UAB Dietetic Internship has been a program of "firsts" since we began in 1963. What started as a a 12-month program with only six students, is now a major influence in nutrition education innovations and healthcare policy reform. We were here before UAB became UAB. We were the first program of its kind in Alabama, one of the first in the U.S. to offer distance education and one of the first to collaborate with Medicine in research. We look forward to watching our graduates' impact for the next 50 years.
History of the Division of Human Nutrition and Dietetics and Educational Programs
University Hospital and Hillman Clinics inaugurated the Dietetic Internship Program in September 1963. Janet Mastin, MS, RD was the Director, Dietetic Department, and director of the internship program. Initially, the internship was a 12-month program with six students. Dr. E Neige Todhunter, Dean, School of Home Economics, University of Alabama, and Matthew F. McNulty, Administrator, University Hospital and Hillman Clinics were instrumental in the development of the program. Initially, key clinical faculty of the internship were: Janet Mastin, MS: Sara Terrell, Administrative Dietitian, University Hospital and Hillman Clinics and later Director, Department of Dietetics, University Hospital; Rebecca Bradley, Outpatient Clinic/School of Nursing Dietitian, later Dietetic Internship Director; Harriet Cloud, Nutrition Consultant, Jefferson County Health Department, later, Director of Director of Nutrition Services, CDLD; and Carol Brewster (Craig), GCRC Dietitian. Carol Craig was appointed Acting Director in 1964 and Director 1966-1980.
The first class was admitted in 1963-64 with Janet Mastin as Director with six interns. According to dietitians history of the early 1940,'s, the well-dressed dietetic student of the day wore a regulation nurse's uniform and was told it was difficult to keep neat with fewer than 12 uniforms. Shoes were white oxfords with rubber heals, slips, petticoats and hose were white. Skirt lengths were at least 16 inches from the floor. The 6 interns came in September with the appropriate dress. Also, the student dietitian, later called Dietetic interns, was on duty from 7:00 a.m. to 7:00 p.m. with three hours off during the day. They had Sunday morning off and one afternoon a week off or they could have two afternoons a week free. This internship was one year in length and they were paid $140.00 a month.
The next class, 1964-5 had 8 interns and Acting Director was Carol Brewster (Craig). Craig remained director until 1980. The Huntsville, Montgomery and Mobile sites started in 1994. The Dothan and Birmingham off-campus sites were started in 1997, with Dothan later closing in 2008.
There were only 686 interns in the U.S. that first year of the internship and there were 62 approved internship programs, mostly in hospitals but three were in business and industry. One was Aetna Life and Causality Company in Connecticut with an emphasis in food service administration; Eastman Kodak Company in New York for persons interested in industrial feeding. The third was Stouffers Food Corporation in Ohio. There were only two internship programs in Colleges and Universities: Oklahoma State University and University of Washington - all of these had an emphasis in Food service Administration. France Stern Food Clinic offered a one-year internship with the emphasis on Nutrition Education and Therapeutic Dietetics. A food clinic training course at the Boston dispensary, under the direction of Frances Stern was approved between 1934-40's. A food clinic was defined by American Dietetic Association as any center, like special clinic to which an ambulatory patient needing diet as a part of medical treatment may come.
The University of California, School of Public Health offered an Internship master’s program of Public Health with emphasis on hospital dietetics and Public health nutrition. In 1963, formal approval was given to Ohio State University in which there was integration and coordination of theory and practice. These graduates would be eligible for American Dietetic Association membership without the necessity for an approved internship. This program was offered by Ohio State University, College of Medicine. The students enrolled at the beginning of the sophomore year in Medical Dietetics. These programs became known as Coordinated Undergraduate programs (Cups). There are now 53 Cup programs. At one time there were approximately 77 Cup programs. All programs were approved at that time. Accrediting programs was initiated in 1979. There are now 251 accredited Dietetic Internship programs and three International programs seeking accreditation status. Many still offer emphasis in clinical, community and food service, but others offer emphasis in wellness, health promotion, urban issues, application of evidence based practice in VA, rural health program monitoring and outcome management, research and school lunch are just a few of the variety of programs. It is interesting that in 1950, E Neige Tohunter, PHD, who headed a joint committee ADA and AHEA on school lunch asked for the creation of an internship program in school lunch. The committee denied her request. Dr. Todhunter was Dean of the School of Home Economics at the University of Alabama, and was President of the American Dietetic Association in 1957-1958. The registration for the meeting was $5.00 and there were 242 exhibits. This fall the registration for the meeting will be $349.00 for active members and there will be approximately 350 exhibits.
