Source: RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY submitted to
IENDEAVORS: INNOVATIVE ENHANCEMENTS OF NUTRITION AND DIETETICS EDUCATION USING ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY TO OVERCOME RDN SHORTAGES
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
ACTIVE
Funding Source
Reporting Frequency
Annual
Accession No.
1027124
Grant No.
2021-70003-35433
Cumulative Award Amt.
$750,000.00
Proposal No.
2021-05405
Multistate No.
(N/A)
Project Start Date
Sep 1, 2021
Project End Date
Aug 31, 2025
Grant Year
2021
Program Code
[ER]- Higher Ed Challenge
Recipient Organization
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
3 RUTGERS PLZA
NEW BRUNSWICK,NJ 08901-8559
Performing Department
NJ IFNH
Non Technical Summary
Registered Dietitian Nutritionists (RDNs) are food and nutrition experts who play a vital role in preventing and treating diet-related health conditions. There is a critical shortage of RDNs, especially ethnically/racially diverse RDNs. To become an RDN, students complete a baccalaureate degree (masters starting in 2024) and 1000 hours of supervised dietetics practice (SDP) mentored by credentialed professionals in clinical, community, and management nutrition sites. The RDN shortage is related to limited availability of positions in SDP programs and inadequate accessibility to training in rural areas, both of which are constrained by insufficient student placements in clinical nutrition sites. This project aims to develop, implement, evaluate, refine, and disseminate a series of high-quality simulations (delivered via full-body patient simulator [smart mannequins] and virtual reality using smartglasses) that develop clinical nutrition skills of food, nutrition, and dietetics baccalaureate, masters, and SDP students. These simulations will help reduce the RDN shortage by increasing access to SDP opportunities; increase accessibility of clinical SDP training that can be delivered remotely; and improve the quality of RDN training by providing standardized learning experiences that promote student immersion and engagement. A second aim is to prepare food, nutrition, and dietetics instructors to confidently incorporate smart mannequin and VR simulations in their curriculum. A final objective is to build sustainability by disseminating instructor training materials and holding workshops that demonstrate implementation of the simulations in nutrition and dietetic program curricula; publishing and presenting project products and outcomes in peer-reviewed venues; and disseminating project results and products to U.S. universities.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
70374101010100%
Goals / Objectives
Major GoalsTo develop, implement, evaluate, refine, and disseminate a series of high-quality simulations delivered via mannequins using artificial intelligence (i.e., Alex-Patient Communication Simulator [Alex-PCS]) and Virtual Reality (VR), that develop clinical nutrition skills of students enrolled in food, nutrition, and dietetics baccalaureate, masters, and supervised practice programs. These simulations, in turn, will help to:Reduce the shortage of Registered Dietitian Nutritionists (RDNs), especially those who are socioeconomically and ethnically or racially diverse, by increasing access to supervised practice opportunities.Increase accessibility of high-quality clinical dietetics supervised practice training that can be delivered remotely, which will especially benefit students in rural areas.Improve the quality of food, nutrition, and dietetics education by providing standardized learning experiences that promote student immersion and engagement and patient safety.To prepare food, nutrition, and dietetics instructors to confidently incorporate the Alex-PCS and VR simulations developed in this project in their curriculum.To build sustainability of the Alex-PCS and VR simulations developed by disseminating instructor training materials and holding workshops that demonstrate implementation of the simulations in undergraduate, masters, and dietetics supervised practice program curricula; publishing and presenting project products and outcomes in peer-reviewed venues; and disseminating project results and products to U.S. universities.
Project Methods
Procedures for accomplishing the objectives follow.ACTIVITY 1: Design & Formative Test Simulations. A total of 35 simulation scenarios addressing common diseases for which nutrition therapy is key to prevention and treatment, with the complexity of the patient needs increasing progressively, will be developed. All simulations will be designed for use in conventional and full-body patient simulator, and 14 will be programmed for virtual reality use with and without smartglasses. Each simulation will be designed to take about 30 minutes for students to complete. Development will begin by clarifying each simulation's goals and objectives; describing patient anthropometric, biochemical findings, clinical observations, dietary intake, environmental characteristics, and medical history; determining the evidence-based treatment plan to use as the 'gold standard' for creating the assessment rubric for evaluating students; developing the didactic instruction that will be provided prior to student use of the simulations; and writing simulation scripts. Formative testing of the developed simulations will be conducted to ensure they are appropriate and acceptable to dietetics instructors and students.ACTIVITY 2: Design & Pilot-test Simulation Assessment Survey. To assess the simulations, students will complete a series of questionnaires before using the simulations, immediately after using them, and about 4 weeks after using them. The questionnaires will assess: knowledge of nutrition therapy for the simulated health conditions, attitudes toward the health condition, self-confidence in providing nutrition therapy for the health condition, clinical judgement skills, and engagement and satisfaction with the simulations. Protocol manuals and data dictionaries detailing survey questionnaires and administration steps will be written to promote use by other instructors and simulation developers.ACTIVITY 3: Design & Pilot-test Simulation Performance Competency Review Rubric To assess level of skill competency gained in the simulations, students will be evaluated using the Performance Competency Review Rubric designed for this project. The rubric will be pilot tested by dietetics preceptors to refine it and rubric training materials developed to ensure fidelity of use.ACTIVITY 4: Conduct Summative & Process Evaluation Summative evaluation will be conducted to assess or summarize the value of the simulations. Instructors of dietetics students will be invited to participate in the summative evaluation. The summative evaluation protocol will be an additive, multi-pronged design intended to determine the types and combinations of simulations are most salient to student learning outcomes. Types of simulations to be assessed: A-conventional simulation (instructor-led class discussion of case study), B-Alex simulation, and C-VR simulation. Simulation combinations to be assessed are (each student will complete 1 group): Group 1=simulation A only; Group 2=simulation B only; Group 3=simulation C only; Group 4=simulations A+B; Group 5=simulations A+C; Group 6=simulations B+C; and Group 7=simulations A+B+C. Sequence of simulations completed by Groups 4 to 7 will be randomized to prevent order effects. Groups will contain at least 15 to 20 students, depending on class size.Process evaluation will access: fidelity, engagement, satisfaction, recruitment, and context.ACTIVITY 5: Analyze Data & Refine Simulations: Summative and process evaluation data will be analyzed to determine differences between the simulation groups and the effect of the full-body patient simulator and virtual relation simulations on student learning and motivation compared to conventional simulations.ACTIVITY 6: Develop Instructor Support Materials: To increase sustainability and extend the project products, an electronic implementation "kit" containing instructional materials will be created and workshops will be held to encourage adoption of project materials. Training sessions and "kit" availability will be promoted widely.ACTIVITY 7: Report & Disseminate Outcomes: Results of the project will be disseminated through presentations at professional meetings and peer-reviewed publications used extensively by dietetics educators.

