By Melissa Talley

Have you ever loved a job so much that it didn’t feel like work? Have you experienced constant desire to continue helping people because they, of all people, deserve the utmost care? That is how I felt for my entire 10 weeks of clinical at the Baltimore VA Medical Center. While we didn’t have the option to choose where we would spend our longest rotation, I was beyond lucky to have the VA be my clinical experience!

I packed my lunch the night before, picked out my outfit, and showed up an hour early in attempt to cancel out the nerves I was feeling on my first day of clinical.  Fortunately my nerves dissipated quickly after I talked with my first patient that day. I felt a sense of relief as I knew this was where I belonged.

The first patient I saw was a challenge. He essentially had no nutritional problems, but per protocol required a nutrition assessment due to the length of his stay. I walked in trying to be as friendly as possible and introduced myself, “Hi, my name is Melissa and I am a dietetic intern. I’m here to talk with you about your nutrition.” So far so good I thought to myself, trying to calm my nerves. That was until the patient opened his mouth, “I don’t care who you are, all I want is a f** full-sized pizza.” I remembered “type two diabetes” from his medical history and noticed “carb-controlled” written in bold on the front of the menu that he was rudely waving at me.” I began asking him what he typically orders in an attempt to calm him down and start a dialogue.

After talking to the patient for a while and explaining the menu, we determined that by eliminating other carbs he was ordering during the same mealtime, he could receive a full pizza. I left the room knowing that he was now content, and also that I had the power to truly help people during their hospital stays. Although, some may not agree that my first encounter was ideal, I learned two very important things:  how to react to unhappy patients and that I can work with patients to find ways to make both their health and happiness a priority.

As the weeks went on, I continued to have a variety of encounters with patients. Some were cheerful, talkative, and open to education, while others were hard to get through to or even denied nutrition education completely. However, regardless of the patient’s mood, mine would never change. A major difference at the VA compared to other medical centers is that one typically has more time to build relationships with patients, since their length of stays are normally longer. I came to appreciate this unique difference in a VA and enjoyed getting to know the veterans, which is a rare experience for the typical clinical dietitian. Whether it was checking up on Mr. J with dementia who always had a grin ear-to-ear, or Mr. C who complained about the coffee but always had something nice to say afterwards, or even Mr. W and his wife who were constantly requesting more strawberry Ensures, I woke up every morning looking forward to talking with patients.

While getting to know patients became my favorite part of inpatient, I was fortunate to experience more patient interaction with outpatient work here and there as well.  These included oncology outpatient, the MOVE weight management classes, and healthy cooking classes. In these settings I was able to continue building relationships with veterans in a setting other than inpatient.

While I learned more than I could have imagined about disease states, chart writing, medications, and nutrition support during my clinical rotation, establishing relationships and developing rapport is something that will stick with me for my entire dietetic career. Working in the VA is a unique experience that I was grateful to have and the feeling of helping a veteran was indescribable. The pride I felt knowing I was helping them fight for change in their lives is the closest I could have come to repaying them for their fight to change ours.

By Danny Turner

Before starting this internship program, I didn’t have a good idea of what it might look like to work in community nutrition as a dietitian. Classes covered benefits programs like WIC and SNAP, but I had never shadowed a community-focused dietitian. Thankfully I was able to rotate with Manna Food Center in Montgomery County, Maryland for two weeks. This experience taught me a lot both about what a dietitian can do in community nutrition, and about the challenges that food banks and non-profits face.

Manna provides food, education and advocacy in order to work towards its goal: completely eliminate hunger in Montgomery County. Through several programs and partnerships, Manna provides over 42,000 food packages each year. The food bank also provides nutrition education classes, combats food waste through food recovery programs, and lends its voice to advocate for legislature and policy changes that would benefit the community.

On my first day at the food bank, I helped volunteer groups assemble boxes of fresh produce, canned foods, meat, and other food items. Later that day, participants in the program came to the food bank, and I helped bring the boxes of food to their cars. Many of the recipients thanked me repeatedly while I did my best to pass the credit on to Manna. It felt incredible to be a part of such a generous and altruistic operation.

Jenna Umbriac is currently Manna’s sole dietitian, and was kind enough to act as my preceptor. She oversees Manna’s many different programs, and while her role is not that of a traditional dietitian, she always tries to incorporate healthy eating into the work she does. While Manna strives to end hunger, they also want to empower those in need to eat well. One way that Manna emphasizes good nutrition is through donor and participant education.

While I was with the food bank, I got to help develop educational materials for Manna’s nutrition education classes. I reviewed existing class content for accuracy and appropriateness, and designed posters that could be used in place of PowerPoint slides for class sessions that could not provide a computer or projector. I also helped Jenna and her staff begin to revamp their class evaluation procedures. My contribution to this was to develop new surveys for their classes that would help demonstrate their ability to influence behavior change. Manna’s status as a non-profit means that it is important to gather data showing the reach and efficacy of their programs to funders.

I found my experience at Manna both educational and inspirational. Everyone who works there does so because they believe in the mission. I can now say that I have a better understanding a dietitian’s role in community nutrition, and I can absolutely see the appeal of working in it.