For the first forty years nearly all association members participated in work of four sections of the association. Members chose the area of most interest to them and worked on national, state and local projects. These sections were: Community, Diet Therapy and Food Service Administration and Education. Our future leaders were developed from within these sections. The community section projects were related to civil defense, rehabilitation and Meals on Wheels. There were three kits of material on how Meals on Wheels were prepared and made available on loan from the ADA library. Dial-a-Dietitian was a project of this committee. Emergency feeding, recruitment, training and part time work for community services and Head Start were the other projects. This group suggested that ADA organize a group of dietitians who would be willing to prepare for presentations on radio and television. "Nutribird" was introduced in April 1976. "Nutribird "was a mass media personality and was developed by the association. It was introduced on the cover of a April journal in 1977. Nutribird was neither female nor male and was capable of changing body form. It was friendly, courteous, outgoing and knowledgeable, symbolizing good nutrition. Now the public may learn about nutrition using the internet, Facebook, Twitter, Linkedin and YouTube. The Academy and its network of Spokespeople continue to serve as the media's trusted source for accurate, timely and science based food and nutrition information. The members who worked to get more involved in the media would be pleased today. Like Good Morning America, Nightline and The Today show are a few where dietitians have participated. There are a wide range of publications availed to members and the public. Food and Nutrition magazine may be found in doctor's offices, hospital waiting rooms. websites, mobile apps are available.
The diet therapy section projects were a survey of practices in diet therapy as related to fat modification and a study of therapeutic dietitians activities. They prepared information on diet and arthritis, development of diet manuals for nursing homes, cookbook and allergy recipes.
A topic that kept coming up in discussion in meetings in the 1960’s was the lack of third -party reimbursement for the delivery of nutrition services. The Academy’s Legislative and Public Policy Committee continues to address Medicaid Services coverage. Your director and many Alabama dietitians have been very active in these groups.
The food administration was developing evaluation forms for foodservice workers and compiling materials on safety in food production facilities, development of curriculum for food service supervisors, and guidelines for automatic foodservice systems and food service in Psychiatric facilities. Now the academy is educating consumers on food safety. The program "Is my Food safe?” was an app for Apple and Android mobile devices.
Projects in education were focusing continuing education programs for dietitians, nursing education and international relations. Thru the years, Education of Dietetic students, nursing and dental and medical students were discussed. After World War 2, there was a shortage of Dietitians; the group was interested in training nutrition aides, food service workers and later Dietetic Technicians. The first educational requirements were developed in 1927 required a major in foods and nutrition. Then the next plan was in effect from 1958-1975. Accreditation Council on Education for Nutrition and Dietetics ( ACEND) accredits baccalaureate dietetic and graduate programs, post baccalaureate dietetic internship and associate degree dietetic programs. There are 251 dietetic internship programs and 3 international programs seeking accreditation status and 53 CUP programs,, 225 didactic programs. The total number of students in 2011-12 rose from 23,241 to 24,205, a 4.1 increase.
(ACEND) has developed two types of standards for overseas programs. International Dietitian Education Standards are designed to provide graduates with the knowledge and skill to sit for the Commission on Dietetic Registration credentialing exam upon successful completion of the program and receive the RD credential. International Dietitian Education require students to be educated to work competently within the US. Students in this program must meet same competencies, and to complete supervised practice in the US. In comparison, ACEND's Foreign Dietitian Education standards are tailored to meet the needs of the host country under the assumption that graduates do not intend to practice in the US. All candidates would be free to practice as allowed by their respective countries and each country could develop an exam to offer a credential to meet local requirements.
A program ISPP, Individualized Supervised Practice Pathway was created in 2011 to ensure qualified students have opportunities to complete the supervised practice component of their education without compromising the autonomy of education programs. In 2012, 98 individuals were enrolled and 41 graduated. More programs have expressed interest in starting these programs, so it is expected that this will grow.
