Research ArticleEffect of Simulated Patient Practice on the Self-Efficacy of Japanese Undergraduate Dietitians in Nutrition Care Process Skills
Introduction
Between 2015 and 2025, the number of elderly people in Japan aged >65 years is estimated to rise by 2.66 million (3.6% of the national population), from 33.92 million (26.7%) to 36.58 million (30.3%). Simultaneously, those aged >75 years are estimated to increase by 5.38 million (5.2%), from 16.41 million (12.9%) to 21.79 million (18.1%).1 This has the potential for a subsequent increase in the number of infirm elderly individuals, ie, home-bound elderly people who cannot perform activities necessary for daily living. Although existing, partially publicly funded hospitals and nursing homes can meet this greater demand, their use is relatively low because people prefer to stay at home. To prevent malnutrition among home-bound infirm elderly people, it is important to provide in-home nutrition support2 including meals and/or supplemental foods, tube feeding, and assisted feeding. This is particularly important for those with medical conditions such as diabetes, the prevalence of which is already high and is estimated to increase considerably in the future among Japan's elderly population.3
In response to this need, in 2014, Japan's Ministry of Health, Labor, and Welfare announced a policy of securing medical treatment and nursing care for people aged >65 years and initiated the development of the Integrated Community Care System, which specifically provides for in-home dietetic support to Japan's infirm elderly population. This raised the issue of how those who provide such support would receive appropriate training.
One solution is to offer instruction in the Japan Dietetic Association's (JDA's) General Nutrition Care Process (GNCP).4 The GNCP is a 3-step approach to individualized nutrition assessment and quality care for which dietitians need to develop the 7 professional practice competencies (PPCs) established by the JDA (Table 1).
The 3-step GNCP and associated 7 PPCs could form the bases of experiential learning activities for enhancing the self-efficacy of undergraduates in dietetics programs in providing in-home nutrition care to infirm elderly individuals. Self-efficacy, defined as “one's belief in one's ability to succeed in specific situations or accomplish a task,”5 strongly influences how individuals view and apply themselves to tasks,6 and has been correlated positively with effort and persistence to complete tasks generally successfully7 and in dietetic student training.8 As with other psychological constructs such as motivation and self-esteem, self-efficacy is often measured objectively via participant surveys using Likert scales.
Experiential learning is predicated upon physical, cognitive, and social participation within a structured, supervised, and supportive educational context. Since it was first advocated in the early 20th century as part of the humanist movement,9 it has become commonplace in mainstream education and offers opportunities for realistic and practical application of fundamental academic and vocational knowledge and skills, complete with instructor and peer feedback. It also encourages trainees to reflect and identify the presence and extent of gaps that might exist between their current competence levels and those needed for professional practice. This study therefore uses experiential learning as a conceptual framework.
One technique that offers such experiential learning is the use of simulated patients (SPs), in which an individual (preferably trained) takes the role of a patient, allowing students or trainees to practice applying relevant knowledge and skills to a particular case study without endangering a real patient's well-being. Several studies used SP training through a 2- or 3-stage process.10 Generally, in the first stage, students are given an SP profile and conduct a counseling session with the SP, applying relevant knowledge and skills and eliciting additional information from the SP if needed, to devise and propose a clinical plan of action intended to enhance the SP's well-being. In the second stage, students receive feedback from the instructor and/or the SP and possibly also from peers who observed the session. Because reflection has been shown to be particularly important in the learning process within clinical settings,11 in the third stage, students reflect on their performance and the feedback they received with the aim of further enhancing the activity's learning outcomes. However, to these 3 steps can be added a fourth, preparatory stage in which students receive their case study's profile well in advance of the SP session.12 This gives them more time to familiarize themselves with the details of their case and to formulate a more considered response for the SP counseling session.
Such SP training has been used to good effect in various fields including medicine,13 nursing,14 pharmacy,10 and physiotherapy.15 Positive learning outcomes have also been reported with this technique in nutrition education16, 17 and its effective application was previously reported12 and with respect to self-efficacy.18 It was also shown to be as effective as using real patients in training dietetic students to conduct counseling sessions.19 Furthermore, SP training has yielded positive outcomes in countries as culturally diverse as North America,12, 13, 16, 17, 18, 19 and Japan.10, 14, 15 This demonstrates that the SP technique is highly adaptable and can offer positive learning outcomes across a range of disciplines, skill sets, cultures, and educational systems.
However, to the authors' knowledge, there appears to be no prior study investigating the effects of SP activities on the self-efficacy of undergraduates in dietetics programs in Japan for the specific purpose of providing training for in-home nutrition support for the infirm elderly population. Therefore, this investigation examined what effect, if any, an adapted SP activity (called the intervention in this article) might have on the self-efficacy of Japanese undergraduates in a dietetics program in relation to applying the JDA's 7 GNCP PPCs with a view to working with homebound infirm elderly people.
Section snippets
Methods
To answer this research question, the authors employed a repeated-measures design. The participants, their recruitment, and the instruments, procedures, and data analyses used to realize that design are described subsequently.
Results
In total, the researchers collected matched pairs from 90 students; 18 others declined to participate, yielding an overall return rate of 83.3%.
Wilcoxon signed-rank analysis revealed that the sample's self-efficacy increased significantly for PPCs A, D, and F and that the overall total change in self-efficacy across all 7 PPCs was also significant (Table 3).
Frequency distributions for PPCs A–G revealed that Q1 (initially low self-efficacy) participants showed a general shift to the right,
Discussion
To the authors' knowledge, no other studies appear to have examined the use of SP interventions to develop the JDA's 7 PPCs within the GNCP framework. Therefore, the authors cannot make direct comparisons of these results with others. However, the current findings of enhanced self-efficacy among dietetics students through SP training support those of Todd et al.18 More generally, these findings are also in line with the positive learning outcomes associated with SP training reported with
Implications for Research and Practice
The SP activity examined here enhanced initially low-scoring participants' self-efficacy in several PPCs while prompting others to reevaluate their initially high self-efficacy assessments, resulting in more realistic self-evaluations of their GNCP skills. Given these results and this educational technique's apparent adaptability to diverse cultural and educational settings, it appears reasonable to suggest tentatively that it be considered by program designers and educators for more widespread
Acknowledgments
This work was supported by JPSS Research Grant No. JP25350869. The authors also wish to acknowledge the cooperation of the participants, SP staff, and facilitators who made this study possible.
References (23)
- et al.
Use of actors as simulated patients in nutritional counselling
J Nutr Educ Behav
(2007) - et al.
Using patient simulators to teach clinical interviewing skills
J Am Diet Assoc
(1981) - et al.
Using standardized patients to train and evaluate dietetics students
J Am Diet Assoc
(1999) - et al.
Comparison of standardized patients and real patients as an experiential teaching strategy in a nutrition counselling course for dietetic students
Patient Educ Couns
(2015) - et al.
The effect of human patient simulation on critical thinking and its predictors in prelicensure nursing students
Nurse Educ Today
(2013) Annual Report on the Aging Society [Summary] FY 2016
- et al.
Nutrition care management in preventative nursing care
Jpn J Public Health
(2008) - et al.
Impact of population aging on trends in diabetes prevalence: a meta-regression analysis of 160,000 Japanese adults
J Diabetes Investig
(2015) Pocket Guide for International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process
(2012)Self-efficacy: The Exercise of Control
(1997)
Social cognitive theory
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Conflict of Interest Disclosures: The authors have not stated any conflicts of interest.