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Addressing remaining issues
The UNU/IUNS Workshop has affirmed the longstanding recognition that the solution to food and nutrition problems requires the integration of knowledge from many disciplines. However, it has also agreed that disciplinary knowledge is not sufficient. Equally important is the need to integrate this with the knowledge and interests of whichever significant groups may be affected by the problems and/or the proposed solutions, as well as those whose cooperation and support may be required for implementing the proposed solutions. In most cases, these significant groups extend beyond the professionals in government, bilateral and international agencies, non-governmental organizations, and academia who make, design, and implement food and nutrition policies and programmes. It also includes communities; private sector entities; civic, religious, and lay organizations; social advocates; media; and others. This integration can occur most readily and effectively through the direct participation of these groups in all stages of the process, from problem formulation through implementation and evaluation of actions. This has long been recognized to be the case at the community level, but it is now recognized to be equally valid for national policy and programme decision-making.
The Workshop has concluded that effective professionals should have four attributes that should be the focus of advanced training:
» a broad interdisciplinary perspective on the nature of food and nutrition problems and the range of approaches required for their amelioration;
» specialized knowledge that will prepare them for at least one of the six career tracks identified at the Workshop;
» specialized skills required for at least one of the six career tracks;
» a set of professional attitudes and orientations that fosters the integration of knowledge from diverse sources and the development of effective working relationships with other professionals and significant groups required for addressing food and nutrition problems.
Although these attributes are considered essential for effective nutrition practioners per se, it is also important to consider how advanced training might enhance the motivation and ability of professionals in other sectors (such as planning, agriculture, economics, and administration) to address the nutritional dimensions of their work more effectively.
Given the overall objective of developing a more effective cadre of nutrition professionals, the Workshop identified the functional specialities, or career tracks, that are likely to differ to a varying extent in their advanced training requirements; the relevant bodies of knowledge and skills; and the training modalities. These are discussed in the next section, followed by a description of specific activities and issues to be addressed in the implementation.
Six functional specialities in applied nutrition were identified, as shown in figure 1:
Teachers in universities or training centres are in a position to train the future generation of nutrition-related professionals.
Problem-oriented researchers have the ability to conduct a variety of food- and nutrition-related research at community, national, and international levels, usually in an interdisciplinary context. It is recognized that a continuing need exists for highly specialized, discipline-based research, but this Workshop focused on the problem-oriented variety.
Policy planners may be employed in food and nutrition sections of government or in other sections that do not have food and nutrition in their titles. These professionals are usually found in the technical and planning sections of national ministries and bilateral and international agencies. They are responsible for identifying and analysing key problems and trends within a given policy domain or sector and advising policy makers on alternative policy options. As such, they can exert a significant influence on the shape of national and agency policy.
FIG. 1. Functional specialities
University teachers and trainers at training centres
-food and nutrition
Industry nutrition specialists
Industry nutrition specialists are responsible for advising their companies on product development, labelling, marketing and advertising, and consumer relations. Given these roles, they are potentially important partners that the other functional specialists should seek out. The effectiveness of those partnerships would be enhanced if these individuals were to receive some exposure to, or training in, the broad multidisciplinary approach to nutrition.
Communicators can have roles at several levels. They may be health or nutrition educators at the community level, designers and implementers of social marketing or other educational programmes at district through national levels, advisers in the design of national advocacy efforts, public relations officers, and employees within governmental or non-governmental mass media organizations (such as journalists). This speciality is considered a critically important component of any national nutrition effort.
Most of these categories can be further divided into those that are directly focused on food and nutrition issues (e.g., nutrition policy planners and nutrition programme managers) versus those working in nutrition-related areas (e.g., agricultural policy planners and health programme managers). Advanced training should be directed at both types, although different levels and methods will be required.
It should be noted that the term functional specialities, as used here, refers to the particular sets of knowledge and skills required to be effective in various professional settings. This is distinct from the more traditional, discipline-based specialities, because the relevant knowledge and skills for a given professional function are likely to come from a variety of disciplines and experiential sources. The more traditional, discipline-based specialities are appropriate for conducting specialized research within a given discipline, but do not provide the necessary breadth for effective practitioners. It is recognized that there may be partial overlap in the knowledge and skills required for some of the six specialities, and that a given individual may play more than one role during his or her career.
