SeAnne Safaii, PhD, RD, LD, is not only utilizing an innovative method to teach tomorrow’s dietitians and employing virtual reality technology to help young people work through their diabetes management, but as the 2013-2014 President of the Idaho Academy of Nutrition and Dietetics, she is working with the state government to get fellow dietitians the recognition and value they deserve.

By: John Parkinson, Clinical Content Coordinator,

When you think of Idaho, your first thought might not be that it’s a place that’s on the cutting edge of diabetes management or dietetics. However, the state, and in particular, SeAnne Safaii is on the forefront in training future dietitians and helping those with diabetes.

Safaii is a professor at the University of Idaho where she teaches nutrition courses and clinical practice sessions to aspiring dietitians. At the university, Safaii is part of a project involving robots, which are used to help students learn how to go through hospital clinical experiences.

 This project has been able to fill in for the large decrease in dietitian internships in recent years, according to Safaii, as well as allow hospital preceptors to participate in this unique clinical experience. 

Here is a video providing an overview of the dietetic program at the University of Idaho as well as discuss the clinical simulation that do using robots.

Safaii has also been a leader in a study looking at using a virtual world diabetes center utilizing the Second Life technology platform to help young adults with their diabetes management. Participants in the study used avatars, which are fictional characters made up by individuals who participate, and they are set up in situations where they meet with healthcare providers. This revolutionary study has just wrapped and Safaii and her students have been in the process of writing up papers for various journals.

In addition to Safaii’s work at the university, she is the 2013-2014 President of the Idaho Academy of Nutrition and Dietetics, an affiliate of the Academy of Nutrition and Dietetics. She has been working with the state government to get dietitians recognition and a place at the table for reimbursement for them. spoke with Safaii about how they are using robots with students, the interesting findings of the virtual reality program, and what she and the Idaho Academy of Nutrition and Dietetics are doing in terms of nutritional programs and trying to get dietitians recognized. Can you talk about how you use robots at the university?

Safaii: We use them in our labs and run students through scenarios. The students go into a hospital room, shut the door and there is a medical simulation robot in the hospital bed. There are cameras in the room. We talk through the robot acting as the patient, so we simulate that experience of being in a real hospital.

We watch the students from the camera in the control center and once in a while we will open it up and put it up on the tv so that their fellow students can watch in the classroom and they critique each other. This method is called experiential learning, which included active experimentation and reflection upon the experience by both learners and observers. It’s a wonderful way of learning.

It’s really helpful because our internships and supervised practices are so difficult to get anymore that we have helped our hospital preceptors by relieving them of 150 hours and taken it on ourselves. It also raises the bar because all of our students are getting the same amount and kind of training. Is this replacing the internships altogether?

Safaii: It’s not totally replacing them but giving students the same type of learning using the robots so that when they are actually at an advanced internship level when they enter the medical settings, they can apply what they’ve learned to real-life situations. When our students walk into an internship now, they are more like dietitians than interns, so consequently, they need less time in their internships. Hospitals like that.

Studying the effectiveness of  dietetic simulation has been one of my areas of research. I had questions going into this, like will the preceptors notice a change in the quality of these students’ work? Will the students be deficient in some areas? And the simulation training has been absolutely seamless to our preceptors. They can’t tell the difference in the reduced hospital time.


Safaii teaching her students by doing medical simulations using a robot in the hospital bed. The simulation helps the dietitians-in-training by going through inpatient scenarios they would see in a typical hospital setting. Can you talk about what your goals are as president of Idaho’s Academy of Nutrition and Dietetics this next year?

Safaii: We are gearing up for healthcare reform. We are trying to position nutrition services as an integral part of healthcare reform and Medicaid redesign in Idaho.
We testified in front of both the state house and senate. From that, we helped draft a joint resolution that says that nutrition services and medical nutrition therapy are keys to preventing diabetes, obesity, and turning around healthcare costs. And, that registered dietitians are the only ones in Idaho licensed to provide medical nutrition therapy. The resolution passed with no opposition through both the house and senate.

This resolution has opened up a lot doors for us. Next year we hope to continue that success and our goal would be to have every single Idahoan have access to nutrition services as part of their healthcare package.

We are trying to have a seat at the table with the committee members who are designing Idaho’s exchanges. We are really trying to let people know that nutritionists can have a big impact on healthcare in Idaho. Was the resolution an acknowledgement of what your profession does with people?

Safaii: It was and it really stated dietitians all over the state are willing to help in the prevention of obesity and diabetes to help reduce healthcare costs. We are eager and ready to work. Do you think this will have an impact on funding for nutrition and for reimbursement?

Safaii: I do in a couple of ways. From a grant writing perspective it’s very helpful. I have an NIH grant that is winding down. When you write grants from little Idaho it helps to say we have a joint resolution in our state that supports nutrition services.

