module specification

Practice Based Learning 3 is an 11 week practice based learning providing the opportunity for learners to observe and develop core skills in implementing the dietetic care process with individuals and groups in a variety of settings.

They will experience different ways of communicating with a variety of people and practice skills that they will use throughout their careers. The learners will also establish links with practising dietitians in the area. They will acquire and demonstrate a range of skills which will be assessed against the British Dietetic Association Curriculum Framework.

All clinical practice based learning modules are undertaken through simulation and in an approved dietetic setting which is primarily within an NHS organisation providing relevant patient care for example but not exclusively within acute, secondary, tertiary or community settings.

The length of time and model of simulation will be 13 days (93.6 hours, 24% of the overall placement) run as a combination of block simulation and collaborative learning. Students will spend the final 3 weeks of their placement solely within the NHS organisation they have been allocated to consolidate their skills and knowledge.

The purpose of the practical practice based learning component of the course is to develop the learner’s dietetic judgment based on the clinical decision making process, through a focus on the integration and practical application of the knowledge and skills learnt in the university setting.

Demonstrate confidence, resilience, ambition and creativity and will act as inclusive, collaborative and socially responsible practitioners throughout this module.
The practice based learning modules are a compulsory component of the course.

If learners do not successfully meet the learning outcomes for all three practice based modules, they will not meet the requirements for registration as a dietitian in the UK.

The practice based learning modules provide opportunity for the learners to develop specific work skills and valuable professional relationships that prepare them for their future career as a dietitian.

Brief Guidance Notes:
• Where significant health problems have arisen an occupational health assessment will be required at any time prior to or during the practice based learning.
• Student services are available to provide counselling and other support mechanisms as required. Learners will have to take action on advice from their practice based learning and university staff.
• If learners have additional learning needs identified on practice based learning such as a requirement for maths study skills or have specific learning difficulties such as dyslexia or dyspraxia they will be required to take appropriate corrective action prior to their next practice based learning. Guidance and support will be offered by the university through the academic tutor (AT) and practice based learning tutor.
• Learners who have requirements which impact on their ability to take up practice based learnings in particular locations (due to a protected characteristic as defined by the Equality Act (2010)) should register with the University’s Disability and Dyslexia Service as recommendations relating to reasonable adjustments made by this service will also be considered at the time the learner is selected for allocation.  Practice based learnings have experience of managing additional needs and reasonable adjustments will be put in place.
• Learners have the opportunity to indicate on their practice based learning application form any carer responsibilities which may impact their ability to take up specific practice based learnings.  Learners must provide details of their carer responsibilities and provide supporting evidence to their practice based learning tutor prior to the point of allocation.  Learners should outline clearly how their carer responsibilities impact on their practice based learning selection and what features are required of the practice based learning.  Providing this information will not guarantee that the learner will be allocated to one of their preferences but the learner’s circumstances will be considered at the time the learner is selected for allocation.
• This module does not provide academic credit but successful completion is an essential requirement of the course to ensure that learners are eligible to apply to the register of health and care professionals on completion of BSc Dietetics and Nutrition/BSc Dietetics/PG Diploma/MSc Dietetics and Nutrition.
• Please refer to section 13: Description of assessment items for details of placement verification and procedures in the event of placement failure.

Module pre-requisites and co-requisites 
In order to be eligible to undertake the Practice Based Learning 3, learners should normally have passed:

i. DT6W52 Practice Based Learning 2 and thus the pre-requisites for this*
ii. DT6W64 Dietetic Practice Preparation 
iii. DT7W65 Postgraduate Dietetic Practice Preparation
iv. DT6W66 Dietetic and Nutrition Practice Preparation
v. A current enhanced DBS Certificate for the Adults' and Children's Workforce which has checked both the Adults' and the Children's Barred Lists.
vi. Undergraduates
vii. DT6059 Applied Public Health Nutrition for Dietitians

Learners who fail subjects that are university pre-requisites for practice based learning will not normally be allowed to progress to practice based learning.
Following successful completion of pre-requisites by the learner, a practice based learning will usually be allocated in the next allocation cycle (i.e. they will join the cohort of learners in the year below). 
Learners who have met the academic pre-requisites for practice based learning, but require reassessments in other modules, may not be able to progress to practice based learning
*For the purposes of eligibility for DT6W63 Practice Based Learning 3 a provisional pass prior to Subject Standards Board is acceptable
Module description

