Abstract
Background
Objective
Design
Participants/setting
Analysis performed
Results
Conclusion
Keywords
Landscapes of Dietetic Practice
Transitioning and Boundary Crossing Across the Dietetic Landscape
Developing Professional Identities

Study Aims and Research Question
Methods
Study Design
Context
Sampling and Recruitment
Data Collection
Academics and Practitioners Interview Guide Version 2: January 24, 2018 | ||||
---|---|---|---|---|
No. | Question | Logic | Prompts | Secondary questions |
Introductory questions | ||||
1 | Can you tell me a little about yourself and role in dietetic education? | Introductions/icebreaker/building rapport | Undergraduate/postgraduate workplace settings | |
2 | What are your understandings of professionalism for dietetics? | Introduction to the topic | Can you explain your understanding of professionalism as it relates to working as a dietitian please? What does professionalism mean to you? | |
Student professionalism interactions | ||||
3 | We are interested in your interactions and experiences with students around issues of professionalism. What are your most recent or most memorable experiences with students related to professionalism or the lack of? (Let participants share their stories as uninterrupted as possible and only chip in with prompt questions if participants have not given full/rich narratives. For example: Where did it take place and who else was there? What happened? What did you do and why? How did you feel at the time and now?) | What impact did this experience (if any) have on your understandings and attitudes toward professionalism? | How has this experience influenced your thoughts and feelings toward teaching and assessing professionalism? | If participants are volunteering all negative experiences, prompt them to talk also about positive experiences and vice versa. |
Managing lapses in professionalism/unprofessional behavior | ||||
4 | We are interested in approaches to managing and dealing with professionalism lapses in the university and workplace setting. | What are your experiences when a student has been engaged in professional lapses, and how has it been handled by the university/in the workplace/placement setting? | Remediation strategies What supports/resources have been or might be helpful? | Has this/does this limit/affect students’ progression? Can you share any examples? |
Teaching, assessing, and curriculum approaches to professionalism | ||||
5 | Professionalism hasn’t always been explicitly taught and has been more a part of the informal and hidden curriculum. Invite participants to share their teaching and learning and assessment approaches in university and placement/workplace settings. | What are your approaches to teaching and learning and assessing professionalism in your:
| Prompts Is there dedicated lecture(s)/unit? How does assessment occur on placement/at university? Who is involved? | |
Strengthening professionalism recommendations | ||||
6 | Exploring areas for strengthening professionalism learning, teaching, and assessing and any other elements raised by participants. This part of the discussion will elicit participants’ recommendations for developing/strengthening professionalism teaching, learning, and assessment. Prompt questions might include those in this row. | How might professionalism be strengthened in curriculum and placement experiences for dietetic students? | How might students learn professionalism better? What are your needs around professionalism to support/strengthen teaching and assessment? | What are current challenges/limitations to teaching and assessment of professionalism in university and workplace settings? |
Thanks and termination of interview/focus group | ||||
7 | Are there any contributions you would like to make or questions you would like to ask that have not been covered? | Participant opportunity | ||
8 | I appreciate your time and contributions. Thank you for participating. Your descriptions of experiences and suggested recommendations have made a valuable contribution to the study. | Thanks and close | ||
Student Interview Guide Version 2.0 May 2018 Interview and focus groups with final-year dietetics students at course completion | ||||
No. | Question | Logic | Prompts | Secondary questions |
Introductory questions | ||||
1 | Can you tell me about yourself and where you studied dietetics | Introductions/icebreaker/building rapport | Undergraduate/postgraduate | |
2 | What are your understandings of professionalism for dietetics? | Introduction | As a newly qualified dietitian, what does professionalism mean to you? | |
Teaching and learning professionalism | ||||
