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Achieving excellence in dietetics practice: Certification of specialists and advanced-level practitioners

1993; Elsevier BV; Volume: 93; Issue: 2 Linguagem: Inglês

10.1016/0002-8223(93)90829-a

1878-3570

Margaret L. Bogle, Lucy Balogun, Joanne Cassell, Amelia Catakis, Harold Holler, Carol Flynn,

Health Sciences Research and Education

The American Dietetic Association (ADA) has taken the lead among professional groups in providing objective and legally defensible certification processes to recognize advanced-level practitioners and specialists in pediatric, renal, and metabolic nutrition. This was accomplished through years of work and an exciting research project, which provided the models for credentialing and established a large base of descriptive data concerning the sociological and psychological contexts of dietetics practice as well as data on the criticality, frequency, and performance of tasks in three specialty areas. This is by far the most complete data available on the practice of registered dietitians (RDs) at all levels.The historic event was completed at ADA's 75th Annual Meeting, when the House of Delegates (HOD) culminated approximately 15 years of work by various units within ADA and the Commission on Dietetic Registration (CDR) by approving the following titles: Fellow of The American Dietetic Association (for advanced-level practitioners) and Board Certified in Pediatric Nutrition, Board Certified in Renal Nutrition, and Board Certified in Metabolic Nutrition (for specialists the initial three areas).ADA has established itself as a leader in the development and monitoring of quality educational and experience components for the dietetic technician, registered (DTR), and the entry-level RD. CDR has maintained innovative, credible certification programs that assure the public of the competence of DTRs and RDs. The certification process for RDs was among the first to require continuing education for renewal of the credential in order to verify continuing competence.The early years after registration focused on activities designed to promote and identify dietitians with the RD credential. As early as 1974, the need to “recognize and certify individuals [dietitians] who wish to be designated as specialists” was being considered by the Committee on Professional Registration, which later became CDR (1.Bogle ML Registration — the sine qua non of a competent dietitian.J Am Diet Assoc. 1974; 64: 616-620Google Scholar). Today we must move forward to “differentiate the roles and functions of dietitians” (2.3rd ed. The Profession of Dietetics: The Report of the Study Commission on Dietetics. American Dietetic Association, Chicago, Ill1972Google Scholar). Additional certification systems have become necessary to recognize dietitians who practice beyond entry level or who limit their practice to specialty areas. A president's report in the August 1990 Journal(3.Wellman NS Bogle ML The President's Page: beyond the RD.J Am Diet Assoc. 1990; 90: 1117-1121Google Scholar) chronicled the events leading to the creation of these new credentials.CONCERNS FOR THE MEMBERSHIPThe HOD has continuing concerns for the recruitment of new members and the retention and recognition of established members. Members leave the profession because of lack of opportunities for professional advancement, lack of appropriate and increasing monetary rewards, lack of recognition among dietetics professionals as well as outside the profession, and lack of time and opportunities to keep up with the knowledge and technical explosion in dietetics and nutrition. The increasing number of experienced practitioners switching careers leaves the profession without role models and peer experts — the very individuals so key to the continued development of the profession and of entry-level practitioners (4.Benditt J Women in science. 3rd ed. Science. 255. 1992: 1365-1373Google Scholar). An article in this Journal(5.Christie BW Kight MA Educational empowerment of the clinical dietitian: a proposed practice doctorate curriculum.J Am Diet Assoc. 1993; 93: 173-176Google Scholar) discusses the need for advanced-level education and practice for continued professional development of dietetics and nutrition practitioners.A system to recognize and identify role models and peer experts will help the profession be seen as having a broad scope of practice and career advancement possibilities. Many outside the profession and some within it view the profession of dietetics and nutrition as entry level only. They have accepted the paradigm that “all dietitians are alike.” This has made experienced and specialized dietitians noncompetitive in the job market. Currently, employers rely on recognition systems of other organizations, eg, the Certified Nutrition Support Dietitian (CNSD) of the American Society for Parenteral and Enteral Nutrition, and the Certified Diabetes Educator (CDE) of the American Association of Diabetes Educators. Each year, more and more dietitians qualify for those certifications in an effort to compete with their peer dietitians and their peers in other professions. Because of this trend and the fact most dietitians are employed in clinical areas, three clinical specialties — pediatric, renal, and metabolic nutrition — were the first to be investigated for certification. It is critical that ADA identify the diversity of practitioners and recognize them through a certification process that will provide for their career advancement and professional