Relevant bodies of knowledge, skills, and professional orientations
The Workshop concluded that the need for cross-disciplinary breadth as well as functional depth is best addressed by conceptualizing a core body of knowledge, skills, and attitudes and a variety of functional specialities. The relevant bodies of knowledge and skills in the core were defined in the Workshop as shown in figure 2. As shown, the relevant knowledge spans a variety of biological and social sciences in order to facilitate the analysis of food and nutrition problems at multiple levels (molecular, physiological, individual, household, population, and institutional) and across multiple sectors (health, agricultural, economic). The requisite skills include those required for the assessment and analysis of problems, causes, and consequences within each level and across various sectors. The skills component also includes those required for initiating, managing, and evaluating actions to ameliorate food and nutrition problems. This includes a variety of programme-management skills (planning, implementation, and evaluation), several forms of communication-centred skills (e.g., negotiation and collaborative problem-solving), and leadership skills (e.g., visioning and strategic planning, motivational skills, group facilitation, and entrepreneurial problem-solving).
FIG. 2. Bodies of knowledge, skills, and attitudes: The core component
- characteristics of foods
Ecology of food and nutrition
- food and agricultural systems
Economics: micro and macro concepts
- as part of programme management skills
Communication, negotiation, motivation, and collaborative problem-solving,
Principles of reflective practice
It is readily appreciated that this collection of knowledge-, skill-, and attitude-development components poses several significant challenges. Among these are the time constraints in various training curricula, the need to integrate concepts and skills across domains and in an operational framework, the need for teachers and trainers from a breadth of backgrounds, and the need to operate a cross-cutting training programme within institutions whose structures, reward systems, and values are still based on a disciplinary model. These issues are addressed in the section on training modalities.
The relevant bodies of knowledge and skills required in various functional specialities were more difficult to define in this Workshop, in part because not all of the relevant specializations were represented. It was proposed that this task be accomplished as a follow-up activity to the Workshop, in collaboration with institutions with recognized strengths in these functional specialities.
A variety of modalities exist for advanced training, including degree programmes (M.S., M.P.S., and Ph.D.) as well as workshops, short courses, in-service and on-the-job training, distance education, fieldwork for research- or programme-based work, exchanges involving lecturers and various forms of practitioners, mentoring, and others. The choice of the most appropriate modality will depend upon the purpose of the training, the audience and their prior knowledge and skills, and the resources and institutional possibilities in a given country or region. As a general principle, the Workshop noted that experience- and practice-oriented modalities are the most effective ones for acquiring and integrating knowledge and skills, and that training programmes should emphasize the use of these forms of training. It was also noted that one of the most effective methods for developing leadership skills and the desirable professional orientation (collaborative, entrepreneurial, innovative, etc.) is through role modelling. Thus, for example, the use of programme- and policy-based practitioners in degree or shorter-term training would be encouraged, as would the use of mentoring and field or experiential learning that exposes students to appropriate role models. There is also some positive experience with the use of practitioner profiles or narratives written in the first person, which could be compiled specifically for this purpose. The profiles are personal experiences in problem-solving, written by practioners to be used in training programmes. They have been found to be an effective tool for practitioner training in professions similar to those being described here for nutrition specialists .
As regards the breadth of the core component and the challenges it poses, the Workshop made the following observations and suggestions.
Defining core concepts and skills
There is a critical need to identify not only the broad bodies of knowledge in the core component (as shown in fig. 2), but also the core concepts and principles within each domain that are critical for effective understanding and problem-solving. One method of doing so, based on analysis of problem-based case studies, was suggested by Pelletier . In deciding the core concepts and principles, it is useful to bear in mind that the goal should be to prepare practitioners to be able to recognize situations in which they should consult specialists in a given area and to meaningfully converse with such specialists. Examples of such situations include the following: (1) nutrient interactions or bioavailability might be an issue, so that it would be necessary to seek out specialists who could elaborate on that possibility; (2) an evaluation design might be flawed by inadequate sample sizes, a grossly non-comparable control group, or reporting biases; (3) an agricultural programme might claim nutritional improvement as one of its goals, but its design might be based on a naive understanding of household behaviour and the causes of malnutrition. This is quite different from expecting students to acquire all of the specialized knowledge from these various domains. It may be useful to define and distinguish the knowledge required for familiarity versus competence versus expertise in formulating the core curriculum.