3 | Now we are going to move on to how you were taught and how you learnt about professionalism. Professionalism isn’t always explicitly taught—sometimes it can be more a part of the informal and hidden curriculum. (Explain hidden and informal curriculum.) First of all, I am interested in understanding how you were taught about professionalism in your course. | Teaching professionalism | Teaching methods Sessions Where—at university? On placement? Workplace? | Can you tell me about some of the teaching you recall related to learning about professionalism? |
4 | What experiences during your course are most memorable in terms of how you learned about professionalism? | Learning professionalism | Where—at university? On placement? | What was memorable or significant about this experience? Why did it have an impact on you? |
Assessment of professionalism | ||||
5 | Professionalism is a component of the Competency Standards that you have to meet to fulfill requirements for entry to practice. How was your professionalism assessed during your course? | Assessment approaches | Where? When in the course? By whom? Key assessment tasks? Evidence provided? | Can you tell me about the approaches used to assess your professionalism during your course? |
6 | Can you tell me (us) about your experiences of professionalism assessment? | Experiences of assessment | Summative/formative Assessors/context Remediation opportunities | I am interested in knowing more about how your professionalism was assessed. |
Memorable professionalism dilemmas | ||||
7 | Research with other health care students has revealed some of them encounter professionalism dilemmas during their course—experiences that they have found challenging or confronting for a range of a reasons. They may be in relation to lapses in professionalism they have observed or been involved in. (Define professionalism lapses.) Can you share with me (us) any memorable professionalism dilemmas you experienced during your course while at university or on placement? | Exploration of memorable dilemmas Gathering narratives on memorable professionalism dilemmas | May have been on placement or at university Who was involved? Where? | How did you make sense of that experience? Opportunity provided to debrief/support? |
Thanks and termination of interview/focus group | ||||
8 | Are there any contributions you would like to make or questions you would like to ask that have not been covered? | Participant opportunity | ||
9 | Appreciate your time and contributions. | Thanks and close |
Data Analysis
Researcher Characteristics and Reflexivity
Results
Characteristic | University faculty members (n = 51) | Preceptors (n = 27) | Students (n = 22) | Total (n = 100) |
---|---|---|---|---|
←n→ | ||||
Gender | ||||
Female | 49 | 26 | 21 | 96 |
Male | 2 | 1 | 1 | 4 |
←median, range→ | ||||
Age | 43 (34-50) | 37 (29-44) | 24 (23-30) | 38 (29-46) |
←n→ | ||||
First language | ||||
English | 46 | 27 | 19 | 92 |
Other | 5 | 0 | 3 | 8 |
Cultural and ethnic identification | ||||
Oceanian | 37 | 18 | 17 | 72 |
European | 17 | 9 | 3 | 29 |
Asian | 3 | 0 | 3 | 6 |
Sub-Saharan African | 0 | 2 | 0 | 2 |
Aboriginal and/or Torres Strait Islander | 0 | 0 | 1 | 1 |
Geographic diversity of participants | ||||
Australia | 45 | 25 | 20 | 90 |
Victoria | 18 | 11 | 8 | 37 |
New South Wales | 8 | 10 | 5 | 23 |
Queensland | 12 | 2 | 6 | 20 |
Western Australia | 4 | 1 | 0 | 5 |
South Australia | 2 | 1 | 0 | 3 |
Australian Capital Territory | 1 | 0 | 1 | 2 |
New Zealand | 6 | 2 | 2 | 10 |
University/workplace diversity | 17 of 18 Australian and NZ universities with accredited dietetics programs: 5 UG; 11 PG; 1 offered both UG and PG | Diverse work contexts and settings including: public and private hospitals (adult and pediatric), subacute, food service, community and public health nutrition, private practice (metro = 18; regional/rural = 9) | From 9 of 18 ANZ universities with accredited dietetics programs (14 UG and 8 PG students); 19 domestic and 3 international enrolled | 17 of 18 universities in ANZ with accredited dietetic programs and multiple diverse work contexts and settings |

Related themes and subthemes | Quote number | Illustrative quote |
---|---|---|
Theme 1: Cultural norms and microcultures | ||
Cohesion | 1 | “[T]here’s a lot of judgment of dietitians against other dietitians . . . I don’t think we need it because we’ve got so many external competitors to our profession and that we actually just need to be cohesive.” AC18 |
Conformity and homogeneity | 2 | “I think it ties up to this idea of people wanting ‘mini mes’ maybe, like we want to kind of replicate ourselves in our profession and I think our profession is limited because we’re too homogenous.” AC38 |
