University of Maryland Dietetic Internship

The new workplace culture is workplace wellness

By Adam Sachs, Dietetic Intern

How would you describe the culture at your work? Maybe with words like “team centered” or “innovative.” But have you heard of a company that establishes health and wellness as one of its core values? I recently had the opportunity to work with the dietitian from FX Studios, a corporate wellness company who partners with Under Armour. FX Studios has several other clients besides Under Armour employees, and they offer services such as nutrition counseling, meal planning, basic medical nutrition therapy, personal training, and exercise classes. I was given the opportunity to observe clients during counseling sessions, as well as participate in seminars given to various businesses who contract with FX Studios. One of the most profound things I noticed about my time in FX Studios was the attitude held towards health and wellness by the Under Armour employees. Most everyone I came into contact with seemed very invested in their well-being, and had a positive rapport with the dietitian, personal trainers, and other staff. Wellness is a very big part of their daily lives and seemed to be incorporated into the culture of the organization.

The prevalence of chronic diseases in the United States has increased dramatically over the past decade alone. Rates of obesity, diabetes, and cardiovascular disease are increasing not only in numbers, but also in younger and younger age groups. These diseases drastically increase mortality risk, and drive up the cost of medical expenses throughout the nation. To combat this, preventative medicine practices are also on the rise. Preventative medicine usually combines many aspects of lifestyle management in order to prevent the onset or progression of chronic diseases. Improvements in diet and exercise practices have been proven to decrease the risk for diabetes, cardiovascular disease, and weight-related complications. Preventative medicine also includes lifestyle management in areas such as alcohol/tobacco use, sleep, and stress management. Working Americans typically spend 40 or more hours each week on the job, and for many people, that involves sitting at a desk for most of the day. Sedentarism is often a contributing factor to developing some of the disease states above. Corporate wellness companies like FX Studios are really striving to promote practices help employees stay engaged in their personal well-being. One of the projects I got the chance to work on was developing a Nutrition challenge for FX Studios to implement at various client sites. The challenges allow employees to track/upload nutrition or exercise practices in order to gain points and compete for prizes. My particular challenge was designed to encourage participants to substitute healthier ingredients in their daily meals and snacks. Points could be achieved through uploading food logs, recipes, or pictures of meals to the wellness portal provided to employees in the program.The dietitian explained to me how easy it was for Under Armour employees to get on board with the challenges, because the company as a whole is already very focused on health and well-being, even during working hours.

Fortunately, many employers of other companies are also on board with idea of corporate wellness. Healthier employees tend to be more productive during working hours and take less sick days throughout the year, which can also save a lot of money for the business. Many employers are encouraging health and wellness by providing a variety of benefits that foster healthy habits. This can be as simple as offering a discount at local gyms or hosting weight loss or step challenges. Other employers even go as far as hiring personal trainers to conduct exercise classes before or after business hours, or contracting with a corporate wellness company to offer nutritional, exercise, and wellness services to employees free of charge. I was able to assist with a nutrition focused seminar for one FX Studios’ clients which is a part of a medical system. The seminar focused on meal planning during the work week. Medical professionals who attended were able to receive continuing education credits for the seminar. Many large-scale businesses such as Google, Facebook, and Amazon have implemented wellness programs for their employees for several years now, which achieved increases in employee morale, productivity, and wellbeing. Corporate wellness programs and resources are becoming more available to the average business owner making it more feasible implement some level of an employee wellness program. The CDC has some great information about promoting wellness at the workplace. Having observed a company with an extensive wellness program first hand, it is very apparent that the employees are happier and healthier while on the job. Incorporating workplace wellness into company cultures helps to promote an overall healthier work environment, especially when employees have the support of their peers and supervisors.

Growing Healthy Habits

By Melissa Talley
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It has been about 15 years since I sat in the miniature chairs and knee-high tables in a low-ceiling elementary school. This past week I not only stepped inside an elementary school for the first time since then but was on the reverse end teaching, conducting, and instructing. My partner Becky and I had the chance to teach kids grades 2-4 about sustainable living and growing your own vegetables with the Food Supplement Nutrition Education (FSNE) program. We traveled to different schools in counties all over Maryland to educate these young, energetic kiddos. During this three-week rotation, I realized that as a teacher I often was learning as much from the children as they were learning from me. Here are a few things I learned while being “Miss Melissa” these past couple weeks.

