Marci Evans on 10 Years of Leading Dietitian Training Online
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[00:00:00] If you're looking to grow your business as a registered dietitian, you've come to the right place. If you're not sure what to do or what steps to take next so that you can create flexibility and freedom in your life, then you're gonna learn a lot from tuning into our podcast here at Dietitian Boss.
I'm Libby Rothchild, the founder of Dietitian Boss, a fellow registered dietitian and business owner, and in our podcast, I share. The highs and the lows, and I talk all about how to grow your business, get it started, and I interview our clients. To date, we've had over 200 interviews from clients who share their journey on our podcast, Dietitian Boss.
Marci identifies as a food and body imager healer, practicing from a weight inclusive and anti-oppression lens. She has dedicated her career to counseling, supervising and teaching in the field of eating disorders. She's a certified eating disorder, registered dietitian and supervisor and certified intuitive eating counselor.
In addition to her group private practice, in 2015, Marci launched an online [00:01:00] eating disorders training platform for clinicians. In 2016, she joined the Simmons Nutrition Department to co-develop a specialized eating disorder internship and teach graduate level courses on nutrition counseling for eating disorders.
In 2018, she received the Professional Integrity Award from the Behavioral Health Dietetics Practice Group of the Academy of Nutrition and Dietetics. She has spoken locally and nationally at numerous conferences and media outlets. She regularly communicates on social media, so be sure to connect with her @MarciRd on Instagram.
Libby: Marci, it's an absolute honor to be here with you today interviewing you. Thank you for making time to be a guest on today's episode.
Marci: Oh, thank you so much for inviting me to join you. As I said before, we made it live. I am incredibly excited for this conversation.
Libby: Great. Happy to hear that. And the feeling is mutual, and I'm sure that the listeners are gonna take a lot away from your storytelling and your experiences.
So I was wondering from your robust experience. Looking back [00:02:00] as I read your bio and our listeners get to know a little bit more about you, what was the turning point in your career that shaped your identity as a clinician and an educator?
Marci: One obvious one comes to my mind very first, which was actually during my dietetic internship, I had thought that I wanted to be a clinical dietitian working in an inpatient hospital setting, and was by chance assigned to a rotation at an eating disorders treatment facility, a residential facility, but also bringing in the mental health and the psychological pieces.
And so that was a massive. Shift for me, probably another shift for me as an educator, since you asked about both, was I learned about an opportunity to teach at a certificate program at Plymouth State University many years ago. My supervisor told me about the opportunity, and even though I was.
Still relatively young in my career. I jumped at the chance of at least putting my name into the ring and ended up getting that position and that [00:03:00] position, which I know we're gonna talk about this a bit today, really shifted things for me in terms of realizing I did have this passion not only for working with clinicians, but or not only with clients, but also with educating clinicians.
And ended up. Informing the development of my online program. So that was a really cool moment for me.
Libby: And to go back to the opportunity that you had, that turning point in your career, when you mentioned that you were exposed or shown the eating disorder clinic, is that correct?
Yeah, I was at a residential treatment facility. How long ago was that Marci.
Marci: Oh, okay. Let me do math. So that was during my dietetic internship, so that was in sometime in 2005, so 20 years ago.
Libby: So at that time, in 2005, I know that eating disorders, that the specialty, and I don't know if you have the stats on how much it's grown, but I would assume at that point it was a lot less.
Well known that it is today. So would you agree with that?
Marci: Yeah. Oh, that's interesting. I definitely don't have the stats on that, but it absolutely has grown. There are more treatment [00:04:00] facilities than there were, 20 years ago and I don't think it's just because I'm biased, because this is the world that I live in, that there is far more awareness.
Of eating disorders being a condition specifically that needs strong nutritional support. And I think part of that, which I actually think is a very positive thing, is that more people are out in the open about either having had or having an eating disorder, particularly within our field of nutrition.