And we have a really supportive legislature. They are talking about creating a wellness package. We would like nutrition services to be included in all wellness packages being delivered to people across the state. According to CDC, the percent of Idahoans that are overweight or obese is around 62 percent. If we could get these individuals to reduce their body mass index by just 5 percent, Idaho could save more than $1 billion in 10 years from obesity-related diseases. Given the observations of the role nutrition plays in managing chronic disease and the current numbers for Idaho, it is necessary that medical nutrition therapy be included as an essential health benefit. What’s your state’s emphasis with regards to obesity, overall nutrition, and diabetes for the coming year? Can you talk about one or two initiatives or events you have related to any of these fields?

Safaii: We are hoping to have a role in providing intensive behavior therapy for obesity under Medicare and Medicaid.  And we have a very active state-wide media campaign to raise the nutritional literacy of Idahoans. We have five newspapers that we write for, including our statewide newspaper, the Idaho Statesman, which appears 6 times a year.

We also have students who are active in writing articles and blogging on the Idaho Academy of Nutrition and Dietetics website.This is the public side of the site where people can come in and get information on translational research and media messages.

Because our state is small, we can have a huge impact on getting the message out there to people.

One of the speakers at our recent state conference did a presentation on (HEAL) Healthy Eating for Active Living. We are actively involved in HEAL which is about obesity prevention.

We are also sponsoring a new showing, of the movie, A Place at the Table, which will be appearing  at one of our great old downtown theaters in Boise. It`s a documentary about food insecurity and hunger. You were part of a team that created a virtual diabetes center. Can you talk about the decision to do so, and what findings you can share about it?

Safaii:This is an important group to study, because young people fall off the grid and often have a difficult time with their diabetes management. They are leaving their parents guidance and transitioning from pediatric to adult care. They are very busy.  Many of them are students, and either have fixed incomes or no income at all. They can’t afford their medical supplies or to see their medical provider. They don’t know how to cook, and they may be drinking. So they have a lot of potential areas where their blood sugar and control can be affected. However, they are also very social.

We conducted a series of focus groups on how to engage them including what would help them manage their diabetes, what they need, and how we could provide it for them in a virtual world.

The virtual world we created had a diabetes center with virtual dietitians and other healthcare providers. For the virtual world, we recreated the exact types of diabetes classes people found in the real world. They had four group classes and two individual counseling sessions. They would meet in this virtual world and then we compared that experience to face-to-face meetings. 

We had 97 people participate who were between 18-29 years of age. Our hypothesis going into the study was that the test subjects in the virtual world would prefer to have the anonymity of having an avatar (made up fictional character by creating an identity in the virtual world), rather than meeting face to face. We thought they would be more open in discussing things and instant messaging each other.

However, we found that we should let people meet first face-to-face in the real world before working together in the virtual world because people did like face-to-face meetings with providers and other people with diabetes first. They liked the social support and meeting people and providers in person.

We also had people who participated in the virtual world evaluate it and say what they would like to add. One common piece of feedback was that people wanted gaming features with rewards added to it. We decided to add a kitchen where the avatar goes in and learns how to cook. They take their avatar through the recipe using the refrigerator to get out the ingredients and the proper cooking equipment to make the recipe.

The other area we studied was dining out. Young adults go out to eat all the time, so we developed a restaurant and there are two parts to it—a buffet and a sit-down area. The sit-down area has a menu comparable to big chain restaurants.The participants put in their diet plan including their carbs and select the food they want to eat from the menu. It then measures what they select off the menu against what their meal plan is.They then get rewards from the game if they meet their diet plan goals. 

With the buffet section, the avatar has to walk down the line and make food selections from the buffet and make sure they don’t go over on their meal plan. They are able to get instant feedback.

We are going to open the site up to the public in August. We spoke to dLife recently and we are hoping to partner with them.

The top image shown below is how the buffet is set up in the virtual world, and the bottom image shows the menu from the sit-down restaurant portion of it.
























 Would you like to open this virtual world up to a variety of people? 

Safaii: The virtual world will be accessible to the public for the next two years.  We will continue to evaluate it’s usefulness during this time. After that, we will need sponsors to keep it open.

It’s a great gathering place for people with diabetes. Everyone’s avatar walks, flys, talks and can instant message (IM). I would love to have a special celebrity guest speaker come in to speak in the virtual world. You could have someone like a Nick Jonas or a Brett Michaels come in and do a lecture for people with his avatar. And one of them could talk about a day in the life of living with diabetes. Do you see it as a teaching and feedback tool for people who may have questions?

Safaii: It is. One of the things this age groups likes—because we are in an age and expectation of instant gratification—is instant contact with their provider or coach. It would be great if we could secure funding to have a 24-hour certified diabetes educator (CDE) in this virtual world who could answer questions. Say a person has high blood sugar, he or she could access the CDE anytime. This is what young people want when they get into trouble. They want somebody they call who is not their parents, and they want to manage the problem themselves, but yet need assistance in knowing what to do.