They Want to be Healthy

As a dietetic Intern for 8 months I have realized that it is extremely hard for adults to want to be healthy. Unless a significant health issue arises, why would they spend hours on a garden growing vegetables when they can spend 5 minutes at a fast food drive-thru? While teaching these sustainable lessons where the kids saw where their vegetables were coming from, I received feedback that every dietetic intern wants to hear including, “I love eating this lettuce in my salads,” and, “Can we take it home so we can have some for dinner?”

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Eager to Learn

Aside from actually wanting to consume the healthy vegetables, children are unique in that they genuinely want to know what sustainability is, what is so great about fruits and vegetables, and how they can include more of them in their life. While they want to learn more, many of them already know a lot about saving the environment by recycling, picking up trash, and saving water. On my first day I was surprised when I saw how eager they were to learn about nutrition, which made me excited to not only teach the lesson, but also influence their lives in a healthy, sustainable way.

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High Energy is Inevitable

With all this excitement to be healthy and eagerness to learn, comes a great deal of energy. I learned that when working with this age group, I needed to be ready to use my teaching voice. After teaching 4, 45 minute lessons in a day, I realized how difficult it is to control, quiet, and calm your students, but also how rewarding it is knowing you are changing so many children’s lives in a positive way.

These past three weeks have been extremely impactful for my experience as a dietetic intern. With an interest in pediatrics already, this rotation only made me more excited to become a registered dietitian and continue teaching children and families about how important it is to incorporate good nutrition into their daily lives. What better way to do that than having the children grow their own vegetables? Thank you to FSNE for such a great, unforgettable experience!

Cooking Up Success

By Danny Turner

My recipe for a successful theme meal at Meritus Medical Center had three essential ingredients: teamwork, planning, and fun! When the executive chef at Meritus told my internship partner and me that we had total control over planning and executing a theme meal, I knew it would go well when my partner and I had the same first thought: chili cook-off. It was going to be a lot of work with many moving parts, and neither of us had organized a food service event like this before, especially not at this scale. We had a month and a half to prepare. Thankfully for us, we would have the help of the entire food service department. They routinely make and provide food for Meritus’ hundreds of employees and visitors every day, and were more than willing to help us carry out the task ahead of us.

The first step was fleshing out our idea and choosing several recipes to test. Since it was meant to be a cook-off, we decided we would sell 3 small portions of different chilis along with two kinds of cornbread, and distribute a survey as a means of selecting a winner. We spent a day researching recipes online, picking several that seemed interesting to us. The woman in charge of inventory and ordering then helped us place small orders of the special ingredients not normally stocked in the kitchen that we would need for recipe testing. She also showed us around the storage areas to help us find the other ingredients we would need. We saw how all foods and ingredients are stored to align with health code regulations, and how refrigerator temperatures are monitored and recorded regularly.

Pictured: Me making sure the cornbread was done and rocking a hair net

We spent all of the next week cooking. In total we tested seven chili and four cornbread recipes. The catering cook showed us how to use the industrial kitchen equipment, and helped us distribute samples of each recipe to as many employees as possible for some first-round feedback. We settled on a creamy chicken queso, a spicy short rib, and a chickpea and sweet potato vegetarian chili. On the side we would have jalapeno cheddar cornbread and sweet honey cornbread. Now that we had our recipes, we needed to plan the event itself, create marketing materials, and analyze the recipes for nutrition info and cost.

Our trifold poster for the event, and Executive Chef Joe

We used a nutrient analysis program that the hospital provided to accurately calculate the nutrition info of each recipe. That information was then sent to corporate communications who put together marketing materials to advertise the cook-off, with input from me and my partner. The front-of-house manager then walked us through pricing our recipes with US Foods purchasing software, and the chef helped us estimate how much food we would need to scale up the recipes in order to sell as much as possible without overstocking and wasting ingredients. We negotiated with kitchen staff and front-of-house employees to get help cooking and serving for the event. It wasn’t too hard to get some staff to chip-in, especially when we offered to cook a little extra for those willing to help. The food service director was even willing to take over making our cornbread during lunch service!

The cover of our event pamphlet, designed by the marketing team

The day of the event finally came, and because we had put in all of the necessary work, and had the expert guidance of the food service department, we were well prepared. The cook-off was a hit! We sold out just as lunch service came to a close, and the surveys were overwhelmingly very positive. We weren’t too surprised to see the chicken queso chili and honey cornbread take first place, but we were thrilled to hear how much people had enjoyed the event. Many people even said they wanted to see our recipes introduced into the regular rotating menu! By teaming up with the foodservice staff and planning, my partner and I were able to make a fun and successful event, and I know I came away from it with a much better understanding of the amount of work necessary to run a large-scale food service operation in a hospital.

