Appendix E
The American Dietetic Association Foundation Knowledge and Skills and Competency Requirements for Entry-Level Dietitians

Individuals interested in becoming Registered Dietitians should expect to study a wide variety of topics focusing on food, nutrition, and management. These areas are supported by the sciences: physical and biological, behavioral and social, and communication. Becoming a dietitian involves a combination of academic preparation, including a minimum of a baccalaureate degree, and a supervised practice component.

The following foundation knowledge and skill requirements are listed in the eight areas that students will focus on in the academic component of a dietetics program. Foundation learning is divided as follows: basic knowledge of a topic, working or in-depth knowledge of a topic as it applies to the profession of dietetics, and ability to demonstrate the skill at a level that can be developed further. To successfully achieve the foundation knowledge and skills, graduates must demonstrate the ability to communicate and collaborate, solve problems, and apply critical thinking skills.

These requirements may be met through separate courses, combined into one course, or as part of several courses as determined by the college or university sponsoring a program accredited or approved by the Commission on Accreditation/Approval for Dietetics Education (CAADE) of The American Dietetic Association.



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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Appendix E The American Dietetic Association Foundation Knowledge and Skills and Competency Requirements for Entry-Level Dietitians Individuals interested in becoming Registered Dietitians should expect to study a wide variety of topics focusing on food, nutrition, and management. These areas are supported by the sciences: physical and biological, behavioral and social, and communication. Becoming a dietitian involves a combination of academic preparation, including a minimum of a baccalaureate degree, and a supervised practice component. The following foundation knowledge and skill requirements are listed in the eight areas that students will focus on in the academic component of a dietetics program. Foundation learning is divided as follows: basic knowledge of a topic, working or in-depth knowledge of a topic as it applies to the profession of dietetics, and ability to demonstrate the skill at a level that can be developed further. To successfully achieve the foundation knowledge and skills, graduates must demonstrate the ability to communicate and collaborate, solve problems, and apply critical thinking skills. These requirements may be met through separate courses, combined into one course, or as part of several courses as determined by the college or university sponsoring a program accredited or approved by the Commission on Accreditation/Approval for Dietetics Education (CAADE) of The American Dietetic Association.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population FOUNDATION KNOWLEDGE AND SKILLS Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to COMMUNICATIONS negotiation techniques, lay and technical writing, media presentations interpersonal communication skills, counseling theory and methods, interviewing techniques, educational theory and techniques, concepts of human and group dynamics, public speaking, educational materials development present an educational session for a group, counsel individuals on nutrition, demonstrate a variety of documentation methods, explain a public policy position regarding dietetics, use current information technologies, work effectively as a team member PHYSICAL AND BIOLOGICAL SCIENCES exercise physiology organic chemistry, biochemistry, physiology, microbiology, nutrient metabolism, patho-physiology related to nutrition care, fluid and electrolyte requirements, pharmacology: nutrient-nutrient and drug-nutrient interaction interpret medical terminology, interpret laboratory parameters relating to nutrition, apply microbiological and chemical considerations to process controls SOCIAL SCIENCES public policy development psychology, health behaviors and educational needs, economics and nutrition   RESEARCH research methodologies, needs assessments, outcomes based research scientific method, quality improvement methods interpret current research, interpret basic statistics

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population FOUNDATION KNOWLEDGE AND SKILLS Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to FOOD food technology, biotechnology, culinary techniques socio-cultural and ethnic food consumption issues and trends for various consumers, food safety and sanitation, food delivery systems, food and non-food procurement, availability of nutrition programs in the community, formulation of local, state, and national food security policy, food production systems, environmental issues related to food, role of food in promotion of a healthy lifestyle, promotion of pleasurable eating, food and nutrition laws/regulations/ policies, food availability and access for the individual, family, and community, applied sensory evaluation of food calculate and interpret nutrient composition of foods, translate nutrition needs into menus for individuals and groups, determine recipe/formula proportions and modifications for volume food production, write specifications for food and foodservice equipment, apply food science knowledge to functions of ingredients in food, demonstrate basic food preparation and presentation skills, modify recipe/ formula for individual or group dietary needs

