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  1. handsholding

    Dietitians have key responsibility for assessing, diagnosing and treating individuals who have diet and nutrition-related problems and diseases. At the heart of this lies the deployment of effective communications skills which can encourage and facilitate behaviour change in individuals and groups of people. Often when people are first diagnosed with serious and lifelong diseases such as diabetes, the enormity of the diagnosis and the complexity of the dietary advice that they are given cannot be properly absorbed. Patient-centred consultations in which the dietitian builds a rapport and takes time and care to individualise advice are of huge importance. These communications skills do not come naturally to the majority of people and so have to be taught, practiced and developed.

    This need for training is now widely recognised in the dietetic profession across the world and approaches to training that involve innovative methods, are being rolled out by universities who train students in the dietetic and nutrition professions. One of the big challenges is to enable students to practice their skills in a safe environment without accessing real patients. This challenge can be overcome by using simulated patients who might be volunteers, other students or in some cases, professional actors. These simulated patients can help students develop and refine their skills before going on clinical placements and finishing their professional training.

    Gibson and Davidson reported the findings of a study which examined the impact of simulated patients in Australian dietetic students in their 3rd and 4th year of training (http://onlinelibrary.wiley.com/doi/10.1111/jhn.12352/epdf). The study looked at whether students benefitted from having repeated consultations with simulated patients rather than a single experience. It was found that whilst students who had good communications skills after a single consultation had only modest improvements in skills, students who struggled with these skills made greater improvements and developed skills to make them better prepared for clinical placements.

    Kirsten Whitehead and colleagues developed a tool for the assessment of communications skills in dietetic consultations (DIET-COMMS: See http://onlinelibrary.wiley.com/doi/10.1111/jhn.12136/abstract). This tool was intended to provide a simple, validated process for use in the training of students who will be engaged in consultations to encourage diet-related behaviour change in patients, and for post-registration dietitians who want to assess or refine their skills. The DIET-COMMS tool and a training package for using it is available at http://www.nottingham.ac.uk/toolkits/play_13244. This site also has some fantastic video examples of good and bad consultations that are useful viewing for student dietitians. Use of tools such as DIET-COMMS will provide simple means of assessing performance of key communications skills that are accessible to students and trainers alike. 

  2. Now later

    As a university teacher I am always very aware of how challenging some of the assessment are that we set our students. This is often not because the concepts are difficult, but because the assessments involve long pieces of writing. We ask for essays, literature reviews, dissertations and theses, and yet our students have generally come to us because they have a passion for science and for hands-on practical work. For many of you each assignment brings the challenges of 'how do I get started?' and 'how do I plan and structure my writing?'. Sad to say, as teachers we sometimes don't give you an awful lot to go on.

    Making a start to a piece of writing can be incredibly tough. There are so many other interesting things to do. Just pop out to see how a friend is getting on and then start... Check Facebook quickly and then start… The flat is an awful mess, better tidy up and then start… Procrastination is easy and it also often covers up a basic fear of writing. Anxiety can stem from a variety of sources that range from the sheer volume of the task (a 10000 word dissertation is a massive job)  through to over-concern about making it perfect. All of these concerns can have a detrimental impact on what you're writing, makes the process painful for you and ensures that it takes you a lot longer. You are your own worst enemy when you're writing.

    So to get started, what do you do? Well although I am an experienced writer (I love to write!) but I still suffer from writer's block and struggle to get things underway. My approach is to keep things simple. What is the word limit for the piece? What are the sub-headings that I am going to use? From there I can allocate words to topic- each sub-heading gets a number of words allocated and then I start to just write key words down for each section. Then I start to add the flesh. Importantly I don't write from start to finish. The introduction is sometimes the last thing that I write. Writing is a psychological thing and the thing that stops us doing it effectively is confidence. So, build confidence by picking off the easy sections of the piece first. If you have to choose between 200 words describing statistics on breastfeeding in the UK, or 500 words that discuss contemporary literature on reasons why women choose not to breastfeed, then it's obvious what to go for. Write that easy stuff first. If you're writing a 2000 word piece and break that down into ten 200 word sections then by doing three or four easy bits first, you are suddenly 30% of the way to finishing without breaking sweat.

    Each piece of writing that you have to do will be different and will follow different rules depending upon who the target audience is. Obviously if you are preparing an information leaflet or writing a blog post, then that's going to be very different to producing an academic essay or a dissertation. One key step has to be to look at examples that are equivalent. How do they look? How are they structured? What little tricks are used to make them interesting and readable? Authors often make good use of sub-headings, graphs, diagrams and clear paragraph structures to ensure that their writing is appealing.

    I have produced a series of blog posts entitled 'How to Write' which were originally aimed at academic writers who are new to trying to get their work published. I've had good feedback from lots of people about this series and apparently they are really useful to undergraduate and postgraduate students. So, if you're putting together a dissertation or a thesis or maybe you've got the chance to go and present your work as an abstract at a conference, why not take a look and see if it helps you write.