A Series of Fortunate Events

Fortunate. A word here which means extremely lucky, blessed in fact.

Let me explain.

A Series of Unfortunate Events is a tale beloved by my whole family. We swooned as Jim Carey played the evil Count Olaf in 2004. We squealed with delight as Neil Patrick Harris played the role in the 2017 Netflix series.

We waited with anticipation for the release of Season 2, which (in 2018) coincided with the Easter Long weekend. We planned a weekend get-together and prepared for a fabulous family weekend. Little did I know I would have wonderful news to share.

A few hours before the Easter break I received an email from my Primary Supervisor asking me if I would be available to support the Maggie Beer Masterclass being conducted in Brisbane from Sunday the 8th April through to Tuesday the 10th April.

Despite my office being at a completely different end of the campus to hers, I am quite sure she heard me squeal with delight!

*cue the flashback scene that provides the necessary background information for the audience*

I began my degree in Nutrition and Dietetics at Flinders University in 2014. This is also the year that the Nutrition and Dietetics Department announced a partnership with the Maggie Beer Foundation. Clearly, a fabulous and auspicious year!

The Foundation was borne out of Maggie Beer’s passion to enhance the food experience of older people (1). Their joint vision is to ensure good nutrition and reduced risk of malnutrition among older Australians living in residential aged care facilities.

Born in Sydney in 1945, and raised in Sydney’s western suburbs Maggie Beer left school at the age of 14 to help support her family. She relocated to the Barossa Valley in 1979 and launched the iconic Barossa Pheasant Farm Restaurant and branched into producing her own line of gourmet products (2). Her love of fresh, seasonal ingredients to create flavoursome food has made her a recognizable personality in most Australian homes.

In 2010 Maggie Beer was named Senior Australian of the Year (3). In preparation for a speaking engagement at the annual Aged & Community Services Australia conference, she researched food service an aged care and recognised many areas for improvement (4).

She met with the Federal Minister for Aging, Mark Butler, to discuss forming a partnership, however, discussions were unfruitful. From this experience, the Maggie Beer Foundation was born and experts from various sectors involved with food provision in aged care such as chefs, cooks, dietitians, and academics, just to name a few, were invited to participate.

The foundation and its partners act as advocates and agents for change to enhance the food experience for older people living in residential aged care facilities.





The Foundation has implemented ‘The Maggie Beer Appetite for Life’ program which provides hands-on workshops chefs and cooks involved in food service provision in residential aged care facilities.

During the workshop participants listen to expert speakers on health, wellbeing and nutrition in the elderly. Hands-on workshops include mystery box challenges and other cooking sessions where theory is put into practice.

The goal of these workshops is to inspire chefs and cooks to transform the food experience of residents in aged care facilities.

I am very excited to be able to meet Maggie Beer and to roll up my sleeves and work side by side with the cooks and chefs who are the backbone of food service provision in this setting. This is a very valuable opportunity for me as a dietitian and an incredible networking opportunity for me as a researcher.

(1) https://www.maggiebeerfoundation.org.au/mission
(2) https://en.wikipedia.org/wiki/Maggie_Beer
(3) https://www.australianoftheyear.org.au/alumni/connect/maggie-beer/
(4) https://www.australianageingagenda.com.au/2014/07/31/maggie-beers-food-crusade/

What does a research dietitian do?

I like to think that research dietitians are the bedrock upon which dietetics as a profession is built (actually I like to think we are rockstars but that's a bit self-serving!)

Every day, in every way, the overwhelming majority of us feel the presence of research dietitians. Whether that is quite removed via reading a food label or directly through a consultation with a dietitian, this is all underpinned by scientific research.

Dietetics is an evidence-based practice. This means that everything we do must be supported by solid evidence. We can’t just make a random recommendation based upon our personal beliefs and biases. That would be unethical.

When we recommend that you eat five serves of vegetables a day it’s because a large body of evidence conducted over a long period of time has shown us that people who eat more serves of veg a day have better health outcomes than people who don’t.

