Integrating nutrition and genetic counseling: A case study approach to interprofessional learning

Interprofessional collaboration is an increasingly important skillset for practicing healthcare professionals including genetic counselors and registered dietitian nutritionists. A multi‐part interactive case study activity was created to develop interprofessional skills for graduate students within genetic counseling and medical nutrition training programs at an academic medical center. Feedback from learners who participated in this activity highlights its effect on their post‐graduation clinical practice. Additionally, since the implementation of this activity, collaboration between students and faculty members of each program has occurred in other scholarly pursuits, fostering longstanding interprofessional relationships. Similar approaches to interprofessional education could be considered with other healthcare professions or at other institutions as another tool to strengthen practice upon graduation.

accreditation standards for these professions have grown to reflect the need for interprofessional care, including care best addressed by collaboration between these disciplines.Current standards of accreditation for graduate programs in genetic counseling published by the Accreditation Council for Genetic Counseling (ACGC) state that gen-  During initial conversations, it became clear that collaborative activities and lectures would support the education of graduate students in both programs by expanding the roster of instructors to include those with expertise in other areas of practice.Over the following months, faculty members from these programs developed a collaborative casebased activity designed to pair students from both programs to work together to provide interprofessional patient care.

| Activity
This activity consists of four clinical case scenarios developed by program faculty and presented to the students in two parts, culminating in a student-led presentation (Figure 2).Each case highlights clinical scenarios that both genetic counselors and registered dietitian nutritionists (RDN) may encounter during practice within different specialty areas including oncology, cardiology, and diabetes care (Figure 3).This first set of questions serves as a 'checkpoint' for assessment by program faculty, prior to providing additional information to the students.

| Case study part 2: Clinical encounter
After student groups present their preliminary responses to faculty, additional clinical information is released to the groups.This to patient care.These questions address psychosocial assessment and counseling techniques that could be used when working with these patients, along with options for genetic testing and how results could change patient care from the perspectives of both the genetic counselor and RDN.

| Case study part 3: Interprofessional presentation
To culminate the learning experience, student groups develop a presentation of their case, including a clinical information summary, thought process, and approach to patient care.At a later date, the MMN and MGC students reconvene, and each group presents their case and plan to their classmates.The presentation portion of this activity provides a chance for the students to gain insight into all clinical scenarios, not just their own.It also allows students and faculty to pose questions for assessment and strengthen learning points.

| Evaluation and Outcomes
The activity is graded using a rubric developed by program faculty, focusing on both quality of content and reflection of interprofessional learning.As part of course evaluations, both the medical nutrition and genetic counseling programs collect student feedback on this activity.A summary of student testimonials is provided in Table 1.Student feedback from both instances supports the continuation of this activity, with reflections showing a strengthening appreciation for each other's profession.For example, one MMN student reflected, Unfortunately, we cannot control our genes and what genetic predispositions we may have that increase our risk for a certain disease.However, nutrition is a risk factor we can modify.I think the collaboration between dietitians and genetic counselors will be very beneficial moving forward as more research emerges regarding the link between nutrition and genetics.This quote highlights the critical thinking application of how both fields can play an important role in patient care, emphasizing the importance of drawing from each other's expertise.Additionally, the MGC students found the activity enlightening and unifying, as illustrated by a MGC student reflection, I was very reluctant going into the activity, but I really enjoyed it!I think that it was a great way to expose us to their field and meet with other students.Going to grad school in COVID era has been a little isolating from other programs, and it was fun to collaborate on something that was useful.

MMN students MGC students
The discussion with the genetic counseling students was very fascinating, as it sparked the need for us, as future dietitians to really consider genetic components and collaboration with genetic professionals.Understanding basic genetics and knowing who to go to can definitely help us tailor our nutrition education/interventions Genetic Counselors often work as part of a team so it was nice to use our expertise while also learning from others This [activity] led to conversations about our different viewpoints and overall helped us work together.In the end, we all agreed that we better understood the others specialty and what they would focus on the most in our case study scenario I think this activity was helpful and a good learning experience!I didn't really know a lot about medical nutrition going into it, so it was helpful to learn from other specialties I liked working with the genetic counseling students, but there were times when I feel like me and the other MMN student did not have much to contribute.There were aspects of the project that were very genetic-focused, and it almost felt like the genetic counseling students had more work to contribute I have mixed feelings about the IPE activity.I did learn from the medical nutrition students, but I didn't enjoy the presentation aspect of it.The questions asked for our group were very Genetics or Nutrition focused so we just broke up the questions and did not collaborate as much as we should have Abbreviations: MGC, Master of Genetic Counseling; MMN, Master of Medical Nutrition.

