Developing Clinical Judgment

By Emily Glass, UMD Dietetic Intern

After almost every nutrition lesson my college professors would add a caveat, such as “this will change, so you will have to use your own clinical judgment.” The concept of using clinical judgment has always scared me a little. I find I often ask myself what is clinical judgment? And how do I develop this skill?

As I began my clinical rotation, I made it my goal to establish great clinical judgment skills.  When faced with a patient with no appetite and poor intake, the question arose: do I still give them the restricted diet that is recommended for their medical condition or do I give them a liberalized diet, hoping they will eat more. Checking in with experienced dietitians, I noticed that the opinion on what to do in this situation varied from person to person due to their own clinical judgment.

Clinical judgment is not rigid, but rather ever changing. I am learning to compile subjective and evidence-based information, and then critically evaluate and reflect based on my experiences and beliefs to determine the best course of action. Clinical judgment is a broad skill that is truly unique to every individual as a result of the experiences they have had throughout their career. In addition to a variety of experiences, the ability to self-reflect is vital. By reflecting on actions and experiences, I strive to make better clinical decisions for patients.

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You do not just develop clinical judgment skills in clinical practice. I began my journey in nutrition at Johnson & Wales University studying culinary arts. I took rigid culinary classes, learning about origins of food and authentic cooking methods. This strong foundation in food has had an impact on my specific clinical judgment. I believe to understand nutrition, you must first understand food. My background gives me the ability to better analyze a diet recall from my patient and give great, realistic ideas for improvements.

The University of Maryland internship is special in that it continues to give me the ability to try many new things and interact with a variety of different people. Through every experience I’ve had in this internship, I have found ways to improve and grow my clinical judgment skills. In my food service rotation I gained a better understanding on how a hospital kitchens operates, the quality of food patients expect and how to provide great service to the patient. I noticed when a patient received great service and had their specific meal order taken, they often ate more of their meal and felt more involved in their care. This has helped me understand a way to potentially increase intake and how best advocate for a patient’s diet. Through my community rotation I gained valuable insight in recognizing the skills and information people already possess, which helped me see the gaps where I could provide education. By reflecting on my lessons in the community, I found certain tones and ways to approach a topic that work well.

Finally, five weeks into my clinical rotation, I have learned no patient is the same. The method that worked during the last diabetes education, may certainly not work the next time. But, by having the ability to pull from my many different experiences and reflect on what has been successful, I grow and improve my clinical judgement for the next time.

Although the skills learned in food service, community, and technology rotations are not necessarily clinical, they play a vital role in developing clinical judgment skills. By having a better understanding of food, the people within the community and the technology that is available, I have more information to draw from when making important clinical decisions.

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