What is research anyway, and why do we need to do it? It wasn’t until I started writing this article that I realised how difficult it can be to explain. They say, however, that if you can’t explain it simply then you don’t understand it well enough yourself. So here goes…

Typically, research begins with a question.

Some studies aim to fill in gaps in knowledge by answering a question that we don’t know the answer to, this could be “What happens if?”

Some studies aim to challenge or improve upon existing knowledge, for example “Is X better than Y?”

The figure below helps to illustrate the different ways in which questions arise (1). Sometimes the question is developed by the researcher or academic. Other times it is developed by the observant practitioner who identifies a problem. Regardless of the type of question, it is usually answered with either primary research or secondary research.

Primary research involves field work. That means getting out there and collecting/analysing the data yourself. Not only are dietitians are involved in developing the question they develop the tool for collecting the data.

This could be a questionnaire or survey asking people to report their habits.

This could be an individual interview asking people about their opinions or experiences.

It could be analysing blood tests or body measurements to objectively quantify the effects of different treatments.

Secondary research means collecting/analysing existing data.

This can be from large observational studies such as EPIC (European Prospective Investigation into Cancer and Nutrition) (2). In this study large amounts of people were recruited (more than half a million) and their lifestyle habits such as diet, exercise, smoking etc were observed over time (15 years). In a study like this participants who are diagnosed with cancer are then compared with people who were not diagnosed with cancer to see if we can understand where the differences are.

Another method of secondary research is analysing the data from published studies.

Any researcher will tell you one isolated study really doesn’t mean that much, you have to look at what several studies say. Do they agree with each other? Do they disagree with each other? If they disagree, why? What accounts for the differences? This method of secondary research is called evidence analysis or literature review.

This helps us to put evidence in context.

In both circumstances, once the data has been collected the dietitian needs to analyse and interpret the data. This often means some pretty hefty statistical analysis.

Indeed, the next few months of my candidature will be spent re-learning the basics of statistics and developing skills in the more advanced concepts. Why are statistics important? Because they help us to demonstrate the size of effect and whether this is clinically relevant.

I fear I haven’t done a very good job of explaining the intricacies of the research dietitian! I didn’t even touch on the differences between quantitative and qualitative research or study design. For now I leave you with the knowledge that research is all about asking, and hopefully answering, questions.

(1) Research in Nutrition and Dietetics—What Can the Academy Do for You?

Hand, Rosa K. Journal of the Academy of Nutrition and Dietetics , Volume 114 , Issue 1 , 131 - 135

(2) http://epic.iarc.fr/

Imposter Syndrome & Internalised Stigma

This isn’t the blog I was expecting to write today.

I wanted to discuss Australia’s aging population and introduce the topic of residential aged care facilities but we had a visiting academic and I took the opportunity to make some new connections and joined the team for morning tea.

I listened, fascinated, as they talked about their experiences as parents, raising young children, private schools, and backyard hens. The conversation turned to children's birthday parties and hand-made birthday cakes and the joy such celebrations bring.

At the risk of sounding maudlin, we didn’t have birthday cakes in our family. Mine was a poor family, we struggled to make ends meet and birthday cakes were a luxury we couldn't afford.

As I listened to these women I felt so…other. They were from a world I knew nothing about. Although we all shared the common point of postgraduate research, I felt like a complete and utter fraud. I didn’t belong here.

At that point, it dawned on me. I was experiencing ‘imposter syndrome’.

My supervisor warned me that imposter syndrome was very common. Imposter syndrome is commonly described as ‘the fear that someday someone will discover you are not the person everyone thought you were’ (1).

What surprised me was the way in which I felt like an imposter. I expected that I would feel academically inferior. I was prepared for that moment when I was facing a complex statistical analysis and started telling myself “I can’t do this, I’m not smart enough”.

That’s not what happened.

I’ve always been what is politely referred to “lower class”, less politely we are called "bogan trash".

I was forced to leave home at fifteen, this meant giving up high school in favour of work. Where once I had dreamed of going to university I was working at Hungry Jacks. Instead of a career, I had children.

All of my life I have lived below the poverty line, sometimes surviving on welfare but mostly making ends meet on a single income.

I felt socially inferior.