development.Thus, in 1985 the HOD charged the Council on Practice (COP) to develop a recognition system for advanced-level practitioners and specialists that would be voluntary, objective, and legally defensible and that would require maintenance and renewal components, would involve CDR as the certifying agency, and would work concurrently with other units of the Association. The 1983 Task Force on Education Report had concurred in the development of recognition systems and educational programs to meet the training and continuing education needs of specialists and advanced-level dietitians (6.3rd ed. Promoting Quality Dietetic Education: Report of the Task Force on Education. The American Dietetic Association, Chicago, Ill1983Google Scholar).ROLE DELINEATIONS FOR ADVANCED-LEVEL AND SPECIALTY PRACTICEA role delineation study for advanced-level and specialty practice was mandatory to provide definitions and models for certification. The results of that study are presented in this issue of the Journal(7.Bradley RT Young WY Ebbs P Martin J Characteristics of advanced-level dietetics practice: a model and empirical results.J Am Diet Assoc. 1993; 93: 196-202Google Scholar, 8.Bradley RT Young WY Ebbs P Martin J Specialty practice in dietetics: empirical models and results.J Am Diet Assoc. 1993; 93: 203-210Google Scholar). The Steering Committee for the study consisted of representatives from the Councils on Education, Research, and Practice, CDR, and the Board of Directors, ensuring that all units were kept up to date and enabling them to proceed simultaneously with related activities. This process allowed for rapid use of information from the study in developing the credentialing systems.Advanced-Level PracticeThis portion of the role delineation study was unique from several standpoints. It was obvious that knowledge and skills of an advanced-level practitioner were similar to those of the entry-level dietitian. Therefore differences, if they existed, had to be in the psychosocial areas or approaches to practice. There was no model to follow as no other group had attempted to study these phenomena among professionals. The steering committee gave anecdotal evidence to suggest differences in individual practitioners practicing at what they considered an advanced level. Such practitioners included mentors, role models, and dietitians sought out for consultation on day-to-day practice issues. Information from the 1989 Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians suggested that the advanced-level practitioner had greater job responsibilities, particularly in the areas of management, supervision, and finance (9.Kane MI Estes CA Colton DA Eltoft CS Role Delineations for Registered Dietitians and Entry-Level Dietetic Technicians. American Dietetic Association, Chicago, Ill1990Google Scholar).Based on this conceptual framework, the research generated an empirical model for advanced-level practice, which has the following minimum characteristics:Education and Experience — a registered dietitian (RD); a master's degree; 8 years of practice experience; current employment in dietetics practice;Professional Achievements — awards or honors; or authorship of journal articles, books, or book chapters; or major conference presentations;Approach to Practice — complements technical knowledge and skills with in-depth holistic understanding plus intervention; uses feelings and a process focus that is adaptable and creative; and values innovation and self knowledge;Role Positions — occupies multiple role positions with diverse and complex duties;Role Contacts — develops network of diverse practice contacts within and beyond local or immediate job area; andFees — payment of application and certification fees.Specialty PracticeThe study found that there were distinct differences among the specialty areas of renal, pediatric, and metabolic nutrition. It verified knowledge and skill requirements that were unique to each specialty and that were consistent across the three areas. The model identified other minimum criteria as:Education and Experience — a registered dietitian (RD); 6 years of practice in dietetics after obtaining RD; current practice in the specialty area;Examination — passing a written examination administered by CDR; andFees — payment of application, testing, and certification fees.THE CREDENTIALING PROCESSA joint task force of COP and CDR is refining the certification processes for advanced-level practice and the three specialty areas. Applications for individuals who wish to obtain either or both credentials will be available this spring, and the first credentials of Fellows or Board Certified Specialists will be awarded in late 1993 or early 1994. Additional information will be available in future Journals, the Courier, and other ADA newsletters.Recent Journal articles have proposed specialty certification in foodservice management areas (10.Sneed J Burwell EC Anderson M Development of financial management competencies for entry-level and advanced-level dietitians.J Am Diet Assoc. 1992; 92: 1223-1229Google Scholar) and defined the functional roles, responsibilities, and educational preparation of public health nutritionists as they advance in their careers (11.Haughton B Shaw J Functional roles of today's public health nutritionist.J Am Diet Assoc. 1992; 92: 1218-1222Google Scholar). In this issue, a report on job satisfaction of dietitians in New York City indicates the need for “higher salaries and more opportunities for advancement” and suggests that recognition of advanced-level practitioners and specialists will be beneficial (12.Dalton S Gilbride JA Russo L Vergis L Job satisfaction of clinical, community, and long-term-care dietitians in New York City.J Am Diet Assoc. 