AKMI METROPOLITAN COLLEGE MEMBER OF AKMI EDUCATIONAL ORGANISATION

PLACEMENTS HANDBOOK (DRAFT)

AKMI Metropolitan College (AMC) in collaboration with Queen Margaret University (QMU) 1

DIETETIC PLACEMENTS IN ATHENS During the four year programme of studies, there are three integrated blocks of Practice Placements know as A, B and C. This approach mirrors QMUs approach and AMC follows all the requirements as specified by QMU concerning the rules for practice placements. The first Placement block A, is a 4 week placement which occurs at the end of the second year of studies. The second placement block B, is a 12 week placement which occurs at the end of the third year The final placement block C, is another 12 week placement which occurs in the second semester of the fourth year.

Placement Block A The overall aim of the A placement is to be introduced to the work of a dietitian by observing working practices and undertaking practical exercises. The structure of the placement is two focused weeks spent on campus in preparation for a following two weeks spent in the practice setting. This placement allows students the opportunity to complete all the specific aims of the placement in both the campus weeks and by working in a healthcare setting e.g.hospital, nursing home, rehabilitation centre and a private dietetic office. Within this placement students must have an opportunity to work in an institutional food production unit. This unit will ideally be in a hospital, in order that they can appreciate the process of meal selection, service and delivery of meals, but some of the other specific aims could be met in a more general catering unit. At the conclusion of Placement A students should: Have a working knowledge of portion sizes of common foods Be familiar with the range of food products available to the general public including major nutrient-modified foods and ready-prepared meals Be aware of how the use of nutrient-modified foods can influence the diet both quantitatively and qualitatively Have a working knowledge and practical experience of producing both standard and modified recipes Be able to demonstrate the ability to record, calculate and analyse individuals nutritional intake both by hand and by computer assisted analysis Appreciate the factors to be considered in all aspects of menu planning Appreciate the process of meal selection, service and delivery within an institutional food production unit Be aware of the major health and safety issues within the working environment Have an understanding of the methods by which dietitians communicate with other health professionals, patients and the general public Have experience of communicating with patients and healthcare professionals Demonstrate an ability to talk with patients and healthcare professionals Be aware of the need to respect the point of view of patients and why it is important to avoid discrimination Demonstrate the ability to maintain confidentiality 2

Be able to explain the reason and need for the Statement of Conduct Demonstrate professional appearance and behaviour Be able to identify those health professionals who work closely with a dietitian Be able to identify the key sources of patient information available to plan dietetic care Demonstrate an interest in and a commitment to the work of dietitians

Placement Block B This placement occurs after the completion of Placement A, at the end of year 3 and must be successfully completed prior to commencing Placement C. The overall aim of this placement is to begin to apply theoretical knowledge and develop the range of skills needed to work as a dietitian with specified clients/care groups and in a range of work settings. The placement will offer experience in a range of settings which can include hospital wards and outpatients, practitioners offices or health centres (Greek equivalent as appropriate), health clubs, rehabilitation centres and nursing/residential homes. The placement can also include non-health settings such as schools, established community groups and should offer some public health/health Promotion experience. Students will gain experience of working with clients of all ages, males and females; different cultural/social backgrounds, established groups, e.g. well adults, cardiac rehabilitation, pre-retirement groups; other health care professionals and catering staff. Students will also develop their dietetic practice within this placement including the development, monitoring and review of care plans for: diabetes, both non-insulin and insulin treated: nutritional support, sip and enteral feeds: eating and drinking problems: weight management; lipid disorders and food intolerance Students should within this placement be able to assess overall nutritional adequacy of the diet and develop general nutritional advice based on Eat well plate/Food pyramid guide principles, as well as identifying therapeutic diet requirements. Students can also develop their communication and practical skills with patients who have more complex clinical conditions. However the students would not be expected to give therapeutic advice to these patients e.g. they could take diet histories from renal patients, gather medical/personal histories from paediatric patients or their parents/carers. At the conclusion of Placement B students should: Demonstrate a working knowledge of all disciplines required to support practice with patients seen in Placement B Be able to communicate effectively using appropriate aids and skills with individuals seen in Placement B Is able to communicate effectively using appropriate aids and skills to groups seen in Placement B Is able to report accurately to dietetic supervisors on action taken Is able to collect and record relevant medical, nutritional, social, cultural, financial and personal information and food intake details in line with established standards and procedures 3