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population FOUNDATION KNOWLEDGE AND SKILLS Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to NUTRITION alternative nutrition and herbal therapies, evolving methods of assessing health status the influence of age, growth, and normal development on nutritional requirements; nutrition and metabolism; assessment and treatment of nutritional health risks; medical nutrition therapy, including alternative feeding modalities, chronic diseases, dental health, mental health, and eating disorders; strategies to assess need for adaptive feeding techniques and equipment; health promotion and disease prevention theories and guidelines; influence of socioeconomic, cultural, and psychological factors on food and nutrition behavior calculate and/or define diets for common conditions, i.e., health conditions addressed by health promotion/disease prevention activities or chronic diseases of the general population, e.g., hypertension, obesity, diabetes, diverticular disease; screen individuals for nutritional risk; collect pertinent information for comprehensive nutrition assessments; determine nutrient requirements across the life span, i.e., infants through geriatrics and a diversity of people, culture, and religions; measure, calculate, and interpret body composition data; calculate enteral and parenteral nutrition formulations

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population FOUNDATION KNOWLEDGE AND SKILLS Content Area Basic Knowledge about Working Knowledge of Demonstrated Ability to MANAGEMENT program planning, monitoring, and evaluation, strategic management, facility management, organizational change theory, risk management management theories; human resource management, including labor relations; materials management; financial management, including accounting principles; quality improvement; information management; systems theory; marketing theory and techniques; diversity issues determine costs of services/operation, prepare a budget, interpret financial data, apply marketing principles HEALTH CARE SYSTEMS health care policy and administration, health care delivery systems current reimbursement issues, ethics of care   Individuals are expected to develop competence to practice dietetics through a supervised practice component in programs accredited or approved by CAADE. Competency statements specify what every dietitian should be able to do at the beginning of his or her practice career. The core competency statements build on appropriate knowledge and skills necessary for the entry-level practitioner to perform reliably at the level indicated. One or more of the emphasis areas are added to the core competencies so that a supervised practice program can prepare graduates for identified market needs. Thus, all entry-level dietitians will have the core competencies and additional competencies according to the emphasis area(s) completed.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Core Competencies for Entry-Level Dietitians Perform ethically in accordance with the values of The American Dietetic Association Refer clients/patients to other dietetics professionals or disciplines when a situation is beyond one’s level or area of competence Participate in professional activities Perform self assessment and participate in professional development Participate in legislative and public policy processes as they affect food, food security, and nutrition Use current technologies for information and communication activities Supervise documentation of nutrition assessment and interventions Provide dietetics education in supervised practice settings Supervise counseling, education, and/or other interventions in health promotion/disease prevention for patients/clients needing medical nutrition therapy for common conditions, e.g., hypertension, obesity, diabetes, and diverticular disease Supervise education and training for target groups Develop and review educational materials for target populations Participate in the use of mass media for community-based food and nutrition programs Interpret and incorporate new scientific knowledge into practice Supervise quality improvement, including systems and customer satisfaction, for dietetics service and/or practice Develop and measure outcomes for food and nutrition services and practice Participate in organizational change and planning and goal-setting processes Participate in business or operating plan development Supervise the collection and processing of financial data Perform marketing functions Participate in human resources functions Participate in facility management, including equipment selection and design/redesign of work units Supervise the integration of financial, human, physical, and material resources and services Supervise production of food that meets nutrition guidelines, cost parameters, and consumer acceptance Supervise development and/or modification of recipes/formulas

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Supervise translation of nutrition into foods/menus for target populations Supervise design of menus as indicated by the patient’s/client’s health status Participate in applied sensory evaluation of food and nutrition products Supervise procurement, distribution, and service within delivery systems Manage safety and sanitation issues related to food and nutrition Supervise nutrition screening of individual patients/clients Supervise nutrition assessment of individual patients/clients with common medical conditions, e.g., hypertension, obesity, diabetes, diverticular disease Assess nutritional status of individual patients/clients with complex medical conditions, i.e., more complicated health conditions in select populations, e.g., renal disease, multi-system organ failure, trauma Manage the normal nutrition needs of individuals across the life span, i.e., infants through geriatrics and a diversity of people, cultures, and religions Design and implement nutrition care plans as indicated by the patient’s/client’s health status Manage monitoring of patients’/clients’ food and/or nutrient intake Select, implement, and evaluate standard enteral and parenteral nutrition regimens, i.e., in a medically stable patient to meet nutritional requirements where recommendations/adjustments involve primarily macronutrients Develop and implement transitional feeding plans, i.e., conversion from one form of nutrition support to another, e.g., total parenteral nutrition to tube feeding to oral diet Coordinate and modify nutrition care activities among caregivers Conduct nutrition care component of interdisciplinary team conferences to discuss patient/client treatment and discharge planning Refer patients/clients to appropriate community services for general health and nutrition needs and to other primary care providers as appropriate Conduct general health assessment, e.g., blood pressure, vital signs Supervise screening of the nutritional status of the population and/or community groups Conduct assessment of the nutritional status of the population and/or community groups