I really want to have a field where nutrition professionals don't feel any sort of shame that they have had or maybe currently struggle with an eating disorder, but I know that it. Inspires a lot of people to enter the field, which I ultimately think is a very positive thing.
Libby: Yeah. And you're innovative in the field.
Given that 20 years ago when you were excited for the opportunity, I don't believe that opportunity was as well paved as it is today, in part because of the work you've done. So you're truly a pioneer.
Marci: Oh, I think that's a generous interpretation. There are a lot of factors there, but I do hope that I have [00:05:00] elevated the awareness of how important, eating disorders are, as well as the work if people wanna do it. That I think is very exciting and very satisfying and available as a career opportunity for dietitians who are looking for it.
Libby: Yeah. And as you mentioned, your large body of work really supports, if that is your mission, helping dietitians feel more comfortable and less shame about their own journey to then help them translate their knowledge and experiences to their clients.
I'm assuming, right? Absolutely. Yes. That's really beautiful. And your reputation as someone who leads with integrity and clarity was that always your approach or did something shift you in your direction?
Marci: I have to say that is very humbling to hear you say that because those are two things that I hold near and dear in terms of the professional work that I do.
So the fact that it's observed by others means a lot to me. So first I wanna thank you for saying that, I can't say that there's necessarily been a change in my approach. I think that's something that has been [00:06:00] instinctive for me. I think it's just true to who I am.
The clarity piece is honestly probably reflective of my own internal process. I'm someone who needs a fairly high degree of organization when I'm learning material, and I find even more so when I'm teaching material, I have to know it really myself. So I am quite particular when I'm, developing a workshop or giving a talk.
I spend, hours upon hours. Not only. Going through the research, but organizing it in pretty particular ways so that it is like clear as crystal. So I'm glad that shines through, but I think that it is more sort of part and parcel of who I am as a person. If you came to my house and saw all of the baskets that I've bought from the container store, it would feel consistent to who I am.
And I try really that integrity piece is really being true to trying to understand and look at the evidence base, but also coming back to my own moral compass and my own values and consistently ac asking myself like, do I feel [00:07:00] in alignment? That there is like a heady place that I go to in terms of, the integrity of my work, but there is also very much a heart and a soul.
That I come back to and do, I feel just in my guts that I'm in alignment and that I feel good. So I'm glad that shines through, but I don't think that's been a shift. I think that's probably just a reflection of who I am.
Libby: Beautiful and you have helped elevate the conversation around eating disorder treatment as we've discussed, and you've been in this field for a very long couple decades.
What would you say are the most important nuances that clinicians like the listeners, dietitians miss with the work that they do?
Marci: There are a couple of things that consistently, I think, that nutrition professionals miss and that is not their fault. I think, we are trained in a medical model and most dietitians are working in much more of a medical type setting with medical diagnoses, and it's less common for us to have a focus on this psychological and [00:08:00] emotional.
Aspect to the work that we do, which I think is a shame because every client we sit with not only has the medical pieces need attending to, they also have their psyche and their sort of emotional world that we have to hold in mind. But that's particularly true when working with mental health diagnoses like eating disorders.
So it means that as nutrition professionals, we tend to miss a couple of things. One of the things is the importance of helping people. And that helping being rooted in the relationship that we form with our clients that the interventions that we do absolutely matter, but the research is pretty clear that the specific interventions only matter when they're laid on a strong relational foundation.
Meaning we have built a relationship with a person that we're sitting with. We have a sense of who they are holistically as a person, not just their illness, right? That there is a sense of trust that's being built, reciprocity, [00:09:00] respect, all of those things that often dietitians start to get a little bit uncomfortable with because we automatically think, oh, that means it's therapy.
No. There are worlds apart in terms of relationship building and building a counseling type relationship. That is foundational. So that would be the very first thing that I would say. And I, anybody hears me speak or give a lecture or take any of my trainings, they hear me talk about that piece over and over again.
