Dining Services from all Perspectives

By: Caty Saffarinia

Food trends are evolving and there is a rise in food allergies. This presents a challenge to universities, where students tend to be adventurous eaters. I am grateful that I was able to work with the University of Maryland’s campus dining services team as they strive to find the best methods of feeding their students while offering more variety. Campus dining services was a great introduction to how to run food services for a large university. Before starting this rotation, I did not know about the rules and regulations nor all the participants needed to run a large-scale dining service operation. This rotation taught me how to order food, receive deliveries, store food properly, prepare and cook the food, serve the food, and manage the whole operation.

My internship partner, Sina D’Amico, and I during our Campus Dining Services Rotation

My internship partner, Sina D’Amico, and I during our Campus Dining Services Rotation

The dining services managers order food every day, Monday through Friday. Before ordering, they review the menus and take inventory so that they order just enough of the foods they will need. One of my responsibilities was to check the food that was delivered by comparing the list of food ordered with the invoice of deliveries and the boxes of food. I think the most challenging part of receiving food deliveries is checking to make sure we received all that we ordered. Many employees mentioned that it becomes much easier when you become familiar with what the food packages look like. Another responsibility was to check the temperature of refrigerated and frozen foods. Once everything was checked, the deliveries were put away in appropriate storage areas, freezers and refrigerators.

To get experience serving, I worked at the sandwich station in the South Campus dining hall. A  student employee showed me the location of the ingredients I needed, how much meat and cheese to use for each sandwich, and how to heat the sandwiches in the oven. I interacted with students and employees during this experience and now understand how to stay organized and delegate tasks when there is a bigger crowd. The students were all very polite to the servers and also were very patient. I appreciated this since the foodservice employees worked hard and took pride in their work. 

Following my serving experience, my internship partner and I shadowed one of the campus dining service managers to observe what this role entails. Then we took a turn at managing the kitchen, making sure everything in the kitchen and dining hall were running smoothly. We ensured the milk was labeled correctly with dates of expiration and that foods were kept at the appropriate temperatures. As managers, we monitored the food being served and observed the employees and students to make sure the food was being handled correctly and the students were getting the food they wanted. Additionally, we inspected the kitchen and dining environment. For example, we looked for flyers posted around the dining hall which didn’t have prior approval from dining service managers. I learned that managers have a huge responsibility; they must organize, supervise, and delegate tasks to employees appropriately. 

This rotation built on my prior education and work experience and helped get me ready for my upcoming 6-week food service rotation. By performing the duties of the foodservice manager and a dining hall food server, I saw different perspectives and gained much experience. A lot goes into making a dining hall run smoothly.

LEARNING THROUGH TEAMWORK

By Megan McClelland

Have you ever heard the saying, “teamwork makes the dream work”? During my interprofessional education (IPE) training I experienced this first-hand. As I worked alongside students of other healthcare professions, my eyes opened to the importance of collaboration between nurses, pharmacists, social workers, and dietitians. It was a wonderful opportunity for each student to share their specialized knowledge.

Patient centered care

What exactly is IPE?

Interprofessional education, or IPE, is when students from different health and social professions work together as a part of their professional training. The goal of this method of learning is to develop collaborative practice so that students provide the best patient-centered care.

IPE training 

So, how does this group learning work? For my IPE, I first had to attend a training session. Nursing, pharmacy, social work, and nutrition students all gathered for a day to learn just how this process works. The training started with each student pairing up with another of a different discipline. I paired up with a second-year nursing student.  We asked each other a series of questions to learn about our educational background. I learned that her program was 3 years long and required both classwork and intense hands-on practice. Next, the entire group came together and shared what each pair had learned about nursing, nutrition, pharmacy, or social work. I thought I knew a decent amount about each profession, but as I listened I was surprised how much I still had to learn! It was fascinating to hear about the academic requirements and years of training that are required to become a licensed health professional. 