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Provide nutrition care for population groups across the lifespan, i.e., infants through geriatrics, and a diversity of people, cultures, and religions Conduct community-based health promotion/disease prevention programs Participate in community-based food and nutrition program development and evaluation Supervise community-based food and nutrition programs COMPETENCY STATEMENTS FOR EMPHASIS AREAS All dietitian education supervised practice programs must offer at least one emphasis area. The emphasis areas are not intended to prepare specialists or advanced level practitioners as defined for credentialing purposes. Competencies for each emphasis area build on the core competencies and are designed to begin to develop the depth necessary for future proficiency in that area of dietetics practice. More experience in at least one area provides a model for learning throughout one’s professional life. For establishing an emphasis area, the program has the following options: Use one or more of the four defined emphasis areas; or, Develop a general emphasis by selecting a minimum of seven competency statements, relevant to program mission and goals, with at least one from each of the four defined emphasis areas. The selected competencies should build on the core competencies. General emphasis does not mean achievement of all competencies from all emphasis areas; or, Create a unique emphasis area with a minimum of seven competency statements, based on environmental resources and identified needs. Nutrition Therapy Emphasis Competencies Supervise nutrition assessment of individual patients/clients with complex medical conditions, i.e., more complicated health conditions in select populations, e.g., renal disease, multi-system organ failure, trauma Integrate pathophysiology into medical nutrition therapy recommendations Supervise design through evaluation of nutrition care plan for patients/clients with complex medical conditions, i.e., more com-

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population plicated health conditions in select populations, e.g., renal disease, multi-system organ failure, trauma Select, monitor, and evaluate complex enteral and parenteral nutrition regimens, i.e., more complicated health conditions in select populations, e.g., renal disease, multi-system organ failure, trauma Supervise development and implementation of transition feeding plans from the inpatient to home setting Conduct counseling and education for patients/clients with complex needs, i.e., more complicated health conditions in select populations, e.g., renal disease, multi-system organ failure, trauma Perform basic physical assessment Participate in nasoenteric feeding tube placement and care Participate in waivered point-of-care testing, such as blood glucose monitoring Participate in the care of patients/clients requiring adaptive feeding devices Manage clinical nutrition services Community Emphasis Competencies Manage nutrition care for population groups across the lifespan Conduct community-based food and nutrition program outcome assessment/evaluation Develop community-based food and nutrition programs Participate in nutrition surveillance and monitoring of communities Participate in community-based research Participate in food and nutrition policy development and evaluation based on community needs and resources Consult with organizations regarding food access for target populations Develop a health promotion/disease prevention intervention project Participate in waivered point-of-care testing, such as hematocrit and cholesterol levels Foodservice Systems Management Emphasis Competencies Manage development and/or modification of recipes/formulas Manage menu development for target populations Manage applied sensory evaluation of food and nutrition products Manage production of food that meets nutrition guidelines, cost parameters, and consumer acceptance Manage procurement, distribution, and service within delivery systems

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Manage the integration of financial, human, physical, and material resources Manage safety and sanitation issues related to food and nutrition Supervise customer satisfaction systems for dietetics services and/ or practice Supervise marketing functions Supervise human resource functions Perform operations analysis Business/Entrepreneur Emphasis Competencies Perform organizational and strategic planning Develop business or operating plan Supervise procurement of resources Manage the integration of financial, human, physical, and material resources Supervise organizational change process Supervise coordination of services Supervise marketing functions RESOURCES Directory of Dietetics Programs: The Directory of Dietetics Programs is the complete listing of CAADE-accredited Coordinated and Internship Programs, CAADE-approved and accredited Dietetic Technician Programs, and CAADE-approved Preprofessional Practice and Didactic Programs in Dietetics. Advanced degree and specialty practice education programs also are listed. Copies of the Directory may be ordered from ADA Customer Service. Call 1-800-877-1600 ext. 5000 for price and ordering information. Web Site: The ADA Web site includes a listing with selected information on CAADE-accredited/approved programs. The URL is http://www.eatright.org/caade.html. For More Information Contact: ADA Education and Accreditation Team 312/899-0040, ext. 5400 Fax: 312/899-4817 E-mail: education@eatright.org SOURCE: Reproduced with permission from The American Dietetic Association, Commission on Accreditation for Dietetics Education.