Competition, criticism, and bullying | 3 | “[W]e are probably our own worst enemies . . . getting into dietetics is really competitive . . . it attracts a certain type of person . . . they’re just not kind . . . we don’t celebrate successes very well . . . As soon as someone kind of gets their head above the parapet . . . we’ll slap them over the wrist for those things.” AC6 |
4 | “I was definitely bullied . . . I’ve had plenty of scenarios where I don’t know who my allies are at work, you know? And workplaces can be really political.” PR73 | |
5 | “[T]he dietitians that had been there for a year or 2 years, were so much more harsh and less inclusive than the more senior ones. The more senior ones were way more . . . confident in our ability, less sort of nitpicky, understood that we were learning, would include us at lunchtime . . . Whereas the new ones, it almost felt like they thought that we were a threat . . . And them picking on us, . . . like, really nitpicking on our work just took like a kick to the confidence I suppose, when a new graduate is sort of picking on the tiniest little things and you’re still learning.” ST08 | |
Conflict aversion | 6 | “[T]raditionally those hard conversations haven’t always been had, but maybe the next lot of professionals . . . will be able to do that sort of thing in the workplace, ’cause we’re actually teaching them from the get-go this . . . very stuff.” AC3 |
Theme 2: Boundaries | ||
Varying types of boundaries | 7 | “[S]taff room discussions, I’ve had students say you know, ‘I’m feeling a bit uncomfortable because my supervisors are all talking about, um, you know the parties they’ve been to and maybe the partners they’ve just recently hooked up with’ . . . I’m receptive to the fact that the student feels that that is inappropriate. Because usually it’s the other way round.” AC48 |
8 | “I used to work in . . . where students weren’t allowed to cross a certain threshold. They were kept to a certain area.” PR69 | |
Inclusion and exclusion | 9 | “I found like going from a small . . . , rural hospital where I really felt a part of the team and then going to a really big metropolitan hospital, like quite shocking . . . in the rural setting I was really welcomed . . . And then went to the lunch room on my first day at the huge hospital . . . no one even basically looked up or said, ‘Hello’ . . . I really felt out, outside . . . we aren’t a part of the team.” ST10 |
Navigating blurred boundaries | 10 | “I had one student recently . . . where . . . every conversation would come back to something about her personal life . . . there’s a line between sharing about yourself but then not oversharing . . . I avoided the hard conversation because I didn’t know how to have it.” PR65 |
Boundary crossing | 11 | “I was not introduced to a single person. And like I’m not the type of person to accept that . . . I sat down and I introduced myself and asked them what their name was, . . . what role they did. I forced myself in. I felt incredibly awkward doing that. But like I had to initiate it. And then they started . . . engaging with me normally, . . . I thought . . . ‘Am I that below you?’ . . . It’s the culture . . . it’s almost like a power play and a bit of an initiation process.” ST10 |
12 | “[O]n my second clinical placement, I was very embraced into the team. I had lunch with them every day. I went to the head of dietetics’ house for dinner . . . I felt very welcome. It was a lot of fun . . . Um, it made me feel more confident working in the team. Because I think it made me feel like they respected my role there, . . . they respect that I’m one of their workers as well, even though I’m a student. Um, so I definitely felt a sense like, belonging in the team from that.” ST06 | |
Hierarchies and power | 13 | “I feel like there’s a hierarchy in the specialties that you go into, and I think the paeds team put themselves on pedestals . . . The paeds intensive care unit dietitian, she thought she was God.” ST17 |
14 | “[T]he community dietitians don’t feel respected by the ward dietitians . . .” AC7 | |
15 | “[Y]ou are an underling. You are on placement. You are a guest in their environment. I certainly wouldn’t have felt comfortable saying anything.” ST03 | |
Theme 3: Developing professional identities | ||
Identity development and transition | 16 | “And it’s kind of my understanding that when you go into degrees later in life you have a really clear idea about what you want from your marks and what you want from the career moving forward . . . when you’re younger it’s . . . quite hard.” ST01 |
17 | “[W]e are helping these students transition . . . developing their identity as a dietitian and not a student anymore.” AC78 | |
