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The Next Generation of Dietitians: Implementing

Dietetics Education and Practice in Integrative
Medicine
a

Leigh E Wagner MS, RD, LD , Randall G. Evans MS, RD, LD , Diana Noland MPH, RD, LD CCN
b

Private Contractor , Rachel Barkley MS, RD, LD , Debra K Sullivan PhD, RD, LD & Jeanne
a

Drisko MD
a

University of Kansas Integrative Medicine, Kansas City, Kansas, USA

University of Kansas Department of Dietetics and Nutrition, Kansas City, Kansas, USA
Published online: 11 May 2015.

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To cite this article: Leigh E Wagner MS, RD, LD, Randall G. Evans MS, RD, LD, Diana Noland MPH, RD, LD CCN Private
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Review

The Next Generation of Dietitians: Implementing

Dietetics Education and Practice in Integrative
Medicine
Leigh E Wagner, MS, RD, LD*, Randall G. Evans, MS, RD, LD**, Diana Noland, MPH, RD, LD, CCN,
Rachel Barkley, MS, RD, LD, Debra K Sullivan, PhD, RD, LD, and Jeanne Drisko, MD
University of Kansas Integrative Medicine, (L.E.W., R.G.E., J.D.);
Private Contractor (D.N.); University of Kansas Department of Dietetics and Nutrition, Kansas City, Kansas, USA (D.N., R.B., D.K.S.)

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Key Words: interprofessional education, dietetics and integrative medicine, integrative medicine, nutrition and dietetics education, future practice
Integrative medicine is a quickly expanding field of health care that emphasizes nutrition as a key
component. Dietitians and nutritionists have an opportunity to meet workforce demands by practicing dietetics
and integrative medicine (DIM). The purpose of this article is to describe a DIM education program and
practicum. We report the results of an interprofessional nutrition education and practicum program between the
University of Kansas Medical Center (KUMC) Department of Dietetics and Nutrition and KU Integrative
Medicine. This partnered program provides training that builds on the strong foundation of the Nutrition Care
Process and adds graduate-level educational and practicum experiences in foundational integrative medicine
knowledge, including nutritional approaches from a systems biology perspective, nutrigenomics, and
biochemistry as the core knowledge to understand the root cause of a chronic disorder and to choose appropriate
nutritional tools for interventions. This interprofessional KUMC program provides a dietetic internship, masters
degree, and graduate certificate in DIM and fulfills a need for dietitians and nutritionists who seek careers
practicing in an integrative medicine setting. The program fulfills expanding workforce needs to provide quality
health care for patients with chronic illnesses.

INTRODUCTION

dietary changes [615]. But if nutritional interventions are to

address the chronic disease epidemic, a well-trained workforce
is mandatory [5,1619].
To address this chronic disease burden, creative
approaches are warranted. These new health care models are
being implemented in academic medical centers by integrative
medicine programs. In fact, among integrative medicine centers in the United States, Food/Nutrition and Supplements are
the leading two interventions [20], but dietitians and nutritionists are only fifth among six employed practitioners in integrative medicine programs (in descending order: physicians,
massage therapists, meditation instructors, acupuncturists, dietitians/nutritionists, yoga instructors). A natural question
arises: Who is implementing and managing these nutrition

The global burden of disease is unsustainable, and changes

in health care and education are required; the public policy,
health care, and economics arenas all agree [1,2]. In past decades, the health care priority was acute illness; today, the major
emphasis is the prevention and treatment of chronic disease
[3,4]. To address noncommunicable diseases, a new model of
health care and education is required [35]. One approach is
the application of nutritional therapies as prevention and treatment interventions [6]. Nutritional interventions are effective
therapies for many chronic illnesses; the top 5 chronic illnessescardiovascular disease, hypertension, asthma, mood
disorders, and cancerare positively impacted by lifestyle and