1993; 93: 184-186Google Scholar). These articles and others confirm the need for and the value of the new credentials.Other specialty areas will be identified and studied as practitioners become aware of credentialing needs in other areas. COP has a procedure in place for investigating additional specialties. For information, contact the Division of Practice, The American Dietetic Association, Suite 800, 216 W Jackson Blvd, Chicago, IL 60606-6996.CONCLUSIONThis research has provided the most complete descriptive data ever about dietitians and their relationships within and outside current practice settings, their social and role contacts, the variety of their professional achievements, and their approaches to practice and decision-making processes. Other professional groups will benefit from the generic nature of the model proposed for advanced-level practice and the unique research methodology. ADA has again taken the lead in professional credentialing.Certification of specialists and advanced-level practitioners comes just as we implement ADA's Strategic Thinking Initiative, which identifies the market segments crucial to dietetics practice: consumer education; retail foodservice; acute and long-term health care; and health care in disease prevention and wellness.The credentials Fellow and Board Certified Specialist will help position RDs in each market segment by identifying practitioners who can network within and outside ADA and who can function in multiple roles. The designation Board Certified Specialist will identify those with in-depth, state-of-the-art, and essential information in three critical areas of dietetics and health care. The credentials are significant implementation strategies for enhancing the RD's ability to obtain a substantial and sustainable competitive advantage in the marketplace.A recurring theme in health care reform proposals is the need for “quality practitioners.” ADA's new credentials will identify quality practitioners in dietetics and nutrition who can provide leadership for external alliances and who can be active in the legislative and political processes.Employers, other professionals, government agencies, and dietitians value and use existing credentials that distinguish quality and promote recognition. As we did with the RD credential, we must understand the value of these new credentials before we can promote their value to others. It is the responsibility of each dietitian to understand and promote the value of credentials provided by ADA. The American Dietetic Association (ADA) has taken the lead among professional groups in providing objective and legally defensible certification processes to recognize advanced-level practitioners and specialists in pediatric, renal, and metabolic nutrition. This was accomplished through years of work and an exciting research project, which provided the models for credentialing and established a large base of descriptive data concerning the sociological and psychological contexts of dietetics practice as well as data on the criticality, frequency, and performance of tasks in three specialty areas. This is by far the most complete data available on the practice of registered dietitians (RDs) at all levels. The historic event was completed at ADA's 75th Annual Meeting, when the House of Delegates (HOD) culminated approximately 15 years of work by various units within ADA and the Commission on Dietetic Registration (CDR) by approving the following titles: Fellow of The American Dietetic Association (for advanced-level practitioners) and Board Certified in Pediatric Nutrition, Board Certified in Renal Nutrition, and Board Certified in Metabolic Nutrition (for specialists the initial three areas). ADA has established itself as a leader in the development and monitoring of quality educational and experience components for the dietetic technician, registered (DTR), and the entry-level RD. CDR has maintained innovative, credible certification programs that assure the public of the competence of DTRs and RDs. The certification process for RDs was among the first to require continuing education for renewal of the credential in order to verify continuing competence. The early years after registration focused on activities designed to promote and identify dietitians with the RD credential. As early as 1974, the need to “recognize and certify individuals [dietitians] who wish to be designated as specialists” was being considered by the Committee on Professional Registration, which later became CDR (1.Bogle ML Registration — the sine qua non of a competent dietitian.J Am Diet Assoc. 1974; 64: 616-620Google Scholar). Today we must move forward to “differentiate the roles and functions of dietitians” (2.3rd ed. The Profession of Dietetics: The Report of the Study Commission on Dietetics. American Dietetic Association, Chicago, Ill1972Google Scholar). Additional certification systems have become necessary to recognize dietitians who practice beyond entry level or who limit their practice to specialty areas. A president's report in the August 1990 Journal(3.Wellman NS Bogle ML The President's Page: beyond the RD.J Am Diet Assoc. 