Flexible use of modules
In many university settings, entire one-semester courses are offered in each of the disciplines or knowledge domains shown in figure 2, which makes it totally infeasible for students to achieve this degree of breadth. Moreover, it is not clear that the content of such courses corresponds to the critical knowledge and skills that practitioners require; many of the social science courses may not be based on nutrition examples and nutrition-relevant issues; and the critical process of integrating knowledge across disciplinary boundaries is left to the student. Thus, the Workshop is not proposing that training programmes attempt to use full-semester courses in each of these disciplines to create a core curriculum. Rather, it is suggested that a core course be constructed anew for this purpose, if one does not yet exist. In some institutions, this has been accomplished through the use of a block or modular system. In such a system, the students interact intensively with peers and specialists in small groups for one to three weeks before proceeding to the next module. This system requires close coordination between the specialists and the overall course director, and a facilitated learning approach. Some positive experiences were reported with this approach by several members of the Workshop. Some of these programmes have been described elsewhere , but one of the recommendations from the Workshop is that more effort be made in sharing descriptions of innovative programmes along these lines.
The use of a modular approach in designing the core is particularly attractive, because each module can easily form the basis for specific workshops, and because degree students can complete their requirements in a more flexible schedule over a longer period of time. The possibility of creating modules for specialized training should be further explored, in relation to the full range of functional specialities.
The two-track model
In the context of masters degree programmes, the Workshop noted the importance of distinguishing a Master of Science (M.S.) degree from a Master of Professional Studies (M.P.S.) degree track. This is the two-track model shown in figure 3. The figure shows that the same core component would apply to both tracks and be taken early in the programme. However, the M.S. students would devote a considerable portion of their electives to methodology and course work in support of their research project. This often requires a second year of study. The methodological and research-oriented requirements for an M.S. would normally preclude taking sufficient course work to become a functional specialist in programme management or policy planning, for example. Thus, it is suggested that a professional degree (M.P.S.) is preferred for such students, so that they have sufficient time to take the specialized courses in support of their speciality. In this track, the functional specialists would devote one-half of their programme to specialized electives. Moreover, a community-based experience, or programme- or policy-relevant experience, would be more readily acceptable as a capstone project for an M.P.S.-type degree. These considerations are important because they make it possible for students to complete a degree in one year instead of two, and they avoid the unrealistic expectation that functional specialists could and should be as expert in research methods as M.S. students, as well as becoming proficient in their functional specialities.
FIG. 3. The two-track model. Experience capstone can often be shorter than M.S. research projects. M.S. research practice usually requires a second year. Capstone is for integration in a speciality area
· Experience capstone can often be shorter than M.S. research projects.
· M.S. research practice usually requires a second year.
· Capstone is for integration in a specialty area.
The Workshop noted the fact that most applicants to such a programme would probably have a life sciences background, including sufficient biology and social sciences to be able to benefit from the core curriculum. However, students with social science backgrounds may not have sufficient background in biology. Since it is desirable to bring a diverse range of students and professionals into such a programme (e.g., economists, planners, administrators, journalists), it is recommended that levelling-off work in biology (or social sciences) be provided in order to minimize the barriers to such a programme. It is also recognized that the M.P.S. track is best suited to those with some prior work experience.
Sensitizing other specialists
Whereas figure 3 addresses the needs for training functional specialists whose core interests are in food and nutrition, it is also necessary to consider how to make the core component accessible to specialists in other sectors or disciplines, such as economics, agriculture, administration, public health, education, mass media, and so on. The Workshop provided three specific suggestions for accomplishing this. First, in the context of academic programmes, the core component discussed here could form the foundation for a minor in food and nutrition for those majoring in other fields of study. Second, in the context of in-service training, advocacy, and sensitization, some of the modules from the core component could become the basis for short courses for professionals in other sectors. Third, as noted in one of the keynote papers , it might be desirable to produce nutrition case studies (as monographs) that are written in the language and concepts of those other disciplines, for use in courses in those other disciplines, in order to provide passive sensitization to food and nutrition issues.
It is recognized that the success of this effort depends upon the broad participation of universities and training centres in developed and developing countries. In considering how to implement this effort, the Workshop realized that there are several ways in which linkages and networks among training institutions could be facilitative and supportive. Likewise, it was recognized that outside resources would be catalytic and instrumental in many cases. It is anticipated that such possibilities will be explored as a follow-up to this Workshop. However, the Workshop felt it important to communicate that, philosophically, the effort should not be made dependent upon the success or timing of such efforts. Rather, it is considered important that each institution or set of national institutions should be encouraged and facilitated to do whatever they can within their own resources, while simultaneously contributing to the continued evolution of this effort. Some suggestions for how this might be accomplished are provided below.
Some of the actions that can be taken by an individual institution are to (1) conduct a review of the focus and content of its own training programme in relation to the one proposed here; (2) share its programme description, syllabi, and materials with other institutions; (3) identify areas in its programme requiring strengthening; and (4) enter into a dialogue with other training institutions to identify mechanisms of mutual support.
