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美國營養師的養成(中華民國營養師公會)

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發表於 2017-4-14 15:46:32 | 顯示全部樓層 |閱讀模式
文/林雅恩營養師    

    很多學生問我,如果畢業後到美國進修,想留在當地擔任營養師一職,要怎麼做?從哪裡開始準備?因此寫了這篇有關美國營養師的訓練過程和專業分級在職進修,希望從這篇文章,不但提供學生們一些資訊,也和大家分享美國培訓營養師、和之後在職進修的流程。
 在美國成為合格營養師,可以經過兩個管道:1. 由美國營養學會(Academy of Nutrition and Dietetics, 也就是前American Dietetic Association)認證的營養師,稱為RD(Registered Dietitian); 2. 由各州政府的教育局(State Office, Department of Education)認證的則稱為CDN(Certified Dietitian-Nutritionist)。也唯有通過這兩種認證的其中之一,才可以自稱為營養師,否則隨便打著營養師的名號做生意,是很有可能被告、被消費者提出訴訟的。RD 的認證較廣泛,可適用美國國境內任何一州,也就是只要有RD 的執照,到哪裡都可以執行營養師的一般業務,包括開立私人的營養診所。CDN 則是以州為單位,如果在紐約州拿到的CDN,想要搬家去加州營業,就必須在加州再申請一次當地的CDN。拿CDN 的原因,通常是與申 請保險的給付有關,也就是保險公司(尤其是聯邦政府的健保單位CMS, Center for Medicare & Medicaid Services),就只承認州立的CDN 來做標準給付。因此許多Outpatient Services 自行開業門診、或是在醫院開門診的營養師,就必須有該州的CDN 才能申請給付,否則就只能收自費的病人了。只要擁有RD 的認證,再申請取得CDN 也比較容易,以紐約州舉例,只需付250 美元的審查費,和等待約6-9 個月的審查過程即可取得。因此一般剛畢業的新鮮人,通常都以先取得RD為目標。
 取得RD 的第一步驟,就是要先修習過必修的課程(DPD program, Didactic
Program in Dietetics),並取得學士學位。這些課程需由美國營養學會認證的學術機構所開立設置。由於目前台灣並沒有一家學術單位經由美國營養學會認證,所以在台灣營養系所修習的課程學分是不能相抵的。因此如果台灣的學生想要在美國取得營養師執照,通常第一步就是先申請營養相關的研究所,並同時修習這些課程。(此網頁可幫助學生搜尋認證的學術機構 http://www.eatright.org/BecomeanRDorDTR/content.aspx?id=8472)這些課程修習完畢之後,則進行下一步驟:申請實習(DI program, Dietetic Internship)。「實習」也需由美國營養學會認證的學術機構舉辦,通常為期可由1年至2年不等,實習必須滿1200 小時,實習的內容也都有所細條規定。近年來由於金融風暴、二次就業市場需求量提升,想成為營養師的人數年年攀升,實習單位的申請程序也越來越複雜、越來越嚴謹。各學術單位也紛紛成立評選委員會,建立評選的機制系統,來過濾不適合的實習生。我本人曾在紐約大學的評審委員,當時的錄取率約20%,也就是約150 人報名,只有30 人錄取實習。申請程序與門檻包括:GPA>3.5(在校成績),GRE 或 GMAT 成績, 師長推薦信3 封,工作經驗(營養飲食相關或非相關皆要有),個人自傳及履歷,個人學習目標等。最後還要經過兩位營養師的面試,和經由電腦做全美國學校與人選的配對,才有可能過關被選上。當然這麼嚴謹的程序有可能是因為紐約大學位處市中心人口密集處,也有可能是他本身的名校名氣,但是這樣的程序其實大部份的學校也都採用,由此可知美國營養師的養成,在一步步的程序中,就已經刷掉許多不適合的人,而最後能被選上的,才能算是真正有營養師氣質的人選。實習可依學制的不同分為全職或半職,以全職來說,一個星期需工作40 小時,依照實習單位的規定輪班。通常以臨床為主的實習單位規定實習生必須完成13-17 週的臨床訓練,外加3-4 週代正式營養師的正常班,6 週的團膳訓練,以及3-4 週的社區營養訓練。若以社區營養為主的實習單位,臨床訓練的週數則較少,社區營養、團體衛教、公衛營養研究的訓練則較多。
 經過1-2 年的實習完成後,最後一步驟則是營養師考試。在通過營養師考試前,不能稱作營養師RD,只能稱作RD eligible。有些醫療機構因為人事上的需要,有時候會先錄用RD eligible 的實習畢業生,規定他們於6 個月內通過營養師執照後再予以加薪。營養師考試分為四個部份:一、營養飲食基本概念佔12%(食物學原理與食物營養素、營養科學、教育與溝通、營養飲食研究、管理概念); 二、個人或團體的營養照護佔50%(篩檢與評估、營養診斷、營養計畫與介入、營養偵測與評量); 三、食品營養的管理基礎佔21%(經營管理、人力管理、財務管理、行銷與公關、品質管理);四、團體膳食系統佔17%(菜單設計、採購生產分送與服務、食品衛生安全、設備與機構的設計、永續食物鏈的概念)。考試以125-145題選擇題組成,其中100-120 題為正式題目,25 題為試驗性題目(將列入營養學會題庫中做備存,經審查後成為正式題目)。所有題目皆於電腦上作答,考試時間為3 小時,費用200 元美金。記分方式為1-50 分,只要超過25 分則通過考試。電腦會依題數、難度等去做累計積分、計算最後的總分。從上列三部驟看來,美國營養師的養成中,比較困難的,應該可以算是申請實習的部份,因為評選的嚴謹程序,加上紮實的訓練過程,一步步的造就了營養師該有的基本能力,而不僅僅是通過考試就可以達到的。