What does IPE look like in practice? 

IPE showed me the benefit of collaborating with other health professionals. By working together, we were able to provide the best care for patients. My IPE experience occurred once a week for three weeks at health clinics in Germantown and Gathersburg, Maryland. The goal of the clinics were to help each patient better control their diabetes. Because the patient population was mostly spanish speaking, we used a phone interpreter to communicate. This took some getting used to. When using an interpreter, you speak to the patient in English, then the interpreter translates it into Spanish for the patient to understand. The patient responds in Spanish, which the interpreter translates back to you. As you can imagine, this process takes time and patience. 

Each week a team consisting of a student from each discipline, nursing, pharmacy, social work, and nutrition, would visit a patient. We each took turns asking the patient questions to learn what brought them there and what we could do to help. The first day I was pretty nervous. I had never worked with students of other health professions before or used a phone interpreter to speak with a patient. So, when I entered the room of our first patient, you can imagine my relief when the patient had a big welcoming smile on his face. My nerves calmed a little. 

Our team decided that our nursing student would be the first to speak. Using the interpreter, she welcomed the patient and explained that this appointment would be a bit different than any other. As the patient shared about himself and the difficulties he had with managing his diabetes, I took notes. After the nursing student finished her questions, the pharmacy student asked about the patient’s medication regimen and the social worker gained insight on his home life. This information was extremely helpful as I brainstormed what questions I needed to ask and what nutrition education he would benefit from. Finally, it was my turn to talk about my favorite topic – food! First, I asked the patient what he typically ate. Then, I asked if he had any questions. I learned during IPE training that if you speak in long sentences, the interpreter has difficulty getting every point across to the patient. So, while speaking with the patient, I intentionally spoke in shorter sentences, making sure that the interpreter could translate my words accurately. After learning about the patient’s lifestyle and way of eating,  I offered insight on how he could make small changes to better manage his diabetes. He was very thankful for my recommendations and determined to make a change.

The nutrition students

The IPE experience showed me the importance of collaborative practice, provided experience communicating with patients of a different language, and gave me confidence in my patient care. I not only gained more insight about the patients, but also was able to use this information to provide more valuable nutrition recommendations tailored to the individual’s lifestyle, culture, and socioeconomic status. Nutrition and health care is not one size fits all. A recommendation for one person may not be useful for another, which is why it is so important to get to know the patient. As I become a registered dietitian, I will remember the importance of working together with other health and social professionals to provide the best individualized care.

Roles in Recovery – A day in the life of a dietitian working with eating disorders

By: Caty Saffarinia

Food, body image, obsession, control, dieting, and weight are all factors that have become very prominent in society. Who wore it best? What is the best diet to follow to lose weight? How can I look like a supermodel? Media has created a “thin” culture by advertising fad diets, telling people what diets to follow to lose weight in a short period of time, and by showing off celebrity’s body types and looks. These all contribute to people having poor body images and developing a bad relationship with food. Dietitians are an important part of the healthcare team caring for those with eating disorders and I was thrilled to get experience in this field. I am already familiar with Center for Discovery (CFD), since I previously worked there as a diet technician and counselor.  CFD is a residential facility for adolescents, ages 10-19, who struggle with eating disorders.

Food is essential to sustain life, but those who struggle with eating disorders have a different relationship with food – to the point of obsession. For some, food causes disordered eating that includes rituals, avoidance, discretion, fear, and many other emotions and behaviors for people struggling with eating disorders.

Why I want to work with adolescents with eating disorders

Throughout my teen years some of my peers experimented with restricting, binging, and purging as a way of building self-confidence and control over their own looks and beauty.  Watching them suffer from these diet trends, made me want to learn more and combat “negative” talk about food.

