1. Tapsell, Linda PhD

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In this issue, an Australian dietitian working in Boston for 2 years returns home and reflects on her experience. With a focus on her background in Victoria, Australia, she considers the potential benefits of union activity to support the development of a career structure in the hospital dietetics setting. This Editorial is based on a summary of the presentation I gave at the International Congress of Dietetics meeting in Chicago 2004. It drew on activities conducted through the Dietitians Association of Australia toward the future of the profession. The two articles provide an opportunity to differentiate between the advocacy of unions in negotiating terms and conditions in the workplace specifically, and the advocacy of the professional association in creating a supportive environment for career development generally. Recognizing the synergies between the two will enable practitioners to build more effective careers within a range of employment contexts.


The challenges facing dietitians in the future concern the development of a strong professional identity, a clear grasp of the tasks required, the determination of a defined knowledge base, and an effective appreciation of professional decision making in the employment context. The traditional employment context for Australian dietitians has been hospitals, community centers, private industry, government agencies, and food service operations.1 With the development of the competency movement, dietitians in Australia have been able to develop a futuristic framework for professional development. This was initiated in 1988 through a partnership between the Dietitians Association of Australia (DAA) and the National Office of Overseas Skills Recognition, leading to the formalized development of competency standards for entry-level dietitians.2 A review of these standards was conducted in 1998, but the exercise has not been limited to entry-level definitions, with DAA introducing a professional recognition program in 2004.


Australian dietetic competencies were identified by 8 standards of practice.3 These encompassed a knowledge and skill base, the implementation of professional practice and overarching professional and ethical conduct (Table 1). The model for competency development was based on a framework of foundation competencies (underlying knowledge, scientific approach, and professionalism), core functional competencies (interpretation and translation, data collection, analysis, and interpretation), and critical practice areas (individual case management, population health, and food supply).4

Table 1 - Click to enlarge in new windowTable 1. Competency Standards for Australian Dietitians

In Australia, the competency standards have been used in the development and accreditation of professional courses for dietitians, the assessment of students, performance appraisals of practitioners, the development of continuing education programs, performance planning, and recruitment and selection of new staff.1


The competencies were evaluated through research comprising ethnographic interviews with new graduates, using an ethnomethodological framework.4 Ethnomethodology is based on an understanding that social behavior is rule based, so determining "what counts" as professional practice is identified through the consequences of not doing it, or doing it to a substandard level.5 In-depth interviews were conducted to determine a description of core activities, then the reasons for nominating these activities as core, the consequences of omission, descriptions of doing it well, description of incompetence, and consequences of competence versus incompetence. Views on the future development of practice were also explored.


This research identified emerging areas of practice that needed to be incorporated into the original framework.6 Not surprisingly, these related to an expansion of both foundation competencies and critical practice areas (Figure 1).

Figure 1 - Click to enlarge in new windowFigure 1. New elements in the Australian Dietitians' Competency Framework.

With the emergence of this sense of identity, the development of career paths was a next obvious step for the profession. The professional organization can support career paths by providing formal and external mechanisms for recognizing credentials (including advanced skill and expertise), recognizing and supporting the use of role models and mentors, and encouraging participation in professional activities.7 The professional recognition program outlined by DAA refers to stages in professional development (Figure 2) that can be managed through well-constructed continuing professional development (CPD) activities. In Australia, CPD is a central component of the Accredited Practising Dietitian (APD) program, which takes the place of formal registration through a self-regulatory process recognized by the authorities.

Figure 2 - Click to enlarge in new windowFigure 2. Stages of professional development in Australia.

By DAA definition, an advanced practitioner or fellow is a proactive leader who integrates high-level nutrition and dietetic skills, and the generation of new knowledge and practice, to produce outcomes that enhance the health of the community.7 Advanced practitioners exert leadership and influence, and they champion change. They develop and lead effective teams and exert influence on organizational direction. They are also experts in the field, committed to excellence in practice in nutrition and dietetics and acting as advisers and advocates. Advanced practitioners may also have a strong research and evaluation profile (demonstrating a critical approach to work and developing innovative methodology) and teaching profile (with a strong background in supervision and mentoring, in education at advanced levels, and in developing learning opportunities). They are managers, working towards service improvement utilizing strategic planning and program evaluation skills. Fellows have progressed through this stage and hold key responsibilities on committees at national and international level. They are involved in complex team building and effective networking to produce positive outcomes. They have made an outstanding contribution to knowledge and to Dietetic scholarship. At any given time, the proportion of fellows is likely to be much less than others, but the advanced practitioner levels should always be growing.


Professional development for Australian Dietitians is an ongoing achievement. Future challenges for DAA include ensuing the ability to grow capacity by consolidating the identity of the Dietitian in a changing environment, and recognizing supportive environments when they emerge. This will be achieved by building bridges across and within organizations and professional groups, further developing the unique characteristics of the Dietitian, and confirming and consolidating frameworks, such as the competency standards and professional recognition programs. The professional development framework of DAA provides hard evidence and external recognition of higher order competency that can then be used in negotiating better working conditions and career opportunities in the work environment. This is a powerful synergy that should not be underestimated by the profession.




1. Phillips S, Ash S, Tapsell LC. Dietitians' views on the current competency standards for entry level dietitians. Aust J Nutr Diet 2000;57:190-197. [Context Link]


2. Ash S, Gonzci A, Hager P. Combining research methodologies to develop competency-based standards for dietitians: a case study for the professions. National Office of Overseas Skills Recognition research paper no.6. Canberra: Australian Government Publishing Service; 1992. [Context Link]


3. Dietitians Association of Australia. The national competency standards for entry-level dietitians. Canberra:DAA;1993. [Context Link]


4. Ash S, Phillips S. What is dietetic competence? Competency standards, competence and competency explained. Aust J Nutr Diet 2000;57:147-151. [Context Link]


5. Phillips S, Ash S, Tapsell LC. Relevance of competency standards to entry level dietetic practice. Aust J Nutr Diet 2000;57:198-207. [Context Link]


6. Baszanger I, Dodier N. Ethnography. In: Silverman D, ed. Qualitative research: theory, method and practice. New Delhi: Sage Publications; 1997. [Context Link]


7. Way M, Vervodin M, Report to DAA Board of Directors, Canberra. March 2004, Unpublished. [Context Link]

FDA Food Advisory Committee Tackles Allergens and Gluten


In its July meeting, the FDA Food Advisory Committee evaluated the agency's draft report on Approaches to Establishing Thresholds for Food Allergens and Gluten that suggests methods for establishing appropriate labeling including the establishment of thresholds for gluten and other allergens in foods. Food allergens include proteins derived from milk, egg, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. Advocates for better food allergy labeling say that label statements that state the product "may contain" are unhelpful and that it is vital that product label information be standardized, reliable, and clearer.


FDA will establish thresholds for major food allergies using a peer-reviewed process. The goal is to use human challenge studies to estimate safe levels using a NOEL (no observed adverse effect level) with an appropriate uncertainty factor. According to discussion at the FDA's Food Advisory Board, its approach was well received. However, members warned that it was virtually impossible to guarantee that foods would be completely free of a given allergy. Not only were thresholds of zero unrealistic, but they were also unnecessary in the committee's opinion.