Navigating Clinical Dietetics: An Intern’s Guide to Personal Growth

-By Alexandra Long

I’ve been told by former dietetic interns that your clinical rotation is the hardest. “Good luck!” they’d say. “You’ll get through it!” Why did everyone anticipate I’d need these good tidings? I did well in my medical nutrition therapy courses in school; I have a strong clinical interest and was looking forward most to the clinical rotation. I assumed a smooth transition from my studies to the application of medical nutrition therapy with real patients. What other skills would I need?

As I am currently in the 9th week of my clinical rotation at Holy Cross Hospital in Silver Spring, MD, I can say that my undergraduate studies provided the knowledge base I needed, but did not prepare me for the complexities of the diverse patient population and medical conditions. This rotation has helped me connect the details in the progress of patient care. For example, I have a better understanding of how a specific lab or medication relates to the patient’s disease state.

While acclimating to the clinical rotation, I’ve learned these four strategies to make the most of the time spent:

  1. Push myself outside of my comfort zone.

Before my internship, I did not have any experience with patient interaction. Knocking on doors and speaking to patients was not something that came easily to me. By reminding myself that I’ll only be able to help someone when I build a rapport, I gained the motivation I needed to see more patients and provide better care.

  1. Take every opportunity to learn.

I’m fortunate to be at a teaching hospital with a preceptor that values interdisciplinary care. She organized for me to observe wound rounds,  PEG tube placement, esophagram, and barium swallow, and sit in a gestational diabetes class. Two of these experiences helped me in ways I hadn’t anticipated.

  • While following the wound care nurse, I witnessed the debridement of pressure ulcers and maintenance of ostomies. From observing the amount of tissue and muscle loss in some of the wounds, I understand the importance of nutrition in the healing process.
  • As dietitians work closely with speech language pathologists, seeing their work first-hand with an esophagram and barium swallow helped me better understand the need for modified-texture diets.
  1. Remind myself I’ll grow with time.

I’ve had growing pains throughout my clinical rotation. There will always be room for improvement, and I’m constantly striving to reach my next goal. Without challenging myself, I’d fail to realize my full potential. After each week, I look back to where I started as a reminder of how far I’ve come.

  1. Remember to take care of myself while taking care of others!

It’s easy for me to become engrossed in my work, but I don’t want to burn out. I try to take time every day to do something that I enjoy. I’ve found that walking helps to relax my mind and relieve stress.

By following these guidelines, I know that I will get through my clinical rotation. I have so much to learn from my preceptors. Constructive criticism may be difficult at times. However, I’ve learned to appreciate the feedback as I know my preceptors’ intentions are to challenge me to grow. The former dietetic interns were right – it has not been easy. I have learned a lot already, and I am proud of my growth.

 

Farm to Dining Hall; UMD Harvest Festival

 

-by Adam Sachs, Dietetic intern
On September 27th, the interns took on University of Maryland’s (UMD’s) third annual Harvest Festival. This festival is an opportunity for the students at UMD to experience and learn about food grown close to home. The festival was held at two UMD dining halls, and featured several menu items from UMD’s Terp Farm site and other sustainably-sourced, local farms. The Terp Farm is a division of UMD’s Dining Services, and employs several students throughout the year. Some of the featured menu items for the night’s event included acorn squash, butternut squash, local apples, Chesapeake Bay catfish and even some livestock raised at local farms. The Interns helped to organize elements of the event and assisted with the main activity during the festival.

harvest festival pic 2I was in the group who was assigned to the 251 North dining hall. We all received matching Terp Farm t-shirts and began to help set up the dining hall with fall decorations, including pumpkins and gourds that were grown at the Terp Farm. The live band began to play, and the dinner rush started to file in. After entering, students were greeted by volunteers who explained the harvest festival, as well as the opportunity to participate in the night’s event. The students were given a card with all the featured menu items in the dining hall. If they went to each station to hear about the featured item they would receive a sticker on their card. If they got all six stickers, they could turn in their card for a free pumpkin and a chance to enter a raffle for a Community Supported Agriculture (CSA) package.