From fearful to fearless, my journey through the infamous clinical rotation

By Julia Werth

Clinical.

One word, just eight letters, but so much fear.

In August, when all 10 interns were first looking over our color-coded schedules many of us were zeroing on just one thing – clinical. It was the one thing we feared. The infamous rotation that could make or break us as interns. Mine didn’t start until January, not until 2018, I had nothing to worry about.

But as the months crept by, and January came ever closer, worry started creeping in.

“I don’t think I remember anything from undergrad,” I told my mom on the phone one night in early December, “and what am I even going to be asked to do?”

“You’ll be fine,” she said.

But would I be? I didn’t know. I didn’t know what would be expected of me or what to do to prepare. I had done well in school, but had I really learned anything, or had I just crammed it in for the test? I didn’t know how a hospital functioned or what role I, as a dietetic intern, could play in it. I didn’t know how much work I’d have or if I’d be able to have any free time during the rotation

I simply didn’t know anything.

From Massachusetts to Maryland in one day with one thought in my head: clinical tomorrow.

I was anxious and teary-eyed the entire drive from home back to Maryland on New Year’s Day with four words repeating themselves over and over again in my head.

I start clinical tomorrow.

“What’s the matter?” my mom said, as I sobbed on the phone driving on the endless New Jersey turnpike.

“I don’t know,” I told her. “I’m scared that I don’t know anything.”

Despite her reassurances that I’d be fine, as the sky got darker and darker I got more and more anxious, dreading when it would become light again.

When tomorrow arrived, I put on a sweater and dress pants, with my white lab coat stuffed in my backpack, and timidly began to discover what I didn’t know.

But over the 10 weeks – 41 days of work – fear eventually faded as I learned what I didn’t know.

I learned that clinical wasn’t scary, but it was challenging. I learned that there was a lot I didn’t remember from undergrad, but a little review at home could solve that. I learned that the time flies by in the hospital. I learned that my preceptors were there to help, not hurt, me. I learned that I could really make a difference for my patients. I learned that some people really, really like pudding, and others, really, really don’t. I learned that doctors would actually listen to what I had to say – most of the time anyway. Most importantly, I learned that helping my patients find foods that they actually liked and wanted to eat could bring a smile to their face, even in the midst of their illness.

I didn’t only see patients during my clinical rotation. I also presented February’s Wellness Wednesday superfood: chiles!

“Is there anything else you think you’d like to eat,” I asked my patient. The third variation of the same question, desperately trying to figure out something that he would actually eat. He hadn’t been eating much of anything for the past two weeks. He wasn’t interested in the food and the two Ensures and puddings I sent him each day just sat in a mounting pile on his bedside table.

He shook his head.

I racked my brains. He was on a ground diet, I needed something soft, but something that was supposed to be that way so he wouldn’t think it looked gross.

“Do you like tuna?” I asked. His eye lit up instantly.

“Do you have that? Can I have that?”

“Yes!” I said, so happy to see his eagerness for this food. “I could send you a little bowl of tuna salad, would you try that?”

“I’d eat it all,” he said. “And egg salad! Do you have that?”

“Yes!” I said again. “I can send a little bowl of tuna salad with lunch and the egg salad with dinner, how does that sound?”

His smile said it all. And my answering smile made me realize the most surprising thing of all.

I actually liked clinical. Maybe, despite my initial doubts, my career would start in a hospital, although I’d never once pictured myself there.

Not only do I miss the hospital, the patients and my preceptors, but I miss the sunrises that greeted me each morning over Baltimore Harbor.

My final week of staff relief, I started tearing up again, and naturally, I called my mom.

“What’s the matter?” she said.

And this time I did know.

“Tomorrow’s my last day of clinical,” I told her on the phone. “I can’t believe it.”

“You’re going to miss it aren’t you?” she asked.

The answer was simple and I knew it, Yes.

Now when I hear the word clinical I don’t feel scared. Those eight letters don’t send me into a panic. I don’t worry endlessly about what I don’t know. Instead, I think back with fondness, even on the toughest days where I felt like I couldn’t do anything right, all fear completely gone.

Clinical…it’s not that scary after all.

