for Nutrition and Dietetics Technicians, Registered (NDTRs), and other applicable focus area SOP and SOPP. The EONDP SOPP and other focus area SOP and SOPP serve as references when designing course content, supervised practice and learning activities, and to illustrate how knowledge and skills learned apply to practice as a credentialed practitioner.
      RDN faculty, nutrition and dietetics education programAn RDN faculty member teaching nutrition and dietetics courses refers to the Revised 2018 SOPP for RDNs in EONDP to understand the competence expectation for educators (ie, in-person or distance). The RDN also accesses other focus area SOPs and/or SOPPs (eg, Nutrition Support, Pediatrics, Oncology Nutrition, Nephrology Nutrition, Diabetes Care, Adult Weight Management, Integrative and Functional Medicine) to identify practice roles and outcomes for entry-level competent practice; and focus area resources to use in development of lectures and assignments. The RDN reviews the Revised 2018 SOPP for RDNs in EONDP to evaluate knowledge and skills, and to set goals for strengthening competence in this area of practice.
      RDN researcher/educator (eg, may work as a faculty member in a nutrition and dietetics program or other related college-level program)An RDN has a faculty appointment that includes research responsibilities. The RDN develops a research proposal with an aim of building capacity and increasing diversity of the RDN workforce. The RDN uses the Revised 2018 SOPP for RDNs in EONDP and other resources to identify areas for nutrition and dietetics students/interns contributing to the research experience (eg, design research protocol, submission to institutional review board, obtain consent, collect and analyze data, and draft the research report). In addition, the RDN may consider guiding the students/interns through culturally relevant approaches in the recruitment phase of the research, such as offering culturally appropriate informational sessions to recruit new students who may be interested in the field of food, nutrition, and dietetics.
      RDN preceptor (eg, may work in a clinical, foodservice management, public health/community, or other setting)An RDN serving in a clinical role that provides care to individuals and/or groups, such as hospital clinical practice, public health/community, or foodservice management has agreed to serve as a preceptor for a nutrition and dietetics education program. The RDN who is unfamiliar with the specific role and responsibilities of being a preceptor reviews the Revised 2018 SOPP for RDNs in EONDP to prepare for an orientation session with the nutrition and dietetics program faculty and/or program director. The RDN identifies skills and competencies for development and sets goals for improvement through reading, mentoring, and targeted continuing education activities including the Commission on Dietetic Registration Online Preceptor Training Course (www.cdrnet.org).
      RDN manager (eg, may participate as preceptor, mentor, or guest lecturer)An RDN manager (clinical or other practice area) oversees several RDNs and NDTRs who agreed to participate as preceptors for nutrition and dietetics students/interns. The RDN, who is liaison to the nutrition and dietetics education program, works with the program director to use the Revised 2018 SOPP for RDNs in EONDP to orient staff, develop guidelines for student/intern experiences, and report student/intern progress. The RDN uses the Revised 2018 SOPP for RDNs in EONDP, and other identified resources to increase knowledge in educational methodologies and competency expectations for preceptors recognizing it is an important tool for staff to assess and develop skills in precepting nutrition and dietetics students/interns.
      a For each role, the RDN updates professional development plan to include applicable essential practice competencies for EONDP roles and activities.
      In some instances, components of the SOPP for RDNs in EONDP do not specifically differentiate between proficient-level and expert-level practice. In these areas, it remains the consensus of the content experts that the distinctions are subtle, captured in the knowledge, experience, and intuition demonstrated in the context of practice at the expert level, which combines dimensions of understanding, performance, and value as an integrated whole.
      • Chambers D.W.
      • Gilmore C.J.
      • Maillet J.O.
      • Mitchell B.E.
      Another look at competency-based education in dietetics.
      A wealth of knowledge is embedded in the experience, discernment, and practice of expert-level RDN practitioners. The experienced practitioner observes events, analyzes them to make new connections between events and ideas, and produces a synthesized whole. The knowledge and skills acquired through practice will continually expand and mature. The SOPP indicators are refined with each review of these Standards, as expert-level RDNs systematically record and document their experiences, often through use of exemplars. Exemplary actions of individual RDNs in EONDP practice settings and professional activities that enhance didactic or supervised practice programs can be used to illustrate outstanding practice models.

      Future Directions

      CDR announced that as of January 1, 2024, entry-level eligibility requirements to become an RDN would increase to include obtaining a graduate degree.
      Academy of Nutrition and Dietetics. accreditation standards, fees and policies.
      This will impact RDNs in EONDP in several ways. First, the need for RDNs with advanced degrees (PhD or other advanced doctoral degree) will intensify to meet the education requirements to teach at the graduate-degree level. Second, because RDNs in EONDP are innovators, now more than ever they will participate in evaluation of current nutrition and dietetics education programs and transform them as needed or create new programs to prepare nutrition and dietetics students/interns to meet the graduate-degree requirement for future entry-level practice.
      • Kicklighter J.R.
      • Cluskey M.M.
      • Hunter A.M.
      • et al.
      Council on Future Practice Visioning Report and Consensus Agreement for Moving Forward the Continuum of Dietetics Education, Credentialing, and Practice.
      The SOPP for RDNs in EONDP are innovative and dynamic documents. Future revisions will reflect changes and advances in practice, changes to ACEND’s
      Academy of Nutrition and Dietetics. accreditation standards, fees and policies.
      nutrition and dietetics education standards, regulatory changes, and outcomes of practice audits. Continued clarity and differentiation of the three practice levels in support of safe, effective, and quality practice in EONDP remains an expectation of each revision to serve tomorrow's students/interns, practitioners and their patients, clients, and customers.

      Summary

      RDNs in EONDP face complex situations every day. Addressing the unique learning needs of each nutrition and dietetics student/intern and creating educational experiences designed to meet program competencies are essential for the education of nutrition and dietetics practitioners. All RDNs are advised to conduct their practice based on the most recent edition of the Academy/CDR Code of Ethics, the Scope of Practice for RDNs, and the SOP in Nutrition Care and SOPP for RDNs, along with applicable federal and state regulations and organization/facility/program accreditation standards. The SOPP for RDNs in EONDP are complementary documents and are key resources for RDNs at all knowledge and performance levels. These standards can and should be used by RDNs in EONDP to consistently improve and appropriately demonstrate competency and value as providers of safe, effective, and quality nutrition and dietetics education. These standards also serve as a professional resource for self-evaluation and professional development for RDNs participating in or specializing in EONDP. Just as a professional’s self-evaluation and continuing education process is an ongoing cycle, these standards are also a work in progress and will be reviewed and updated every 7 years. Current and future initiatives of the Academy, as well as advances in practice and technology, changes to nutrition and dietetics education standards, regulatory changes, and outcomes of practice audits will provide information to use in future updates and in further clarifying and documenting the specific roles and responsibilities of RDNs at each level of practice. As a quality initiative of the Academy and NDEP, these standards are an application of continuous quality improvement and represent an important collaborative endeavor.
      These standards have been formulated for use by individuals in self-evaluation, practice advancement, development of practice guidelines and specialist credentials, and as indicators of quality. These standards do not constitute medical or other professional advice and should not be taken as such. The information presented in the standards is not a substitute for the exercise of professional judgment by the nutrition and dietetics practitioner. These standards are not intended for disciplinary actions or determinations of negligence or misconduct. The use of the standards for any other purpose than that for which they were formulated must be undertaken within the sole authority and discretion of the user.

      Acknowledgements

      Special acknowledgement and thanks to Robyn Osborn, PhD, RD, past-chair of NDEP who willingly gave of her time to review these standards, and the NDEP Council and membership for their support and guidance. The authors also extend thanks to all who were instrumental in the process of the revisions of the article. Finally, the authors thank Academy staff, in particular, Karen Hui, RDN, LDN; Dana Buelsing, MS; Carol Gilmore, MS, RDN, LD, FADA, FAND; and Sharon McCauley, MS, MBA, RDN, LDN, FADA, FAND, who supported and facilitated the development of these SOPPs.