1990; 90: 1117-1121Google Scholar) chronicled the events leading to the creation of these new credentials. CONCERNS FOR THE MEMBERSHIPThe HOD has continuing concerns for the recruitment of new members and the retention and recognition of established members. Members leave the profession because of lack of opportunities for professional advancement, lack of appropriate and increasing monetary rewards, lack of recognition among dietetics professionals as well as outside the profession, and lack of time and opportunities to keep up with the knowledge and technical explosion in dietetics and nutrition. The increasing number of experienced practitioners switching careers leaves the profession without role models and peer experts — the very individuals so key to the continued development of the profession and of entry-level practitioners (4.Benditt J Women in science. 3rd ed. Science. 255. 1992: 1365-1373Google Scholar). An article in this Journal(5.Christie BW Kight MA Educational empowerment of the clinical dietitian: a proposed practice doctorate curriculum.J Am Diet Assoc. 1993; 93: 173-176Google Scholar) discusses the need for advanced-level education and practice for continued professional development of dietetics and nutrition practitioners.A system to recognize and identify role models and peer experts will help the profession be seen as having a broad scope of practice and career advancement possibilities. Many outside the profession and some within it view the profession of dietetics and nutrition as entry level only. They have accepted the paradigm that “all dietitians are alike.” This has made experienced and specialized dietitians noncompetitive in the job market. Currently, employers rely on recognition systems of other organizations, eg, the Certified Nutrition Support Dietitian (CNSD) of the American Society for Parenteral and Enteral Nutrition, and the Certified Diabetes Educator (CDE) of the American Association of Diabetes Educators. Each year, more and more dietitians qualify for those certifications in an effort to compete with their peer dietitians and their peers in other professions. Because of this trend and the fact most dietitians are employed in clinical areas, three clinical specialties — pediatric, renal, and metabolic nutrition — were the first to be investigated for certification. It is critical that ADA identify the diversity of practitioners and recognize them through a certification process that will provide for their career advancement and professional development.Thus, in 1985 the HOD charged the Council on Practice (COP) to develop a recognition system for advanced-level practitioners and specialists that would be voluntary, objective, and legally defensible and that would require maintenance and renewal components, would involve CDR as the certifying agency, and would work concurrently with other units of the Association. The 1983 Task Force on Education Report had concurred in the development of recognition systems and educational programs to meet the training and continuing education needs of specialists and advanced-level dietitians (6.3rd ed. Promoting Quality Dietetic Education: Report of the Task Force on Education. The American Dietetic Association, Chicago, Ill1983Google Scholar). The HOD has continuing concerns for the recruitment of new members and the retention and recognition of established members. Members leave the profession because of lack of opportunities for professional advancement, lack of appropriate and increasing monetary rewards, lack of recognition among dietetics professionals as well as outside the profession, and lack of time and opportunities to keep up with the knowledge and technical explosion in dietetics and nutrition. The increasing number of experienced practitioners switching careers leaves the profession without role models and peer experts — the very individuals so key to the continued development of the profession and of entry-level practitioners (4.Benditt J Women in science. 3rd ed. Science. 255. 1992: 1365-1373Google Scholar). An article in this Journal(5.Christie BW Kight MA Educational empowerment of the clinical dietitian: a proposed practice doctorate curriculum.J Am Diet Assoc. 1993; 93: 173-176Google Scholar) discusses the need for advanced-level education and practice for continued professional development of dietetics and nutrition practitioners. A system to recognize and identify role models and peer experts will help the profession be seen as having a broad scope of practice and career advancement possibilities. Many outside the profession and some within it view the profession of dietetics and nutrition as entry level only. They have accepted the paradigm that “all dietitians are alike.” This has made experienced and specialized dietitians noncompetitive in the job market. Currently, employers rely on recognition systems of other organizations, eg, the Certified Nutrition Support Dietitian (CNSD) of the American Society for Parenteral and Enteral Nutrition, and the Certified Diabetes Educator (CDE) of the American Association of Diabetes Educators. Each year, more and more dietitians qualify for those certifications in an effort to compete with their peer dietitians and their peers in other professions. Because of this trend and the fact most dietitians are employed in clinical areas, three clinical specialties — pediatric, renal, and metabolic nutrition — were the first to be investigated for certification. It is critical that ADA identify the diversity of practitioners and recognize them through a certification process that will provide for their career advancement and professional development. Thus, in 1985 the HOD charged the Council on Practice (COP) to develop a recognition