My interests were further deepened by experiences with a friend struggling with anorexia nervosa. She felt that the only way to control her life was by the food she consumed, which eventually turned into an unhealthy obsession. Over the years she became emaciated as her self-confidence began to dwindle.  She was plagued by her obsessive thoughts and behaviors surrounding food and body image.  Unfortunately, after several years she lost her battle.  This loss helped me realize the importance of nutrition. Helping individuals with eating disorders became my passion.  My goal was to help transform these devastating situations into powerful success stories. I became more motivated than ever to help those struggling with fear of food and poor body image to gain a sense of control in a healthy manner.

From diet tech to dietetic intern

The nutrition program at CFD instructs that all foods fit in balance, variety and moderation. I really like this belief because it shows clients that there are no “bad” foods. Incorporating this into their treatment is essential for their recovery. I kept this in mind during my internship rotation at CFD. As I worked with my preceptor and the clients, I learned how to utilize nutrition counseling when meeting with clients in individual sessions and how to get clients to talk about foods they fear the most and what they are willing to do for their recovery. When I worked at CFD as a diet technician, I learned about the importance of connecting with patients through empathy, honesty, and patience to create a safe place for recovery. I practiced creating a level of trust with clients to break down barriers in the way of their recovery. I used this skill by meeting the client where they were at with their recovery and focused on achievable goals. Building trust with clients benefited me during my internship because it allowed me to connect with clients and made it easier for them to share their emotions and challenges with me and my preceptor.

My Preceptor, Maureen, and me holding the All Foods Fit model

I was able to use the knowledge I gained from my education and work experience to help me navigate my way through my dietetic internship, specifically my clinical rotation. I have also had the amazing opportunity to work in a hospital with great dietitians as preceptors for my clinical rotation, where I learned so much more about diagnosing patients with malnutrition and following lab trends to assess for refeeding syndrome. For my second clinical rotation, I got to go back to CFD and shadow two dietitians that I formally worked with when I was a diet technician. It was like going home…to where my passion began to flourish.

It was wonderful to see all of my old coworkers and to actually be a part of the treatment team and see the role the dietitians have in the treatment of adolescents with eating disorders. When a new client arrives, the dietitian meets with them to gather a diet history and full nutrition assessment. They also get a 24-hour food recall from the clients to give them a better idea of how much they were consuming prior to arrival. Based on this information and their growth chart, the dietitian is able to calculate required energy, protein, and fluid needs, as well as determine if the client needs weight gain, weight loss, or weight maintenance. CFD uses the diabetic exchange system for all clients. The dietitian uses the required needs to provide the client with the appropriate amount of exchanges to allot and plan for during meal planning. As a part of treatment, each client’s family comes to the site midway through treatment. They meet with the dietitian and therapist together, without the client present, to discuss the client’s progression and so that the dietitian can provide the family with an explanation of how the exchange system works. After meeting, the client joins the family and they share a meal together. During this meal the family is responsible for checking the client’s food measurements for accuracy. The client describes the “table rules” to their family, which include: no food talk, no shoes, hands on the table, no fidgeting, no micro-biting, and completing the meal within the allotted 30 minutes. Following the meal, the clients share “triggers” that might affect their recovery as well as any concern they have about completion of treatment. The dietitians have individual sessions with clients, where they discuss how the client is doing with meal/snack completion as well as developing goals relating to food and nutrition as part of their recovery. The dietitians offer clients support and work with them on trying a “fear” food as part of an exposure therapy. Throughout treatment, the client’s weight and food compliance are assessed by the dietitian. CFD has a treatment team meeting, where the dietitians, therapists, doctor, psychiatrist, facility manager, and program director all meet once a week, to discuss the progression or regression of each client and if they are eligible to “phase up,” meaning the client has shown improvement, both physically and mentally, and is following their treatment plan with the intention to recover.  Based on this, the client is then considered for discharge from residential and referred to an outpatient team.