      Author Contributions

      Each author contributed to editing the components of the article (eg, article text and figures) and reviewed all drafts of the manuscript.

      Supplementary Materials

      Figure 1Standards of Professional Performance for Registered Dietitian Nutritionists (RDNs) in Education of Nutrition and Dietetics Practitioners. Note: The term customer is used in this evaluation resource as a universal term. Customer could also mean student/intern, preceptor, client/patient/customer, family, participant, consumer, or any individual, group, or organization to which the RDN provides service.
      Standards of Professional Performance for Registered Dietitian Nutritionists in Education of Nutrition and Dietetics Practitioners

      Standard 1: Quality in Practice

      The registered dietitian nutritionist (RDN) provides quality services using a systematic process with identified ethics, leadership, accountability, and dedicated resources.

      Rationale:

      Quality practice in nutrition and dietetics is built on a solid foundation of education and supervised practice, credentialing, evidence-based practice, demonstrated competence, and adherence to established professional standards. Quality practice requires systematic measurement of outcomes, regular performance evaluations, and continuous improvement.
      Indicators for Standard 1: Quality in Practice
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      1.1Complies with applicable laws and regulations as related to his/her area(s) of practiceXXX
      1.1AImplements quality practice by following an evidence-based/best practice approach to education and meeting credentialing, licensure, and regulatory requirementsXXX
      1.1BExplains the Centers for Medicare and Medicaid Services regulations and interpretive guidelines (eg, Conditions of Participation for Hospitals, Long-Term Care Facilities), and health care facility accreditation standards and elements of performance (eg, The Joint Commission, Healthcare Facilities Accreditation Program) as key standards guiding quality patient care to achieve best practicesXX
      1.1CLeads a team to review other nutrition and dietetics education programs and assists the Accreditation Council for Education in Nutrition and Dietetics (ACEND) Board in developing and/or revising standards for educationX
      1.2Performs within individual and statutory scope of practice and applicable laws and regulationsXXX
      1.2AInterprets and applies individual and statutory scope of practice at all program levels for the Education of Nutrition and Dietetics Practitioners (EONDP)XXX
      1.2BEnsures that curriculum and, where appropriate, supervised practice experiences include orientation to the Academy Scope of Practice, individual scope of practice, and statutory scope of practice for both RDNs and Nutrition and Dietetics Technicians, Registered (NDTRs)XXX
      1.3Adheres to sound business and ethical billing practices applicable to the role and settingXXX
      1.3AEnsures the nutrition and dietetics program curricula and supervised practice experiences provide students/interns with the ability to learn and apply payer and organization-type billing policies and ethical billing practices; seeks input from experienced practitioners as neededXX
      1.4Uses national quality and safety data (eg, National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division, National Quality Forum, Institute for Healthcare Improvement) to improve the quality of services provided and to enhance customer-centered servicesXXX
      1.4AOrients students/interns to national quality and safety data resources applicable to nutrition and dietetics practitioner roles and practice settingsXXX
      1.5Uses a systematic performance improvement model that is based on practice knowledge, evidence, research, and science for delivery of the highest quality servicesXXX
      1.5AIdentifies performance improvement measures to monitor quality of education services; seeks assistance if neededXXX
      1.5BEvaluates quality of nutrition and dietetics education in terms of pedagogy,
      Pedagogy: Pedagogy is the art or science of teaching; education; instructional methods.
      ACEND standards, educational process, and student/intern learning outcomes
      XX
      1.6Participates in or designs an outcomes-based management system to evaluate safety, effectiveness, quality, person-centeredness, equity, timeliness, and efficiency of practiceXXX
      1.6AInvolves colleagues and others, as applicable, in systematic outcomes managementXXX
      1.6A1Monitors and conducts regular evaluations and provides feedback to colleagues and others involved in outcomes measurement consistent with role and responsibilitiesXX
      1.6BDefines expected outcomes (eg, student/intern learning outcomes for didactic and/or supervised practice experiences)XXX
      1.6B1Participates and/or leads in identifying expected student/intern learning outcomes applicable to didactic, experiential learning, and/or supervised practice experiencesXXX
      1.6B2Develops student/intern learning outcomes for assigned course(s) including experiential learning, if appropriate, and/or setting-specific supervised practice experiencesXX
      1.6B3Operationalizes and advises faculty and preceptors
      Preceptor: A preceptor is a teacher, an instructor, an expert, or a specialist, such as an RDN, who provides practical experience and training to a student/intern, especially of medicine, nursing, or nutrition and dietetics.
      on the identification of learning outcomes that meet ACEND standards, academic guidelines, and student/intern and other stakeholder expectations
      X
      1.6CUses indicators that are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)XXX
      1.6DMeasures quality of services in terms of structure, process, and outcomesXXX
      1.6D1Collects measurable data, and documents outcomes applicable to education of nutrition and dietetics practitioners and/or other area of research expertiseXXX
      1.6D1iDevelops and monitors systematic processes to determine, define, collect, and analyze measurable data comparing to expected outcomesXX
      1.6D2Measures educational services and identifies and addresses student/intern learning needs using educational processes/systemsXXX
      1.6D2iIdentifies and addresses potential problems in relation to diversity of student/intern learning needs that may compromise expected outcomes; variances evaluated include, but are not limited to:
      • receptivity related to generational differences
      • diversity issues
      • literacy
      • provider-centered vs learner-centered teaching/instruction styles
      XX
      1.6D2iiProvides expertise in identification and evaluation of educational structures and processes to meet student/intern learning outcomesX
      1.6EIncorporates electronic clinical quality measures (eCQM) to evaluate and improve care of patients/clients at risk of malnutrition or with malnutrition (www.eatrightpro.org/emeasures)XXX
      1.6E1Ensures students/interns have opportunities for observation and participation in nutrition care and performance improvement activities addressing screening, assessment, and interventions for individuals with or at risk of malnutrition in health care settings and applicable community settingsXXX
      1.6E2Provides examples to students/interns of how eCQMs can be used to improve patient/client outcomes, reduce cost burden, and advance the role of the RDNXX
      1.6E3Identifies and provides examples to students/interns on requirements for reporting on quality measures using health information technology standards and eCQM-driven documentationXX
      1.6FDocuments outcomes and patient reported outcomes (eg, PROMIS
      PROMIS: The Patient-Reported Outcomes Measurement Information System (PROMIS) (https://commonfund.nih.gov/promis/index) is a reliable, precise measure of patient-reported health status for physical, mental, and social well-being. PROMIS is a web-based resource and is publicly available.
      )
      XXX
      1.6F1Documents achievement of student/intern learning outcomesXXX
      1.6F2Assesses and communicates program outcome measuresXX
      1.6GParticipates in, coordinates, or leads program participation in local, regional, or national registries and data warehouses used for tracking, benchmarking, and reporting service outcomesXXX
      1.6G1Leads students/interns in reviewing, developing, and/or publishing nutrition and dietetics-related benchmarking toolsXX
      1.7Identifies and addresses potential and actual errors and hazards in provision of services and brings them to the attention of supervisors and team members as appropriateXXX
      1.7ADesigns learning activities to provide students/interns with skills to evaluate potential hazards in provision of services (eg, food/drug interactions, charting accuracy)XXX
      1.8Compares actual performance to performance goals (ie, Gap Analysis, SWOT Analysis [Strengths, Weaknesses, Opportunities, and Threats], PDSA Cycle [Plan-Do-Study-Act], DMAIC [Define, Measure, Analyze, Improve, Control], Lean/Six Sigma)XXX
      1.8ACompares actual performance to expected student/intern learning outcomes and competenciesXXX
      1.8BReports and documents action plan to address identified gaps in care and/or service performance at program and student/intern levelXXX
      1.8B1Documents actions taken when discrepancies exist between achievement and expected student/intern learning outcomesXXX
      1.8B2Develops and monitors action plan for students/interns whose achievement and expected outcomes have discrepanciesXX
      1.9Evaluates interventions and workflow process(es) and identifies service and delivery improvementsXXX
      1.9AContinuously monitors processes and outcomes of course, rotation, and/or programsXX
      1.9BDesigns and tests interventions to improve the education process and service with the objective of improving quality and student/intern learning outcomesXX
      1.10Improves or enhances patient/client/population care and/or services working with others based on measured outcomes and established goalsXXX
      1.10AMonitors and refines educational methodology based on measured student/intern learning outcomesXXX
      1.10BImplements an outcomes management system to evaluate the effectiveness and efficiency of educationXX
      1.10B1Utilizes and applies collected data as part of a quality improvement process to improve student/intern learning outcomesXX
      1.10B2Leads in systematically improving processes of educational services to improve student/intern learning outcomes reflecting understanding of variationsX
      1.10CLeads in creating and evaluating systems, processes, and programs that support institutional, ACEND, and Academy core values and objectivesXX
      1.10C1Serves in a leadership role to evaluate benchmarks of educational methodology (eg, theories of adult education, ACEND standards, and institutional standards) to positively influence curriculum planning and developmentX
      Examples of Outcomes for Standard 1: Quality in Practice
      • Actions are within scope of practice and applicable laws and regulations
      • National quality standards and best practices are evident in customer-centered services
      • Performance improvement systems specific to program(s)/service(s) are established and updated as needed; are evaluated for effectiveness in providing desired outcomes data and striving for excellence in collaboration with other team members
      • Performance indicators are specific, measurable, attainable, realistic, and timely (S.M.A.R.T.)
      • Aggregate outcomes results meet pre-established criteria
      • Quality improvement results direct refinement and advancement of practice; and nutrition and dietetics education program, and supervised practice experiences
      Standard 2: Competence and Accountability