Progress 09/01/23 to 08/31/24

Outputs
Target Audience:Dietetic Practitioners Food, Nutrition, and Dietetics Instructors Nutrition Undergraduates Dietetic Interns Changes/Problems:The project has continued to move at a somewhat slower pace than anticipated due to the steep learning curve for VR of the non-VR project staff (i.e., the dietetics content experts) in addition to evolvingVR technology. What opportunities for training and professional development has the project provided?This project has trained non-dietetics project faculty and staff in dietetic intervention components, and needs/gaps and use to facilitate VR development. This project also has trained non-VR faculty and staff regarding the capacity of this technology and how it can be best used to advance dietetic student learning as well as how to actually use VR and the scenarios developed in this project. How have the results been disseminated to communities of interest?The simulation development process is being documented and will be presented at the FNCE professional meetings in October. What do you plan to do during the next reporting period to accomplish the goals?The achieve our goals for the next year, we plan to complete evaluation of all the VR and Alex-PCS scenario scripts and prepare the project outcomes for dissemination. We also plan to offer virtual training to food, nutrition, and dietetics instructors to implement the Alex-PCS and VR simulations in their curriculum.

Impacts
What was accomplished under these goals? Goal 1 The virtual reality simulation scenarios addressing common diseases for which nutrition therapy is key to prevention and treatment have been developed, including goals, objectives, tone, and patient characteristics. Development this year has included consultations with experts, regular discussions with the project investigators, and completion of the virtual reality scripts. Mannequin script development continued. Training to use virtual reality equipment was completed and refreshed periodically. Virtual reality software elements and characterization of patients and healthcare environments have been completed for all scenarios. Testing has been completed for completed scenarios by project investigators and implementation procedures for student and preceptor use were developed and tested. Instruments for evaluating the simulations were updated and formative testing is nearing completion. Goal 2 Training materials for food, nutrition, and dietetics instructors to confidently incorporate the Alex-PCS and VR simulations have been conceptualized and develop is nearing completion. Goal 3 Instructor training materials are nearing completion and will be refined using instructor feedback. The VR development process will be reported at the FNCE meeting in October.