*Address correspondence to: Leigh Wagner, MS, RD, LD, University of Kansas Integrative Medicine, 3901 Rainbow Blvd. Mailstop 1017, Kansas City, KS 66160,
lwagner@kumc.edu. **Address reprints requests to: Randall G. Evans, MS, RD, LD, University of Kansas Integrative Medicine, 3901 Rainbow Blvd. Mailstop 1017,
Kansas City, KS 66160, USA. E-mail: revans5@kumc.edu.
Abbreviations: KU D University of Kansas, KUMC D University of Kansas Medical Center, IM D Integrative Medicine, DN D Dietetics and Nutrition, DIM D Dietetics
and Integrative Medicine, DIFM D Dietitians in Integrative and Functional Medicine, DPG D Dietetic Practice Group, The Academy D The Academy of Nutrition and
Dietetics, ACEND D Accreditation Council for Education in Nutrition and Dietetics.

Journal of the American College of Nutrition, Vol. 0, No. 0, 16 (2014) American College of Nutrition/
Published by Taylor & Francis Group, LLC
1

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The Next Generation of Dietitians

interventions? Dietitians and nutritionists are called to address
the changing health care needs in the dietetic workforce
[19,21]. Beyond conventional dietetic training, an understanding of systems biology, nutrigenomics, and biochemistry is
required as the core knowledge to understand the root cause
of a chronic disorder and to choose appropriate nutritional
tools for interventions [22,23], which is a piece of the newly
defined term personalized lifestyle medicine [24]. We contend that dietitians practicing integrative medicine are
addressing these challenges and that this paradigm needs
expansion to supply the skilled workforce.
The approach to dietetics and integrative medicine (DIM)
begins with food as a foundation for health and adds biochemically active nutritional supplements based on nutritional
assessments and guided by laboratory testing. Dietitians interested in a systems biology approach to nutritional assessment
require comprehensive educational opportunities in dietetics
and integrative medicine to gain knowledge and develop practice skills. Building upon the strong foundation of the Nutrition
Care Process by the Academy of Nutrition and Dietetics (the
Academy; formerly the American Dietetic Association), a
DIM educational program based on the framework of didactic
and supervised practice experiences in dietetic education, is an
avenue to fill workforce needs.
To address this problem, an interprofessional team at the
University of Kansas Medical Center (KUMC) developed programs and curriculum with the goal of training the next generation of dietitians of integrative medicine. The interprofessional
collaboration was facilitated by a nationally recognized dietitian practicing in an integrative medicine setting [4] and sought
to strengthen the relationship between the KUMC Department
of Dietetics and Nutrition (University of Kansas School of
Health Professions) and Integrative Medicine (University of
Kansas School of Medicine) to create sustainable educational
programs. This paper summarizes the phased approach to
implementing the DIM educational programs. A feasibility
study assessed the existing curriculum in the two University of
Kansas programs, identified content required to meet competencies in DIM, and developed plans for implementation,
benchmarks, and evaluation of the end products. We describe
the process undertaken beginning in 2009 to design and
develop a curriculum and programs in DIM for the dietetic
internship combined with the master of science in dietetics and
nutrition program, and a graduate certificate to educate students and health professionals in the concepts of DIM practice.

METHODS
Phase I
Designed as a partnership between the University of Kansas
Medical Center Department of Dietetics and Nutrition (KU

DN) (http://www.dietetics.kumc.edu/) and Integrative Medicine (KU IM) (https://integrativemed.kumc.edu), the scope of
the educational objectives and training includes a dietetic
internship along with a Master of Science degree in Dietetics
and Nutrition with a graduate certificate in DIM. We sought to
build on the pre-existing relationship between KU DN and KU
IM by exploring a more formal cooperative educational
arrangement. A consultant (D.N.) developed and implemented
the feasibility study in October 2010 and concluded in February 2011; the study explored two primary questions: (1) Does
the DIM Internship/Fellowship certificate fill a need in dietetic
education? And, (2) could the educational objectives be implemented considering regulations, funding, staffing, and time
involved? We provide results of the feasibility study below.