The publication of these proceedings in the Food and Nutrition Bulletin and the advent of the 1997 IUNS Congress in Montreal represent opportunities to move this process forward. Specifically, this issue of the Bulletin provides guidance to individual institutions to assist in their own internal review. The IUNS Congress may include a mini-symposium to inform others of this movement more fully and invite them to contribute to its further development and implementation.
This Workshop places a high priority on ensuring an open and inclusive process in order to achieve broad participation and maximum impact. Individual institutions may participate in any number of ways. It is expected that participating institutions would have in common (1) an interest in addressing food and nutrition problems from a broad, interdisciplinary, and problem-oriented perspective; (2) a desire to improve the effectiveness of their trainees; (3) an interest in sharing programme descriptions, syllabi, and materials with other institutions and having access to similar information from others; and (4) a longer-term interest in serving as a model in the country or region and in advocating for a problem-oriented, multidisciplinary approach.
Despite the progress made at this Workshop, a number of key issues remain to be resolved. First among these is how to achieve as broad a participation as possible, and it is proposed that the IUNS Congress in Montreal be one of the venues for doing so. One of the outcomes of that meeting may be an agreement concerning a mechanism for addressing these issues. Some of the remaining issues include the following:
» identifying institutional strengths in various functional specialities;
» deciding how to implement quality assurance;
» ensuring that teachers are prepared to use the multidisciplinary, problem-oriented approach;
» linking interdisciplinary, problem-oriented research by Ph.D. and M.S. students to the development and implementation of programmes and policies;
» identifying additional institutional needs;
» finding ways to implement this new approach within traditional university structures;
» finding ways for institutions to support each other in exchange of materials, lecturers, and so forth;
» developing mechanisms for cross-institutional degree programmes;
» developing a database of graduates to assist with communication, continuing education, and future evaluation;
» obtaining financial and other resource support from industry, agencies, and governments.
Finally, one of the most important issues to be resolved is how to monitor the progress in implementing this multidisciplinary, problem-oriented approach to training and how to evaluate its impact. To some extent, it is premature to discuss this until some of the remaining issues identified above have been discussed and some more concrete strategies and activities have been agreed upon. However, even at this stage, it is possible to propose some indicators and approaches for monitoring and evaluation.
These would be defined on the basis of the more detailed implementation plan to be developed subsequent to the Montreal Conference in mid-1997. In principle, however, they might include such things as the number of institutions that have expressed interest in or joined the regional networks; the extent to which course descriptions, syllabi, and materials have been developed, shared with others, and incorporated into training programmes; the number of courses (of all modalities) and the number and proportion of students receiving training in this approach, as registered in a UNU global database; and the number of training institutions participating in a quality assurance programme and thereby indicating that their curricula reflect this approach.
Although it would be desirable to be able to evaluate the impact of this programme on the prevalence of food- and nutrition-related problems, the multiple determinants of such problems render that an unrealistic expectation. Instead, it is highly realistic to expect to see an improvement in the quality of knowledge, skills, and performance of graduates of these programmes. A systematic evaluation design for this would require the construction of a database on registered graduates (which would be one of the products arising from the process evaluation described above), which could provide the basis for a sampling frame. On a periodic basis, a sample of these graduates could be contacted (e.g., at the time they attend refresher courses) to discuss challenges they face in their jobs, how they have addressed these in the past, and the types of training that might assist in the future. These discussions may reveal the types of decisions and judgements they have made in the past, which may be the most revealing indicators of impact, because they represent the indicators that are least affected by the institutional and other factors that are beyond the control of the graduate. In principle, it should be possible for the evaluation process to reveal the quality of past decisions and thus assess the quality of the training effort (recognizing that this is, in turn, a reflection of the quality of recruits, the quality of the training, and the quality of the continuing education and information networks). For example, the quality of decisions could be evaluated in relation to the following: the degree to which the programmes designed by an individual are found to match with the nature of the problem, the country context, and other requirements for sound programme design; the degree to which elements of a national plan match with the country situation (e.g., food self-sufficiency versus trade as food security strategies); or the design of a social marketing campaign or growth monitoring programme. As noted, evaluations along these lines would be most appropriate as part of a larger reentry plan, as discussed in the paper on short-term training .
Chairperson: Kraisid Tontisirin
Rapporteur: David Pelletier
Participants: Corazon Barba, Purnima Kashap, Rainer Gross, Mohd. Ismail Noor, Gail Harrison
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