I compared myself to these incredibly accomplished and respected women and I felt like a second-class citizen.

The phrase “you can’t make a silk purse out of a sow’s ear” clanged through my brain. You cannot produce something refined, admirable and valuable from something which is unrefined, unpleasant or of little value (2).

When I caught those thoughts I realised what I was experiencing was more nuanced, and far more insidious, than imposter syndrome. I was experiencing internalised stigma (3).

I was repeating to myself the same classist and discriminatory comments I had heard my entire life. When I let this sink in I had an epiphany. It wasn't that I didn't belong, I was simply under-represented. 

Going through my undergrad degree in Nutrition and Dietetics I was keenly aware that I was the largest person in the room. I eventually understood this didn't mean I was in the wrong place but rather, there is a lack of diversity in our profession.

I realised today that my history didn't mean I was in the wrong place.

Although it might be uncommon for a previously uneducated middle-aged woman from a lower class background to undertake postgraduate studies, that was not an indicator that I do not belong. Quite the opposite, in fact. It told me how very important it was that I am there, representing others like me. 

If you ever find yourself questioning whether you belong somewhere, stop and check your surroundings. Are there others like you around?

If you don't see anyone who could be your role model that means you (yes, you) are going to be a role model for someone else. I think that's incredible. Lonely and challenging perhaps, but incredible.

I invite you to share the words of the talented Shane Koyczan with me.

(1) http://geekfeminism.wikia.com/wiki/Impostor_syndrome
(2) https://en.wiktionary.org/wiki/make_a_silk_purse_of_a_sow%27s_ear
(30 https://www.mentalhealth.org.nz/assets/ResourceFinder/individual-self-stigma-resource-card-4.pdf

Image courtesy of Pexels.

What does a food service dietitian do?

Compared to the other areas of dietetics, the role of the food service dietitian doesn’t appear very glamorous.

You won’t see us creating personalised meal plans for famous athletes, you won’t see us on hospital wards caring for the ill.

Chances are though, if you eat out, at some point, your menu choices have been influenced by a food service dietitian.

Increasingly, organisations are coming on board with wanting to provide their staff and patrons with nutritionally balanced options.

Your in-flight meal might have been given the nod by a dietitian, the food served in child-care centres is often reviewed by us, and even cafeterias in large corporate offices may request our services.

Meal delivery services that provide you with a week's worth of lunch and/or dinners delivered directly to your door are almost certainly going to have a dietitian on board.

These interactions typically only comprise a small portion of the food you regularly eat and as such, our influence can be easily missed.

If, however, you find yourself eating a meal provided by the military, hospitals, boarding schools, prisons or residential aged care facilities then we are the people responsible for ensuring you receive a nutritionally balanced meal.

When you need us the most, when you are 100% reliant on food provided to you, we’re there to help.

Our job in these situations is to ensure that the food provided to people in these facilities is:

• Nutritionally adequate and aligned with the dietary guidelines. This means ensuring that you are being offered a broad range of foods from the five food groups. Sounds pretty simple right? If it were simple more Australians would be doing it, however, Census data suggests that less than 4% of Australians are eating in line with our guidelines (1). But wait, there’s more…

• The food on offer should be appropriate to your clinical/cultural and aesthetic needs. This means that it if you have a clinical condition, such as hypertension, then the food offered to you is low in salt. It also means that if you have cultural preferences, such as preferring Asian cuisine, that you aren’t only being offered British-style foods. It also means your meal must look good AND you must be able to eat it (no point giving you a juicy T-bone if you’ve just had dentures fitted). It’s starting to become a bit more complicated... but wait, there’s more…

• We don’t just have to know about the food you are being served, we have to know about the food service system that is creating and serving your food. How are you ordering your food? The day before? A week before? Ala Carte? Do you order electronically or with pen and paper? How is the food made? Is it made fresh in an on-site kitchen? Is it brought in from an external site and reheated before service? How is the food served? In a community dining room? On a tray by your bed? Taking all of that into consideration, how do we ensure that you get a meal that meets your needs, looks good, tastes good and is still warm when you get it? Starting to feel like a lot of balls to juggle... but wait, there’s more…

• Not only do we need to do ALL of the above but we have to make ALL of the stakeholders happy including the chefs and cooks, the food service staff, the carer staff, the family and last but not least, the economists. Yes, we have to run a food service which meets patient/client needs, supports improved outcomes and is cost-effective... AND we have to find a way to continually make improvements.