Question (1): Does the Dietetics and Integrative

Medicine Internship/Fellowship certificate and MS
degree Fill a Need in Dietetic Education?
The Academy published a report titled Health Care Reform
in 2008 on chronic disease, stating that obesity is an epidemic
affecting every age and demographic group [25]. Of particular
concern is the increased obesity rate among children, along
with development of hypertension and type 2 Diabetes. Heart
disease is the leading cause of death in the U.S. and stroke is
the third leading cause. These two cardiovascular diseases
account for more than 35% of all deaths in the United States
and are among the most widespread and costly health problems
facing our nation today, yet they are also among the most preventable. The report states that the World Health Organization
views nutrition as the foundation of health. Poor nutrition leads
to poor health and greater disease; the converse is that optimal
nutrition leads to good health and less disease.
Employment of registered dietitians is expected to grow
20% faster than the average rate from 2010 through 2020 in
practices related to treatment of chronic disease, caring for the
elderly population, and addressing public interest in nutrition,
so there is an undeniable need to expand the workforce [26].
The Academys Report of the Phase 2 Future Practice &
Education Task Force [27] contained pertinent recommendations related to the growing needs of the dietetic workforce.
Recommendation #5 is that . . . faculty of dietetics education
programs continue to implement a variety of flexible quality
education models. The Task Force also recommended the
continued implementation of an array of experiential routes
that satisfy entry-to-practice requirements. While the Task
Force fully supported continuation of current education models
to prepare dietitians for entry-level practice, it recognized that
additional models are needed to respond to challenges in
todays education and health care arenas. Recommendation #8
stated that the Academy should continue to recognize specialty practice areas in dietetics and provide support for additional appropriate education and credentialing opportunities.

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The Next Generation of Dietitians

Future specialty areas were identified that included health promotion/disease prevention. Within each broad specialty practice area, we propose a subspecialty area for DIM.
The Academysr Future Practice Visioning report [5] again
addressed the growing need for specialists and proposed
advanced practice areas in dietetics. The Task Force recommended (Recommendation #7) that the Academy continue to
recognize specialty practice areas in dietetics and provide support for additional, appropriate education and credentialing
opportunities, and suggested that the Academy define and recognize advanced practice specialties. Advanced practitioners
will be supported with educational programming and the
appropriate credentials. Again, we propose that dietitians practicing in integrative medicine be included as an advanced practice specialty. Practitioners of DIM are trained to work in a
variety of areas, including: medical clinics, private practice,
sports nutrition, corporate wellness, preventive services, contract work/consulting, industry, communications, public relations, marketing, restaurants and culinary arts, international
nutrition, research, and education.
The reports confirmed the need for an educational program
for dietitians in the area of DIM.

Question (2): Could the Educational Objectives Be

Implemented Considering Regulations, Collaboration
between University of Kansas Medical Center
Departments, Funding, Staffing, and Time Involved?
The DIM project Feasibility Study presented the findings of
the initial objectives and determined that the relationship
between KU DN and KU IM was sound. The approach for
implementation met regulatory and policy standards of KUMC
and met expectations of the Feasibility Study Team. The program plans met conditions of the accrediting organization, the
Accreditation Council for Education in Nutrition and Dietetics
(ACEND), and of the Academy for a dietetics and integrative
medicine track within the Dietetic Internship. All requirements
and implications of the DIM program were thoroughly
researched and met standards within the following departments: KUMC School of Health Professions, KUMC Office of
the Senior Vice Chancellor for Academic and Student Affairs,
Office of Graduate Studies Vice Chancellor of Academic
Affairs, State of Kansas.
The Feasibility Study resulted in the following recommendations presented to the stakeholders:
RECOMMENDATION 1: Continue collaboration between
KU DN and KU IM to develop and build upon an existing
ACEND-accredited Dietetic Internship and Master of Science
Degree by adding a Graduate Certificate in DIM.
RECOMMENDATION 2: Initiate the DIM project and the
commitment of supportive grant funds over three years, starting
May 2011, to be re-evaluated quarterly by stakeholders from

JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION

development to completion. Consider a possible fourth year for

completion of the full DIM project if the need arose.
RECOMMENDATION 3: Guide development of a goldstandard DIM program with KU DN and KU IM serving as
educational and supervised practice experiences for education
and training of dietetic interns, fellows, and graduate students.
RECOMMENDATION 4: Provide professional development
experiences during the DIM project for KU DN Faculty and
KU IM Registered Dietitians, to strengthen their knowledge
and understanding of the paradigm of integrative medicine to
develop skills in dietetics practice to support the DIM program.
RECOMMENDATION 5: Develop and publish a Curriculum
for DIM Internship/M.S./Fellowship with anticipated publication by August 2014.
RECOMMENDATION 6: Develop a plan to disseminate the
concept and curriculum nationwide to Nutrition and Dietetic
Educators and Preceptors (NDEP) and other nutrition educators
and organizations.

Phase II
Results of the feasibility report advised team members to
proceed to Phase II and develop goals for curriculum development and writing to include online and classroom content, dietetic internship, and practicum schedules. The DIM didactic
portion dovetailed with KU DNs academic schedule, while
the clinical training for the students selected to undergo the
DIM training was designated to take place in the KU IM clinic
for mentoring by experienced integrative dietitians. Additional
DIM rotations were scheduled as needed to meet program
requirements. The benchmarks were successfully completed
by the end of 2011. At the outset of Phase II, all parties agreed
that a Master of Science degree would be required for dietetic
interns to ensure adequate education to prepare them for specialization and complete the Graduate Certificate in DIM.
The KU IM clinic was chosen as a supervised practice
experience site for dietetic interns because of the interdisciplinary integrative practice environment. KU IM practices shared
decision making about care of patients with complex, chronic
diseases with participation from medical doctors, registered
nurses and advanced practice registered nurses, a naturopathic
doctor, board-certified neurofeedback technicians, and masters-level registered dietitians trained in the advanced specialty
of the application of clinical nutrition in integrative medicine.
The weekly chart review meeting allows discussion of cases
that require collaborative oversight to solve chronic complex
disorders. Interprofessional patient care is modeled in a nonthreatening, educational atmosphere with students from all disciplines, including residents and fellows. This is the optimal
training environment for dietetic interns to learn about DIM,
manage care for their own patient population, and actively participate in case discussion.

The Next Generation of Dietitians

Phase III

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Phase III was implemented in January of 2012 with a beta test

of the DIM internship curriculum with participation by an interested student who was, at that time, enrolled in the KUMC Dietetic Intern/Master of Science Program. The student spent time in
KU IM under the guidance of the staff dietitian from January
2012 through July 2012 prior to his graduation from the formal
KU DN Masters Program. Because of the early, apparent success of the beta test, the team decided to go forward with implementation of the KU DIM supervised practice experiences as
part of the existing dietetic internship. There was a subsequent
announcement in early 2012 that invited interested prospective
students to apply as fellows for the program with official start
date in August 2012. Two candidates were selected and began
the course of study. During this time period, KU DN faculty continued with professional development training in DIM.

Phase IV
Phase IV is underway and includes curriculum publication
projected by or before September 2014. At that time, the curriculum will be available to other interested universities and/or qualified organizations. Professional development funding was offered
during the three-year project to KU DN faculty to expand the
knowledge base of the DIM paradigm. With that, faculty members have attended national and local meetings, campus seminars,
and conferences focused on DIM approaches as well as shadowed
one of the KU IM dietitians. The team has invited outside integrative medicine experts for training of faculty and students campuswide. Plans are underway to host professional development
educational events for the national DIM professional community.
The collaboration between KU DN and KU IM is robust and
appears sustainable, with discussion of potential collaborative
research projects with graduate students and faculty.