And then maybe the second piece that I would highlight that I think is particularly difficult for dietitians is that the work that we do in eating disorders. Is so very nuanced and it that can feel really frustrating and it can feel a little scary because we learn, for instance, okay, when you're working with celiac disease, here are the nuts and bolts of a gluten-free diet, right?
And you're working with somebody with cardiovascular disease or diabetes. You have these like really clear tenets of the MNT, but when you're working with someone with an eating disorder. There are, yes, some nutritional protocols that are [00:10:00] really important, but so much of the work is in the gray.
It's trying something on or seeing how this fits. Does this help, does it not help? And so there's a ton of art in the science and that can feel really anxiety provoking. When we wanna do a really good job, we wanna, make the best intervention. We wanna be the most helpful. We don't wanna cause harm.
But we have to get really comfortable with the not knowing. Whenever I'm teaching, my students will ask a question and they'll say, okay, imagine a patient, and then they'll give me an imagine scenario. And I always respond and it's probably really annoying, is that I'll say it depends, and that is like.
The key phrase when working with eating disorders in that you have this kind of collection of information and things that you're thinking about, but you're making these clinical decisions in concert with your clients based on so many different factors. And so that's actually one of the things that I love about eating [00:11:00] disorders work is that it's so nuanced and there's such a craft to it and such an art, but that can feel overwhelming, particularly to dietitians in the beginning stages.
Libby: So if there's a protocol for MNT and we can measure that with a rubric, how would one measure the efficacy of an eating disorders counseling session? If we were looking for, I understand the fluidity in what you're saying, but what are some benchmarks that listeners can say, oh, I'm on track.
Oh,
Marci: That's a fantastic question. And I actually think that could be a great research question. So I'm gonna hold onto that. I think that there are two things that you're tracking simultaneously, and I'm speaking. Predominantly as an outpatient provider, it's gonna be a little bit different when you're working in a more acute setting, when you're working with someone for a shorter period of time and the work is more intense.
But I'm simultaneously tracking short-term and also long-term shifts. So short term, I'm looking at, okay. Are there shifts and changes that are happening in their eating disorder symptoms? Are they becoming [00:12:00] less preoccupied with food? Are they developing greater, say dietary flexibility?
Are they able to increase their intake? Are they Vomiting less often? Are they compensating less often? So there's nuts and bolts we're looking at in terms of their eating disorder symptoms. But then we're looking at really qualitative sort of the felt experience. And that can be easier to look at over time.
Can they step back and say. I'm developing a more positive to relationship to food. Can they step back and say, I'm pointed in the direction of recovery. And for me, recovery means food is taking up less space in my life. I'm feeling more relaxed around it. I'm able to feel more freed up in the way that I relate to food.
Food is becoming less of a strategy in the way that I manage my emotional life. So I think about it a little bit both. But in terms of evaluating the efficacy of, say, a single session to me, we get that powerful data from our clients and we ask the questions like, and I think skilled clinicians are hopefully doing [00:13:00] this session to session.
Looping back last week we talked about making a different choice at breakfast. How did that feel for you? Was that helpful? Does that still feel like the most important thing for us to be focusing on? Why or why not? And I think often clinicians, because we are tracking a lot, can forget to actually do their due diligence of where were we at last week.
Do we carry that thread forward or do we make a conscious decision to go a different direction?
Libby: Yeah, so that would be a great rubric of creating that full circle moment where you are looking at the big picture, right? You're not just in the moment with that session, but you're referencing the past to tie in, right?
So do you agree that could be one way that you're measuring your interventions?
Marci: Absolutely. And one thing that I was taught early on as a clinician, and I still do this and I teach my supervisees and my students to do this, and it's a little bit different 'cause we all work electronically now we don't have our paper folder that, I started my career out with, but we have somewhere visible to [00:14:00] us that is something that we visually see or that, is easy for us to access.
