ISTE Standards for Coaching

Simulation learning in dietetics education: What options are available?

As a dietetics educator, I am keenly aware that securing clinical nutrition rotations for dietetics interns is the most difficult aspect of scheduling supervised practice experiences. A few reasons why securing clinical nutrition rotations can prove to be difficult include local competition with other programs, a limited number of preceptors available, lack of facilities in proximity to program sites, and a limited number of overall placement opportunities due to the amount of experiential learning time required. 

Clinical nutrition rotations can be scheduled with a variety of healthcare organizations, including hospitals, clinics, renal dialysis centers, eating disorder clinics, and long-term care centers. Of utmost importance, however, is providing opportunities for dietetic interns to fulfill the requisite learning competencies as mandated by the Accreditation Council for Education in Nutrition and Dietetics (ACEND). Dietetic internship programs must offer learning experiences that allow interns to meet a variety of clinical nutrition competencies. Some examples of clinical nutrition competencies are as follows: 

  • CRDN 1.6: Incorporate critical thinking skills in overall practice. 
  • CRDN 2.4: Function as a member of inter-professional teams.
  • CRDN 3.1: Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings. 
  • CRDN 3.6: Use effective education and counseling skills to facilitate behavior change. 
  • CRDN 4.9: Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee for service and value-based payment systems (ACEND).  

An additional layer of complexity in securing clinical nutrition rotations this past academic year was the onset of the COVID-19 pandemic. While some hospitals and clinics chose to continue taking our interns in person, others requested partial or fully virtual rotations, while others decided to opt out due to difficulties transitioning to online learning. Several of our hybrid and fully online sites provided opportunities for interns to observe and engage in telehealth sessions with clients. 

Currently, we are a few weeks away from our first cohort of dietetic interns completing our inaugural program year. Though I am quite satisfied with the quality and variety of learning experiences our interns have had this year, I want to investigate how clinical nutrition education can be provided to dietetic interns through use of simulation learning. 

Specifically, my question for this module is: How can dietetics educators incorporate innovative clinical nutrition simulation learning experiences into their dietetic internship curriculum to improve student outcomes while advancing their technological skills? 

My question aligns with the International Society for Technology in Education’s (ISTE) Standard 1 Learner: “Educators continually improve their practice by learning from and with others and exploring proven and promising practices that leverage technology to improve student learning. Educators (ISTE). 

In this blog post, I will be focusing on ISTE Standard 1a: 

“Set professional learning goals to explore and apply pedagogical approaches made possible by technology and reflect on their effectiveness” (ISTE). 

Simulation learning: an advanced educational approach in dietetics education

According to Levett-Jones and Lapkin (2014), simulation learning is: “A technique used to replace or amplify real experiences with guided experiences that evoke or replace substantial aspects of the real world in a fully interactive manner. Simulation isn’t a technology, but rather a mode of learning meant to replicate clinical experiences as closely as possible.” Further, Davis (2015) states that “simulation education serves as a bridge between classroom learning and real-life clinical experience.” 

Simulation learning and corresponding curriculum theory 

According to Cooper (2018), simulation learning stems from Transformative Learning Theory, “which suggests that either real or simulated experiences serve as catalysts for learning. Students take the knowledge they already possess and put it into practice in realistic scenarios.” 

Simulation learning is also rooted in Experiential Learning Theory, which focuses on learning by engaging in direct experiences rather than rote memorization (Ellis, 2020). The phases of experiential learning are as follows: concrete experience (i.e. the actual experience), reflection and observation (i.e. reflecting on the experience), forming abstract concepts (i.e. developing concepts based on the experience), and testing these concepts in new situations (Lindsey & Berger, 2009; Miettinen, 2010).  