      The registered dietitian nutritionist (RDN) demonstrates competence in and accepts accountability and responsibility for ensuring safe, quality practice and services.

      Rationale:

      Competence and accountability in practice includes continuous acquisition of knowledge, skills, experience, and judgment in the provision of safe, quality customer-centered service.
      Indicators for Standard 2: Competence and Accountability
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      2.1Adheres to the code(s) of ethics (eg, Academy/Commission on Dietetic Registration (CDR), other national/international organizations, and/or employer code of ethics)XXX
      2.1AInterprets and shares ethics guidelines within the context of educating students/interns and practitioners in all practice settingsXXX
      2.1BAssists or leads in developing codes of ethics; and/or sits on ethics board/councilXX
      2.2Integrates the Standards of Practice (SOP) and Standards of Professional Performance (SOPP) into practice, self-evaluation, and professional developmentXXX
      2.2AIntegrates applicable focus area(s) SOP and/or SOPP into practice (www.eatrightpro.org/sop)XXX
      2.2A1Integrates applicable focus area(s) SOP and/or SOPP into the educational processXX
      2.2BUses the SOP and/or SOPP as a guide for quality practice, management and leadershipXXX
      2.3Demonstrates and documents competence in practice and delivery of customer-centered service(s)XXX
      2.3AReviews and obtains guidance as needed to understand requirements of ACEND Accreditation Standards, and academic institution’s and/or supervised practice setting’s guidelines applicable to role and responsibilities (eg, program director, faculty, preceptor)XXX
      2.3BDocuments program adherence to ACEND accreditation standards and academic institution’s and/or supervised practice setting’s requirementsXX
      2.4Assumes accountability and responsibility for actions and behaviorsXXX
      2.4AIdentifies, acknowledges, and corrects errorsXXX
      2.4BDocuments and reports errors, complaints, and problems as required by the organization or ACEND’s accreditation processXX
      2.5Conducts self-evaluation at regular intervalsXXX
      2.5AIdentifies needs for professional developmentXXX
      2.5BReviews skills and knowledge to determine whether they meet future educational needs of practitioners, and to qualify for expanded role(s) in practice settingXXX
      2.6Designs and implements plans for professional developmentXXX
      2.6ADevelops plan and documents professional development activities in career portfolio (eg, organizational policies and procedures, credentialing agency[ies])XXX
      2.6A1Identifies and seeks out essential practice competencies to support continuing education needs as an educator and/or preceptorXXX
      2.6A2Includes professional goals around key dimensions of nutrition and dietetics education, performance improvement, research, service, and leadershipXX
      2.7Engages in evidence-based practice and uses best practicesXXX
      2.7AFamiliarizes self with best practices in education through faculty development, and/or through educational publicationsXXX
      2.7BIntegrates evidenced-based practice and research in delivering quality education utilizing, but not limited to, scientific and point-of-care databases (eg, Lexicomp, Clinical Key, Dynamed, UptoDate, Cochrane Reviews) and Academy tools (see Figure 3 resources) in designing student/intern education experiencesXXX
      2.7CUses evidence-based educational theories and strategies (eg, problem-based learning, student-centered learning, and interactive learning) to inform appropriate curricula development and identify relevant educational methodsXXX
      2.7DPromotes best practices both internally and externally with faculty, students, interns, preceptors, and practitionersXXX
      2.7EUses planned change management principles to integrate research into practiceXX
      2.7FIntegrates research findings and evidence into peer-reviewed publications and recommendations for educating nutrition and dietetics practitionersX
      2.8Participates in peer review of others as applicable to role and responsibilitiesXXX
      2.8AProvides feedback and evaluation of performance to preceptors engaged in EONDPXXX
      2.8BAddresses the educational domain in evaluation of self-performance, peer (preceptors) reviews, and/or fellow faculty members reviewsXXX
      2.8CTrains and participates as a site visitor for nutrition and dietetics education program accreditationX
      2.9Mentors and/or precepts othersXXX
      2.9AParticipates and/or assists in mentoring students/internsXXX
      2.9BServes as a preceptor in supervised practice settingsXXX
      2.9CPromotes student/intern relationships with nutrition and dietetics practitioners who will mentor them and further their knowledge in nutrition and dietetics practiceXXX
      2.9DDevelops professional mentor/mentee knowledge, skills, and attributes with current students/interns, colleagues, preceptors, and future employersXX
      2.9EDevelops mentor/mentee programs with current students/interns, colleagues, preceptors, and future employers (eg, research collaboration opportunities)XX
      2.9FAssists in the development of mentor/mentee relationshipsXX
      2.9F1Trains and mentors peers and preceptors about nationally recognized educational practicesXX
      2.9F2Evaluates the teaching and training effectiveness of mentors and preceptors of students/internsXX
      2.9F3Coordinates internal and external reviews of the mentoring educational process utilizing input from students/interns, faculty, preceptors, and other stakeholdersX
      2.10Pursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations, and requirements of practice settingXXX
      2.10ARemains informed about practice-related laws (ie, state licensure and certification, telehealth) and regulations, and regulations that may impact distance educationXXX
      2.10BParticipates in interprofessional
      Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, RDNs, pharmacists, psychologists, social workers, and occupational, physical therapists, faculty, preceptors, and academic administrators), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary.
      education and collaboration
      XXX
      2.10CAdvocates and supports the educational advancement of credentialed nutrition and dietetics practitioners to achieve Masters- and Doctorate-level educationXX
      2.10DSeeks leadership roles at institutional, state, and national levels to advance the education of nutrition and dietetics practitionersX
      Examples of Outcomes for Standard 2: Competence and Accountability
      • Practice reflects:
        • o
          Code(s) of ethics (eg, Academy/CDR, other national organizations, and/or employer code of ethics)
        • o
          Scope of Practice, Standards of Practice and Standards of Professional Performance
        • o
          Evidence-based practice and best practices
        • o
          CDR Essential Practice Competencies and Performance Indicators
        • o
          Compliance with ACEND Accreditation Standards expected for role and responsibilities with the nutrition and dietetics education program
      • Practice incorporates successful strategies for interactions with individuals/groups from diverse cultures and backgrounds
      • Competence is demonstrated and documented
      • Services provided are safe and customer-centered
      • Self-evaluations are conducted regularly to reflect commitment to lifelong learning and professional development and engagement
      • Professional development needs are identified and pursued
      • Directed learning is demonstrated
      • Relevant opportunities (education, training, credentials, certifications) are pursued to advance practice
      • CDR recertification requirements are met
      Standard 3: Provision of Services

      The registered dietitian nutritionist (RDN) provides safe, quality service based on customer expectations and needs, and the mission, vision, principles, and values of the organization/business.