Curriculum Development
Throughout all phases, curriculum was drafted and refined
through collaborative meetings. The team agreed upon learning
needs, competencies, and courses to fulfill core competencies
to earn a certificate in DIM. To earn the certificate of DIM, students must complete 4 core courses: (1) Dietary & Herbal Supplements, (2) Introduction to Dietetics and Integrative
Medicine, (3) A Nutrition Approach to Inflammation and
Immune Regulation, and (4) Nutrigenomics and Nutrigenetics
in Health and Disease. Each of the core courses emphasizes the
connection to, and prevention of, chronic diseases through
teaching individualized nutrition and lifestyle assessment,
intervention, and monitoring. See Table 1 for a curriculum
outline.
Additional practicum-specific curriculum was developed
for students completing internship hours with the KU IM registered dietitians. This curriculum is included in the e-book and

is divided into 5 modules: (1) Orientation and Introduction to

DIM; (2) Whole Foods and Targeted Nutrients; (3) Clinical
DIM; (4) Research in DIM; (5) Community DIM. These practicum modules are built on the principles of integrative medicine
focused on individualizing the diet and lifestyle of a patient
and include practical nutrition counseling skills like motivational interviewing lessons and observation, preparing and
teaching whole foods cooking classes in the KU IM Healing
Foods Kitchen and other community locations, experience
working on a local organic farm, and participation in campus
communitysupported agriculture activities.
Both conceptual and practical curricula provide a comprehensive foundation for future practitioners of DIM to not only
master in-depth nutritional biochemistry content but to partner
with patients in developing a therapeutic relationship to facilitate promoting restoring wellness. The training also includes
learning to teach basic cooking and nutrition to individual
patients as well as the general community in order to foster
behavioral change.

DISCUSSION
The results of the feasibility study were compelling and
guided the development of DIM clinical competencies and
training tools, and implementation of the training program that
began in 2012. With the need for advanced-practice DIM professionals, training in a rigorous academic environment with a
well-developed curriculum is mandatory [4,5,26]. Although
programs exist in DIM education, these programs do not
include the dietetic internship supervised practice experience
[29]. This KUMC program provides a dietetic internship, masters degree, and graduate certificate in DIM; it is expected to
meet expanding workforce needs to provide quality health care
for patients with chronic illnesses.
Integrative medicine is an evolving approach to health care
that is patient-centered and addresses the physical, emotional,
social, spiritual, and environmental influences impacting health
[20,30]. Integrative medicine also emphasizes a personalized
strategy that considers the patients unique conditions, needs,
and circumstances; it uses the appropriate interventions from
an array of health disciplines to promote healing and help people regain and maintain optimum health [16,20]. Integrative
medicine is an expanding discipline and the general practice of
personalized health care is increasing [5,14,16,20,31]. Moreover, there is a call for progressive health care education by
professional organizations and supported by the scientific literature [4,32]. The practice of DIM is an advanced specialty
practice that focuses on individualized medical nutrition therapy for chronic disease, informed by evidence that reaffirms
the importance of the relationship between practitioner
and patient and utilizes the growing scientific knowledge
of nutrition and metabolism regarding chronic disease

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The Next Generation of Dietitians

Table 1. Core Curriculum for DIM Graduate Certificate. Required courses are shown in bold
Year 1 End of year 1 dietetic intern completes DI certificate & eligible to take RD exam
Fall Semester 2013 11 hours

Spring Semester 2014 11 hours

DN 817 Seminar in Dietetics & Nutrition I

1 hr.
DN 825 Medical Nutrition Therapy I 3 hr.

DN 818 Seminar in Dietetics & Nutrition II

1 hr.
DN 826 Medical Nutrition Therapy II 3 hr.