Clinical simulation learning is available to dietetics educators using a variety of models and tools. Some of the options include the following: 

Laboratory simulation using robots, which depict human patients, are used to gain professional practice in a simulated clinical environment. According to Cooper (2018), The University of Idaho’s dietetics education program is the pioneer academic site to incorporate the SimMan robot to provide experiential learning to their students. After students complete 150 hours of simulation learning with a focus on 10 disease states, such as type 2 diabetes and celiac disease, students then advance to a real clinical environment where they are mentored by preceptors. This link provides a description of how this type of simulation learning is utilized at The University of Idaho ( An important learning experience for dietetics students using SimMan would be to perform Nutrition-Focused Physical Exams. 

SimMan in action
  • Laboratory simulation using human actors to replicate patient interactions. An instructor observes interactions from a nearby booth and provides instant feedback on student performance via a microphone. Additional human actors are present in the simulated environment to mimic an interdisciplinary healthcare team (Cooper, 2018). 
  • Computer software programs designed with 3D virtual simulation learning environments and avatars, which allow interns to interact with patients of varying backgrounds and interdisciplinary healthcare providers (Davis, 2015). Students can practice providing medical nutrition therapy (MNT) services to patients in acute and out-patient settings while increasing their skills in utilizing the Nutrition Care Process, performing coding and billing tasks, and using the Academy of Nutrition and Dietetics’ Evidence Analysis Library (Academy of Nutrition and Dietetics Foundation). An example of this type of simulation learning is described on New Mexico State University’s website:


Computer software programs using a case study approach in a virtual learning environment to provide opportunities for students to enhance their critical thinking and problem solving skills by engaging in the Nutrition Care Process, completing coding and billing exercises, and pre-recorded video interviews with patients to review. One example is Nutrition Care Professionals (NCPRO) Virtual Learning Environment ( 

Source: Davis, A. (2015). Virtual reality simulation. An innovative teaching tool for dietetics experiential education. The Open Nutrition Journal. 9, (suppl. 1-M8),65-75.

  • Virtual reality training using a headset and hand controls, such as Oculus Rift, was not seen in my research on dietetics-specific virtual reality simulation training. However, I did locate software that is currently being used in nursing education. 

How can simulation learning improve student outcomes? 

Numerous benefits of simulation learning in dietetics education have been shared with the dietetics community. A few examples are listed below (Cooper, 2018): 

  • “ability to simulate rare cases and situations that students may not otherwise encounter in their traditional training”
  •  “increased time for instructors to focus on student learning rather than patient care”
  • “ability to quickly repeat and refine student performance”
  • ability to move from simple to more complex skills for progressive learning”
  • “immediate feedback to students”
  • “opportunities for interprofessional interaction with professionals in a wide variety of roles before the student enters the hospital setting.” 

What expertise do dietetics educators need to oversee simulation learning? 

To administer a successful simulation learning curriculum, dietetics educators must: 

  • Understand simulation learning pedagogy 
  • Possess expertise in clinical nutrition to develop curriculum, provide real time feedback to students, and debrief on student performance. 
  • Possess a variety of technological skills required to oversee the various types of simulation learning system adapted. 

The chart below depicts the expertise needed by dietetics educators administering virtual simulation learning in their curriculum: 

Source: Davis, A. (2015). Virtual reality simulation. An innovative teaching tool for dietetics experiential education. The Open Nutrition Journal. 9, (suppl. 1-M8),65-75. 

Evaluation of clinical simulation learning resources

There are several variations of clinical simulation learning resources available for dietetics education. All have merits, but some are more realistic to consider implementing due to the resources required. Laboratory simulations, whether using robots or human actors, require a designated laboratory space and in-person participation. Though this may be something to consider in the future, due to the COVID-19 pandemic, I am currently interested in focusing on simulation software that can be accessed from any remote location and can be utilized asynchronously (vs. in real time). These features would allow our interns to either enhance their in person clinical nutrition experiences with supplemental simulation learning, or would enable interns to complete clinical nutrition competencies in a remote learning environment. I have decided to narrow my focus to simulation software, such as NCPRO since it does not require instructors to create the curriculum as opposed to the virtual reality software options. However, now that I have learned so much about options available that simulate the clinical environment, I will definitely consider virtual reality and robot simulations in the future. 