      Rationale:

      Quality programs and services are designed, executed, and promoted based on the RDN’s knowledge, skills, experience, judgment, and competence in addressing the needs and expectations of the organization/business and its customers.
      Indicators for Standard 3: Provision of Services
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      3.1Contributes to or leads in development and maintenance of programs/services that address needs of the customer or target population(s)XXX
      3.1AAligns program/service development with the mission, vision, principles, values, and service expectations and outputs of the organization/businessXXX
      3.1A1Participates in identifying and securing appropriate didactic and/or supervised practice opportunities to achieve student/intern learning outcomesXXX
      3.1A2Establishes administratively sound didactic and/or supervised practice programs (eg, curricula in accordance with ACEND standards, academic institution guidelines, and student/intern learning outcomes)XX
      3.1A3Fosters relationships with key organizations and businesses that support the program’s missionXX
      3.1A3iDevelops policies and procedures to maintain written agreements with institutions, organizations, and/or agencies providing supervised practice experiences to meet the competencies and/or performance indicators outlined in program curriculaXX
      3.1A3iiEvaluates selection, adequacy, and appropriateness of facilities to ensure sites are able to provide meaningful supervised practice learning experiencesXX
      3.1A4Leads collaborative process for determining and monitoring program curriculum and/or supervised practice experiences to assure compliance with ACEND standards and academic institution guidelines with:
      • academic setting faculty and administrators
      • organization liaison and preceptor(s) in supervised practice settings
      XX
      3.1A5Negotiates and/or establishes changes at systems level for new advances in education of practitioners (eg, leads initiative to establish a center for interprofessional education [IPE])X
      3.1A6Leads strategic and operational planning and curriculum designX
      3.1BUses the needs, expectations, and desired outcomes of the customers/populations (eg, students/interns, preceptors, faculty, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service developmentXXX
      3.1B1Routinely assesses needs, expectations, and desired outcomes of students/interns and potential employers to reflect in design of educational program (eg, curriculum, experiential learning, and supervised practice experiences)XXX
      3.1B2Routinely assesses needs for the use of technology to meet the needs of customers/populations, and/or patients/clients, familiesXX
      3.1CMakes decisions and recommendations that reflect stewardship of time, talent, finances, and environmentXXX
      3.1C1Advocates for staffing and other education program resources that support student/intern education and practice activities, enrollment, and achievement of academic program and ACEND standardsXX
      3.1DProposes programs and services that are customer-centered, culturally relevant, and minimize disparitiesXXX
      3.1D1Applies trends (eg, public health, policy, clinical, management) and epidemiological data to professional practice and education programsXX
      3.1D2Insures that programs are routinely evaluated for cultural relevance, equity, and accessibilityX
      3.2Promotes public access and referral to credentialed nutrition and dietetics practitioners (eg, RDN or NDTR) for quality food and nutrition programs and servicesXXX
      3.2AContributes to or designs referral systems that promote access to qualified, credentialed nutrition and dietetics practitionersXXX
      3.2A1Participates as part of an interprofessional team in education, research, and practice, increasing awareness of the roles and responsibilities of qualified, credentialed nutrition and dietetics practitionersXXX
      3.2A2Guides development or review of a referral system as part of a supervised practice experience for students/internsX
      3.2BRefers customers to appropriate providers when requested services or identified needs exceed the RDN’s individual scope of practiceXXX
      3.2B1Establishes and maintains campus, preceptor, stakeholder networks to support program and student/intern needs/interestsXX
      3.2CMonitors effectiveness of referral systems and modifies as needed to achieve desirable outcomesXXX
      3.2DRefers students, interns, and RDNs to the appropriate practitioners (eg, RDN, NDTR, nurse, physician, other health professionals) for purposes of mentoring, tutoring, and/or counselingXXX
      3.2D1Maintains an updated referral system of RDNs and other credentialed practitioners who are willing to mentor students and internsXX
      3.2EAdvocates for credentialed nutrition and dietetics practitioners (eg, RDN or NDTR) representation as part of facultyXX
      3.3Contributes to or designs customer-centered servicesXXX
      3.3AAssesses needs, beliefs/values, goals, resources of the customer, and social determinants of healthXXX
      3.3A1Acknowledges differences and solicits input from the customers/target populations when contributing to the design of servicesXXX
      3.3BUses knowledge of the customer’s/target population’s health conditions, cultural beliefs, and business objectives/services to guide design and delivery of customer-centered servicesXXX
      3.3B1Considers customer (eg, student and/or intern and/or preceptor) concepts of education and their cultural values, belief systems, and worldviews in didactic and/or supervised practice experienceXXX
      3.3B2Considers how culture, gender, sexual orientation, and previous educational and work experience might influence learning and experience expectationsXXX
      3.3B3Adapts methods to maximize learning potential for diverse populations (eg, counseling and teaching modalities, accessibility accommodations, and electronic methods, such as distance education)XXX
      3.3CCommunicates principles of disease prevention and behavioral change appropriate to the customer or target populationXXX
      3.3C1Teaches students/interns to incorporate understanding of cultural safety in delivery of patient/client care and communicationsXXX
      3.3DCollaborates with the customers (eg, students and/or interns and/or preceptors) to set priorities, establish goals, and create customer-centered action plans to achieve desirable outcomesXXX
      3.3D1Participates in or develops appropriate curricula and educational methods to ensure that the educational process provides the exposure, experience, and training necessary to meet the ACEND foundational knowledge, competencies, and/or performance indicators for entry-level RDNs and NDTRsXXX
      3.3D1iEvaluates the effectiveness of curricula and educational methodsXX
      3.3D1iiConducts systematic assessment and evaluation of effectiveness of nutrition and dietetics education programs to ensure quality of servicesXX
      3.3D1iiiLeads interprofessional team on changes and process revisions as neededX
      3.3D2Demonstrates understanding of current pedagogical theory related to the customer-centered education of adult learnersXXX
      3.3D2iApplies current pedagogical theory related to the education of a diverse audience of adult learners to practiceXXX
      3.3D2iiDevelops and implements educational systems based on current pedagogical theories related to adult learnersXX
      3.3D2iiiConducts ongoing systematic reviews of program, course, and training approaches/materials/resources and updates materials/resources (eg, books, modules) as indicatedXX
      3.3D2ivLeads in developing, evaluating, and communicating success related to the different theoretical frameworks for education (eg, problem-based learning)X
      3.3EInvolves customers in decision makingXXX
      3.3E1Involves customers (eg, students and/or interns and/or preceptors) in decision making, including the development, monitoring, evaluating, and reporting of learning outcomes in didactic and/or supervised practice experiencesXXX
      3.4Executes programs/services in an organized, collaborative, cost-effective, and customer-centered mannerXXX
      3.4ACollaborates and coordinates with peers, colleagues, stakeholders, and within interprofessional teamsXXX
      3.4A1Provides students/interns opportunities to participate in interprofessional team rounds, conferences, care plan, and/or discharge planning conferencesXXX
      3.4A2Uses input and feedback from collaborations in execution of programs/servicesXXX
      3.4A3Leads nutrition/dietetics-related classes/lectures to other professions at the graduate or doctorate levelX
      3.4BUses and participates in, or leads in the selection, design, execution, and evaluation of customer programs and services (eg, nutrition screening system, medical and retail foodservice, electronic health records, interprofessional programs, community education, grant management)XXX
      3.4B1Understands and uses the concepts of nutrition screening and assessment processes and parameters for efficiency and effectiveness in didactic courses and/or supervised practice experiencesXXX
      3.4B2Understands and uses the concepts of the food/formulary delivery systems in terms of the nutrition status, health, and well-being of target populations in didactic and/or supervised practice experiencesXXX
      3.4B3Understands, applies, and educates others about the use of the Nutrition Care Process and workflow elements, standardized terminology, and electronic Nutrition Care Process and Terminology using appropriate educational pedagogy and technologiesXXX
      3.4B4Provides professional and technical expertise and new knowledge for ongoing revisions of programs and services (eg, participates in the development of a new nutrition screening system for a local health care institution)X
      3.4CUses and develops or contributes to selection, design, and maintenance of policies, procedures (eg, discharge planning/transitions of care), protocols, standards of care, technology resources (eg, Health Insurance Portability and Accountability Act [HIPAA]–compliant telehealth platforms), and training materials that reflect evidence-based practice in accordance with applicable laws and regulationsXXX
      3.4C1Understands and uses the Nutrition Care Process and workflow elements and standardized terminology in didactic and/or supervised practice experiencesXXX
      3.4C2Understands and uses the concepts of nutrition protocols and policies within the Nutrition Care Process and workflow elements for target populations in didactic and/or supervised practice experiencesXXX
      3.4C3Participates in the development of policies and procedures using evidence-based guidelinesXXX
      3.4C4Implements education program and departmental policies and procedures consistent with evidence-based methods, pertinent federal and state regulations, and ACEND standards foundation knowledge, core competencies, and/or performance indicatorsXXX
      3.4C5Incorporates into educational programs regulatory, accreditation, and reimbursement processes and standards for institutions and providers that are specific to nutrition care and educationXX