I was only able to shadow at CFD for a few days and didn’t have enough time to see everything. Two other important things that the CFD dietitians do is to run weekly nutrition and kitchen skills groups. The dietitians run a nutrition group to provide all clients with additional nutrition education relating to the mind, body, and proper health. They also run a weekly kitchen skills group where the residents pick a sweet or savory food to make together and then they eat it as part of their exposure therapy to fear foods. This helps them reintroduce these foods back into their life.

The dietitians at CFD utilize the mindfulness and intuitive eating principles, in addition to nutrition counseling. Mindful eating teaches the clients to get in touch with their satiety cues by using their five senses and staying aware/present while eating. With intuitive eating clients must learn to focus on their individual recovery, as well as reject the diet restriction mentality, make peace with food, honor feelings without using food, honor health, and respect your body.

Working with adolescents with eating disorders as a dietetic intern reaffirmed my goal to make a difference helping those struggling with eating disorders to recover and gain a healthy relationship with food, mind and body.

Getting Comfortable with Being Uncomfortable

By: Sina D’Amico

It’s funny how when you start college you are surrounded by new people and places, and over four years you become comfortable; then, post-graduation you once again must begin the same process. As my internship got underway, I found that this unfamiliarity also applied to the learning environment. I had just spent four years in college sitting in a classroom learning what I could theoretically say and do in various situations.  This mentality is also applied to your learning environment. The four years of college are spent sitting in a classroom learning all of the “what if” situations that could arise in the field without ever actually experiencing those in person. As a student studying dietetics in college, the core classes focused on implementing medical nutrition therapy in a clinical setting (aka a hospital). Much of my undergraduate curriculum focused on various disease states and how adequate nutrition could be the determining factor in the management or recovery of the specific disease. I was prepared to spend the majority of my dietetic internship immersed in the world of clinical dietetics.  The internship is all about getting hands-on experience; taking the theoretical knowledge learned in school and applying it to real, live patients. However, for how uncomfortable I would be in a hospital and talking to patients. I didn’t want anything to hinder my learning experience.

As I walked into my first day of orientation, which just happened to be at a hospital, I was excited about the next 10 months of rotations. I was oblivious to the fact that I could have to start my rotations in a hospital. Although I had not received my actual schedule yet, I was confident and ready to learn more about the different roles of a dietitian. Then it happened: I looked at my rotation schedule and I was set to start in clinical the following week. My calm, cool and collected demeanor immediately switched to feeling anxious and panicking in a matter of seconds. Luckily, that day of orientation just so happened to be at the same hospital where I would be for my clinical rotations – St. Agnes Hospital in Baltimore, MD. Because of this, I was able to meet the dietitians that day, which eased my nerves. Each of the three dietitians assured me that there was nothing to worry about because they were there to answer all of my questions – that did NOT stop me from worrying for the entire next week.

Fast forward one week to my first day of clinical, to say that I was sweating with nerves would have been an understatement. I began shadowing my first preceptor in the Intensive Care Unit (ICU). The critical condition of the patients did not help; my fear of making a mistake added to that uncomfortable feeling. I continued that day observing her interactions with patients and interdisciplinary team members, trying to obtain as much information as possible. I left that day unsure about how the following 12 weeks would play out. My mind was moving at 1,000 miles a minute and was filled with endless questions regarding my ability and, ultimately, my career choice. What would the following 12 weeks hold? Would this anxious feeling ever disappear? How would I be able to talk to patients about their diets when they had much bigger medical problems to worry about? 

The days went on and I found myself being unable to shake the anxious feeling that was looming overhead. Then it happened: it was time for my first solo interview with a patient. I had watched my preceptor do this exact thing countless times and knew exactly what I wanted to ask to obtain the information I needed. I started off strong, but then lost my train of thought halfway through and started to panic. Thankfully my preceptor was in the room and jumped in while I collected my thoughts. After we exited the room, my preceptor assured me that I would get more comfortable as I got more experience conducting patient interviews. But would I really?