| Future directions
While the activity had notable strengths and evident gains in interprofessional knowledge, student critique and desire for further natural collaboration between specialties has driven targeted changes, leading to a more dynamic and hands-on approach.To address student feedback, clinical experience with standardized patient encounters was developed, allowing the students to directly eral content areas required to support the development of practicebased competencies in genetic counseling must include personalized genomic medicine and establishing and maintaining professional interdisciplinary relationships (Standards of Accreditation for Graduate Programs in Genetic Counseling, 2019).Similarly, graduate programs that are accredited by the Accrediting Council for Education in Nutrition and Dietetics (ACEND) emphasize the importance of teambased care, with performance indicators requiring students to "work with and facilitate intraprofessional and interprofessional collaboration and teamwork" as well as, "understand and respect roles and responsibilities of interprofessional team members" (ACEND, 2019).Furthermore, understanding concepts of genetics and their relationship to nutrition and disease development, such as nutrient-gene interactions and inborn errors of metabolism, are now a part of the required foundational knowledge competencies (ACEND, 2019).As the fields of genetics and nutrition continue to grow, these overlaps in content expertise provide a critical opportunity to create interprofessional collaboration (Figure 1).
This need for interprofessional collaboration has been recognized by the University of Nebraska Medical Center (UNMC) and its College of Allied Health Professions (CAHP), who have encouraged faculty to create opportunities for collaboration to include students within training programs at UNMC.UNMC's CAHP houses both the Master of Medical Nutrition (MMN) and Master of Genetic Counseling (MGC) graduate training programs.Seeking to elevate practice and prepare students to be competent in the increasing integration and collaboration between the genetic counseling and medical nutrition spheres, the MMN and MGC programs created a shared vision of interprofessional development.In the winter of 2019, faculty members from UNMC's MMN and MGC training programs met to discuss potential opportunities for interprofessional collaboration between these programs.
2.2.1 | Case study part 1: Examination of evidenceStudents are initially provided with a summary of the clinical scenario which includes patient phrases, attitudes, or statements to allow for psychosocial assessment.With this information in hand, students are tasked to answer an initial set of questions, prompting F I G U R E 1 Opportunities for Interprofessional Collaboration in the fields of Genetic Counseling and Nutrition and Dietetics.an examination of what pieces of clinical data are missing to formulate a plan of action.This includes considering the etiology of the patient's condition(s), including the possibility of complex multifactorial forms of disease versus those secondary to monogenic disorders, and the role genetic testing may play in risk assessment.Students are also tasked with reviewing the current research evidence on the nutrition recommendations and the disease state and understanding other clinical guidance tools.Students work together to answer these questions, explaining their reasoning and thought process to their interprofessional colleagues as they document their responses.
second set of information includes further clinical data, which the students should have identified as being needed for clinical assessment during the first part of the activity.Depending on the clinic scenario and student thought process, this data may change their clinical impression and plan for patient care.For instance, information initially provided may suggest a multifactorial etiology to the patient's condition, but upon review of the additional data provided, students may recognize data points that instead suggest a monogenic disorder.Along with the second set of information, students complete additional questions assessing their learning and approach F I G U R E 2 Outline of Progression of Interprofessional Case Work.F I G U R E 3 Summary of the Interprofessional Case Studies.
Several genetic counseling students noted the lasting impact of the activity on their clinical practice post-graduation.Program graduates from the last 2 years were contacted for additional feedback and shared, Having this practice opportunity prepared me for my current position where I collaborate with other healthcare providers that have different training experiences.I learned a lot about how there can be multiple factors that play a role in a person's presentation/symptoms.I am now a part of a "Cancer Risk & Prevention" clinic, where I work with a NP [Nurse Practitioner] or PA [Physician Assistant], and we counsel on ways to reduce cancer risk after someone has had genetic testing, including nutrition, physical activity, behaviors, surgeries, screenings, etc.
observe and learn from each other's assessment and counseling skills.Now, students will continue to complete part one of the case study, creating an action plan of what further information needs to be obtained, but will then apply this into a simulated clinical experience.Students will gather further information and develop a synergistic co-counseling plan while working with a standardized patient who has been trained to portray the role of the patient presented in the clinical scenario.Students will also have the ability to observe how each other's profession navigates patient care, fostering interprofessional understanding and respect.As before, students will present their case summary and interventions, along with an interprofessional reflection, to the whole class.The clinical experience expansion will be implemented Fall 2022 and will continue annually for second-year students of each program.While the benefits and feedback of the new approach are not available at the time of writing, we expect the hands-on, collaborative approach to deepen the cross-learning between specialties.3| D ISCUSS I ON AND CON CLUS I ONThis case study activity not only promoted collaboration and learning between the MMN and MGC students within the context of their respective courses but has directly benefited the CAHP programs in other ways.This collaboration led to more direct, open communication and partnership between members of the MMN and MGC programs at UNMC.As a result of this strengthened relationship, our students have access to interprofessional expertise in other ways.Faculty of the MGC program now provide lectures to the MMN students on genetic concepts, including direct-to-consumer testing, and both programs participate in a combined research course led by MMN faculty.Additionally, a student of the MGC program designed and executed her capstone project with mentorship from both MGC and MMN faculty on the topic of providing nutrition recommendations for cancer prevention after receiving genetic counseling to improve patient empowerment (Tlusty et al., 2022).Now published, the results support the need for additional research on the impact of diet education on patient outcomes within the genetic counseling environment.This type of research innovation between genetics and nutrition directly aligns with current funding opportunities and initiatives from the National Institutes of Health (NIH), including the 2020-2030 NIH Strategic Plan for Nutrition Research (2020-2030 Strategic Plan for NIH Nutrition Research, 2020) and NIH All of Us Research Program ("All of Us Research Program,", 2022), focusing efforts on understanding personalized healthcare, including precision nutrition and genetics.As genetic counseling and medical nutrition continue to be recognized and expand as integral parts of personalized healthcare, the benefits of capitalizing on the complementary nature of these two disciplines are clear.Therefore, innovative collaborations, such as the examples presented here, are essential to preparing our respective students to navigate shared responsibilities and recognize when to involve each other to optimize patient care.Similar approaches to interprofessional education could be considered with other healthcare professions, such as pharmacy and physician assistant programs, to promote other interdisciplinary collaboration.Based on student feedback and faculty assessments, our MMN and MGC program faculty recommend academic medical centers or other institutions with professional healthcare programs consider an interactive partnership model, such as the one presented here, as another tool to strengthen clinical skills and increase knowledge of resources across specialties.