Is able to assess client information qualitatively and quantitatively Is able to plan and justify dietary advice to patients seen in Placement B Is able to review, monitor and evaluate dietetic practice with patients or clients Demonstrates an understanding of the strategies which can be used to influence nutritional intake Demonstrates an ability to contribute to both dietetic and multi-disciplinary teamwork Practises within the Statement of Conduct and Ethics for students (HPC) Practises in line with anti-discriminatory policies such as discrimination on grounds of race, gender, religion, physical disability, learning disability, sexual orientation Manages available time and resources in completing tasks allocated Reflects on experience and evaluates their own practice Demonstrates an enquiring attitude and shares knowledge and experience with others. Begins to take responsibility for personal and professional development and shows commitment to excellence of practice. Demonstrates a professional attitude.

Placement Block C This 12 week placements occur after the successful completion of Placement B and in the second semester of year 4. . The overall aim of this placement block is for students to become competent in translating theory into practice and demonstrate the range of skills needed to work as a newly qualified dietitian. The placement will offer experience in a range of settings including hospital wards and outpatients, practitioners offices or health centres (Greek equivalent as appropriate), health clubs, rehabilitation centres and nursing/residential homes. The placement will also include non-health settings such as schools, established community groups and offer public health/health promotion experiences. Students should be given experience with client groups of all ages, males and females: different cultural/social backgrounds: established groups, e.g. well adults, cardiac rehabilitation, pre-retirement groups, other healthcare professionals: catering staff and patient groups such as. Diabetes, coeliac and other chronic illnesses, school children, youth groups, low income groups. Within this placement students should develop their dietetic practice which will include devising, monitoring and review of care plans for: diabetes, both insulin and non-insulin treated: nutritional support, sip and enteral feeds: GI tract problems relating to diet: eating and drinking problems: weight management: lipid disorders: Food allergy and conditions where dietitians work as part of multidisciplinary teams, e.g. renal disease, liver disease, major trauma/critical care, ITU, palliative care, paediatric disorders. In the latter, students will contribute to the dietetic management of these patients, but not take over their care. Students will also develop their communication skills with a wider range of patients than in Placement B including patients with disorders affecting communication e.g. learning disability.

Students should continue to be able to assess overall nutritional adequacy of the diet and develop general nutritional advice based on Eat well plate/Food Pyramid guide principles, as well as identifying therapeutic diet requirements. At the end of Placement C the student should have had the opportunity to work with clients/patients in the same way as a newly qualified dietitian. At the conclusion of the placement students should: Demonstrate a working knowledge of all disciplines required to support practice with patients seen in Placement C Be able to communicate effectively using appropriate aids and skills with individuals seen in Placement C Is able to communicate effectively with colleagues, other health professionals and clients at an appropriate level and pace Is able to report accurately to relevant people on action taken Continues to be able to collect and record and use relevant medical, nutritional, social, cultural, financial and personal information and food intake details in line with established standards and procedures Is able to assess and use information qualitatively and quantitatively to support dietetic practice Is able to plan and justify dietary advice to patients seen in Placement C Continues to review, monitor and evaluate dietetic practice with patients or clients Demonstrate an understanding and ability to implement the strategies which can be used to influence nutritional intakes and nutritional standards Demonstrates an ability to contribute to the effectiveness of both dietetic and multi-disciplinary teamwork Continues to practise within the Statement of Conduct and Ethics for Students (HPC) Continues to practise in line with anti-discriminatory policies such as discrimination on grounds of race, gender, religion, physical disability, learning disability, sexual orientation Prioritises and manages a given work load Reflects on experience and demonstrates reflection in action Evaluates practice Continues to demonstrate an enquiring attitude and shares knowledge and experience with others Takes responsibility for personal and professional development and shows commitment to excellence of practice Continues to demonstrate a professional attitude

Portfolios For each of the three placement blocks students will develop a portfolio of evidence in which they will record all the information necessary to demonstrate completion of the specific aims and any other relevant information in order that they can clearly demonstrate the achievement of the learning outcomes. This will include their pre placement report and review of each of the Placement blocks. They will also record within their portfolio the clinical conditions seen and the settings worked in for both the B and C placement.