It was a concern of the earlier board meetings that scholarships be available and encourages research in the profession. The academy Foundation was established in 1966. The purpose was to further education and scientific activities. The Foundation serves as the largest provider of dietetic scholarships. The foundation's vision is we all eat right, focusing on: Scholarships, awards, food and nutrition research and public education related to Kids eat right. In 2013, $213,000 was awarded through the foundation research efforts. Of the 17,000 dietitians in 1964, 44 percent of dietitians worked in hospital (including teaching and work in clinics), 31 percent were homemakers, the other 4%represented college teaching, college food service, school lunch, nutritionist, commercial, and research, consultant and graduate student. A concern at this time was the potential pool of dietitians who were unemployed 2/3 of dietitians had been unemployed within past 5 year and planned to work within the next 5 years. The average age of those seeking reinstatement was 45.5 years and after an average lapse of 17 years. Dietitians were predominately female but there were approximately 40 -50 males.
The average age were found to be 24 percent under age 33, 35 percent aged 33-43 and 41 percent over 43 years old. Twenty percent of the dietitians held a master’s degree and 2 percent held a doctoral degree. In 2014, Membership in the association is over 75,000 and there are 89,000 Registered Dietitians. 95 percent of practitioners are female. Median age is 46 years; 29 percent are 55 and older and 36 percent under 35. Nearly half of practicing dietitians hold master's degree and 4 percent hold doctoral degrees as their highest level of attainment.
Licensure and Registration
Registration became a reality for Dietitians in the United States and became effective on June 1, 1969. A Wisconsin delegate reported a proposed state bill in 1945 to provide a registration for dietitians. A California delegate reported that such a bill was presented to their legislature several years before. The difficulty in both states lay in forming an encompassing definition of the role of the dietitian. The executive board had not taken a position on this issue but suggested that each member work effectively by acquainting others with the meaning of the term dietitian. In 1965, a committee was appointed again to study registration. The first examination was given in January 1970 to 56 interns. all 56 passed.
The Commission on Dietetic Registration (CDR) was organized in 1975 and given responsibility for all aspects of the registration process. This included credentialing, and monitoring continuing education. In October 1987, membership in the association became separate from registration. The need for specialist was in discussed in early years of the association and a mechanism for specialty certification for dietitians was proposed to the council of Practice in 1986. Now the Commission on Dietetic Registration administers seven separate and distinct credentialing programs: Registered Dietitian, Dietetic Technician, Registered, Board certified Specialist in Renal Nutrition, Pediatric Nutrition, Sports Dietetics, Gerontological Nutrition and oncology Nutrition.
The issue of licensure and registration for dietitians had been discussed in the House of Delegates since the early days. Voluntary registration of ADA members occurred during the late 30's during and during world war ll but was primarily a method to locate qualified dietitians. Proposed bill for state licensure were presented in two states (California and Minnesota) but never passed. This issue appeared in the minutes of House of Delegates regularly over the years but never received support of the membership or Board. In the 1960's - thing changed! Forty six states have statutory provisions regarding regulation of dietitian or nutritionist. Alabama was the 8th state to achieve legal certification for dietitians and nutritionists and the first to first to regulate use of the title "nutritionist."
In conjunction with the history of the Dietetic Internship, UAB was also making great strides in nutrition research. In 1965 Dr. Butterworth received a grant and formed a team to study tropical sprue in San Juan, Puerto Rico. The team included Drs. C. E. Butterworth, Raul Santini, Bill Scott, Hugh Dempsey, and clinical research dietitian, Carol B. Craig, and Dietetic Internship Director. This was one of the first interdisciplinary efforts between the Department of Dietetics, University Hospital, and Department of Medicine. This research was continued for a number of years utilizing the NIH sponsored GCRC metabolic kitchen on 3 West, University Hospital.
UAB Department of Nutrition
An interdisciplinary committee drafted a proposal and petitioned Dr. S. Richardson Hill, Jr., President of the University of Alabama in Birmingham, during 1976, to establish a Nutrition department within the Medical center. Those participating in this effort were Drs. Butterworth, Krumdieck, Weinsier, C. E. Hunt, Navia, Mennaker and Mrs. Carol B. Craig, MS, RD. In February of 1977, Dr. Hill announced the creation of the Department of Nutrition Sciences, an undertaking sponsored jointly by three schools: The School of Community and Allied Health, the School of Medicine and the School of Dentistry. From its inception this department has been based on a philosophy of interdisciplinary collaboration involving many departments and several Schools.