      3.4C6Designs and implements best teaching/instruction methods following systematic review of literature and consideration of past student/intern program evaluationsXX
      3.4C7Leads the process of developing and/or updating nutrition and dietetics program policies and procedures, protocols, guidelines, and toolsX
      3.4DUses and participates in or develops processes for order writing and other nutrition-related privileges, in collaboration with the medical staff,
      Medical staff: Medical staff is composed of doctors of medicine or osteopathy and can in accordance with state law, including scope of practice laws, include other categories of physicians, and non-physician practitioners who are determined to be eligible for appointment by the governing body.7
      or medical director (eg, post-acute care settings, dialysis center, public health, community, free-standing clinic settings), consistent with state practice acts, federal and state regulations, organization policies, and medical staff rules, regulations, and bylaws
      XXX
      3.4D1Uses and participates in or leads development of processes for privileges or other facility-specific processes related to (but not limited to) implementing physician/non-physician practitioner
      Non-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, qualified dietitian or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.7,8 The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and long-term care facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.10,11
      -driven delegated orders or protocols, initiating or modifying orders for therapeutic diets, medical foods/nutrition supplements, dietary supplements, enteral and parenteral nutrition, laboratory tests, medications, and adjustments to fluid therapies or electrolyte replacements
      XXX
      3.4D1iUnderstands and applies processes related to order writing and other nutrition-related privileges, including decision making, autonomous practice, and all components of the assessment processesXXX
      3.4D1iiIncludes teaching and/or mentoring on hospital privileging for order writing and/or with physician-delegated orders in hospitals or long-term care settings consistent with federal and state-specific regulationsXXX
      3.4D2Uses and participates in or leads development of processes for privileging for provision of nutrition-related services, including (but not limited to) initiating and performing bedside swallow screenings, inserting and monitoring nasoenteric feeding tubes, providing home enteral nutrition or infusion management services (eg, ordering formula and supplies) and indirect calorimetry measurementsXXX
      3.4D2iIncludes teaching and mentoring on clinical privileging for the provision of nutrition-related servicesXXX
      3.4EComplies with established billing regulations, organization policies, grant-funder guidelines, if applicable to role and setting, and adheres to ethical and transparent financial management and billing practicesXXX
      3.4E1Ensures that in supervised practice settings, relevant billing and reimbursement processes and organization financial guidelines applicable to the RDN’s or NDTR’s practice are addressedXX
      3.4E2Oversees financial management of program and/or grant funding following established institutional guidelinesX
      3.4FCommunicates with the interprofessional team and referring party consistent with the HIPAA rules for use and disclosure of customer’s personal health informationXXX
      3.4F1Teaches nutrition and dietetics students/interns about personal health records, electronic records, and online access and how patients could use themXXX
      3.4F2Reviews HIPAA rules with students/interns, including application to nutrition and dietetics practitioners when using protected health information in health care facilities, private practice, community settings, or through telehealth technologies used to communicate with patients/clientsXXX
      3.5Uses professional, technical, and support personnel appropriately in the delivery of customer-centered care or services in accordance with laws, regulations, and organization policies and proceduresXXX
      3.5AAssigns activities, including direct care to patients/clients, consistent with the qualifications, experience, and competence of professional, technical, and support personnelXXX
      3.5A1Ensures students/interns understand:XXX
      3.5A2Assigns educational and/or research activities to students/interns consistent with his or her qualifications, experience, and competenceXX
      3.5BSupervises professional, technical, and support personnelXXX
      3.5B1Provides relevant training and supervision of teaching assistant or administrative staff assisting with the nutrition and dietetics education programXXX
      3.5B2Guides and monitors student/intern interactions with professional, technical, and support personnelXXX
      3.5B3Ensures preceptors meet qualifications (eg, education and experience within their areas of practice) to provide appropriate guidance in supervised practice experiencesXX
      3.6Designs and implements food delivery systems to meet the needs of customersXXX
      3.6ACollaborates in or leads the design of food delivery systems to address health care needs and outcomes (including nutrition status), ecological sustainability, and to meet the culture and related needs and preferences of target populations (ie, health care patients/clients, employee groups, visitors to retail venues, schools, child and adult day-care centers, community feeding sites, farm-to-institution initiatives, local food banks)XXX
      3.6A1Communicates the need for food delivery systems to address health care needs and outcomes, ecological sustainability, and to meet the culture and related needs and preferences of target populationsXXX
      3.6BParticipates in, consults/collaborates with, or leads the development of menus to address health, nutritional, and cultural needs of target population(s) consistent with federal, state, or funding source regulations or guidelinesXXX
      3.6B1Teaches students/interns to develop food and fluid items, menus, medical foods, and nutritional supplements that address health, nutritional, and cultural needs of populationsXXX
      3.6B2Incorporates activities reviewing regulations and evidence-based guidelines that impact development of menus for specific populations (eg, hospitals [adult, pediatric], long-term care settings, senior feeding programs, schools, child and adult care centers, corrections facilities) into didactic and supervised practiceXX
      3.6CParticipates in, consults/collaborates with, or leads interprofessional process for determining medical foods/nutritional supplements, dietary supplements, enteral and parenteral nutrition formularies, and delivery systems for target population(s)XXX
      3.6C1Reviews interprofessional process used by health care settings to identify and manage nutrition-related product formularies and delivery systems (eg, group purchasing processes, role of Food and Nutrition and Pharmacy, budget responsibility, equipment [eg, infusion pumps, feeding tubes]; ordering, storage and distribution; and billing, if applicable)XX
      3.6C2Leads and educates students/interns on review process for choosing/maintaining nutrition-related product formularies and delivery systemsX
      3.7Maintains records of services providedXXX
      3.7ADocuments according to organization policies, procedures, standards, and systems, including electronic health recordsXXX
      3.7A1Orients students/interns to types of manual and electronic health record systemsXXX
      3.7A2Oversees management of records related to student/intern/human resources within the nutrition and dietetics education programX
      3.7BImplements data management systems to support interoperable data collection, maintenance, and utilizationXXX
      3.7B1Develops and/or uses data collection tools for analyzing process, performance, and outcomesXX
      3.7B2Leads interprofessional collaborations to identify or develop tools to support education program data managementX
      3.7CUses data to document outcomes of services (ie, staff productivity, cost/benefit, budget compliance, outcomes, quality of services) and provide justification for maintenance or expansion of servicesXXX
      3.7C1Tracks student/intern learning outcomes and competency achievement according to ACEND, institution, and department policy to support revision, as necessary, in course or supervised practice learning activitiesXXX
      3.7C2Implements and manages information systems to track student/intern progressXX
      3.7DUses data to demonstrate program/service achievements and compliance with accreditation standards, laws, and regulationsXXX
      3.7D1Conducts data analysis, develops report of outcomes and improvement recommendations, and disseminates findings using informatics skills and knowledgeXX
      3.7D2Directs collaborative process for preparing data and reports for program accreditation and site visitsX
      3.8Advocates for provision of quality food and nutrition services as part of public policyXXX
      3.8ACommunicates with policy makers regarding the benefit/cost of quality food and nutrition servicesXXX
      3.8A1Actively initiates and/or participates in public policy initiatives on a local, national, or international level to advocate for quality nutrition servicesXXX
      3.8A2Guides and encourages students/interns to develop advocacy skills to effectively engage stakeholders, legislators, and decision makers; and to communicate succinct messages that inform and gain support for desired outcomesXX
      3.8BAdvocates in support of food and nutrition programs and services for populations with special needs and chronic conditionsXXX
      3.8B1Leads advocacy activities/policy initiatives, conducts research, authors’ articles, and delivers presentations on topicXX
      3.8CAdvocates for protection of the public through multiple avenues of engagement (eg, legislative action; establishing effective relationships with elected leaders and regulatory officials; and participation in various Academy committees, workgroups and task forces, Dietetic Practice Groups, Member Interest Groups, and State Affiliates)XXX
      3.8C1Routinely reviews federal and state legislation related to education and nutrition and dietetics practice to contribute and influence issues (eg, submits comments [e-mail, phone, letters] to lawmakers, attends town halls or committee hearings [eg, testify], and participates in Affiliate and Academy Public Policy Workshops)XXX
      Examples of Outcomes for Standard 3: Provision of Services
      • The design of the EONDP program reflects the mission, vision, principles, values, and customer needs and expectations
      • Customers participate in establishing the EONDP program goals and customer-focused action plans
      • Customer-centered needs and preferences are met
      • Customers are satisfied with services and products
      • Customers have access to all learning tools necessary to result in optimal learning outcomes
      • Ethical and transparent financial management and billing practices are used per role and setting
      Standard 4: Application of Research