DN 822 Management in Dietetics &

Nutrition I 2 hr.
DN 841 International Nutrition 1 hr.
DN 827 Practicum 4 hr. (graded S/U)

DN 823 Management in Dietetics &

Nutrition II 2 hr.
DN 842 US Public Health Nutrition 1 hr.
DN 827 Practicum 4 hr. (graded S/U)

496 hours supervised practice

496 hours supervised practice

Summer Semester 2014 6 hours

DN 880 Dietary & Herbal Supplements
3 hr.*
DN 819 Scientific Writing for Nutrition
1 hr.

DN 827 Practicum 2 hr. (graded S/U)

248 hours supervised practice
Curriculum includes motivational
interviewing lessons and observation

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Curriculum includes motivational

Curriculum includes motivational
interviewing lessons and observation
interviewing lessons and observation
Year 2 End of year 2 graduate student completes M.S. degree and DIM certificate
Fall Semester 2014 10 hours

Spring Semester 2015 10 hours

Summer Semester 2015 4 hours

DN 881 Introduction to Dietetics and

Integrative Medicine 3 hr.*

DN 882 A Nutrition Approach to

Inflammation and Immune Regulation
3 hr.*
DN 896 Micronutrients & Integrative
Metabolism 3 hr.
BIOS Principles of Statistics in Public
Health 3 hr.
DN 899 Thesis 1 hr. **
Non-thesis option requires additional 3 hour
elective course

DN 980 Nutrigenomics and Nutrigenetics

in Health and Disease 3 hr.*

DN 895 Macronutrients & Integrative

Metabolism 3 hr.
DN 834 Methods of Research in Nutrition
3 hr.
DN 899 Thesis 1 hr.**
**Non-thesis replace 3 hr. DN 899 with DN
854 in fall or spring semester

DN 899 Thesis 1 hr.**

52 graduate hours completed over 2 years
for thesis option; 55 hours for non-thesis
option

*Required courses for DIM Certificate; Updated May 8, 2013.

pathophysiology, long-latency nutrient insufficiencies, diet,

lifestyle,
genomics,
and
environmental
influences
[20,29,30,33,34].
The demand for education in DIM to address chronic health
problems necessitates the identification of required core competencies, learning objectives, and activities to guide the development of curriculum for dietetic internship supervised
practice experiences and content of courses for the graduate
certificate in DIM [4]. Developing flexible educational programs and curricula allows for individualized learning experiences. This process requires interprofessional education and
teamwork, which KUMC has adopted to teach the next generation of health care practitioners utilizing the KU DN programs
and the KU IM clinic. This is paramount given the current crisis in the health care delivery system and with the ascendancy
of noncommunicable chronic disease; a team of health professionals from multiple disciplines is required. A team-based
learning environment arms dietetic interns and graduate students for work as health care professionals [4]. We contend
that the KU DN and KU IM collaboration is a model for the
development of innovative educational programs for dietetic
interns and graduate students in the area of dietetics and integrative medicine. The result of this collaboration provides tools
for solving chronic and complex diseases with patient-focused,

JOURNAL OF THE AMERICAN COLLEGE OF NUTRITION

biochemically based nutritional interventions, and models a

method to train future practitioners.

ACKNOWLEDGMENTS
We thank KUMC Faculty and KU Integrative Medicine
staff and faculty for support and input regarding project design
and execution. KUMC dietetic interns and masters students
have contributed greatly to continued improvement of the education and practicum program. Due to trademark restrictions
on the term integrative nutrition, the authors of this article
and administrators of the program must use the term Dietetics
and Integrative Medicine or DIM and were unable to use
the preferred name for the program, which included
integrative nutrition.

FUNDING
Grant funding for this research project was made possible
by an anonymous private foundation. The funder had no input
into the design, writing, or submission of this project or authorship of the article.

The Next Generation of Dietitians

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Received February 18, 2014; accepted October 18, 2014.

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