That has your clients, what are the short term, medium term, and long term goals? And I am regularly following up with my clients and I'm saying, we made a decision together to focus on these things. Are you consenting and are we deciding together that is what still feels important. And that means we are regularly coming back to what they say matters most to them. And we've provided our clinical input as well, right? Because our both work together synergistically the client's perspective and the clinician's perspective. And that in that regularly coming back to that means we are holding at the forefront what the client is saying they most want, and that we are hopefully keeping at the forefront what is most meaningful to them, and that regular reviewing means we don't find ourselves two months later, three months later, oh, we meandered over here, but why are we talking about [00:15:00] X, Y, and Z?
And is this really what feels most important? So it keeps us really honest. I think, and on
Libby: track. So from what I'm capturing as a recap of what you're saying is that perhaps I would say the difficulty could be the fluidity of needing to be present with what the patient or client needs, but also the discipline to stick with that circular, like how was the short-term medium long-term goal?
So bouncing back from being present with what they need, but also focusing on the goal, short, long, medium term. Could really help you as a eating disorders clinician? Is that kind of appropriately summarized? Yes.
Marci: I think that's well articulated and it takes some practice and that when we as clinicians get comfortable with not just going along with what the client is bringing, but when they're bringing it, saying, Hey, could we pause a second today? It sounds really important that you really wanna process this thing. Last week we finished off here. I. I just wanna make sure so that you leave this session [00:16:00] feeling like you got the most out of what you wanted.
Do you wanna continue where we were at? Or do you wanna put that to the side and really focus on this thing? And it isn't because you're trying to take control. It isn't because you're trying to force the session in a particular direction, that you're slowing it down enough for a client to make a conscious choice.
They might say, oh my gosh, I totally forgot we were talking about this. I actually do wanna go back to that. What if we split the time and then you're making the decision together, so you're not necessarily sacrificing one for the other. Are you a fan of motivational interviewing? Oh, absolutely.
I would say motivational interviewing is the first foundation of my counseling skills, and I don't think that there's a session that goes by that I don't use motivational interviewing.
Libby: You're already using it in your examples. Open ended questions summarizing, reflective, so that, that's great. I just didn't know if that was the word you used.
I know you have a specific way that you teach, so I wanted to make sure that was something that you yes. Very
Marci: good. Very good observational [00:17:00] skills.
Libby: And what would you say your philosophy on teaching and mentoring, has it evolved as your audience has grown and matured over the years? Or have you pretty much stuck the same in terms of your philosophy?
Marci: I think that it's probably a combination that there are certain values and an orientation and philosophy that I've had the good fortune to be trained in from early on. So I was exposed to a weight inclusive model during my dietetic internship that really formed my path. So there are some sort of foundational roots there that feel consistent, but I would say.
I hope to always be evolving. I hope that the way that I teach and the way that I supervise and the way that I mentor evolves, I think it's evolved in that I feel way more comfortable. I think this is natural. But I feel way more comfortable not knowing things. It feels really scary in the [00:18:00] beginning of one's career to not know things because there's so much that we don't know because we're brand new and we're trying so hard to learn and to grow.
So there's a comfort and ease that I think comes with a couple decades of experience of saying I actually don't know that, or, I'd like to learn more about that, or, that's an interesting question. I haven't thought about that. And so I feel that as a mentor and as a teacher. Really freed up in being in a collaborative space with my students and supervisees about bringing both of our perspectives together, which is really nice.
And I think some of my big growing that I've done over the past probably five years, has been really weaving in. Much more social justice oriented themes and really appreciating the fact that a person's lived experience because of the identities they hold shape so much of who they are, how they experience me, how they experience the words that I use, my style.
[00:19:00] And so being really comfortable about inquiring. What works and what doesn't and what I offer and how it might land. So I think that's definitely sh grown and shaped over the years.
Libby: Yeah, I would say it's, I would expect it to grow in shape. It's just interesting, as you mentioned, the last five years you've leaned into social justice with your messaging, et cetera.
So that's, I think that's inspiring for the listeners to hear. Sometimes we get hung up with having, needing our messaging and our philosophy to be so good from day one, that we don't give ourselves the permission to evolve and we all do. It's just something that when the listeners hear they probably get more inspired from.