      The registered dietitian nutritionist (RDN) applies, participates in, and/or generates research to enhance practice. Evidence-based practice incorporates the best available research/evidence and information in the delivery of nutrition and dietetics services.

      Rationale:

      Application, participation, and generation of research promote improved safety and quality of nutrition and dietetics practice and services.
      Indicators for Standard 4: Application of Research
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      4.1Reviews best available research/evidence and information for application to practiceXXX
      4.1AUnderstands basic research design and methodologyXXX
      4.1BFormulates research questions pertinent to nutrition and dietetics practice and education of nutrition and dietetics students/interns (eg, using the PICO [Population; Intervention/Indicator; Comparison; Outcome] approach)XXX
      4.1CRecognizes research ethics and utilizes responsible conduct in researchXXX
      4.1C1Participates as a member of an Institutional Review Board (IRB) to apply knowledge of research ethics on human subjectsXX
      4.1DUses systematic methods to extract answers that are based on scientific evidenceXXX
      4.1EMentors RDNs and other health care professionals in developing skills in accessing and critically analyzing research and applying to practiceXX
      4.1FDevelops evidence-based tools as a basis for stimulating awareness and integration of current evidenceX
      4.2Uses best available research/evidence and information as the foundation for evidence-based practiceXXX
      4.2ADemonstrates understanding of interpretation and application potential of primary peer-reviewed publications for education and uses evidence-based practice guidelines and related resources to guide education of nutrition and dietetics practitionersXXX
      4.2BUses evidence-based practice and education research and other data to reduce variation in nutrition and dietetics education practice and for design of student/intern educational experiencesXXX
      4.2CApplies evidence-based research to the design of primary, secondary, and tertiary disease prevention approachesXX
      4.2DProvides leadership in the creation of nutrition and dietetics program benchmarks using evidence-based research in educationX
      4.3Integrates best available research/evidence and information with best practices, clinical and managerial expertise, and customer valuesXXX
      4.3ATranslates research findings into the development of policies, procedures, content, and guidelines for education of nutrition and dietetics practitionersXX
      4.4Contributes to the development of new knowledge and research in nutrition and dieteticsXXX
      4.4AParticipates in research and scholarly activity
      Scholarly activity: Scholarly activity is defined differently across institutions of higher education; for example, from http://www.fresnostate.edu/academics/facultyaffairs/documents/apm/325.pdf: 1) as a teacher-scholar strengthening and updating professional expertise for classroom instruction (Scholarship of Teaching); 2) as a scholar strengthening and broadening the faculty member’s scholarly and academic credentials (Scholarship of Discovery); 3) as a practitioner engaging in both theory and application (Scholarship of Application); and 4) as an integrated scholar placing specialties in a broader context (Scholarship of Integration).
      to acquire new knowledge (eg, journal clubs, Academy’s research workgroups)
      XXX
      4.4BContributes to the development of new knowledge and research in education of nutrition and dietetics practitioners, and/or other areas of expertiseXXX
      4.4B1Participates in nutrition and dietetics education of practitioners research studies and/or other area(s) of researchXXX
      4.4B2Participates as a member of an editorial board on peer-reviewed journalsXX
      4.4B3Serves as principal investigator in nutrition and dietetics education of practitioners research studies and/or other area(s) of research expertiseXX
      4.4B4Publishes nutrition and dietetics education research studies and/or other area of research expertise in peer-reviewed journalsXX
      4.4B5Leads nutrition and dietetics students/interns in conducting nutrition and dietetics research, including problem development, literature review, research methodology, data analysis, and preparation of final reportsX
      4.4CUses educational exemplars to generate new knowledge and develop new guidelines, programs, and policies in nutrition and dietetics educationX
      4.5Promotes application of research in practice through alliances or collaboration with food and nutrition and other professionals and organizations (eg, including other colleges and universities)XXX
      4.5AParticipates in research-focused service opportunities (eg, member of committees, task forces)XXX
      4.5BCollaborates in practice-based research networks (eg, contributes to data collection for multi-institutional studies)XX
      4.5CDevelops service opportunities within partnerships to broaden research opportunities (eg, partnering in development of multi-institutional studies)X
      Examples of Outcomes for Standard 4: Application of Research
      • Evidence-based practice, best practices, clinical and managerial expertise, and customer values are integrated in the delivery of nutrition and dietetics services, and nutrition and dietetics education program curriculum and supervised practice experiences
      • Customers receive appropriate services based on the effective application of best available research/evidence and information
      • Best available research/evidence and information is used as the foundation of evidence-based practice
      Standard 5: Communication and Application of Knowledge

      The registered dietitian nutritionist (RDN) effectively applies knowledge and expertise in communications.

