September 2009 - Constituent Society Corner

PHRED: Creating and Sustaining a Public Health Nutrition Workforce

by Marie Traynor (KFL&A Public Health PHRED) and Joanne Beyers (Sudbury PHRED)

Together with their public health colleagues and community partners, public health nutrition professionals are integral to efforts to promote healthy growth and development, prevent chronic disease prevention and address determinants of health. We look to our colleagues for support of our advocacy efforts and ongoing core work to ensure communities have access to sufficient numbers of competent registered dietitians (RD) in public health and throughout the health sector.

Advocacy

A major barrier to workforce development is the overall insufficient number of dietetic internship programs relative to the number of well qualified applicants. In Ontario, at the spring 2009 recruitment, the profession was only able to offer 72 internship places to the 184 applicants from accredited Ontario undergraduate programs in food and nutrition. Nationally a total of 315 applicants applied for 124 positions. (click here for a description of the steps necessary to become a Registered Dietitian).

Existing internship programs can find themselves struggling to find adequate numbers of public health/community health rotations. These rotations allow interns to use evidence and preceptor expertise to learn to assess the status, strengths, needs and capacity of communities and larger populations in relation to food and nutrition. They gain experience in planning and implementing appropriate strategies to meet objectives and to evaluate the efforts.

In an effort to further develop the public health nutrition workforce, two OPHA constituent societies, PHRED and OSNPPH, have been sitting on The Pan Canadian Task Force on Public Health Nutrition Practice. This national group of leaders in public health nutrition practice received funding from the Public Health Agency of Canada. They have, through a situational assessment and broad consultation, reviewed existing dietetic competencies relative to public health work needs, defined practice and considered national leadership and work force development possibilities and strategies. Their set of recommendations is due for dissemination by year's end. (click here to view the Foundation documents).

Workforce Development - A Core Function of PHRED

One of PHRED's longstanding core functions has been to provide leadership in undergraduate, graduate and continuing education of future public health professionals. Our work has also involved staff development opportunities for existing public health practitioners.

The Southeastern Ontario Dietetic Internship program (SODIP)

The Southeastern Ontario Dietetic Internship program (SODIP) continues to be supported by the PHRED at KFL&A Public Health in Kingston, Ontario. Since 1993 this flagship program has included significant opportunities for interns to experience the work and gain competency in public health nutrition practice through longer rotations and focused projects. The program has expanded from two to six interns across nine counties from Brockville to Cobourg and played a significant supportive role to the Sudbury PHRED as they prepared for their role in the Northern Ontario Dietetic Internship Program.

Northern Ontario Dietetic Internship Program at the Northern Ontario School of Medicine (NODIP @NOSM)

Research and Preceptor Support: The achievement of a sustainable Dietetic Internship in Northern Ontario at NOSM represents over six years of committed effort by a number of key stakeholders, including advocacy efforts by SDHU PHRED staff. The first graduating class of ten newly minted Registered Dietitians was October 2008. With placements across over thirty Northern Ontario rural, Aboriginal and Francophone communities, and the four principal sites, ten dietetic interns worked with, and learned from, preceptors in hospitals, public health units, long-term care facilities, and clinics. After 46 weeks of unpaid rotations the graduates now have an appreciation for the unique health-care needs of Northern Ontario and are gainfully employed. Many SDHU staff continue to play various key roles in NODIP's success including: preceptor interns for 6 week rotations; research projects' consultation; professional development on research, evaluation, analysis and ethics; Program Advisory Committee representation. The second graduating class of ten interns completed their program in August and eight of the ten have chosen to work in northern Ontario, of which three will be at northern public health units. The NODIP has expanded in the third year and is now taking twelve interns, to commence mid-September, 2009. While expansion is welcome further efforts are required to ensure sufficiently staffed RD preceptors are available.

RD Recruitment and Retention Workforce Survey: In 2006, SDHU PHRED assisted Dietitians of Canada in the development of a northern Ontario RD workforce survey. Those data were instrumental in highlighting the longstanding need and receptivity for northern internship training (ie NODIP). There still is a lack of specific information on recruitment and retention barriers and facilitators as they relate to RDs in northern Ontario. NODIP @ NOSM is leading in the development of a survey to address this from both RDs and employers' perspectives. This Spring two dietetic interns pretested and piloted the survey tools with the intent to fully conduct across northern Ontario later this year.

U of T Graduate Course: NFS 1221 Nutrition Programs and Strategies, On Line Distance Education Format, Department of Nutritional Sciences

In an effort to retain Public Health Dietitians in Sudbury and throughout northern Ontario, and offer career advancement opportunities without leaving the North, six years ago SDHU approached U of T Department of Nutritional Sciences to gauge the receptivity of U of T to offer the Community and Public Health Nutrition graduate program on-line. This graduate program at the time was one of only two Ontario university programs that met the Ontario Health Protection and Promotion Act's Regulations that stipulate Public Health Nutritionist qualifications (ie how a Public Health Dietitian can become a Public Health Nutritionist).Through extensive advocacy efforts, this program is now a full-fledged U of T graduate program where the RD students can do three out of four semesters in their home town while working in public health. The purpose of this web –CT advanced community nutrition course is to examine and critically assess different health promotion strategies as well as programs that use these strategies to address the nutrition needs of different population groups. This past spring, five students (who are practicing RDs) explored the implications of the material discussed for their own public health and primary health care practices. Topics included advocacy, social marketing, community development, environmental strategies, nutrigenomics. The course will be offered again Winter 2009/10 with approximately 10 students.

Dietitian Preceptor Support

Dietitians of Canada (DC), the national accrediting body for dietetic internship programs and, food and nutrition university programs has recognized the need for more preceptor support. This past year, both NODIP @NOSM and SODIP @ KFL&A Public Health contributed to the development of Focus on Feedback . Identified by preceptors nationwide as an area requiring further support and training, DC led the development of train-the-trainer instruction. Those trained are bringing this professional development opportunity to preceptors across the country so they can better provide feedback to dietetic interns.