Q + A: An Interview with Heidi Silver

There's a whole new opportunity driven by biomedical and nursing informatics to apply advance technology to dietetics research, teaching and practice

There's a whole new opportunity driven by biomedical and nursing informatics to apply advance technology to dietetics research, teaching and practice

Program Director Heidi Silver, Ph.D., R.D., has taken on many challenge throughout her 20-plus-year career in dietetics and nutrition. Now she is working with the School of Nursing to launch a master’s program that will educate a new generation of advanced practice dietitians and move the profession forward in meaningful ways.

What do you want everyone reading this to know about the new program?

It is unusual to have a School of Nursing expand to offer academic degrees to other health care professionals. But, the nursing profession can teach dietitians many lessons and provide key insights. It’s a fabulous opportunity for both professions to interact and learn from each other academically and professionally. We offer two speciality tracks at the master’s level&emdash;Nutrition Informatics and Nutrition Management in Health Care Systems.

Why is now the right time to launch this?

Several reasons . . . the School of Nursing has been very, very successful with its undergraduate nutrition courses, but there are no academic programs at Vanderbilt University for those who want to pursue the profession. There is a renewed interest in nutrition practice and research throughout the University which is driven by changes in health care delivery and the epidemics of obesity and diabetes. Tennessee is the third highest state in the incidence of obesity. It’s the first time in our nation and in our state, where malnutrition is affecting every life stage, every disease state and every health care setting. We can’t ignore nutrition anymore because these problems are not going away. We need to create advanced degree programs that train a whole new cadre of dietetics professionals whose knowledge and skills can make a positive impact on this health crisis.

Why does this make sense for a school of nursing?

Because there are many similarities in terms of practice and philosophy between nursing and dietetics. For one thing, they are both predominantly female professions. And, nurses have been very successful in creating advanced degrees and career paths that moved their profession beyond bedside nursing. The profession of dietetics is working on that, too.

What kind of graduate student are you trying to attract?

We want students who want to advance dietetics practice by learning specialized skills that require assuming greater responsibility and accountability in the profession. Our students will need to create new markets for dietitians in terms of jobs and raise awareness for the value of the profession. We want pioneers because we have chosen two unique specialty tracks&emdash;especially our nutritional informatics track, which we believe is the first program to offer this as a dietetics specialty.

What is Nutrition Informatics?

There’s a whole new opportunity driven by biomedical and nursing informatics to apply advanced technology to dietetics research, teaching and practice. The electronic health record is a strong example of how informatics can be used routinely in nutrition screening, but there are many other applications such as using digital photography to record and measure food intake or using wearable electronic devices for dietary assessment or using hand-held devices to calculate nutrient needs or deriving formulas for enteral and parenteral nutrition.

There's a whole new opportunity driven by biomedical and nursing informatics to apply advance technology to dietetics research, teaching and practice

There's a whole new opportunity driven by biomedical and nursing informatics to apply advance technology to dietetics research, teaching and practice

What are some other changes?

Technology in dietetics is also being used for food and supply inventory management, in research for large software databases of foods and beverages that allow nutrient analysis, in electronic systems for reimbursement of medical nutrition therapy, and most recently in using Internet resources to provide nutrition education and counseling. Also new, due to the bioterrorism events we face, is the use of technology in food surveillance.

What is Nutrition Management in Health Care Systems?

Many dietitians in management positions have learned on the job. Traditionally, management in our field has meant the hospital clinical nutrition manager or food service administrator. But there are many other opportunities with advanced academic training. For example, dietitians can be excellent case managers. Most dietitians have years of clinical training, building on comprehensive academic training in health and disease, so there is no educational or technical reason that we can’t assume those responsibilities. It is also important to the future of dietetics that dietitians are involved in decision making. Our profession does not have staffing ratios in health care settings. So there may be 10 dietitians for a 600-bed facility or 35 dietitians for the same facility&emdash;this significantly impacts the quality of care. But, if dietitians have positions that enable them to participate in higher level decision-making these types of quality issues can be improved.

What is the course delivery for this program?

We will use the block format already in place at the School of Nursing, with a three- to seven-day block on campus at the beginning and end of each semester, and course delivery online in the middle. Distance education is relatively new in dietetics so this is another lesson we are learning from nursing.

What is the Lipscomb connection with this program?

Lipscomb undergraduates can do a 3-2 program&emdash;three years at Lipscomb and two years at VUSN. They would graduate with a bachelor’s from Lipscomb and a master’s from Vanderbilt in five years. Lipscomb is also offering a one-year undergraduate certificate in dietetics for Vanderbilt undergraduates so that a VU undergrad could enter our master’s program with a bachelor’s degree in another field.

How did you first get interested in the world of nutrition and dietetics?

I started my health career with a bachelor’s in speech and hearing sciences. After graduation I taught sign language to deaf kindergarten and first graders in Georgia. During this time, my father was diagnosed with colon cancer. He had all these gastro-intestinal problems which resulted in severe weight loss and a rapid decline. So, I became interested in the role of food and nutrition. After he died, I relocated from our family home in Massachusetts to Florida and pursued my master’s in nutrition. I worked for many years at the University of Miami /Jackson Memorial Center as the chief dietitian on their nutrition support service.

Did you have an “aha” moment that prompted you to pursue your Ph.D.?

As a dependent practitioner, I had to rely on physicians to write orders for nutrition care plan implementation. I started collecting outcomes data on my patients that was heartbreaking. I found that 57 percent of my plans were either not being implemented or inaccurately implemented. That propelled me to present my results to the chairs of surgery and medicine. They were as shocked as I was at the gap in care delivery. So we decided to pursue getting me clinical privileges for nutrition order writing. It was a long process, but we achieved it. After that, I decided I wanted to continue to do research that has the potential to impact clinical practice.

Why did you want to be the program director?

We have an untapped opportunity to combine the quality of teaching that VUSN is known for with the high-impact research being conducted at Vanderbilt. We can use this to produce advanced practice dietitians who will use their knowledge and skills to move our profession forward in new and great ways.

For more information about the M.S. in Nutrition and Dietetics contact Sarah Mcllvaine at Sarah.Mcllvaine@vanderbilt.edu