The specified learning outcomes will be developed around a framework based on the following subject matter:
• Performing nutrition and dietetic assessments and monitoring plans through the application of the relevant anthropometric, biochemical, clinical, dietary information. Learners will apply information related to wider and behavioural determinants of health and functional status in their assessment processes.
• Model and process for nutrition and dietetic practice as applied to a range of conditions and circumstances.
• Planning, implementing and evaluating all aspects of dietetic care.
• Behaviour change and behaviour modification techniques; promotion of self care and facilitation of learning
• Professional skills - reflection, presentation skills, critical thinking, emotional intelligence
• Model and process for nutrition and dietetic practice as applied to a range of conditions and circumstances.
• Decision making, demonstration of professional judgement to enable autonomous practice.
• Taking responsibility for clinical decisions including the acceptance or refusal of referrals and the ability to refer to other members of the healthcare team
• Multidisciplinary working including learning with and from students and professionals from other healthcare disciplines.
• Management of the dietetic treatment of individuals with long and short term health needs in variety of environments.
• Application of skills in prioritising workload and managing time effectively
• Workload management and effective use of resources
• Interpretation of current professional conduct documents through their dietetic practice
• Dietetic group education sessions to clients and health care professionals
• Observation and reflection on how audit enhances dietetic practice
• Effective communication with individuals and groups including the facilitation of learning, the promotion of self-care and the use of behaviour modification techniques.
• Principles of person centered care including advocacy, consent and demonstration of core NHS values, including respect, dignity and upholding service user autonomy.
• Safe and effective dietetic practise understanding scope of practice, including an awareness of their limitations and when it is appropriate to seek advice or refer to another professional
• Development of trust with service users and respecting their right in decision making
• Duty of care and upholding high quality care; including challenging situations and at times of personal incompatibility
• Confidentiality, information governance, appropriate information sharing within professional legal and ethical boundaries.
• Managing risk including the maintenance of safe environments in all aspects of dietetic care.
• Informed consent
• The legal and ethical implications of dietetic and clinical care including the withdrawal of feeding
• Fitness to practice including maintenance of high standards of personal and professional conduct and one’s own health. Ensuring currency of knowledge.
• Assessment skills to inform clinical and professional judgements
• Problem solving, clinical reasoning and decision making
• Appropriate selection, use, modification and adaptation of verbal and non-verbal communication skills in the assessment and engagement of service users.
• The influence of the wider determinants of health, behaviour and lifestyle on verbal and non-verbal communication
• Information sharing to facilitate service users to make informed decisions including the use of aids or interpreters for example
• Positive interpersonal skills to support service user interaction
• Use of appropriate information and communication technology for dietetic practice
• Building and sustaining professional relationships and work appropriately individually and with others as part of a team.
• Empowering and engaging individuals and groups in planning and evaluating interventions, making informed choices and implementing changes to improve health, quality of life and mean aims and goals.
• Maintaining and managing healthcare records in line with legal, ethical and professional requirements
• Reflective practice; to allow the adaptation of practice to changing environments and to evaluate practice. Valuing research in the critical evaluation of practice.
• The application, use and recognition of evidenced based practice.
• Monitoring and reviewing care as an individual, dietetic team and multi-disciplinary team

Learners will work the same hours as a full time member of staff.  Some flexibility may be required to allow for out of hours work.
Learners should normally attend 100% of the practice based learning. If sickness results in absence from practice based learning, learners will be expected to make up an agreed number of hours or repeat the practice based learning, subject to discussion between the HEI and lead practice educator. This will take into account current performance and potential effects on future progression.  Any occupational health requirements related to prolonged sickness absence should be managed through the HEI provision.

The attendance requirement is the same for both simulated and direct practice-based learning experiences and attendance will be monitored on a daily basis throughout the experience.

Learners will receive on-going reflective formative feedback through assessment of their performance of undertaking clinical activities and through the completion of a portfolio. Activities undertaken within simulated practice based learning will be assessed against the learning outcomes and form part of the students portfolio of evidence.

Learners will receive on-going reflective formative feedback through assessment of their performance of undertaking clinical activities and through the completion of a portfolio.

Learners must demonstrate competence for each learning outcome with regard to individuals, groups and organisations/communities in a variety of settings and demonstrate the ability to practice as a dietitian at a level consistent with entry to the profession by the end of Practice Based Learning 3.
The learning outcomes apply to individuals, groups and organisations/communities
In relation to patient/client assessment phase, learners will be able to:
1. With minimal guidance, demonstrate the ability to identify, collect and interpret relevant   information and evidence from the range of sources available.
In relation to the nutrition & dietetic diagnosis, learners will be able to:
2. Independently formulate and justify appropriate nutrition and dietetic diagnoses.
In relation to patient/client intervention, planning and implementation, learners will be able to: :
3. Develop suitable dietetic management goals.
4. Design and implements an action plan for achieving dietetic goals.
In relation to monitoring and evaluation, learners will be able to:
5. Review, monitor and evaluate dietetic interventions
In relation to professional attributes, learners will:
6. Understand and demonstrate reflective practice and consistent professional behaviour in accordance with the legal and ethical boundaries of the dietetic profession and the requirements of the Health and Care Professions Council.
7. Communicate effectively in all areas of dietetic practice.

In order to pass Practice Based Learning 3 the learner must have satisfied the dietitian in charge of training that they have demonstrated competence in each learning outcome listed in section 9 above.