The Department of Nutrition Sciences, School of Community and Allied Health, was established in 1977, with Carol Craig as Chairman of the Division of Human Nutrition and Dietetics until 1996.
The purposes of the department were: (1) to unify all members of the UAB faculty interested in nutrition and provide for their concerted action and mutual stimulation; (2) provide the academic structure for the development of Advance Degree Programs in Nutrition Sciences; (3) provide identity and serve as the element for outside recognition of the nutrition activities at UAB necessary for the recruitment of faculty and students, and for securing grant support. The Chairman reported to the Dean of the School of Community and Allied Health and through him to the Deans of Medicine and Dentistry. The Graduate School approved and oversees the Advanced Degree programs. The department initially consisted of the following divisions: Clinical Nutrition, Human Nutrition and Dietetics, Nutritional Biochemistry, Nutrition and Food Science, and Nutritional Pathology and Overseas programs.
The program became part of SCAHR in 1974. It was based in the newly developed Department of Clinical Nutrition and Dietetics, Carol Craig MS, RD, Department Chair. A U. S. Public Health Service Allied Health Training grant was first awarded in the early 1970’s. Approximately two million dollars over a ten year period was received in Federal monies for the development and/or improvement of the dietetic internship, dietetic technician and MS degree programs.
The first two primary clinical instructors were hired in 1972, Rebecca Bradley and Cynthia Williams; Annie Bonney Cornwell replaced Cynthia Williams in 1975. The internship program became a 9 – month program coordinated with graduate credit in 1975.
Rebecca Bradley, MA, RD served as Director, Dietetic Internship Program in 1980-1998. Following Mrs. Bradley’s retirement, Gayle Canfield PhD, RD was director in 1998-2002 followed by Amanda Brown, PhD., RD in 2002. Patricia Riester, MS, RD and Susan Wood, MA, RD were faculty members in the 1980’s. The internship developed part time and distance education programs in 1994 with clinical sites in Huntsville, Montgomery, Mobile, and in 1997, Dothan and Birmingham. The program was one of the first in the nation to begin distance education programs. There were 497 internship graduates up to 1998 who were selected from applicants from colleges and universities thought out the U.S. Graduates of the program are in leadership positions in a variety of dietetic specialties and related fields in the U. S.
The Dietetic Technician Program was established in SCAHR in 1974 with 5 students. The program was an associate degree certificate program and linked to the Regional Technical Institute and both state and private Junior Colleges. The Directors of this program were Joan Sokol, MS, RD, 1974-75; Linda Godfrey, MS, RD, 1976- 79; Julia Bryant, MS, RD 1979-82 and Annie Cornwell, MS, RD 1982-89. The program was closed in 1989 due to lack of qualified applicants.
A Master’s degree in clinical nutrition was approved by ACHE and the University of Alabama Board of Trustees in June of 1975 and students were enrolled in the program which combined the internship with graduate study in September 1975. Carol Craig was Director of the program from 1975 – 1996.Upon Mrs. Craig’s retirement, Rebecca Bradley, served as Director, 1996-97 as well as Division and Internship Director; followed by Gayle Canfield, Director, Internship/Graduate Program– 1997-2002 and Amanda Brown, PhD, RD. in 2002. There were 155 graduates of the program up to1998.
Required theses research was directed by many Nutrition Sciences faculty who hold appointments in the graduate school in addition to their department appointment(s). Copies of theses are on file in the Graduate School, Medical Center Library and the department. The program enjoyed, as thesis committee members, the contributions of a large number of Medical Center faculty from other disciplines.
Specialty clinical traineeships coordinated with the internship and master’s degree programs were developed soon after the initiation of the masters program.
In 1968 the Center for Developmental and Learning Disorders was organized on campus through a grant from the Department of Maternal and Child Health Services to provide interdisciplinary training in mental retardation and developmental disorders. Nutrition was one of the disciplines included in these programs and became a natural site for the training of the dietetic interns. In the 1975 when the graduate program in nutrition was established in the department, CDLD provided graduate traineeships for students entering the master’s degree program. The traineeships were 12 months in length, provided a stipend, and resulted in a research thesis on topics in the area of mental retardation and developmental disabilities. Between 1977 and 2002, these were completed 25.