      Rationale:

      The RDN works with others to achieve common goals by effectively sharing and applying unique knowledge, skills, and expertise in food, nutrition, dietetics, and management services.
      Indicators for Standard 5: Communication and Application of Knowledge
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      5.1Communicates and applies current knowledge and information based on evidenceXXX
      5.1ADemonstrates critical thinking and problem-solving skills when communicating with others (eg, students/interns, preceptors, future employers)XXX
      5.1A1Documents interpretation of relevant information and results of communication with students/interns, preceptors, future employers, and other key stakeholdersXXX
      5.1BSeeks current and relevant information related to nutrition and dietetics education practiceXXX
      5.1B1Attends/presents at conferences and meetings to share information in peer-reviewed forumsXXX
      5.1B2Builds relationships between researchers and decision makers so that effective knowledge transfer can take placeXX
      5.1B3Provides commentary and analysis of relevant informationXX
      5.1B4Presents information to establish collaborative practice at a systems level (eg, a student/intern learning outcomes assessment program)X
      5.2Selects appropriate information and the most effective communication method or format that considers customer-centered care and the needs of the individual/group/populationXXX
      5.2AUses communication methods (ie, oral, print, one-on-one, group, visual, electronic, and social media) targeted to various audiencesXXX
      5.2A1Orients students/interns to guidelines for the appropriate use of social media and other electronic platforms in professional practiceXXX
      5.2A2Designs learning experiences for nutrition and dietetics students/interns to gain skills in verbal communication (ie, facilitated discussion, motivational interviewing, professional presentations)XXX
      5.2A3Oversees development of marketing materials to promote nutrition and dietetics education program recruitmentXX
      5.2A4Leads efforts for campus wide and/or community outreach activities that highlight department, program and/or student/intern accomplishments (eg, social marketing campaign initiative, with a community nutrition focus as part of an advanced practice residency competency)X
      5.2BUses information technology to communicate, disseminate, and manage knowledge, and support decision makingXXX
      5.2B1Incorporates use of information technology into educational programs and curriculaXXX
      5.2B1iExplains and applies concepts of nutrition informatics (ie, the effective retrieval, organization, storage, and optimum use of information, data, practice simulation software, and knowledge for food- and nutrition-related problem solving and decision making) to nutrition and dietetics students/interns, program faculty, staff, preceptors, and other customers, as appropriateXX
      5.2B2Effectively uses administrative software applications and technology (ie, accounting, publications, project management) to manage department-level activitiesXX
      5.2B3Develops education tools using web-based and other technologies that use interoperability across different settingsXX
      5.2B4Provides expertise in creating and using electronic and web-based technology specific to practice setting environment and need, using interoperability across different care settingsX
      5.3Integrates knowledge of food and nutrition with knowledge of health, culture, social sciences, communication, informatics, sustainability, and managementXXX
      5.3ADemonstrates the ability to integrate new knowledge of nutrition and dietetics education practice in varied contexts (eg, different education environments, such as undergraduate/graduate, students, interns, preceptors, colleagues); seeks assistance if neededXXX
      5.3BUnderstands health, culture, social sciences, communications, sustainability, management, nutrition, and informatics, which is necessary for data collection, analysis, and application of new knowledgeXXX
      5.4Shares current, evidence-based knowledge, and information with various audiencesXXX
      5.4AGuides customers, families, students, and interns in the application of knowledge and skillsXXX
      5.4A1Develops learning modules on nutrition and dietetics skills (eg, nutrition-focused physical exam, behavior counseling) and demonstrates techniques for nutrition and dietetics students/interns to modelXX
      5.4BAssists individuals and groups to identify and secure appropriate and available educational and other resources and servicesXXX
      5.4B1Oversees supervised practice placement for nutrition and dietetics students/interns and assures supervised practice experiences meet the need of the student, preceptor, placement site, and nutrition and dietetics education programXX
      5.4B2Establishes and maintains administratively sound nutrition and dietetics education programs (eg, curricula in accordance with institution mission, ACEND standards, and nutrition and dietetics student/intern learning outcomes)XX
      5.4B3Leads efforts to identify and secure appropriate and available resources and servicesX
      5.4CUses professional writing and verbal skills in all types of communicationsXXX
      5.4C1Understands and demonstrates ability to write scientific peer-reviewed papers, proposals, reports, and other documents and present in oral formatsXX
      5.4DReflects knowledge of population characteristics in communication methodsXXX
      5.4EExhibits knowledge related to the profession of nutrition and dietetics, including nutrition and dietetics educationXXX
      5.4FServes as invited reviewer, author, and presenter at local and regional meetings and media outletsXX
      5.4GServes as invited reviewer, author, and/or presenter at national and international meetings and media outletsX
      5.5Establishes credibility and contributes as a food and nutrition resource within the interprofessional academic, health care, and management team, organization, and communityXXX
      5.5AServes on planning committees/task forces to conduct program review and/or develop/revise courses or supervised practice experiencesXXX
      5.5BUses habits of good interfacing (communication, information gathering, and practices) to lead in nutrition and dietetics education practiceXXX
      5.5CServes as author for articles for consumers and professional groupsXXX
      5.5DDevelops innovative approaches to practice issuesXX
      5.5D1Develops an appropriate academic remediation process to support at-risk nutrition and dietetics students/internsXX
      5.5D2Designs educational programs with multiple entry/admission points to enhance recruitment of nontraditional nutrition and dietetics students/internsX
      5.6Communicates performance improvement and research results through publications and presentationsXXX
      5.6APresents nutrition and dietetics practice and education research activities and results at the local level (eg, department meetings)XXX
      5.6BPresents innovations in nutrition and dietetics practice, education, and other research findings at the regional and national level, including, but not limited to, nutrition and dietetics meetings as well as scientific, academic, or professional conferences and practice forums (eg, Nutrition and Dietetics Educators and Preceptors [NDEP] meetings; Academy of Nutrition and Dietetics annual Food & Nutrition Conference & Expo, National Kidney Foundation, American Heart Association, American Diabetes Association)XX
      5.6CPublishes nutrition and dietetics practice, education, and other research activities and results (eg, NDEP newsletter, education journals, and other peer-reviewed journals)XX
      5.6DProvides leadership for content development of education-focused publications and national meetingsX
      5.6EServes as an author of education-related publications and presenter for colleagues, preceptors, and future employers on topics related to educational theories and nutrition and dietetics practiceX
      5.6FServes in leadership role for publications (ie, editor, editorial advisory board) and program planning committeesX
      5.7Seeks opportunities to participate in and assume leadership roles with local, state, and national professional and community-based organizations (eg, government-appointed advisory boards, community coalitions, schools, foundations, or nonprofit organizations serving the food insecure) providing food and nutrition expertiseXXX
      5.7AParticipates in associations related to nutrition and dietetics education planning, delivery, and evaluation with stakeholdersXXX
      5.7BSeeks opportunities to share best practices related to nutrition and dietetics education planning, delivery, and evaluation with stakeholdersXXX
      5.7CServes as consultant and/or opinion leader to health care providers, business, industry, public, the Academy of Nutrition and Dietetics, and other national organizations regarding education needs of health care practitionersXX
      Examples of Outcomes for Standard 5: Communication and Application of Knowledge
      • Expertise in food, nutrition, dietetics, management, and nutrition and dietetics education is demonstrated and shared
      • Interoperable information technology is used to support practice
      • Effective and efficient communications occur through appropriate and professional use of e-mail, texting, and social media tools
      • Individuals, groups, and stakeholders:
        • o
          Receive current and appropriate information and customer-centered service
        • o
          Demonstrate understanding of information and behavioral strategies received
        • o
          Know how to obtain additional guidance from the RDN or other RDN-recommended resources
      • Leadership is demonstrated through active professional and community involvement
      Standard 6: Utilization and Management of Resources

      The registered dietitian nutritionist (RDN) uses resources effectively and efficiently.