Academy of Nutrition and Dietetics Foundation. EatrightPro Practice simulation series.

2017 Standards and Templates. Accreditation Council for Education in Nutrition and Dietetics.

Cooper, C.C.(2018). Using simulation in dietetics education. Today’s Dietitian. 20,7,30.  

Davis, A. (2015). Virtual reality simulation. An innovative teaching tool for dietetics experiential education. The Open Nutrition Journal. 9, (suppl. 1-M8),65-75. 

Ellis, A. (2020). Podcast on instructional theory. Seattle Pacific University. 

Levett-Jones T, Lapkin S. (2014). A systematic review of the effectiveness of simulation debriefing in health professional education. Nurse Educ Today. 34,6, 58-63.

Lindsey, L., & Berger, N. (2009). Experiential approach to instruction. In Reigeluth, C., & CarrChellman, A. (2009). Instructional-design theories and models, volume III: Building a common knowledge base (pp. 118-40). Taylor & Francis Group. 

New Mexico State University. Virtual reality and dietetics simulation lab.

Nutrition Care Pro Virtual Learning Environment.

University of Idaho.(2021). Dietetics simulation.

ISTE Standards for Coaching

Project-Based Learning: A Recipe for Student Autonomy, Voice and Choice, and Sustained Inquiry

As a university dietetics instructor and internship director, I am focused on developing curricula that enables my students to practice and prepare for professional work. As budding professionals, dietetics students need opportunities to build knowledge and develop professional skills in food and nutritional sciences through simulation exercises and experiential learning in authentic settings. Further, due to the explosion of digital technologies utilized in the dietetics field, it is vitally important that dietetics students are provided educational opportunities to practice communicating their knowledge and skills via digital platforms. 

Incorporating projects into dietetics education that utilize digital platforms not only help prepare students for the professional realm, but offer students “voice and choice” in the design process. This curricular approach gives students the freedom to be creative and innovative as they make decisions about content, format, and overall design. My experience as a college professor leads me to believe that this approach to learning will likely increase intrinsic motivation among students since they are not constrained to a rigid set of assignment requirements, topics they are not interested in exploring, or project designs that are not appealing to them. Rather, by following a broad set of project guidelines, students are encouraged to investigate and design based on what is interesting and important to them.    

Further, I believe a critical aspect of being an effective college instructor involves periodic reflection on curriculum and instruction. Some questions to ponder as one reflects on course design include the following: 

  • What makes learning exciting and rewarding to students? 
  • How does the structure of the curriculum affect student motivation? 
  • What types of assignments enable students to build knowledge and develop skills that they will retain beyond a particular college course/term? 
  • How can assignments be designed to foster student autonomy, creativity and imagination? 

As I consider best practices in the instruction of dietetics students, I reflect on the following question as it pertains to utilization of digital technology in project-based learning, and how student voice and choice increase intrinsic motivation and creativity in the design process of project-based learning. How does student autonomy in selection and utilization of digital tools affect the quality of outputs in the design process?

The International Society for Technology in Education’s (ISTE) Standard 4 for Students, “Innovative Designer,” states that: “Students will use a variety of technologies within a design process to identify and solve problems by creating new, useful or imaginative solutions” (ISTE). Within this category, ISTE Standard 4a states: “Students know and use a deliberate design process for generating ideas, testing theories, creating innovative artifacts or solving authentic problems” (ISTE).

What is project-based learning? 

According to the Buck Institute for Education, “Project-based learning is a teaching method in which students learn by actively engaging in real world and personally meaningful projects” (Buck Institute for Education). This type of learning enables students to work on a project that allows voice and choice while investigating a problem or question. Sustained inquiry is a key component of project-based learning whereby students dive into the depths of a subject area over an extended period of time to answer questions or problems that are meaningful to them. Projects culminate with a public product, such as a blog post or a website. This instructional model enhances the learning process by including student reflection, which is an essential component of Kolb’s theory of experiential learning (Lindsey & Berger. 2009).  