To know that there's room and permission to make a move to the left or make some directional changes.
Marci: And I'll remind them that if you've appreciated seeing that in anybody else that you admire, that it will be the same for you. And that evolution and change in growth is a guarantee.
Like the number of times I've changed my paperwork, like my intake [00:20:00] paperwork based on feedback that we've gotten from clients, right? Or even with my supervisees I'll say, I attended this conference and I learned about this and I'm gonna try this on. And they've said to me, it's really cool to see that you are doing things differently or that you'll try something on differently.
Like I'm running a supervision group that I've ran this group for several years. And I said what if we actually start together by doing a meditation? And I facilitated a meditation, and the feedback that I got from one of the participants was. It's really inspiring to see you come into this group and try things on and do it differently with us.
It gives me sort of the confidence to go in with my clients and say, Hey, I went to this conference and I learned this thing. What if we try this on? That we don't have to. There's so much pressure that we feel like you said, to have it exactly right and that if we show that maybe we're gonna change direction or try something else on that's somehow.
Shows our infallibility, whereas I actually think [00:21:00] it just highlights, growth and willingness to experiment and that's only a good thing in my opinion.
Libby: I love that story about how the participant made that observation to further validate the acceptance and appreciation of things evolving.
That's a really nice story, so thanks for sharing that. And when you created your first training, I know you had mentioned it's been a couple decades since your internship, but when you created your first training 10 years ago, what were you exactly trying to solve and like, how did it grow into the respected program it is today?
Which is similar to the other question I asked about evolution and adapting your philosophies.
Marci: It was a really a straightforward problem I was trying to solve, which was eating disorders. People who have eating disorders need dietitians and dietitians don't get much by way of eating disorders training as part of, our undergraduate and dietetic internship education, and so I had the opportunity to begin teaching at this certificate program that I had mentioned at Plymouth State. I think it was back in maybe 20 14 when I started teaching and I was like, oh, I could just. [00:22:00] Take my curriculum and turn it into an online version and like a self study.
And at that time, self study and online trainings were not nearly as prevalent as they are today. But that was a problem I was trying to solve. I was just like, more people can do this. They just don't have the training. And dietitians are amazing learners. They're incredibly compassionate. There is no reason that without some training we can't have some more confident clinicians. And so that was really the problem that I was trying to solve, and although I would be very curious to hear your perspective on this, Libby. I think it grew mostly out of word of mouth. I think I was lucky because I did it early on before a lot of other people were doing online training, so there was just a little bit of luck in the timing.
But I think it was a lot of word of mouth and then very similar, just like you said in your question. I think that one of the reasons why it is well respected. Is because I've continued to improve it and every improvement I [00:23:00] have made in my training programs has been based on the feedback I've gotten from the participants of the program.
And so I read every single piece of feedback. I personally read every single piece of feedback from every single participant. So if you've taken my course and you've submitted a feedback form, I've read it, and then I save that, and then I use that information and I've used participants to give me specific feedback to build and improve the next version of my course.
So that might. First online training program is now in its third iteration and in the next year I'm gonna be building the fourth iteration. So it's always
Libby: improving. That's true instructional design, which is like building online training materials. That's how you're supposed to do it, is get the feedback and then make improvements based on what people tell you, not what you think 'cause oftentimes. We go down a rabbit hole. We need to make it beautiful, this and that. But the best use of improving a program is actually from the mouths of your paying clients or [00:24:00] participants. Would you agree with that?
Marci: Oh, 100%. I agree with it. 100000000%. And I actually, got a handful of people who I paid literally to take my course and give me really specific feedback, like line by line. Like I had participants who took my course and they gave me lesson by lesson, module by module. This is what I liked. This is what could be different. I would think it would be really cool.
So one quick example is that people always want more vignettes, right? To make it feel real. And so one major change I did was one, adding more vignettes, but I made a master client who we take from the beginning of the training and it's a very long training to the end of the training, so they go through with a full client.