      Rationale:

      The RDN demonstrates leadership through strategic management of time, finances, facilities, supplies, technology, and natural and human resources.
      Indicators for Standard 6: Utilization and Management of Resources
      Bold Font Indicators are Academy Core RDN Standards of Professional Performance IndicatorsThe “X” signifies the indicators for the level of practice
      Each RDN:CompetentProficientExpert
      6.1Uses a systematic approach to manage resources and improve outcomesXXX
      6.1AFollows the current ACEND Accreditation Standards for Nutrition and Dietetics Education Programs to guide planning, implementation, and evaluation of nutrition and dietetics educationXX
      6.1BConducts a budget analysis to insure there are sufficient financial resources to meet goals and improve outcomesXX
      6.1CCreates, maintains, and reports on department and/or program budget, keeping in mind organizational mission and vision and education needs of students/internsXX
      6.2Evaluates management of resources with the use of standardized performance measures and benchmarking as applicable (eg, documents use of measurable resources, such as personnel, monies, equipment, reference materials, and time in the provision of nutrition and dietetics education)XXX
      6.2AUses the Standards of Excellence Metric Tool to self-assess quality in leadership, organization, practice, and outcomes for an organization (www.eatrightpro.org/excellencetool)XXX
      6.2BParticipates in strategic and operational planning of education programmingXX
      6.2CManages effective delivery of educational programsXX
      6.2DIntegrates program outcome evaluation into institutional planning and assessmentX
      6.3Evaluates safety, effectiveness, efficiency, productivity, sustainability practices, and value while planning and delivering services and products (eg, student/intern educational courses and practice activities)XXX
      6.4Participates in quality assurance and performance improvement and documents outcomes and best practices relative to resource managementXXX
      6.4AParticipates in data collection, collation, summarization, distribution, and/or reporting on findings; proposes possible resolution(s) to identified area(s) of concern to improve and/or maintain desired outcome(s)XXX
      6.4BProactively recognizes needs, anticipates outcomes and consequences of different approaches, and makes necessary modifications to plans/services/programs to achieve desired outcomesXX
      6.4CEngages in continuous quality improvement through the process of program outcomes assessmentXX
      6.4DEffects long-term thinking and planning; anticipates needs; fully understands strategic and operational plans and student/intern learning outcomes; and integrates justification into plansX
      6.5Measures and tracks trends regarding internal and external customer outcomes (eg, satisfaction, key performance indicators)XXX
      6.5AConducts surveys with students, interns, faculty, and preceptors to assess key stakeholder satisfactionXXX
      6.5BIdentifies and develops a plan to address internal and external problems that may affect delivery of educational programsXX
      6.5CResolves internal and external problems that may affect delivery of educational programsX
      Examples of Outcomes for Standard 6: Utilization and Management of Resources
      • Resources are effectively and efficiently managed
      • Documentation of resource use is consistent with operational and sustainability goals, and organizational requirements
      • Data are used to promote, improve, and validate services, organization practices, and public policy
      • Desired outcomes are achieved, documented, and disseminated
      • Identifies and tracks key performance indicators in alignment with organizational mission, vision, principles, and values
      a Pedagogy: Pedagogy is the art or science of teaching; education; instructional methods.
      b Preceptor: A preceptor is a teacher, an instructor, an expert, or a specialist, such as an RDN, who provides practical experience and training to a student/intern, especially of medicine, nursing, or nutrition and dietetics.
      c PROMIS: The Patient-Reported Outcomes Measurement Information System (PROMIS) (https://commonfund.nih.gov/promis/index) is a reliable, precise measure of patient-reported health status for physical, mental, and social well-being. PROMIS is a web-based resource and is publicly available.
      d Interprofessional: The term interprofessional is used in this evaluation resource as a universal term. It includes a diverse group of team members (eg, physicians, nurses, RDNs, pharmacists, psychologists, social workers, and occupational, physical therapists, faculty, preceptors, and academic administrators), depending on the needs of the customer. Interprofessional could also mean interdisciplinary or multidisciplinary.
      e Medical staff: Medical staff is composed of doctors of medicine or osteopathy and can in accordance with state law, including scope of practice laws, include other categories of physicians, and non-physician practitioners who are determined to be eligible for appointment by the governing body.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed November 19, 2018.

      f Non-physician practitioner: A non-physician practitioner may include a physician assistant, nurse practitioner, clinical nurse specialist, certified registered nurse anesthetist, certified nurse-midwife, clinical social worker, clinical psychologist, anesthesiologist’s assistant, qualified dietitian or qualified nutrition professional. Disciplines considered for privileging by a facility’s governing body and medical staff must be in accordance with state law.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix A-Survey protocol, regulations and interpretive guidelines for hospitals (Rev. 183, 10-12-18); §482.12(a)(1) Medical Staff, non-physician practitioners; §482.23(c)(3)(i) Verbal Orders; §482.24(c)(2) Orders. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_a_hospitals.pdf. Accessed November 19, 2018.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix W-Survey protocol, regulations and interpretive guidelines for critical access hospitals (CAHs) and swing-beds in CAHs (Rev. 183, 10-12-18); § 485.635(a)(3)(vii) Dietary Services; § 458.635 (d)(3) Verbal Orders; §458.635 (d)(9) Swing-Beds. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_w_cah.pdf. Accessed November 19, 2018.

      The term privileging is not referenced in the Centers for Medicare and Medicaid Services long-term care (LTC) regulations. With publication of the Final Rule revising the Conditions of Participation for LTC facilities effective November 2016, post-acute care settings, such as skilled and long-term care facilities, may now allow a resident’s attending physician the option of delegating order writing for therapeutic diets, nutrition supplements or other nutrition-related services to the qualified dietitian or clinically qualified nutrition professional, if consistent with state law, and organization policies.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; reform of requirements for long-term care facilities. 42 CFR Parts 405, 431, 447, 482, 483, 485, 488, and 489. Final Rule (FR DOC#2016; pp 68688-68872)–Federal Register October 4, 2016; 81(192):68688-68872; §483.30(f)(2) Physician services (pp 65-66), §483.60 Food and Nutrition Services (pp 89-94), §483.60 Food and Nutrition Services (pp 177-178). https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-for-long-term-care-facilities. Accessed November 19, 2018.

      US Department of Health and Human Services, Centers for Medicare and Medicaid Services. State Operations Manual. Appendix PP Guidance to surveyors for long-term care facilities (Rev. 173, 11-22-17); §483.30 Physician Services, §483.60 Food and Nutrition Services. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf. Accessed November 19, 2018.

      g Scholarly activity: Scholarly activity is defined differently across institutions of higher education; for example, from http://www.fresnostate.edu/academics/facultyaffairs/documents/apm/325.pdf: 1) as a teacher-scholar strengthening and updating professional expertise for classroom instruction (Scholarship of Teaching); 2) as a scholar strengthening and broadening the faculty member’s scholarly and academic credentials (Scholarship of Discovery); 3) as a practitioner engaging in both theory and application (Scholarship of Application); and 4) as an integrated scholar placing specialties in a broader context (Scholarship of Integration).

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      Biography

      K. Border is an assistant professor, Department of Dietetics, D’Youville College, Buffalo, NY.
      C. Endrizal is chief quality officer and an adjunct junior specialist, Department of Complementary and Integrative Medicine, John A. Burns School of Medicine, University of Hawaiʻi at Mānoa, Wahiawā.
      M. Cecil is a consultant dietitian, Salisbury, MD, and retired assistant professor and director of didactic program in dietetics, University of Maryland Eastern Shore, Princess Anne.