Assessment of placements and placement regulations Overall responsibility for the supervision and assessment of students on placement will be undertaken by an experienced dietitian with training in supervision and assessment (normally the Lead or Supervisory Dietitian). This dietitian is also responsible for the final assessment of the student, which includes completing a joint report at the end of each placement block and returning this to AMC. In addition, as part of Interprofessional Health Principles, other appropriately qualified health and social care professionals may contribute to the assessment of and provide evidence for the achievement of particular placement outcomes. Placement A This is based on the evidence gathered to demonstrate completion of the specific aims. This placement is neither passed nor failed but is an opportunity to learn and understand more about the work of dietitians. Discussion and feedback on the evidence being collected will occur during the 4 weeks. Placement B Discussion and continuous feedback (formative assessment) on the evidence being collected will occur in a structured way throughout the 12-week placement and a formal review will occur at 6 weeks This will allow for the successful completion of learning outcomes, the identification of areas of weakness and additional activities to help improvement. Another formal review will take place at the end of the 12-week placement. This placement must be passed to continue the programme. All learning outcomes must be achieved by the end of the 12-week placement at the identified performance level for this stage of academic and practical experience. The student and the placement dietitian will formally review what has been done and been achieved. Through discussion, areas of strength and weakness will be identified to enable more work on return to university. The review form will be completed together, a copy will be retained by the student in their portfolio and a copy will be sent to their AMC tutor. If the placement is failed, the consequences and options will be identified and discussed with the student. Placement C As per Placement B, discussion and continuous feedback (formative assessment) on the evidence being collected will occur in a structured way throughout the 12-week placement and a formal review will occur at 6 weeks This will allow for the successful completion of learning outcomes, the identification of areas of weakness and additional activities to help improvement. Another formal review will take place at the end of the 12-week placement. This placement must be passed to contribute to achieving the requirements for the award of the BSc (Hons) Dietetics. All learning outcomes must be achieved by the end of the 12-week placement at the identified performance level for this stage of academic and practical experience. A review form will be completed at the end of the 12 weeks by the Placement Dietitian and student. A copy will be retained by the student in their portfolio and a copy will be sent to their AMC tutor.

Extended training after failure to achieve a satisfactory standard in Placement Block B and Placement C: In order to pass Placement B and Placement C, the student must have satisfied the dietitian in charge of training that they have demonstrated competence in each learning outcome. In the event of failure to achieve a satisfactory standard at the end of Placement B or Placement C the student and the relevant AMC University tutor must each be informed of the reasons for the failure. The final assessment should be undertaken at the end of the placement and before the student leaves the placement in order that adequate feedback can be given. A student cannot fail the placement before s/he completes the full 12 weeks. Failure of Placement Block B: If a student fails to demonstrate competence in more than 6 learning outcomes they must repeat the whole 12 weeks. If a student fails to demonstrate competence in up to 6 learning outcomes they should repeat a minimum of 2 and a maximum of 6 weeks of the placement, depending on the number of learning outcomes failed. The actual length of extended training required is to be decided in consultation with the Practice Provider, the AKMI University tutor and External Examiner where relevant. The extended placement must be undertaken in a centre approved for either Placement B or Placement C. If a student fails to demonstrate competence in all learning outcomes at the end of the extended training, they must repeat the whole placement.

Failure of Placement Block C:

If the student fails to demonstrate competence in more than 4 learning outcomes they must repeat the whole 12 weeks. If the student fails to demonstrate competence in up to 4 learning outcomes they must undertake a minimum of 4 weeks and a maximum of 6 weeks extended training to be decided in consultation with the Practice Provider, AKMI University tutor and External Examiner where relevant. The extended placement must be undertaken in a centre approved for either Placement B or Placement C. Failure of the extended training will result in the student having to repeat the whole placement.