Significance of preceptors and work placements | 18 | “I had that influence of the nurse educator saying negative things, and then my dietitian supervisor was just, ‘No.’ . . . Complete positives, and that’s how she was with all her patients the whole time, and that really impacted me . . . It was patient centered to the nth degree . . . she never said anything derogatory about any of them . . . that was 2 years ago, and I still think about that, almost, you know, weekly.” ST03 |
19 | “[T]he worst thing is when you have a supervisor who’s, um, whatever, negative or, um, a bully or something. And I think that contributes to them . . . learning how to be a professional.” PR71 | |
20 | “And I also say to them, ‘I will treat you as my young colleague until you prove to me otherwise.’ And they love it. They go, ‘Ooh, she actually trusts me.’ So, you know, to me that- that’s all part of setting them up for success . . . ” PR60 | |
Identity modulation and identity conflicts | 21 | “I’ve had this 2-hour . . . session that I’ve listened to . . . I’m thinking, ‘This is not professional’ . . . I was communicating that to the university saying, ‘I’m feeling really uncomfortable with this dietitian.’ Um, I’m 10 years older than her and she’s assessing me on professional behaviors. Yet, her professional behavior itself is not appropriate . . . I look really young, but I’m not . . . I’ve had a working life, and I’m a parent . . . But I’ve been treated at a level that I’m just not at.” ST05 |
Examples of interplay between themes and mealtime practices and lunchroom conventions | Illustrative quote |
---|---|
Sharing meals is an opportunity for professional socialization and helps to foster relationship building and boundary crossing and builds confidence and a sense of belonging, fostering professional identity development. (Boundaries—inclusion/exclusion; identity development and transition) | “[O]n my major placement, there was this sense of being embraced. You know, you are the new student, and we value you . . . So, meet us for lunch at 1 o’clock. Everyone comes to the cafeteria at 1 o’clock for lunch. And it was really contrasted with another friend’s experience, who was told that she wasn’t to sit with the dietitians at lunchtime . . . not to be embraced would have just been horrific for 8 weeks.” ST03 |
Exclusive mealtime practices and distancing cultural norms can disrupt identity development and professional socialization. Within microcultures, an experienced preceptor expresses discomfort with some of the established mealtime practices. (Cultural norms; boundaries—hierarchies and power, inclusion and exclusion) | “I’ve heard of, of supervisors who don’t wanna have lunch with their students . . . I think it’s really shortsighted, too, they’re going to be your colleague in 12 months’ time . . . that horrifies me that people would create that power imbalance for no good reason.” PR72 |
Mealtime conventions and rules are not always made explicit, yet students and newcomers are expected to be able to navigate these conventions successfully (Boundaries—navigating blurred boundaries, physical, hierarchies and power; identity development and transition; cultural norms and minicultures) | “[A] student goes on placement and they, um, they go to use the staff room, and they use a mug from the cupboard, and they don’t know that . . . you don’t do that. You bring your own mug, or actually you don’t go into the staff room because it’s not available for students. But they don’t know that unless someone tells them.” PR59 |
Theme 1. Cultural Norms and Microcultures—Too Nasty, Too Nice, or Somewhere in Between?
Cohesion
Conformity and Homogeneity
Competition, Criticism, and Bullying
Conflict Aversion
Theme 2. Boundaries
Varying Types of Boundaries
Inclusion and Exclusion
Navigating Blurred Boundaries
Boundary Crossing
Hierarchies and Power
Theme 3. Developing Professional Identities
Identity Development and Transitions
Significance of Preceptors and Work Placements
Identity Modulation and Identity Conflicts
Intersecting Themes
Discussion
Cultural Norms in the Profession
Boundaries
Identities Development
Strengths and Limitations
Educational Implications
Conclusions
Acknowledgements
Author Contributions
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Footnotes
Supplementary materials: Figure 2 is available at www.jandonline.org.
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Faculty Learning and Teaching Small Research Grant 2018 and an Australian Government Research Training Program Scholarship.
ETHICAL APPROVAL Monash University Human Research Ethics committee approved this study (Approval No. 0431).
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