The learner must demonstrate this through the completion of a reflective portfolio which demonstrates the learners ability to meet the learning outcomes at a level consistent with entry to the dietetic profession. It should contain:
- Individual Patient Self Reviews
- Clinical Observation Forms
- Working with Groups Self Reviews
- Group Work Observation Form
- Professionalism / Clinical Governance Grid
- Audit Project Sign off Sheet – If not completed on last practice based learning
- Anonymised patient records
- Weekly Feedback Forms
- End of Practice based learning Review
- Overall Practice based learning Reflection
In addition assessment criteria will include:
• The ability to justify, communicate and evaluate all aspects of dietetic practice in relation to the learning outcomes considering disease presentation and pathology, lifestyle and the wider determinants of behaviour and health.

• Demonstrate in all aspects of dietetic practice understanding of the requirements by the Health and Care Professions Council. This will include demonstrating the understanding of the expectations of professional behaviour and the ability to practice within the ethical and legal boundaries of the dietetic profession.
Learners must engage in all aspects of assessment which will include gathering evidence for their portfolio, obtaining approval and sign off of evidence for the portfolio, preparing for and leading on the weekly review meetings. This will be learner led working collaboratively with their supervisors. The learner will also prepare for the end of review meeting where there is an obligatory attendance requirement.

Practice based learning verification

Following completion of Practice Based Learning 3 the following categories of learners will be required to meet with a relevant member of academic staff to devise a non-negotiable programme of learning with specified competencies in order to progress. The learning programme will be devised on the basis of feedback received during practice based learning visits and on the end of practice based learning form.

The categories of learners are:

1. Learners who qualify for extra time for Practice Based Learning 3 after the event and who need to demonstrate continued learning prior to their new practice based learning.

Procedures in the Event of Failure

1. Learners failing to successfully complete Practice Based Learning 3 may be eligible for additional training weeks as guided by the BDA (2013) Curriculum Framework and the relevant course specification (BSc (Hons) Dietetics and Nutrition, BSc Dietetics or PG Dip Dietetics and Nutrition)
2. Learners who have not met four or more learning outcomes will be considered as having failed their practice based learning and will be entitled to apply for a full repeat practice based learning through the repeat practice based learning panel process.
3. If learners have failed to meet up to three learning outcomes at the end of Practice Based Learning 2 or 3, they will normally be allowed to extend by up to 4 weeks (within the total limit, see point 1.) The decision to extend their practice based learning will be taken in consultation with the learner, practice based learning educator and tutor. The learner should normally complete extended practice based learning weeks at the site where they completed their original practice based learning
4. If following an extension to practice based learning, the learner has still failed to meet all of the learning outcomes, they will be entitled to apply to repeat practice based learning.
5. The decision to allocate learners a repeat practice based learning period will be made by the Repeat Practice based learning Panel. The panel will consist of the external examiner for the dietetics courses, a dietetic practice educator who is a member of the practice based learning sub set, the dietetics practice based learnings tutor and the dietetics course leader. In addition to this the panel may also include members of academic staff who are involved in the delivery of dietetic practice based learning education in London
6. The decision to allocate a repeat practice based learning period will be based on the total hours allowed (see point 1), the learner’s ability to acknowledge the reasons for the initial failure, the action taken to address the issues for failure and the learner’s engagement with a remedial programme
7. If the panel decides not to allocate a learner a repeat practice based learning they will be either transferred to a suitable alternative course or awarded with the most suitable alternative qualification.

Textbooks:
Core Text:
Food Standards Agency (2014) McCance and Widdowson's The Composition of Foods. Seventh Summary Edition. The Royal Society of Chemistry, Cambridge.
Gandy J (2014) Manual of Dietetic Practice, 5th Edition, Wiley-Blackwell

Websites:
British Dietetic Association (2017) Code of Professional Conduct.
https://www.bda.uk.com/professional/practice/professionalism/code_of_conduct (CORE)
British Dietetic Association (2012) ‘Model and Process for Nutrition and Dietetic Practice’ https://www.bda.uk.com/professional/practice/process (CORE)
Health and Care Professions Council (2016) Confidentiality - guidance for registrants http://www.HCPC-uk.org/assets/documents/10002C16Guidanceonconductandethicsforlearners.pdf (CORE)
Health and Care Professions Council (2016) Guidance on conduct and ethics for learners. https://www.hcpc-uk.org/globalassets/resources/guidance/guidance-on-conduct-and-ethics-for-students.pdf (CORE)
• Health and Care Professions Council (2016) Standards of Conduct, Performance and Ethics. https://www.hcpc-uk.org/standards/standards-of-conduct-performance-and-ethics/ (CORE)
Health and Care Professions Council (2013) Standards of Proficiency - Dietitians.  http://www.HCPC-uk.org/assets/documents/1000050CStandards_of_Proficiency_Dietitians.pdf (CORE)

Other
• Todorovic and Mafrici (2018) A pocket Guide to Clinical Nutrition.  5th Edition.
Birmingham:  The Parenteral and Enteral Group of the British Dietetic Association.(CORE)