NB Any designated placement block may normally only be repeated once. Attendance regulations for placement blocks In accordance with QMUs regulations students must normally undertake not less than 1000 hours of practical learning and experience and students are normally required to attend practice placements full-time, Monday-Friday. NB. The specific start and finish times will vary depending on the business hours of the practice placement provider. Students are normally expected to complete a 100% of the clinical placement, but where absences due to sickness do occur these will normally be dealt with as follows: 7

A placement (refers to both campus and practice weeks): Loss of up to 2 placement days: No action needs to be taken if the Clinical Educator and University consider that there is no detrimental effect on the students progress, ie they have met all of the learning outcomes for that placement. If this is not the case the lost time must be made up.

Loss of more than 2 placement days Students should normally make up any additional days beyond the 2 day threshold (ie they should normally complete a minimum of 18 days). No action needs to be taken beyond this if the Clinical Educator and University consider there is no detrimental effect to the students progress ie they have or will meet all of the learning outcomes. If this is not the case then the rest of the lost time should be made up.

B & C placements: Loss of up to 5 placement days No action needs to be taken if the Clinical Educator considers that there is no detrimental effect on the students progress, ie they have demonstrated competence in all of the learning outcomes for that placement. If this is not the case the lost time must be made up.

Loss of more than 5 placement days The student must complete a minimum of 11 weeks; any lost time must be made up to 11 weeks. No action needs to be taken beyond this if the Clinical Educator considers that there is no detrimental effect on students progress, ie they have demonstrated competence in all the learning outcomes. If this is not the case the rest of the lost time should be made up.

If the student requires a prolonged period of absence from their placement, the period of training required will be determined in consultation with the Clinical Educator and University Tutor. Notification of absences Students should follow local dietetic departmental policy regarding the notification of any absences to Dietetic Supervisors and provide medical certification where relevant. The AMC University Tutor should also be notified of any absences as a matter of course. Expectations of students AMC and QMU believe that students should be treated as adult learners. This means students will take full responsibility for their own learning and it is up to the student to provide evidence of their progression and their professional qualities at each stage. Students will not be chased to hand in work or undertake other tasks. However, should a student regularly fail to complete work within the allotted time, this will be considered to demonstrate a lack of commitment or a professional attitude. 8

In addition students will be reminded and asked to appreciate that a dietetic department/clinic is a working department/clinic and the needs of the service must be the priority. In view of this the placement programme could change at short notice and students must be able to demonstrate flexibility if this happens.
What students can expect from AMC Tutors and Placement Dietitians :

To be treated with respect To be provided with a programme for each placement block in advance of commencing the placement block To be clear about the aims and tasks of your placement To be treated fairly and non-judgmentally That their training is well organised and that students are given adequate notice of tasks where possible To be clear about what each dietitian expects of them during their the time that they are facilitating the students learning To be given adequate support To have confidential matters kept confidential To be given the opportunity to contribute to the day to day running of the dietetic department in the practice setting To receive honest and constructive feedback To be given every opportunity to demonstrate your skills and abilities To have the opportunity to meet with a task facilitator after each task and receive feedback To be appointed a Lead and/or Supervisory Dietitian in the practice setting.

What AMC and Placement Dietitians expect from students: When working with peers students should contribute equally to the task and work submitted When discussion of a topic is required with peers around a task / topic, students will listen and acknowledge their views and opinions To treat all members of staff with respect To let us know if you have a problem with anything that affects your work To accept feedback and work to address any areas highlighted To be self-motivated To inform supervisors / student training coordinator if tasks or tutorials have been cancelled and need to be rearranged To follow the student code of conduct and ethics (HPC Document) NB Should students fail to do so, this must be aware that this will be reported to the AMC Programme Leader. To be prepared to reflect on their learning experiences and plan their future learning To prepare adequately for tasks, revising notes or reading around a subject if needed To ask if they are unsure about something (although this doesnt mean asking a die titian something that you could easily look up instead) To use their initiative at every opportunity, for example answering the phone if everyone else in the office is busy To be honest and say if they dont know or understand something To be punctual to meetings, tutorials etc To meet deadlines without prompting and inform the facilitating dietitian in advance if they are having difficulty 9