As the dining hall began to fill up, students became more engaged. They saw other students travelling from station to station and receiving stickers on their cards. I was handing out stickers at several of the stations and we even began to have short lines forming with groups of students coming up to learn about each featured menu item. Many of them seemed genuinely interested in how the food they were eating came from farms down the road. Others were intrigued that food items were grown by some of their fellow students. I’m sure the free pumpkin encouraged their participation, as well.

As the festival was winding down I was at the station which featuring a roasted leg of lamb carving table. The lamb had been raised on the Campus Farm which is a part of the college of Agriculture and Natural Resources. One of the students came up to hear about the station and receive her sticker. I explained to her that the lamb on the carving table had been raised on campus with the help of students enrolled in certain animal science classes. She responded by saying “You mean the lambs I say hi to on my way to class?” I told her that it was a possibility. A look of understanding crossed her face as she finished listened to the rest of our facts about the menu items, and she sat down to eat. She did not seem disgusted or offended, but I think she really made a connection about the concept of farm to table, and having a better understanding of where our food comes from was the main purpose of the Harvest Festival.

A DI’s Experience at the Natural Foods Expo East

By Melissa Talley

What better way to get a feel for the diverse natural, organic, gluten-free, and non-GMO products that are on the market than to attend the Natural Foods Expo East– the largest natural food expo on the east coast! It was held on Saturday, September 16, 2017, at the Baltimore Convention Center. I had the pleasure of working for one of the vendors and experiencing it for myself. Prior to attending this event, I had no idea what to expect; I knew that my job was to promote Pamela’s brand gluten-free products, but I didn’t know that it would be such a memorable experience.

The plethora of natural products occupied almost 3 floors of the convention center, leaving room for 1,523 exhibitors to inform, engage, provide samples, and “hype-up” their products to potential customers. While my job there was to hand out Pamela’s gluten-free samples and work with their team to showcase their items, I found myself with wandering eyes, itching to learn more about every single product in the building. Fortunately, I was able to take an hour-long break to explore the three floors myself and one thing I can say is that one hour was not nearly enough.

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The expo showcased kombucha teas, protein bars, granola, granola bars, microwaveable dinners, chocolates, pastas, milks, and even plain water. They had brands that were extremely popular, such as “Skinny Pop,” and other brands that weren’t as common, such as  a prebiotic and probiotic bar called “Truth Bar.” Throughout my time exploring the convention center and talking to promoters, I realized that businesses love buzzwords. Almost every station I passed highlighted their product as “the best gluten-free item on the market,” or “inspired by the paleo diet!” It was eye-opening for me to see so many new products on the market. For example, The Modern Pod Co. promoted their hummus ball enclosed in a multigrain crust, and the company “LYNQ: Love Yourself No Questions” promoted “sneaking vegetables into kids diets” through a drink.

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It was a stimulating experience to not only see, but also take part in the business side of the food industry. I got to see some of the finances behind attending this event as a vendor and was able to meet unique business people. For example, Pamela’s Products station was placed adjacent to “Three Jerks Jerky.” I first heard about this line of all natural filet mignon jerky on the show “Shark Tank,” where ambitious entrepreneurs present their business concepts.

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As a dietetic intern and aspiring registered dietitian, I think attending this event was extremely important for my awareness of products on the market. I now understand what to look for in products as well as what not to look for. Future clients may ask me about certain products; now I have some firsthand experience and can help them make informative decisions.

Reaching a Diverse Audience in Corporate Wellness

Corporate wellness programs teach the employees of large companies about healthy lifestyles, but as a dietetic intern with the corporate wellness program at Johns Hopkins, I learned so much more. In less than two months, and after just my first rotation, I’m already practicing many of the skills a dietitian needs to be successful. Under the guidance of my preceptors, I edited and developed talks on various topics, located educational materials to use, helped run the wellness program booth at health fairs, attended meetings and observed individual counseling sessions. Most importantly, I got to see the unique difficulties dietitians face in this setting, and how experienced professionals handle this type of work.