Examples of Project-based Learning in Higher Education 

In a research article titled, “Fostering students’ autonomy: Project-based learning as an instructional strategy,” the author describes the curriculum design and outcomes of incorporating project-based learning design into an English language immersion class. Thirty university students worked in pairs to research a business of their choice and design a 15-minute PowerPoint presentation on the organization’s characteristics, such as the marketing mix, their mission and vision statements, a SWOT analysis, etc. Students were required to incorporate multimedia into their presentations, but were given autonomy on what to include. The results showed that the use of project-based learning instruction had a positive impact on student autonomy, collaborative learning, content knowledge, presentation skills, language acquisition, and use of technology tools (Rostom, 2019).  

Further, in an article titled, “Everyone designs: Learner autonomy through creative, reflective, and iterative practice mindsets,” the authors underscore the importance of an instructional approach that is open to creativity and reflection. The authors discuss that although encouraging autonomy in the learning process requires teachers to forgo some instructional control and the need to create learning opportunities that support autonomy, this approach benefits students through the development of 21st century skills, which are necessary for success in the professional world (Henriksen, Cain, & Mishra, 2018). 

Following are some of the many 21st century skills that can be formed through project-based learning (

  • Critical thinking and problem solving
  • Communication, teamwork and leadership skills 
  • Creativity and innovation
  • Information and communication technology, digital citizenship, and digital literacy 
  • Research skills
  • Planning and self-direction

Lastly, in a research paper titled, “Facilitating adoption of web tools for problem and project based learning activities,” the authors provide examples of the types of digital tools that are appropriate to use during various stages of project-based learning.  The paper provides an enlightening table detailing specific web-based tools that can assist students when they are working on various components of project-based learning, such as assimilating, communicating. producing, and practicing (Khalid, Rongbutsri, & Buus, 2012).  

In conclusion, project-based learning offers numerous benefits to college students and supports voice and choice in their educational pursuits. Dietetics students need opportunities to practice communicating their knowledge and skills using an instructional format that encourages revision and reflection and the opportunity to create products that are shared with the public. Project-based learning is an ideal teaching method for these purposes, and its use in dietetics education should be encouraged. 


21st Century Skills. (2016).

Henrickson, D., Cain, W., Mishra, P. (2018). Everyone designs: Learner autonomy through creative, reflective, and iterative practice mindsets. Journal of Formative Design in Learning, 2, 69-81. 

International Society for Technology in Education.

Khalid, M. S., Rongbutsri, N., & Buus, L. (2012). Facilitating Adoption of Web Tools for Problem and Project Based Learning Activities. In V. Hodgson, C. Jones, M. D. Laat, D. McConnell, T. Ryberg, & P. Sloep (Eds.), Proceedings of the Eighth International Conference on Networked Learning 2012 (pp. 559-566).

Lindsey, L., & Berger, N. (2009). Experiential approach to instruction. In Reigeluth, C., & CarrChellman, A. (2009). Instructional-design theories and models, volume III: Building a common knowledge base (pp. 118-40). Taylor & Francis Group. 

Rostom, M. (2019). Fostering students’ autonomy: Project-based learning as an instructional strategy. SOCIOINT 2019- 6th International Conference on Education, Social Sciences and Humanities

ISTE Standard 1: Change Agent ISTE Standard 2: Connected Learner ISTE Standard 3: Collaborator ISTE Standard 4: Learning Designer ISTE Standard 5: Professional Learning Facilitator ISTE Standard 6: Data-Driven Decision-Maker ISTE Standard 7: Digital Citizen Advocate

Digital literacy: An essential component of professional competence in the nutrition and dietetics profession

In an era of evolving digital technology, it is essential that university dietetics programs incorporate curriculum on digital literacy in preparation of student contributions to the collective digital media environment.  This instruction is an important aspect of professional competence, as it will provide students with tools needed to critically navigate sources of information available on the Internet, and subsequently increase their competence as providers of evidence-based food and nutrition information available to the public.  When thinking of outcomes succeeding instruction on digital literacy, a component of digital professionalism, Ellaway et al. (2015) state that “professionals should maintain the capacity for deliberate, ethical, and accountable practice when using digital media” (p. 844).  