To use any spare time within the placement constructively whether on campus or in the practice setting To ensure that they have completed all paperwork required before meetings and to ensure that all forms are filed in your portfolio Ensure supervisor / secretary knows where they are at all times To check that they understand what is expected in terms of your evidence portfolio Mobile phones should be switched off during the working hours of your placement Respect the policy and the procedures of the placements venue and that includes any specific dress code. Wear closed shoes in kitchen areas Wear a white apron when on the wards. Have a black or blue pen, a portable calculator, a notebook and a notebook for collecting relevant data

Students must also strictly preserve the confidentiality of patient information: It is strictly prohibited to disclose patient names to anyone who should not have this kind of information, including family members or friends of the student. It is strictly prohibited to remove patient status record from the hospital. It is strictly prohibited to use full patient name, apart from the first name or the initials, in any documents or presentations of students assignments. It is strictly prohibited to remove patient records from the health unit. It is strictly prohibited to place medical records in a non secure area, as well as transferring them outside the health unit. This should also apply for any record/file containing patient names or information on medical records. It is strictly prohibited to Copy files without permission. In addition as per QMU Guidelines (which are in line with the HPC Health, Disability and Registration Consultation Document 2005) students should only undertake practice placement(s) in the knowledge that they are fit to practice. If a student is aware of any circumstances which may prevent the completion of their placement or require the placement to be postponed then they should discuss this with their tutor in the first instance. Allocation of Placements All placements will be allocated as defined by AMC (and in line with QMUs existing policies) and at no point should students contact practice placement providers directly to negotiate (or modify their own training), as such actions will not influence allocations made. Those students that do so will be referred back to the College. Applications for the individual matching of placements are accepted based on the criteria given below: student with young/school age children or with other family responsibilities e.g. sole carer of an elderly relative; student with health problems that requires individual matching of placement due to those specific health grounds.

Students who decline an allocated practice placement(s) will be placed at the bottom of any existing waiting list for an alternative placement. A further offer will only be made once all other students above them on the waiting list accessing that cohort 10

time have been allocated placements. Students are strongly recommended to discuss all such decisions with their course tutor Students who decline an allocated placement due to a change in their circumstances which then qualifies them for an individual matching of a placement will be offered an alternative placement subject to availability. The necessary evidence must be provided and submitted to the AMC Practice Placement Supervisor to support such a change. Any application for individual matching of a placement must include supporting evidence. Examples of the evidence needed are given on the form itself. Students should discuss their position with their AMC course/placement tutor and keep them informed of any changes in circumstance either qualifying or disqualifying them. Applications which fail to provide supporting evidence, for example the evidence is missing or it cannot be verified will result in the application being declined. Students are responsible for informing the relevant AMC tutor of any issues which may affect practice placement allocation. This may include: changes in personal circumstance which may qualify or disqualify them for individual matching of a practice placement or affect the completion of a practice placement in the time allocated; a personal decision to defer undertaking a practice placement or withdrawal from the course. The AMC placement supervisor may be required to make a change to allocated practice placements due to the practice placement no longer being available. Students will only be reallocated by the AMC Placements Supervisor if there is an alternative practice placement available. Every effort is made to identify practice placements for students whose initial practice placements have been withdrawn. Although this is subject to availability these students will be prioritised over other students on the waiting list. Students will be notified of any changes to practice placement allocation by their Programme Leader. Approval and monitoring of placements In accordance with QMU processes.AMC will approve placements and monitor their ongoing quality in order to establish and maintain the required high quality of the placement. In accordance with this policy students can only undertake placements with approved practice placement providers.Health and safety and policies for equality and diversity will be addressed as part of these processes. Also as part of this process students complete an evaluation form for each placement and these are reviewed as part of the ongoing approval and monitoring process. Uniforms AMC in accordance to QMU regulations will require students to wear uniforms in the practice placement blocks of the programme. AMC contacts: Any questions, queries or problem should in the first instance be addressed to the following individuals: Dr Glykeria Psarra Dr Maria Neonaki glpsarra@gmail.com mneonaki@amc.edu.gr

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