CLINICAL
STUDENT TRAINING IN ENTERAL FEEDING Rachel Hall Dietitian, Betsi Cadwaladr University Health Board (East)
Rachel has worked as a Dietitian for the last five years and currently works in Gastroenterology and Obesity Management, as well as being one of the Lead Student Trainers.
Nasogastric feeding is a common request for students to observe and participate in throughout their practice placements. However, are students really prepared for ‘real life’ tube feeding? From experience I have found that students can struggle to grasp nasogastric feeding in practice, despite their knowledge of the theory. I was hoping to write this article and look at what guidance and research had previously been carried out into teaching student dietitians in this important area of practice. However, the evidence in terms of teaching students whilst on practical placement, is very limited. What I did come across was a brief statement about artificial feeding in the BDA curriculum guidance from 2013,1 which stated that Graduate dietitians are expected to have an ‘Extensive critical, integrated and applied knowledge of dietetics for the prevention and treatment of disease’, which includes artificial nutrition with enteral and parenteral feeding as one of its points. This is a very brief statement to say the least. I thought, therefore, that I would look at the tutorial which I use with students and the theories of adult learning. ADULT LEARNING2
The theories of adult learning (Andragogy) where first discussed by Malcolm Knowles in the 1980s. Through his work, he identified a number of key characteristics of Adult Learners. Our dietetic students will be aged approximately 20 plus when they commence their first practice placement, so these theories will apply to them. Knowles identified the key characteristics of the following points: 16
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• Self-concept: self-direction. • Learner experience: Experience developed though life. • Readiness to learn: learning becomes orientated to developmental tasks of their role. • Orientation to learning: learning adapts to a more problem based approach. • Motivation to learn: becomes internal. He then suggested that there are four principals of andragogy which include:3 • adults being involved in the planning and evaluation of their training; • learners’ experience, including mistakes become a basis of learning activities; • relevance: adult learners are more focused on aspects which will be involved in their job; • problem centred, rather than content centred approach. Therefore, as practice placement providers, we need to ensure that our tutorials take into consideration these learning theories. As well as taking into account the specific learning styles of the individual students. Learning styles:4 • Theorist - understand theory behind practice.