system for advanced-level practitioners and specialists that would be voluntary, objective, and legally defensible and that would require maintenance and renewal components, would involve CDR as the certifying agency, and would work concurrently with other units of the Association. The 1983 Task Force on Education Report had concurred in the development of recognition systems and educational programs to meet the training and continuing education needs of specialists and advanced-level dietitians (6.3rd ed. Promoting Quality Dietetic Education: Report of the Task Force on Education. The American Dietetic Association, Chicago, Ill1983Google Scholar). ROLE DELINEATIONS FOR ADVANCED-LEVEL AND SPECIALTY PRACTICEA role delineation study for advanced-level and specialty practice was mandatory to provide definitions and models for certification. The results of that study are presented in this issue of the Journal(7.Bradley RT Young WY Ebbs P Martin J Characteristics of advanced-level dietetics practice: a model and empirical results.J Am Diet Assoc. 1993; 93: 196-202Google Scholar, 8.Bradley RT Young WY Ebbs P Martin J Specialty practice in dietetics: empirical models and results.J Am Diet Assoc. 1993; 93: 203-210Google Scholar). The Steering Committee for the study consisted of representatives from the Councils on Education, Research, and Practice, CDR, and the Board of Directors, ensuring that all units were kept up to date and enabling them to proceed simultaneously with related activities. This process allowed for rapid use of information from the study in developing the credentialing systems.Advanced-Level PracticeThis portion of the role delineation study was unique from several standpoints. It was obvious that knowledge and skills of an advanced-level practitioner were similar to those of the entry-level dietitian. Therefore differences, if they existed, had to be in the psychosocial areas or approaches to practice. There was no model to follow as no other group had attempted to study these phenomena among professionals. The steering committee gave anecdotal evidence to suggest differences in individual practitioners practicing at what they considered an advanced level. Such practitioners included mentors, role models, and dietitians sought out for consultation on day-to-day practice issues. Information from the 1989 Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians suggested that the advanced-level practitioner had greater job responsibilities, particularly in the areas of management, supervision, and finance (9.Kane MI Estes CA Colton DA Eltoft CS Role Delineations for Registered Dietitians and Entry-Level Dietetic Technicians. American Dietetic Association, Chicago, Ill1990Google Scholar).Based on this conceptual framework, the research generated an empirical model for advanced-level practice, which has the following minimum characteristics:Education and Experience — a registered dietitian (RD); a master's degree; 8 years of practice experience; current employment in dietetics practice;Professional Achievements — awards or honors; or authorship of journal articles, books, or book chapters; or major conference presentations;Approach to Practice — complements technical knowledge and skills with in-depth holistic understanding plus intervention; uses feelings and a process focus that is adaptable and creative; and values innovation and self knowledge;Role Positions — occupies multiple role positions with diverse and complex duties;Role Contacts — develops network of diverse practice contacts within and beyond local or immediate job area; andFees — payment of application and certification fees.Specialty PracticeThe study found that there were distinct differences among the specialty areas of renal, pediatric, and metabolic nutrition. It verified knowledge and skill requirements that were unique to each specialty and that were consistent across the three areas. The model identified other minimum criteria as:Education and Experience — a registered dietitian (RD); 6 years of practice in dietetics after obtaining RD; current practice in the specialty area;Examination — passing a written examination administered by CDR; andFees — payment of application, testing, and certification fees. A role delineation study for advanced-level and specialty practice was mandatory to provide definitions and models for certification. The results of that study are presented in this issue of the Journal(7.Bradley RT Young WY Ebbs P Martin J Characteristics of advanced-level dietetics practice: a model and empirical results.J Am Diet Assoc. 1993; 93: 196-202Google Scholar, 8.Bradley RT Young WY Ebbs P Martin J Specialty practice in dietetics: empirical models and results.J Am Diet Assoc. 