My rotation went on and I continued interviewing patients. Some got better while others remained uncomfortable and awkward. The dietitians kept up their encouraging words stating that feeling comfortable and confident comes with practice and experience, everything that I was there to learn. This feeling was extremely discouraging for me. I had experience speaking with clients and patients so I was unsure why I was struggling with it in this setting. The more I thought about it, I began to realize I had never spoken to anyone in a hospital setting before. My experience was with speaking to athletes right before or after practices who were always smiling and did not have to worry about anything besides performing their best. I had never been in an environment where patients were being bombarded by countless doctors and nurses and also having a dietitian questioning their eating habits. And in many cases, their nutrition was the last thing these patients were worried about. The more I let myself think about how uncomfortable I felt in these situations, the worse my patient interviews would go.  I decided that changing my mentality around the situation might actually change the situation itself.

When it came time for my final weeks with my last preceptor, she talked about how she often got nervous during patient interviews with the dietitians looming over her shoulder in the rooms. Because of this, she wanted me to go into the room alone while she waited outside. I took a deep breath and instantly felt my nerves wash away as I walked into the patient’s room alone. I conducted my interview, still having a couple of hiccups, but not feeling nearly as uncomfortable as I felt in the previous weeks. My preceptor asked how that went as soon and I walked back into the hallway. “A lot better than all of the other ones,” I was happy to report.

My preceptor, Stephanie and I unintentionally matched outfits during my rotation

We kept this up for the remainder of our time together and I finally started to notice a difference in my confidence in patient rooms. Instead of thinking about how I couldn’t mess up because the dietitian was standing right behind me, I started focusing on my conversation and making it more personal to each individual. Instead of feeling nervous walking into a room, I was confident and ready to tackle the questions I had prepared to ask. I had come a long way from the first day when I could not have imagined ever feeling comfortable enough to conduct an interview alone.

I wouldn’t take it as far as to say that I was completely comfortable with interviewing patients in a clinical setting. However, I was confident in myself and my ability to hold a conversation and share appropriate information. The location of the conversation is not as important as its content. Whether it be in an outpatient office, on a soccer field, or in a hospital room, the premise behind each conversation is similar. You want to learn about your patient or client and relate to them so they will open up to you. So that’s what I did. I learned to get comfortable with being uncomfortable, and it worked. 

Now, here I am, finished with my clinical rotation. I survived my staff relief without any problems. I know that I am capable of adapting and getting the job done. These last 12 weeks have been a rollercoaster of emotions but have taught me many valuable lessons about my own ability and the confidence I  have in myself. It’s completely normal to feel uncomfortable in a situation, and that feeling might not quickly go away. When this happens in the future, I will lean into it, grow and develop and get comfortable with being uncomfortable. Sometimes that just might be the only answer.

Your favorites, but low-FODMAP

By Adam Sachs

For one of my recent rotations, I was able to work with Wellness Corporate Solutions (WCS), a company that provides health and nutrition programs to businesses in order to promote a healthier workplace. Having healthier employees improves the overall working environment, and is also cost effective for business owners. One of the projects I assisted with, was a health seminar to educate participating employees on current nutrition or health topics. The evidenced based information was to be presented to various companies by the dietitians at WCS. The topic of the seminar was the low-FODMAP diet. What is the low-FODMAP diet…and what does FODMAP even mean? Some people have heard of the term FODMAP, but not everyone knows what it is. If you are a sufferer of Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), or other GI disorders, a low-FODMAP diet is something that may be a part of your daily life. The low-FODMAP diet is most commonly used to treat symptoms of IBS, which is a stomach and/or intestinal disorder that causes bloating, abdominal pain, and a variety of other GI distresses. The low-FODMAP diet seminar topic had actually been requested by a few of the clients working with WCS, most likely due to the high prevalence of IBS. Around 10-15% of the world’s population have some varying degree of IBS or related disorders.  FODMAP is an acronym that describes certain carbohydrate molecules that can exacerbate symptoms of IBS or other similar conditions. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.