If that sounds like a lot to juggle and keep on top of, it is. In fact, one publication even refers to us as "superheroes" (2).

My area of interest is food service in residential aged care facilities, which have additional considerations on top of those highlighted above. Enough considerations that it warrants a stand-alone post. Stay tuned!

(1) Australian Health Survey: Consumption of Food Groups from the Australian Dietary Guidelines, 2011-12

(2) Wright, O. R. (2017), Foodservice management returns: The need to rejuvenate the superhero contribution of dietetics. Nutr Diet, 74: 113-115. doi:10.1111/1747-0080.12349

Photograph courtesy of Pexels. https://www.pexels.com/

Planning Meeting

*cue motivating soundtrack*

The big day was finally here! I was getting to sit down with both my Primary Supervisor and Associate Supervisor. I had a list of questions a mile long and I was finally going to get some answers....

*screeching sound as needle drags across the record*

That's not exactly how my meeting went but forward planning certainly helped to fill in a lot of blanks. Thinkwell has a Ph.D. Toolkit that includes a three-year thesis planner, meeting agenda and meeting notes template. Over the past two weeks, every time a question popped into my head, I jotted it into the agenda.

When I walked in and sat down the first thing my Primary suggested was that I come to meetings armed with an agenda. I was able to smile and say "Well actually...." She handed the meeting over to me and let me direct the content for the remainder of the session. I believe this was confidence building, for us both. It reassured her that I was organised and it let her know that I could be proactive.

This is a rundown of the items I had on my first agenda.

Protocol for meetings

What tone will the meeting have? Formal/informal?
Does your supervisor want you to email an agenda prior to the meeting?
Will you need to take minutes and circulate them after the meeting?

Project related questions

Detailed project outline including a tentative timeline
Discussed publication expectations
Discussed recruitment method and ethics modification
Outlined concerns regarding originality

Administrative and personal matters

Debrief about acclimation to new surroundings
Questions regarding scholarship
Negotiating flexi-time
Research Student Maintenance Funding

This took around ninety minutes to cover. At the end of the meeting, I had a list of actionable items to complete and we had organised a repeating schedule of fortnightly meetings. I had a plan!

Image courtesy of Pexels

More things to do (when you think you have nothing to do)

The planning meeting was rescheduled and deferred for a week. I was almost relieved when I found out. The university is undergoing a restructure of processes for postgraduate students. As mentioned in the last post this involves doing a needs assessment at the commencement of candidature and then finding professional development courses that address identified needs.

Postgraduate students are also required to undergo an induction which includes an online component and face-to-face workshop. It is suggested the online component should only take two hours to complete however I have spent several more becoming comfortable with the system and really familiarising myself with online facilities available to me. This, however, is just an extension of the work I began last week.

Here are some more things to do if you find yourself with unexpected free time.

Explore

If you are new to the campus you are studying at, now is also a great time to familiarise yourself with the physical facilities. I am based on the top of a seven-floor building. I have, within reason, explored the areas that are safe for me to do so. I know where the best cafes are. I know which toilets are kept the cleanest. I know where to find a quiet spot when I need one. Take your phone with you and go on a photo exploration. This is an excellent habit to get into and provides great stress relief.

Schedule

If you have the flexibility to do so, figure out a schedule that works best for you. I spent my second week leaving home at different times to observe the traffic flow. I discovered I could leave home at 8.15am and still land at my desk by 9.00am and avoid most of the rush hour congestion. I also discovered the best (and worst) time to leave the university. At around 4pm there is a mass exodus and so I found myself lined up for 15 minutes just to get off campus. If I waited until 5pm most everyone was gone and I was still ahead of the city peak. This process has helped me cut down on my travel time and reduce the amount of time wasted in traffic.