1993; 93: 203-210Google Scholar). The Steering Committee for the study consisted of representatives from the Councils on Education, Research, and Practice, CDR, and the Board of Directors, ensuring that all units were kept up to date and enabling them to proceed simultaneously with related activities. This process allowed for rapid use of information from the study in developing the credentialing systems. Advanced-Level PracticeThis portion of the role delineation study was unique from several standpoints. It was obvious that knowledge and skills of an advanced-level practitioner were similar to those of the entry-level dietitian. Therefore differences, if they existed, had to be in the psychosocial areas or approaches to practice. There was no model to follow as no other group had attempted to study these phenomena among professionals. The steering committee gave anecdotal evidence to suggest differences in individual practitioners practicing at what they considered an advanced level. Such practitioners included mentors, role models, and dietitians sought out for consultation on day-to-day practice issues. Information from the 1989 Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians suggested that the advanced-level practitioner had greater job responsibilities, particularly in the areas of management, supervision, and finance (9.Kane MI Estes CA Colton DA Eltoft CS Role Delineations for Registered Dietitians and Entry-Level Dietetic Technicians. American Dietetic Association, Chicago, Ill1990Google Scholar).Based on this conceptual framework, the research generated an empirical model for advanced-level practice, which has the following minimum characteristics:Education and Experience — a registered dietitian (RD); a master's degree; 8 years of practice experience; current employment in dietetics practice;Professional Achievements — awards or honors; or authorship of journal articles, books, or book chapters; or major conference presentations;Approach to Practice — complements technical knowledge and skills with in-depth holistic understanding plus intervention; uses feelings and a process focus that is adaptable and creative; and values innovation and self knowledge;Role Positions — occupies multiple role positions with diverse and complex duties;Role Contacts — develops network of diverse practice contacts within and beyond local or immediate job area; andFees — payment of application and certification fees. This portion of the role delineation study was unique from several standpoints. It was obvious that knowledge and skills of an advanced-level practitioner were similar to those of the entry-level dietitian. Therefore differences, if they existed, had to be in the psychosocial areas or approaches to practice. There was no model to follow as no other group had attempted to study these phenomena among professionals. The steering committee gave anecdotal evidence to suggest differences in individual practitioners practicing at what they considered an advanced level. Such practitioners included mentors, role models, and dietitians sought out for consultation on day-to-day practice issues. Information from the 1989 Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians suggested that the advanced-level practitioner had greater job responsibilities, particularly in the areas of management, supervision, and finance (9.Kane MI Estes CA Colton DA Eltoft CS Role Delineations for Registered Dietitians and Entry-Level Dietetic Technicians. American Dietetic Association, Chicago, Ill1990Google Scholar). Based on this conceptual framework, the research generated an empirical model for advanced-level practice, which has the following minimum characteristics:Education and Experience — a registered dietitian (RD); a master's degree; 8 years of practice experience; current employment in dietetics practice;Professional Achievements — awards or honors; or authorship of journal articles, books, or book chapters; or major conference presentations;Approach to Practice — complements technical knowledge and skills with in-depth holistic understanding plus intervention; uses feelings and a process focus that is adaptable and creative; and values innovation and self knowledge;Role Positions — occupies multiple role positions with diverse and complex duties;Role Contacts — develops network of diverse practice contacts within and beyond local or immediate job area; andFees — payment of application and certification fees. Specialty PracticeThe study found that there were distinct differences among the specialty areas of renal, pediatric, and metabolic nutrition. It verified knowledge and skill requirements that were unique to each specialty and that were consistent across the three areas. The model identified other minimum criteria as:Education and Experience — a registered dietitian (RD); 6 years of practice in dietetics after obtaining RD; current practice in the specialty area;Examination — passing a written examination administered by CDR; andFees — payment of application, testing, and certification fees. The study found that there were distinct differences among the specialty areas of renal, pediatric, and metabolic nutrition. It verified knowledge and skill requirements that were unique to each specialty and that were consistent across the three areas. The model identified other minimum criteria as:Education and Experience — a registered dietitian (RD); 6 years of practice in dietetics after obtaining RD; current practice in the specialty area;Examination — passing a written examination administered by CDR; andFees — payment of application, testing, and certification fees. THE CREDENTIALING PROCESSA joint task force of COP and CDR is refining the certification processes for advanced-level practice and the three specialty areas. Applications for individuals who wish to obtain either or both credentials will be available this spring, and the first credentials of Fellows or Board Certified Specialists will be awarded in late 1993 or early 1994. Additional information will be available in future Journals, the Courier, and other ADA newsletters.Recent Journal articles have proposed specialty certification in foodservice management areas (10.Sneed J Burwell EC Anderson M Development of financial management competencies for entry-level and advanced-level dietitians.J Am Diet Assoc. 