Translating Nutrition Focused Physical Examination (NFPE) Knowledge and Skills Acquired Through Virtual Learning into Practice

Objective: Virtual learning supports the growing demand of borderless education and continuing professional development. Nutrition focused physical examination (NFPE) is a standard of practice for dietitians to identify factors impacting ability to eat and drink, nutritional problems and malnutrition risk in patients. This study aimed to explore the feasibility of IMU final year dietetics students who were in clinical internship to acquire NFPE skills through virtual learning.

Methodology: Through a collaboration between IMU N&D and USA Rutgers University SHP, 14 IMU dietetics students were taught NFPE skills using computer-assisted instruction (CAI), an innovative web-based technology. In addition to their daily clinical training, these students volunteered to complete an 8-week online course on NFPE through a combination of synchronous live lectures, demonstrations and asynchronous lectures and skill videos by Rutgers SHP faculty using Zoom and Moodle platforms. Students participated in live case study discussions, online demonstration of skills on peers, pre- and post-knowledge tests, video recording of NFPE skills for instructor- and self-evaluation. After completion of the virtual learning, students practiced and recorded performing NFPE on patients during their internship.

Results and Discussion: In the 8-week internship, students identified 14 patients with cerebrovascular accident (CVA) (n=8), cancer (n=5), and chronic kidney disease (n=1) to perform a NFPE as part of their nutrition assessment. The NFPE skills most frequently performed included fat and muscle examination, extra- and intra-oral examination and selected cranial nerves screening. The students identified 6 patients with severe fat and muscle loss, 4 patients had chewing difficulty and 2 patients had swallowing difficulty. A patient with CVA failed to detect sensation on the right facial region during cranial nerve screening. As part of the nutrition care process, students recorded these findings in their case notes and recommended appropriate and tailored care plans.

Conclusion: This collaboration was a success and has extended to training the clinical dietitians and educators in Malaysia. Virtual learning can be successfully used to teach NFPE skills to students and enable the translation of knowledge into practice.