The Extent and Cause of Variation in Energy Requirement Estimates by Student Dietitians; a Cross-Sectional Survey
Cardiff Metropolitan University
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Background: Limitations in predictive methods available place significant weight on dietitians’ clinical judgement and clinical reasoning skills to appropriately estimate energy requirements for patients. Concern exists regarding the estimating ability of entry-level dietitians due to their inexperience. The aim of this study was therefore to investigative the extent and cause of variations in energy requirement estimates by post placement student dietitians. Methods: A cross-sectional survey including a case study and questionnaire was performed using an opportunistic sample of student dietitians. Results: 23 students completed the survey. 100% of students used a ‘Henry’ equation. Estimates ranged from 1698-3021kcal/day, added stress factors ranged from 0-25% of BMR, and activity factors ranged from 0-25% of BMR. Four (13%) students showed consideration of the patient’s BMI (>30). Students reported university training and clinical experience to be influential in their choice of predictive method; with clinical experience having increased significance. Clinical reasoning skills were evident in students’ responses. Some differences existed between undergraduate and postgraduate students calculations, but these were not statistically significant. Conclusions: Significant variations in energy requirement estimates exist amongst student dietitians, primarily influenced by the selection of stress and/or activity/DIT factors; however this was not greater than reports of variations by more experienced dietitians. Aside from concerns regarding students consideration of patients’ BMIs, there was a lack of evidence to suggest student dietitians lack confidence or ability in their clinical reasoning skills; although larger studies are warranted to confirm the findings of this study.
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