Read

If you have begun your candidature I assume you have at least some idea of the area of research your project is situated in. My project is vastly different to the one I completed during Honours so I had no background knowledge or research to draw upon. This meant having to figure out the 'who's who' from scratch. Our Dean of Graduate Research recommends finding out who the top ten authors in your field of interest are and reading their work. Not only is this scoping for your inevitable literature review it will mean when you do get to that first planning meeting you will make a good impression.

Blog

Read blogs on the Ph.D. experience, The Thesis Whisperer comes to mind as a particularly good example. This can help to normalise your experience and prepare you for the journey ahead. For example, knowing that at some point over the next three years it is highly probable that I will find myself in The Valley Of Shit may help me to recognise it sooner rather than later. Also, consider writing your own blog as a way of documenting your own experience.

What to do when you have nothing to do

I had been told that the first six months of candidature were 'pretty cruisy'. Apparently, you get to sit, drink a lot of coffee and think. If you buy into pop-psychology you might describe me as a Type A personality. Sitting around doing nothing doesn't work for me. I wanted to start Day 1 with an actionable plan. Accordingly, I had set up a meeting with my supervisor for first thing Monday morning so that I could get started.

My Ph.D. project is part of a larger, ongoing project related to food service in residential aged care. At some point throughout this meeting, I was hoping to receive the mountains of previous research and data and acclimatize myself to the project. Instead, I received orientation and was welcomed into the family. My project planning meeting was promptly scheduled for the following week.

Wait. What? I had nothing to do! 

They say that every Ph.D. journey is unique, but in case you find yourself on Day 1 with nothing to do, here's what I did.

Conduct a needs assessment

All postgraduates at my university are required to complete a needs assessment at the beginning of their candidature and then yearly at their milestones. We have to prove that we are aware of areas that require further professional development and that we have the initiative to seek out and engage in continual learning. The needs assessment includes the four domains that are deemed to be important for success not just throughout your candidature but once you have your post nominals. These are:

• Knowledge and intellectual abilities: do you have the academic skills to do what needs to be done?
• Personal effectiveness: do you have the personal skills to get you through?
• Research governance and organisation: do you know the rules, regulation, and conduct of research?
• Engagement, influence, and impact: can you disseminate your information effectively?

After filling out this needs assessment and identifying where my areas for growth were, these are the steps I took.

Make Friends

I commenced my Ph.D. immediately after completing my undergrad degree (with Honours). For the past four years I had studied in a relatively solitary environment, now I was staring at a desk in a shared office and being told to make myself at home. I spent a great deal of my first day building relationships with the other people in the department. Many of the faculty had been my lecturers and tutors during the past four years, as such I was beginning the transition from student to colleague. I did this by engaging in more personal and less formal conversations than I had as a student. Before long, I knew which television shows were staff favourites and, whilst you might think this type of thing isn't important, I assure you... it is. 

Sign up for stuff

I discovered that postgraduates have access to staff only professional development courses, many of which teach essential skills for completing a thesis. I signed up for every statistical analysis and SPSS workshop I could. I am also enrolled in classes to enhance communication between myself and my supervisor (she doesn't need it, but I do!), how to use Nvivo to do a literature review and how to manage your personal brand. These were all areas I identified as needing improvement in my skills assessment.

Volunteer for stuff

In amongst the many emails that post-grads get I discovered a call for volunteers for the Quality in Postgraduate Research (QPR) Conference. This is the world’s biggest and longest-standing conference on doctoral education and by volunteering to assist for one day I was granted free access for the remaining days. Brilliant! Once again, ticking plenty of boxes for my needs assessment.

Claim your space

If you are fortunate enough to have a dedicated desk and you have the freedom to personalise it, do so. I have a cubicle and was allowed to remove an unnecessary bookcase and rearrange the remaining furniture so that it was a comfortable working environment. I brought in some little items from home to add a bit of cheer. I have a comfy floor cushion that I can sit on when I want to take a break from my desk and read. I have my favourite coffee mug. For days when the office is lively and vibrant I have noise cancelling headphones. Find a way to claim your space, it's going to be your home away from home for the next three years. If you hate sitting in your space you are going to hate the whole experience.