By Kelsey Felter

My clinical rotation days always start the same way: I wake up, put on my royal blue scrubs, make my coffee, pack my lunch, fill up two 64-ounce water bottles, and head out the door for a long drive to Meritus Medical Center in Hagerstown, Maryland. The rest of the day is anything but routine. During this clinical rotation I have been able to see many different patients with a myriad of health issues. Going into this is experience, I was slightly nervous thinking that the patients are so sick, how can I possibly learn all the information and ways to treat them? What if I do not understand something in the patient’s chart? Fortunately, Meritus uses an interdisciplinary team approach. The team is essentially a web of health professionals who share their experience and expertise to ensure each patient receives great, holistic care. My team is composed of a hospitalist or intensivist, all nurses on the floor, a pharmacist, a social worker, a nurse care manager, and, of course, a dietitian! Not only is this network effective, but I have found it to be extremely educational, too. I have learned so much from the team. Before clinical, I overlooked the significance of the interdisciplinary team. I knew it existed and would be a helpful tool; however, I had no idea that it would be a constant sounding board for my ideas and questions, a resource for excellent education, and a guide to improve treating patients.

I am currently in my seventh week of my clinical rotation. So much has happened over these past seven weeks, yet I still perfectly remember sitting in on rounds for the very first time. My preceptor and I were a few minutes early. It was 9:53 am and all was quiet. When 10:00 am hit, the atmosphere in the room shifted. The doctor stated a room number and a name, and rounds began. It was like hot-potato! Information was shared and my pen struggled to keep up. The nurse shared current diagnosis, past medical history, lab results, current mental status, bowel movements, family and patient wishes, and anything else to bring the team up to date. The pharmacist chimed in when necessary to discontinue medications or upgrade dosages of medications. The dietitian confirmed the patient’s current diet, intake, and swallowing or other nutrition concerns. The nurse care manager and social worker filled the team in on where this patient planned to go after discharge and if there were other family concerns. The exchange of information was constant, fast, and effective. Within about five minutes, the entire team was aware of the patient’s status and a treatment and care plan was determined. As I sat in rounds for the first time, I struggled to keep up. What was the medication the pharmacist just recommended? I was still writing down the nurse’s update post-op. What are TEDs? SCDs? Why was the patient going to CIRS? What was CIRS? Reflecting on this now makes me realize how much I have learned. Now I quickly follow the team and understand the acronyms, but I have learned so much more than that.

The interdisciplinary team is a concept I was taught in school. I recognized its importance at the time, but I had no idea how much being a part of the team would teach me and improve my communication skills. It all makes sense to me now. Each health professional brings a specific skill set to the team, and it has been educational for me to experience how the team tackles intense cases that require coordinated, round-the-clock care. One experience in particular taught me about the tedious process of ordering and initiating TPN. While in rounds, the Physician’s Assistant (PA) mentioned that a patient’s discharge was pending the central line placement and TPN order, as TPN was deemed necessary at this point in his chemotherapy treatment. There were many stressed and apprehensive voices from the team, wondering how we were going to get this all accomplished by the end of the day so the patient could be discharged and receive his chemo the next day. My preceptor communicated with the team that she would perform and document a physical assessment as soon as possible to help with insurance coverage and move the process along. I shadowed her as she performed a nutrition physical assessment on the patient. She informed the patient that he was malnourished and that she would communicate with his PA and oncologist to make sure they do everything possible to get the TPN covered by insurance and ordered in time to allow him to be discharged. By the end of the day, the TPN had been ordered, which meant the patient could have his central line placed and be discharged in time for his chemo treatment. My preceptor and I were overjoyed by the accomplishment. I learned so much more from this situation than I could have from any textbook or reading. I got to see a physical assessment for the first time, which taught me what to look and feel for when assessing the patient’s skin, muscles, bones and appearance. I also learned how constantly speaking with the patient, letting him or her know what you are doing and why can help the patient stay as comfortable as possible. Most importantly, I had witnessed the extreme importance of communication and time efficiency as every minute counted for this patient. I learned all about TPN in school; however, I had not learned about the process and making the initiation as time efficient, and stress-free as possible. This success was possible because the team coordinated their efforts.

As I reflect on my experience as part of an interdisciplinary team, I think back to my interview for the University of Maryland Dietetic Internship. I remember being asked to describe what attributes I brought to a team that made the team effective and successful. Now, I understand the significance of this question. To be a successful dietitian, you have to be a successful team member. You must be able to actively listen, communicate, ask questions, delegate, bring positivity, and be able to look at situations from different perspectives. Being a good team member is an important skill in life, especially when your team affects the health of patients. Working with the interdisciplinary team has taught me that you can know the facts, the education material, and the evidenced-based nutrition knowledge; however, problem-solving, open-mindedness and communication are the three most important skills when working with patients. Throughout my time in clinical, I have found that these skills are used every day in patient rounds within the interdisciplinary team, and it is quite amazing to be a part of. Therefore, in my career as a dietitian, I will not hesitate to seek advice from other health professionals. I have greatly enjoyed my contributions to the interdisciplinary team as an intern and look forward to working as part of a team in my future career.