Some of the special clinical services in CDLD included inborn errors of metabolism which was directed and organized by the nutrition division, feeding clinic, and interdisciplinary clinics addressing many syndromes involving mental retardation and developmental disorders. A major thrust of the Center was leadership education for all of the students from nine disciplines including of course nutrition. Nutrition students were challenged to work in the community in various agencies such as mental retardation centers, schools, and Children’s Rehabilitation Services. In many of these agencies nutrition services did not exist. As a result of the student’s involvement and grants written by the Nutrition Sciences faculty employed by the CDLD, Harriet Cloud, Carrie Ganong, and Janet Isaacs nutrition services were initiated in Children’s Rehabilitation Services utilizing dietitians as vendors and full time staff in the 14 district offices. In turn the CRS staff throughout many locations in the state provide training for the UAB dietetic interns.
In the late 1980’s CDLD was named the Chauncey Sparks Center for Developmental and Learning Disorders (Sparks Center). At that time the Nutrition faculty of Sparks Center submitted a five- year grant application for a Course entitled Nutrition for the Child with Special Health Care Needs. The course was co-sponsored by the Department of Nutrition Sciences and the Center for Developmental Disabilities, University of Southern California, Los Angeles. The grant was funded for the first five-year period with a second five-year grant awarded in 1993. During its tenure over 600 dietitians and other disciplines attended the course from all over the United States and Canada. The course became part of the leadership training for the graduate students from Nutrition Sciences.
During the time that the Maternal and Child Health Grant was received for CDLD, other MCH grants were also received by the Department of Pediatrics on the Birmingham campus. These included a Children and Youth project, Dental training project, and Human Genetics training program. The Children and Youth project had a nutrition director and later this program was replaced with the Adolescent Training Program and the Pulmonary Training program. These programs provided training stipends for graduate students from a number of disciplines, including nutrition. Faculty for the Adolescent Training Program and Pulmonary Projects are Bonnie Spear, PhD, RD and Nancy Wooldridge, MS, RD., both faculty members of the Department of Nutrition Sciences. Both dietetic interns and graduate trainees are enrolled in these programs. Other traineeships were Long-term Care, Nutrition Information Service and General Clinical Research Center, University Hospital.
Clinical and Community Activities
The division served the community in a number of ways providing consultation to public schools, nutrition programs for the elderly and continuing education for health professionals.
The development of a Nutrition Outpatient Clinic at the Kirklin Clinic was an initiative of the Division of Human Nutrition and Dietetics and was in operation for a number of years following the opening of Kirklin Clinic. The Clinic served as a center for referral and follow – up of patients with special nutrition problems. Common among these were patient with morbid obesity, diabetes, eating disorders, inborn errors of metabolism, home nutritional support, all of which necessitated long term nutritional counseling.
Several outpatient clinic programs were developed and operated for varying lengths of time with other RD faculty providing consultation for physicians and counseling for patients. Some of those included Obstetrics and Gynecology, Family Practice, Hypertension Research, and 1917 Aids Clinic. An ongoing effect by dietitians was the establishment of third party reimbursement for RD’s.
A year (1983) long study of nutritional status of overweight children and food service practices at the Institutes for Deaf and Blind in Talledega, Alabama resulted in nutrition education of teachers, students and families taught by graduate students under the direction of division faculty, Carol Craig, Annie Cornwell, Harriet Cloud and later Nedra Wilson.
An early community nutrition education initiative, developed in 1980, funded through the Alabama Department of Education, was a collaborative effort between the Division of Human Nutrition and Dietetics and the UAB Theater Department. Nedra Wilson was hired as a consultant to coordinate that project prior to her joining UAB faculty as NIS Director. A musical play, “Nutriworld,” and companion workbooks and videos for grades K through 4 were developed. Thousands of school children in the Greater Birmingham Area saw performances of this play. Videos and workbooks were made available to teachers throughout the state from the Alabama State Department of Education Resource Library. Another project grant from the Department of Education funded stipends for continuing education for public school teachers and instructor’s salary in the division.