Corporate wellness programs are a huge business, and field is only expected to grow. They offer work for dietitians that differs from the more commonly cited areas of clinical, community and food service. Initially, many companies offered wellness programs simply to try to avoid rising employee health insurance costs by improving the health and physical well-being of their workers. Over time however, employers began to recognize the importance of providing mental health, stress management and other services as part of their wellness programs, aiming to create a more holistic approach to employee well-being. Because of this, a dietitian working in a wellness program may need to learn about aspects of health that weren’t explicitly covered in their education or training. Backgrounds, education levels and job titles may vary drastically across the employee populations, so wellness dietitians need to know how to serve diverse audiences.

The workforce of a hospital is particularly varied; the wellness program may work with doctors, housekeeping staff, management, office workers and others, all of whom come from different backgrounds and levels of formal education. When giving advice on healthy living habits, dietitians may need to talk with authority on a large variety of topics, not all of which center around nutrition. They also need to tailor their message to their audience. A physician probably doesn’t need to be told what hypertension is, but may still benefit from ideas on how to fit physical activity into their daily routine. An employee without a formal education in health and medicine shouldn’t be expected to already know jargon, so teaching them what HbA1c means might be necessary.

Throughout my assignments and activities, I learned how important it is to be able to use plain language to communicate to the widest audience possible, while still conveying useful and relevant information. In corporate wellness, the goal is to promote healthy behaviors to as many employees as possible. To accomplish that I have learned to tailor my message so it is accessible to a diverse group of employees.

Just take one bite

Note to reader: This is our new blog. Please visit our old blog to read more intern experiences.

By Julia Werth

“The last rule I need each of you to remember before we start our tasting is that no matter what, everyone will take at least one bite of the pear today.”

I looked around the first grade classroom, trying to discern if the message had made sense to the 20 or so 6-year-olds that, unlike me, seemed to be eagerly awaiting their piece of pear.

“That means, even if you think you don’t like pears or fruit at all, you are going to take at least one bite,” I made eye contact with the boy who just minutes before had pronounced, “I don’t like fruit and vegetables.” He nodded.

Good, I thought. You and me both buddy.

Despite a degree in nutritional sciences, a love of apples, grapes, beets and dozens of other fruits and vegetables and the title of dietetic intern, I had yet to come to terms with the pear.

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Before the pear tasting, my internship partner and I led the students in a lesson about where their food comes from. Teaching them the steps from the farm to the fork. The lesson we taught is part of a series called ‘Read for Health’. Each lesson incorporates a picture book so the children can more easily understand the message.

As I delivered a pear slice to each child, I did my best not to look at the oddly porous, white flesh of a fruit I had never voluntarily eaten.

“It looks funny,” one of the kids said as I placed a tasting dish in front of her. I wanted to agree, but I stopped myself. I had just told each of these kids that they had to try the pear. I supposedly wanted them to learn to love fruit. I wanted them to choose it as a snack over crackers or cookies. I wanted each one of these first graders, to grow up to be healthy, strong adults. I wanted them to have health eating habits from the start, and not spend their adult lives relearning how to eat. I wanted that even if it meant that in less than a minute I would bite into my least favorite fruit, smile and say “yum.”

In my past two weeks working with the Food Supplement Nutrition Education program I have learned that in order to convince others to change or try something new, you yourself must model that very behavior.

During this time, I ate Tuscan Kale salad in order to help nearly 900 elementary schoolers try it for the first time, and a week later more than 100 bought it for lunch! Additionally, I ate apple coleslaw in 85 degree heat so farmers market shoppers felt brave enough to give it a taste, raw fennel at a food bank where it was available in abundance, two different types of apple slices amidst enthusiastic fourth graders, and (of course) a slice from the smallest pear I’ve ever seen while I watched nearly all of the first graders chow down with a smile on their face.

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Our station in the cafeteria to introduce 900 elementary schoolers to kale.

“Oh, wow, that’s good”;
“I actually like that”;
“Can I have some more?”
I heard again and again at each event.

Children and adults alike were trying and learning to give fruits and vegetables a chance. They discovered that they could be yummy, and even better than that, they could keep them healthy.

But what about me? Could I learn that lesson? Would I be able to not only choke down a bite of pear and slice of fennel, but could I really learn to give once disliked or less common fruits and veggies a chance? I don’t want to speak too soon, but I will say that I didn’t just take one bite of pear.