表一:成為美國營養師的三大步驟


 拿到了 RD 認證的營養師,美國營養學會也對這些人有所規範。RD 營養師必須要填寫個人的專業發展紀錄(Professional Development Portfolio),裡面詳細敘述自己未來5 年對營養專業的相關計畫與執行方案,並於5 年內完成75 個繼續教育訓練學分。如果沒有達到上述的要求,美國營養師學會則有可能取消RD 營養師認證的資格。75 學分可以從很多方面拿到(如表二、三、四Approved CPE Activities),包括學術教育、個案報告、進階認證、展示、研討會、院內會議、小組討論、海報展示、擔任學會幹部、個人閱讀、研究報告、進階實習、以及網路、電腦、有聲書、影片學習等,都可列入紀錄中,由美國營養學會審查。

表二:


表三:


表四:


 因此,5 年75 學分對大部份的營養師來說,都不是難事。另外不論學會或就業市場(醫院、學校等),也鼓勵營養師再進修,拿到進階證照(如表五),包括CDE(糖尿病衛教師)、CNSC(重症營養支持認證)、以及美國營養學會本會認證的CSG(老人營養師)、CSS(運動營養師)、CSP(兒童營養師)、CSR(腎臟營養師)、CSO(癌症營養師)等等。
以上大致分享了有關美國營養師的養成過程,以及在職訓練與發展的趨勢,希望大家能從別人的經驗上學習,看看如何可以更進一步的加強國內未來每一位營養師的各項技能,才能實際上提升營養師專業的地位。







出處中華民國營養師公會全國聯合會電子報第24期-美國營養師的養成
http://www2.dietitians.org.tw/tdnews_epaper/epaper_024/epaper024-06-1.htm


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發表於 2017-12-3 20:52:11 | 顯示全部樓層

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發表於 2017-12-3 21:04:16 | 顯示全部樓層

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發表於 2017-12-3 21:34:27 | 顯示全部樓層

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