Publications

  • Type: Other Status: Other Year Published: 2024 Citation: Instructional Materials for VR Simulations
  • Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: Formative Testing of Virtual Reality Simulations for Dietetic Interns


Progress 09/01/22 to 08/31/23

Outputs
Target Audience:Dietetic Practioners Food, Nutrition, and Dietetics Instructors Changes/Problems:The project has move somewhat slower than anticipated due to the steep learning curve for VR of the non-VR project staff (i.e., the dietetics content experts) in addition to unforseen changes in prevailing VR technology and slower than anticipated availability and delivery of equipment due to COVID related supply chain issues. What opportunities for training and professional development has the project provided?This project has trained non-dietetics project faculty and staff in dietetic intervention components, and needs/gaps and use to facilitate VR development. This project also has trained non-VR faculty and staff regarding the capacity of this technology and how it can be best used to advance dietetic student learning as well as how to actually use VR and the scenarios developed in this project. How have the results been disseminated to communities of interest?The simulation development process is being documented and prepared for publication and presentation at professional meetings in year 3. What do you plan to do during the next reporting period to accomplish the goals?The achieve our goals for the next year, we plan to complete all the VR and Alex-PCS scenario scripts, developmentally test them, complete programming of the Alex-PCS mannequins, evaluate the scenarios, and prepare the project outcomes for dissemination. We also plan to train food, nutrition, and dietetics instructors to confidently the Alex-PCS and VR simulations in their curriculum.

Impacts
What was accomplished under these goals? Goal 1 The virtual reality simulation scenarios addressing common diseases for which nutrition therapy is key to prevention and treatment have been developed, including goals, objectives, tone, and patient characteristics. Development this year has include consultations with experts, regular discussions with the project investigators, and preparation of the virtual reality scripts. Mannequin script development continued. Training to use virtual reality equipment was completed and refreshed periodically. Virtual reality software elements and characterization of patients and healthcare environments have been completed for some scenarios with others nearing completion. Testing has been completed for completed scenarios by project investigators and implementation procedures for student and preceptor use are in development. Instruments for evaluating the simulations has been developed and cognitive testing is beginning. Goal 2 Training materials for food, nutrition, and dietetics instructors to confidently incorporate the Alex-PCS and VR simulations have been conceptualized and development is underway. Goal 3 This goal is scheduled to start in year 3.

Publications

  • Type: Other Status: Other Year Published: 2023 Citation: Esophageal Cancer Scenario Script
  • Type: Other Status: Other Year Published: 2023 Citation: Esophageal Cancer Virtual Reality Experience
  • Type: Other Status: Other Year Published: 2023 Citation: Type 2 Diabetes and Blood Glucose Management Scenario Script
  • Type: Other Status: Other Year Published: 2023 Citation: Type 2 Diabetes and Blood Glucose Management Virtual Reality Experience
  • Type: Other Status: Other Year Published: 2023 Citation: Cardiovascular Disease and Obesity Scenario Script
  • Type: Other Status: Other Year Published: 2023 Citation: Nasogastric Tube Placement Scenario Script


Progress 09/01/21 to 08/31/22

Outputs
Target Audience:Food, Nutrition, and Dietetics Instructors Dietetic Practitioners Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?This project has informally trained non-dietetics project faculty and staff in basic dietetic intervention components to facilitate VR development. Similarly, this project has formally and informally trained non-VR faculty and staff regarding the capacity of this technology and how it can be best used to advance dietetic student learning. How have the results been disseminated to communities of interest?The simulation development process is being documented and prepared for a presentation at professional meetings in years 2 or 3. What do you plan to do during the next reporting period to accomplish the goals?The achieve our goals for the next year, we plan to have all the VR and Alex-PCS scenario scripts developed, developmentally tested, VR interface developed, Alex-PCS programmed, and evaluation instruments developed. We also plan to begin training food, nutrition, and dietetics instructors to confidently the Alex-PCS and VR simulations in their curriculum. In addition, we plan to begin to disseminate project work.

Impacts
What was accomplished under these goals? Goal 1 The simulation scenarios addressing common disease for which nutrition therapy is key to prevention and treatment are in development, including goals, objectives, tone, and patient characteristics. Development has include consultations with experts, regular discussions with the project investigators, and preparation of a prototype script. Simulation script development is underway. Training to use virtual reality equipment is underway. Virtual reality software elements and characterization of patients and healthcare environments are being conceptualized and tested. Additionally, a library of instruments for evaluating the simulations has been assembled and are being refined to be specific to the simulations developed in this project. Goal 2 This goal is scheduled to start in year 2. Goal 3 This goal is scheduled to start in year 3.

Publications

  • Type: Other Status: Other Year Published: 2022 Citation: Esophogeal Cancer Prototype Scenario Script Draft