Nutrition Information Service
The Nutrition Information Service (NIS) was established in 1984 to provide nutrition education activities for the public and continuing education for professionals in dietetics. The NIS was initially developed and operated through the Cancer Center Grant and in later years through a cooperative relationship with Oxmoor House and Cooking Light magazine. (A number of faculty served on this editorial board.) The NIS was established to provide a nationally available resource for nutrition information through a 1-800 hot –line staffed by dietetic interns, graduate students, dietetic technicians, and trained volunteers. Bonnie Richards, MA served as coordinator the first year.
After the first year, the program was coordinated by Nedra Wilson, MS, RD, who developed a strong community education liaison through on-site presentations and weekly appearances on local television. The NIS, as well as students and faculty were key participants in UAB community education programs such as Med Wise Health Fair.
Another focus of the NIS was the coordination of the development of specialized cookbooks in cooperation with Oxmoor House. Carol Craig, Nedra Wilson, Annie Cornwell, Sue Wood and a number of departmental faculty participated in concept and recipe development, testing and nutritional analysis. Books published by Oxmoor House and authored by nutrition faculty included: Delicious Ways to Lower Cholesterol; Eat Right, Heart Smart; and Lose Weight, Simple Steps. Another departmental cookbook initiative was spearheaded by Dr. Sarah Morgan, and was developed for persons with arthritis.
Some of the strengths of this Division and Department were the continued interdisciplinary nature of the initial philosophy, programs, research, and patient care. Both medical and dietetic faculty contributed professional leadership at critical periods serving on local, state, and national committees concerning dietetic practice standards; professional review standards; internship and graduate curricula; National Registered Dietitian standards and testing; commission on accreditation, maternal and child health and adolescent nutrition issues, to name a few.
The Division of Human Nutrition and Dietetics was combined with the Division of Clinical Nutrition in 1997 and became the Division of Clinical Nutrition and Dietetics with Sarah Morgan, MD, RD, as Director. In 2008, the Divisions were dissolved and a matrix leadership style of missions was created; shortly thereafter, the Clinical Nutrition title was replaced with Nutrition Sciences in program name and all degrees granted.
In Fall of 2015, three educational tracks were developed; the clinical track which combines dietetic internship and a MS degree, the research track and the PhD track. Additional tracks are currently under development.
References of Educational Programs
The Beacon, University Hospital and Hillman Clinics, Vol. 7- Number 11, November 1963
Birmingham News, August, 1966
The Beacon, Vol. XII- No. 6, December 1968
Birmingham News, August, 1966
The Beacon, Vol. XV, Number 5, October, 1971
SCAHR Annual Report, 1974-75
Dietetic Technician Program Review, Annual Report, 1980
Department of Nutrition Sciences Brochure 1980
Graduate Program Bulletin Brochure, Department of Nutrition Sciences, 1988
Dietetic Technician Program Review, Annual Report 1980
Dietetic Internship Self – Study for Accreditation, 1988
Graduate Program Brochure, Department of Nutrition Sciences 1994 Twenty –Fifth Anniversary, School of Health Related Professions, UAB, 1969- 1994
Brochure of Twenty – Fifth Anniversary of the Dietetic Internship, 1988
Oral Communication: Carol Craig, Rebecca Bradley, Annie Cornwell, and Harriet Cloud and Nedra Wilson.
UAB Dietetic Internship Directors
1963 Janet Mastin MS, RD
1964 Carol Craig MS, RD Acting Director
1965-1980 Carol Craig MS, RD
1980-1998 Rebecca Bradley MS RD
1998-2002 Gayl Canfield PhD, RD
2002-2012 M. Amanda Brown PhD, RD
2012 Susan Miller MS, RD Acting Director
2013 – Present Susan Miller MS, RD Director
1977-1996 Carol Craig, MS, RD
October 1, 1996 – December 31, 2009 (Division of Human Nutrition and Dietetics was combined with the Division of Clinical Nutrition in 1997 and became the Division of Clinical Nutrition and Dietetics) Sarah Morgan, MS, RD
January 1, 2010 – August 25, 2012 Jamie Ard, MD
February 8, 2008 - Change to Mission Leaders Occurred: Ard/Clinical, Nagy/Research, Fernandez Education
January 2012 – Change in Mission Leaders Occurred: Soleymani/Clinical, Gower/Research, Fernandez/Education
1977 - 1988: Dr. Charles Butterworth
1988 - 1999: Roland Weinsier, M.D., Dr.PH
2003 – Present: W. Tim Garvey, M.D.