Another big change I made was making each of the lessons shorter. And more bite-sized. So all of the changes I've made, one, I would not have thought of them myself, and they were given by people who had taken my course, and it's made my course better and better without a doubt. [00:25:00]
Libby: To clarify vignette case study.
Is that what you Yeah, with the case study, make sure exactly. I don't, I just make sure that that's understood by everybody listening. Fantastic. Yeah, making it really practical is very helpful. Vignette, do you have a ratio of a certain amount of vignette or case studies per like lesson or objective or like how many vignettes are we talking about here?
Marci: Oh, that's interesting. I have no idea.
Libby: Okay, so it's not structured as in each objective has three vignettes and a different, okay, alright. No, but
Marci: maybe I'll take that away, Libby for 4.00.
Libby: That's how I think I like to have them structured and it doesn't always work perfectly that way, but for example, in motivational interviewing, you might have two vignettes for, asking open questions or elicit change, et cetera.
So it's just a structured way of thinking. Alright. Marci, it's been an absolute pleasure. I wanna have us wrap up with, what advice you would give to dietitians who wanna step into leadership, whether that means creating, teaching a course, mentoring others, or being well known for what they do.
Like you are, 20 years ago you tapped into an area that is, [00:26:00] has grown substantially and you tapped into online training, which has grown exponentially. So how would you know, how would dietitians do that? In this current economy that we're living in, virtual landscape that is definitely more popular and saturated than was when you tapped into it.
Marci: There are definitely some different and unique challenges that people are facing who are more at the start of their careers. And I will say I'm facing them too. I am continually evaluating, reevaluating, and looking at how I might do things differently. A couple of things I will say. One, it is gonna sound very cheesy.
I mean it, which is follow your heart. If your heart is not in it, but it looks popular, or that other people are doing it, or you think that you should do not do it, that is not a good enough reason. You need to follow your heart. It's gotta be something you feel really excited about and passionate about.
So for a long time, people who went into private practice thought I'll start in a solo practice and [00:27:00] then to look successful. I quote, unquote, should be hiring other dietitians. What if you don't wanna hire other dietitians? What if you don't wanna spend your time managing a staff? That is not enough reason to do it.
You should only take a step because you feel really excited about it. The second thing I will say is that you have to be willing to take some risk. So it's gotta feel scary for it to feel worth it, in my opinion. So that if you wanna be an entrepreneur, you wanna do things that are maybe less traditional.
There has to be some willingness to do something that feels a little bit like, I don't know if this is gonna work out, or I feel, a little bit stressed about, how this is gonna pan out. Maybe even financially. And I'm not talking about unreasonable risks, but there is a degree of risks that if you're just wanting to play it safe or you're gonna wait until you feel totally sure you're, wait until you feel totally comfortable.
Uhuh, nope. Nope. You take a little bit of a leap and that's why you have, your support around you, a mentor around you, [00:28:00] a community around you. The scariest things, I'm doing something very big and scary right now, but everything that I have done that has felt exciting and worthwhile, has felt scary.
Whether it was like the first talk I gave on a national stage or building a course terrifying absolutely terrifying. But those are the things that have been the most rewarding. And the things that I don't regret and I've had. Tons of failures along the way, so it's just like
Libby: part of the deal.
Beautiful reflections. Anything that you want to promote that you anything from your body of work or, I know we want people to follow you on social, but as we wrap up, any final words for the listeners?
Marci: Oh I hope that people will find me on social media and that if there is an interest in pursuing anything related to eating disorders and body image counseling, you can find me on my website marcird.com.
You can look on my socials. My teachable website is marcird.teachable.com. So I am very easy to find. I would love to connect with you, and if you have any questions about my online trainings, you can of course, shoot me a [00:29:00] note and let me know, and I'm happy to answer your questions.
Libby: It was an absolute pleasure to have you, Marci.
Thank you for your time and energy today.
Marci: Thanks so
Libby: much, Libby. Have a good one. You too.
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