1992; 92: 1223-1229Google Scholar) and defined the functional roles, responsibilities, and educational preparation of public health nutritionists as they advance in their careers (11.Haughton B Shaw J Functional roles of today's public health nutritionist.J Am Diet Assoc. 1992; 92: 1218-1222Google Scholar). In this issue, a report on job satisfaction of dietitians in New York City indicates the need for “higher salaries and more opportunities for advancement” and suggests that recognition of advanced-level practitioners and specialists will be beneficial (12.Dalton S Gilbride JA Russo L Vergis L Job satisfaction of clinical, community, and long-term-care dietitians in New York City.J Am Diet Assoc. 1993; 93: 184-186Google Scholar). These articles and others confirm the need for and the value of the new credentials.Other specialty areas will be identified and studied as practitioners become aware of credentialing needs in other areas. COP has a procedure in place for investigating additional specialties. For information, contact the Division of Practice, The American Dietetic Association, Suite 800, 216 W Jackson Blvd, Chicago, IL 60606-6996. A joint task force of COP and CDR is refining the certification processes for advanced-level practice and the three specialty areas. Applications for individuals who wish to obtain either or both credentials will be available this spring, and the first credentials of Fellows or Board Certified Specialists will be awarded in late 1993 or early 1994. Additional information will be available in future Journals, the Courier, and other ADA newsletters. Recent Journal articles have proposed specialty certification in foodservice management areas (10.Sneed J Burwell EC Anderson M Development of financial management competencies for entry-level and advanced-level dietitians.J Am Diet Assoc. 1992; 92: 1223-1229Google Scholar) and defined the functional roles, responsibilities, and educational preparation of public health nutritionists as they advance in their careers (11.Haughton B Shaw J Functional roles of today's public health nutritionist.J Am Diet Assoc. 1992; 92: 1218-1222Google Scholar). In this issue, a report on job satisfaction of dietitians in New York City indicates the need for “higher salaries and more opportunities for advancement” and suggests that recognition of advanced-level practitioners and specialists will be beneficial (12.Dalton S Gilbride JA Russo L Vergis L Job satisfaction of clinical, community, and long-term-care dietitians in New York City.J Am Diet Assoc. 1993; 93: 184-186Google Scholar). These articles and others confirm the need for and the value of the new credentials. Other specialty areas will be identified and studied as practitioners become aware of credentialing needs in other areas. COP has a procedure in place for investigating additional specialties. For information, contact the Division of Practice, The American Dietetic Association, Suite 800, 216 W Jackson Blvd, Chicago, IL 60606-6996. CONCLUSIONThis research has provided the most complete descriptive data ever about dietitians and their relationships within and outside current practice settings, their social and role contacts, the variety of their professional achievements, and their approaches to practice and decision-making processes. Other professional groups will benefit from the generic nature of the model proposed for advanced-level practice and the unique research methodology. ADA has again taken the lead in professional credentialing.Certification of specialists and advanced-level practitioners comes just as we implement ADA's Strategic Thinking Initiative, which identifies the market segments crucial to dietetics practice: consumer education; retail foodservice; acute and long-term health care; and health care in disease prevention and wellness.The credentials Fellow and Board Certified Specialist will help position RDs in each market segment by identifying practitioners who can network within and outside ADA and who can function in multiple roles. The designation Board Certified Specialist will identify those with in-depth, state-of-the-art, and essential information in three critical areas of dietetics and health care. The credentials are significant implementation strategies for enhancing the RD's ability to obtain a substantial and sustainable competitive advantage in the marketplace.A recurring theme in health care reform proposals is the need for “quality practitioners.” ADA's new credentials will identify quality practitioners in dietetics and nutrition who can provide leadership for external alliances and who can be active in the legislative and political processes.Employers, other professionals, government agencies, and dietitians value and use existing credentials that distinguish quality and promote recognition. As we did with the RD credential, we must understand the value of these new credentials before we can promote their value to others. It is the responsibility of each dietitian to understand and promote the value of credentials provided by ADA. This research has provided the most complete descriptive data ever about dietitians and their relationships within and outside current practice settings, their social and role contacts, the variety of their professional achievements, and their approaches to practice and decision-making processes. Other professional groups will benefit from the generic nature of the model proposed for advanced-level practice and the unique research methodology. ADA has again taken the lead in professional credentialing.