Still a little confused? Let me share with you some of the things that I learned as I worked on the low-FODMAP diet seminar. A basic explanation of FODMAPs is that they are different types of carbohydrate chains that can be digested by bacteria naturally found in your stomach and intestines. These bacteria break down these carbohydrate chains using a process known as fermentation, which is the same process used to make beer. Similar to how beer making produces CO2 gas, the bacteria in your gut also produce certain gases as byproducts of the fermentation process. These gases are what can contribute to the symptoms of IBS and other disorders.

Not all FODMAP foods will trigger symptoms. Those suffering with IBS will usually go through a trial period, ideally with the help of a Physician or Dietitian, to figure out which foods are triggers for them. The hardest part about a low-FODMAP diet is figuring out how to cook your favorite foods while still limiting the amount of FODMAPs in your diet. Here are some common examples of high-FODMAP foods that may trigger IBS symptoms.

FODMAP chart

It may seem like a daunting task to reduce intake of these foods, but be aware that people suffering from IBS are not aggravated by all high-FODMAP foods. It can take some time to figure out what works and which of these foods need to be avoided. To help those following a low-FODMAP diet, these recipes have been tweaked to reduce the amount of FODMAP containing foods and replace them with well-tolerated options.

 

Chicken Alfredo pasta (makes two servings)

Ingredients                                                         amounts
Rice or Soba noodles (see notes)                      ½ pound
skinless chicken breast                                      4 oz
goat cheese                                                           ¼ cup
shredded parmesan cheese                              ¼ cup
lactose free milk                                                  ½ cup
scallions (green tops only)                                1 tablespoon
olive oil                                                                  as needed
salt & pepper                                                        to taste

Preparation:

Grill or sauté the chicken with a little olive oil; cut into strips and set aside. In a small saucepan, heat together the milk, parmesan, and goat cheese. Allow the cheeses to melt over medium low heat and continue to stir until the sauce thickens some, and season with salt and pepper. Cook your rice or soba noodles according to the package directions. Pour the sauce over the cooked noodles. Top with the scallions and cooked chicken.

Notes: Soba noodles are made from buckwheat flour, but some packaged soba noodles contain some wheat flour. Look for “Gluten Free” on the label and check ingredients to make sure there’s no wheat flour used. The dairy sources in this recipe are usually well tolerated in people with IBS, and scallions are a great way to add some onion flavor while using a low-FODMAP food.

 

Low-FODMAP Flatbread (makes two servings)

flatbread

Ingredients                                            amounts

Buckwheat flour                                    ½ cup
rice flour                                                 ½ cup
dry active yeast                                     one packet
warm water                                           ½ cup
salt                                                           ½ teaspoon
olive oil                                                   1 tablespoon
canned tomato sauce                           ¼ cup
bacon, raw                                             2 tablespoons
feta cheese                                             1 Tablespoon

Preparation:

Preheat an oven to 450 degrees. In a small bowl mix together the warm water and yeast packet, and allow the mixture to sit for 5 minutes. Place the rice and buckwheat flour into a medium bowl, and slowly pour the water/yeast mixture into the flour. Mix together until a dough forms. Knead the dough for 10 minutes and return it to the bowel, and lightly brush the dough with olive oil. Allow the dough to rest in a warm place for 30 minutes. Roll out the dough into an oval shape and place onto an oiled baking sheet. Spread the tomato sauce evenly over the dough. Chop the bacon into small pieces and place on the pizza. Sprinkle the feta cheese evenly along the pizza. Bake the pizza for 10-15 minutes or until the dough has puffed up slightly around the edges, and turned golden brown, and the bacon is brown and crispy. Slice and enjoy!

Notes: Many non-wheat based flours are great substitutes for those on a low-FODMAP diet. Most canned tomato products are also low in FODMAPs and well tolerated by those with IBS.