Deye (2017) defines digital literacy as “. . . the use and security of interactive digital tools and searchable networks. This includes the ability to use digital tools safely and effectively for learning, collaborating and producing.”  Digital literacy is reflected in the International Society for Technology in Education’s Coaching Standard Digital Citizen Advocate (7c): “Support educators and students to critically examine the sources of online media and identify underlying assumptions” (International Society for Technology in Education). 

Prior to becoming credentialed practitioners, dietetics students should be able to demonstrate competence in digital literacy through proper access, utilization, and referencing of online sources. Skills acquired in digital literacy will enable dietetics students to critically evaluate online nutrition and health information prior to referencing their curated digital communications intended for consumer communications.  Paulus, Baker, and Langford (2019) assert that “. . . we should enable our students to use [information and communications technology] ICTs to create contributions to public knowledge while they are still in school.  ‘. . . Students work best when they know their work is for their future beyond school…when they realize their work contributes (p. 55).’” An earlier start to contributing to the collection of digitally accessed, evidence-based food and nutrition information may further enhance identity formation as professionals while students are still in college.   

However, for dietetics students to be competent in digital literacy, it is essential that they understand the ethical considerations when making contributions to the digital media landscape.  Regarding competencies related to access, utilization, and referencing of online sources, Helm (2016) describes this as “content credibility,” and states the best practices in this area are as follows (p. 1828):

  • “Always provide accurate and truthful information.
  • Distinguish between science-based facts and a personal point of view.
  • Share only information from credible sources.
  • Include the source of nutrition studies or claims cited.
  • Place results of new studies in context.
  • Correct misinformation and respond to inaccuracies.”

Helm’s words of wisdom reflect several principles housed within the Code of Ethics for the Nutrition and Dietetics Profession, which are listed here:

  • “1a. Practice using an evidence-based approach within areas of competence, continuously develop and enhance expertise, and recognize limitations
  • 1b.Demonstrate in depth scientific knowledge of food, human nutrition and behavior.
  • 1c. Assess the validity and applicability of scientific evidence without personal bias.
  • 2d. Respect intellectual property rights, including citation and recognition of the ideas and work of others, regardless of the medium (e.g. written, oral, electronic).
  • 2e. Provide accurate and truthful information in all communications.
  • 3d.Refrain from communicating false, fraudulent, deceptive, misleading, disparaging or unfair statements or claims” (Academy of Nutrition and Dietetics).

Additionally, Helm (2016) discusses the importance of giving proper credit and providing citations to the original source of information. In the case of citing other blogs, the author pointed out that there must be a link to the original source of information as well as proper credit to the author or organization for which the author works.

In summary, when instructing students on the use of digital media tools to communicate evidence-based information, we must recognize that they are still learning core content, including key concepts in food and nutritional sciences as well as methods used and ethics involved in accessing digital information. Thus, it is important that students are knowledgeable in digital literacy and ethics as well as applicable core content before they publish information online, but these experiences are encouraged to increase to the contributions of evidence-based food and nutrition available to consumers as well as aid in the development of students’ professional identity formation.  


Academy of Nutrition and Dietetics. Code of Ethics for the Nutrition and Dietetics Profession.

Deye, S. (2017). Promoting digital literacy and citizenship in school. National Conference of State Legislators, 25(7).

Ellway, R, Coral J, Topps, D, Topps, M. (2015). Exploring digital professionalism. Medical Teacher, 37(9), 844-849.    

Helm, J. (2016). Practice paper of the Academy of Nutrition and Dietetics. Social media and the dietetics practitioner. Opportunities, challenges, and best practices. J Acad Nutr Diet, 116: 1825-1835. 

International Society for Technology in Education. ISTE Standards for Coaches.

Paulus, M, Jr., Baker, B, Langford, M. (2019). A Framework for digital wisdom in higher education. Christian Scholar’s Review, 49(1): 41-61.