A Whole New World: Outpatient Counseling

By: Kelsey Felter

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What does a University of Maryland intern do after completing a rotation that focuses on inpatient, clinical training? In my case, I did a second clinical rotation, but one that focused on outpatient counseling. I enjoyed my time in my primary clinical rotation and I was excited to observe and learn in a completely different setting. For my second clinical rotation, I had the amazing opportunity to learn about diabetes and pediatric failure to thrive counseling by shadowing dietitians in outpatient clinics and interacting with patients. I went into this experience with knowledge about these conditions but no experience actually counseling these patients one-on-one. After just two weeks, I learned so much about these conditions and their treatments. More importantly, I learned how to motivate and counsel patients.

My first outpatient experience was through the University of Maryland Medical Center (UMMC). I had the privilege of shadowing an outpatient dietitian as she counseled patients with Type 2 Diabetes Mellitus (T2DM) and taught classes about pre-diabetes, diabetes, and the management/treatment of diabetes. My favorite part about this experience was getting to see the importance of working around people’s schedules, lives, and comfort levels. For example, one patient had a very unconventional work schedule. He would work all night in a soda company warehouse and sleep until the late morning or early afternoon. His meal times were greatly affected by his work schedule. Dinners were either before he left for work at 5pm or after he got home from work at 2am. Eating during the day was variable for the patient due to his challenging sleeping pattern. Many times, he would eat high carbohydrate, nutrient-poor snacks, such as chips and candy because he could get and eat them quickly. This is not beneficial for patients with diabetes because foods high in carbohydrates cause more sugar to be in the blood. For people without diabetes, a hormone called insulin works to remove the sugar from the blood. However, for someone with diabetes, insulin does not work properly and the sugar stays at high levels in the blood. Most of this counseling session ended up focusing on a meal schedule, a medicine schedule, and a plan for healthy, quick snacks for when he is tired. Making the task of eating and preparing meals easier is something I think would help many people with and without diabetes. I am so grateful to have sat in on this and other counseling sessions at UMMC. I learned that problem solving is an extremely important tool in counseling, as most patient already understand the condition but need help overcoming specific barriers to their health.

In addition to observing counseling sessions, I also had the opportunity to help prepare for Heartbeat for Health. Heartbeat for Health is a day of health activities, education, music, health screenings, and refreshments for attendees. In preparation of this event, I was given the task to design a poster educating attendees about prediabetes, which would be displayed at this event. I made infographics focusing on defining blood glucose, eating tips to prevent diabetes, and advice on journaling to track sugar intake. I also constructed a matching game for kids and adults to learn more about food groups, exercise, and MyPlate.

Heartbeat For Health 1 — Above, is the compilation of infographics that I designed for the Heartbeat for Health poster.

Heartbeat For Health 2 — Above is the matching game that I created for Heartbeat for Health attendees. The goal was to make a straightforward, visual game that could be played by users of all ages.

My next experience with outpatient counseling took place in a Growth and Nutrition Clinic, where a team of health professionals counselled parents of children with failure to thrive. This health team was composed of a registered dietitian, a phycologist, and a doctor. Each specialist would speak with the patient’s parent(s) for about an hour. The doctor would see the patient first to rule out any medical problems. The psychologist would see the patient next, acquire a full history of the patient’s behavioral patterns and food behaviors around mealtime from the parent. Usually, the psychologist counsels on how to manage mealtime and what behaviors should be addressed or changed. The dietitian would see the patient last, gather more diet history and finally counsel with mealtime tips and dietary recommendations. I loved getting to work so closely with each patient and their families to understand their issues by diving deeply into their behaviors. I also loved how every specialist came back with new information about the patient to build an even broader story. After meeting with the parents, each specialist would update the team about the information they gathered so the team could piece together the story, as one does a puzzle. What is making the child resistant towards food? What goes on at mealtime? How does the parent respond to the child? Who is in control, the child or the parent? After shadowing at this clinic two times, I learned that there is a common theme for families with children suffering from failure to thrive or picky eating. The most repetitive advice that was given to parents was: you are in charge of what is being served at the meal, what time you serve the meal and how much is provided at the meal. The child is in charge of whether they eat the food provided. Keeping the mealtime procedure as simple as this is extremely helpful to parents because they are being told their role, as well as their child’s role. I am extremely grateful to have shadowed at this clinic because I learned so much about children’s eating behaviors and how to help parents navigate ways they can regain control at mealtime.

My two weeks of outpatient were rewarding and eye-opening. I can see myself working in an outpatient practice. I enjoy connecting with patients by understanding what motivates them. I believe that one of the most important aspects of counseling is to piece together important parts of the patient’s history to really understand their issues and tailor their goals and eating plan to their unique needs. I learned how to counsel through educating, questioning, motivating, advising and supporting, and I hope to implement these skills in my future career!