119 ESD Competency Application in Clinical Nutrition Education

Discipline: Health and Welfare

Programme: UCD MSc in Clinical Nutrition and Dietetics

Student Engagement: 20 students registered to the module in Dietetics Professional Practice in Spring Trimester 2024/2025

Initiative Description

Dietitians, as the regulated nutrition experts in healthcare, can act as change agents in the transition to more sustainable food and healthcare systems and thus improving planetary health. Dietitians contribute to achieving the Sustainable Development Goals (SDGs), particularly SDG 2 Zero hunger, SDG 3 Good Health and Well Being and SDG 12 Responsible Consumption and Production. Universities must adequately prepare dietetic students so that they are workforce ready to deliver on these outcomes.

This teaching and learning case study was conducted within a 2-year master’s programme in Clinical Nutrition and Dietetics at UCD as part of a professional practice module in year 1 semester 1 of the programme. The purpose of the teaching session was for students to learn about and apply the nutrition care process. The nutrition care process is a systematic approach that dietitians use to guide nutrition assessment and care. It provides a framework for critical thinking and decision making and improved clinical nutrition outcomes have been demonstrated. This approach is used as the backbone to all clinical case studies throughout the programme and then extends into professional practice in Ireland. The aim was to recontextualise the learning outcomes and teaching strategies for this aspect of clinical education through the lens of ESD. Given the cross-cutting application of the nutrition care process, this will ultimately support the development of dietitians who can provide high quality, patient-centred sustainable healthcare in diverse scenarios.

Through the recontextualising process, opportunities to improve teaching pedagogy to support our goals in improving patient care and sustainability in healthcare became apparent. We identified opportunities to integrate a systems thinking approach and to facilitate growth in a systems thinking mindset, underpinned by the development of deeper problem solving and critical thinking competencies. Firstly, we introduced a new systems thinking introductory session with a case study application. Thereafter, we flipped the classroom to support students’ learning on the nutrition care process integrating reusable resources including pre-recorded videos, case studies, a systems thinking checklist and reflective activities. Finally, we utilised our classroom to collaboratively tackle problem-based case studies which required the students to apply critical thinking, problem solving, and a systems thinking approach to provide high quality patient care. The learning activities were underpinned by the I-SEE approach to ensure a student-centred learning experience that supported metacognitive skill development and effective learning.

Collaboration, Partnerships & Student Participation

The initial concept was presented to a cross disciplinary group of educators at UCD with feedback provided through the lens of ESD.

The learning initiative also utilised a strong student-educator co-creation approach by:

1. students providing feedback on their understanding of systems thinking and their ability to apply it in the context of nutritional care.
2. students providing feedback on the teaching and learning strategies employed to build knowledge and skills on systems thinking.
3. educator analysis of tasks allocated to the students as part of the initiative.

Intended Learning Outcomes

The case study was an exploration of the integration of the ESD competencies and the metacognition framework in dietetics clinical education. Exploratory learning outcomes were developed.

At the end of the case study the students should be able to:

• Apply a systems thinking approach in the provision of individualised nutritional care.
• Demonstrate critical thinking and collaboration in the provision of individualised nutritional care.
• Demonstrate metacognitive skill development.

Teaching and Learning Approach

To achieve the learning outcomes, the following strategies were employed:

• Step 1: Introduction of a teaching session on systems thinking with socio-ecological model integration and case study application.
• Step 2: Self-directed completion of recorded videos and activities on the early stages of nutrition care process and systems thinking integration. Students asked to complete reflective activities, resolve problems, and provided with a tool to aid the application of systems thinking.
• Step 3: Workshops which centred on the collaborative completion of complex case studies using the nutrition care process and systems thinking tool, reflection, critical thinking, and problem solving skills.
• Step 4: Leverage the virtual learning environment to develop metacognitive skills across steps 1-4 by scaffolding learning and providing clear instructions, signposting, checkpoints, and evaluation tools.

Assessment Strategy

The assessment for our case study was formative as we were using exploratory learning outcomes for this activity. The formative assessment involved reviewing students’ submissions of the completed clinical case study activity forms provided for independent study and at a group level documenting what they did competently and what they seemed to find challenging. We also captured students’ responses in class to questions posed by the lecturer.

Impact & Outcomes

There was a positive impact on student learning, with students developing confidence to apply systems thinking to deliver individualised nutritional care in a clinical context.

The learning initiative is now embedded in year 1 of the dietetics programme and across case study templates in the placement modules. We plan to incorporate teaching and learning strategies on the ESD competencies of systems thinking, integrated problem-solving and anticipatory in year 2 of the programme to ensure continuity of skills and expectations.

Best Practices & Resources — Top Tips

• Reusable learning objects (e.g. videos, case studies, checklists) were essential to the implementation of the I-SEE method as part of the metacognitive design framework. They support students in transformational, active learning pedagogy, and competency development.
• Seek student feedback on the challenges they encounter in their learning. This will support the educator in planning for educational scaffolding and gradual exposure to more complex scenarios and competencies.