USDA: An experience that will push your boundaries

By: Rachell Burgos

Moira and me on our first day at the USDA.

My time at the United States Department of Agriculture (USDA) Food Nutrition Services (FNS) brought many emotions. It started with filling out various documents and getting our fingerprints taken at the USDA in downtown DC. Who knew rotating at the USDA would require so much preparation? However, time flew by and soon we were ‘’working’’ for the federal government. I found that exciting. 

Our program hosted a joint class day in which my preceptor would speak. Before she walked on stage, I introduced her to the crowd and later was able to speak with her. While starting a new rotation always makes me a little nervous, meeting my preceptor the day before really helped calm my nerves. Starting somewhere new, with people you don’t know and in a new environment can be challenging at first. What if I’m not a good enough intern? What if I can’t deliver? 

For the next seven weeks, time management would become one of the skills I would most work on. I quickly learned about the importance of meal prepping and setting good weekly habits. This was crucial since it would dictate how the remainder of the week would play out. Moira, my partner, and I would wake up at around 5:15am to make our 8:00am clock in. We’d then clock out at 5:30pm and make it home at around 7:15pm. 

My everyday work area for seven weeks.

As I adjusted to my new work environment, I focused on familiarizing myself with FNS programs such as Food Distribution Program on Indian Reserves (FDPIR), Commodity Supplemental Food Program (CSFP), USDA Foods in Schools, among others. These would be the programs I would be working with for the majority of the following weeks. My first assignment involved transferring 160 nutrition sheets from an old template to a new and updated template. These are used in the USDA Foods in School program for ordering and yielding in school kitchens, therefore I had to examine the information for accuracy and relevancy. Other projects I worked on included making an FDPIR themed bingo for educators to teach individuals about the variety of foods offered in the program. This was fun; it allowed me to make something creative that can be used to educate FDPIR participants. This opportunity also allowed me to learn about all the foods available in the program. 

One of the three FDPIR Nutrition Bingo cards I created along with it’s key.

 

 

Throughout this rotation, I was given the opportunity to host a journal club to discuss the article “Gender Disparities in the Food Insecurity-Overweight and Food Insecurity-Obesity paradox among Low Income Older Adults.’’ The results stated that food insecurity coexists with obesity in low-income older women, but not for older men. While trying to master this article, I brainstormed five questions I wanted the team to discuss. A couple of the questions that were discussed included: 

  • How will the results of this study affect the way you approach decisions that need to be made regarding the CSFP and FDPIR food packages? 
  • The researchers concluded that there is a complex association between food insecurity and overweight and obesity. Based on your experience, what other variables may contribute to this paradox?. 

These questions provoked a lot of feedback and conversation which provided different points of view. Due to the journal club’s success, the dietitians were inspired to continue the tradition with each member of the team hosting a meeting monthly. 

Lastly, I will be working on a project about the School Nutrition Association (SNA) in which I will create a globally inspired menu featuring USDA Foods in Schools. Through this project, I will be incorporating Asian and Latin cuisine as meal inspirations to be prepared by the school’s kitchen staff for school lunches. The purpose of this is to use USDA Foods in Schools as highlights to encourage students to eat the delicious food the program has to offer. 

Though I stayed very occupied with different projects, I still had the ability to participate in team meetings. I learned about product changes in the FDPIR program, website updates, partnerships with organizations to train FDPIR educators, consolidation of categories, and additions to USDA Foods in Schools program. I also sampled foods and learned about quarterly nutrition meetings that include all regions in the nation, among other things. The meetings I attended allowed me to gain a deeper understanding of the importance of the programs and the roles each person held.

All in all, I had a great experience interning at the USDA. I improved my time management skills, worked in an environment I had never worked in before, learned a tremendous amount regarding the resources provided to schools, Native Americans and older adults, and developed great appreciation for the huge responsibility dietitians hold in these programs. Out of the few rotations I’ve completed, this one, by far, has taught me the most. I’ve learned to shift my mindset from team work to individual work. I’ve also learned immensely about the programs, and the importance of a dietitian in decision making processes. I am grateful for the time I’ve had here and am excited to bring these skills with me to all my future rotations.

MD DHCC Fall Workshop

By: Grace Horgan

Have you ever experienced something that is exciting and scary at the same time? That’s exactly how I felt when I took to the stage at the Maryland Dietetics in Health Care Communities (MD DHCC AND) Fall Workshop. As part of my internship experience, I was asked to introduce a speaker to the large group of dietitians at the conference so that I could practice public speaking. As soon as I received the speaker’s bio, I immediately started practicing in hopes I wouldn’t make a mistake.

Prior to this event, my partner Claire and I had analyzed data from the spring 2019 MD DHCC workshop, so we had a sense of how the day was going to proceed. This data was collected and analyzed in hopes of making adjustments and improvements based on member preferences. This was the first big nutrition conference I attended and I was very excited! My classmates and I got to help throughout the day; besides introducing all of the speakers, we greeted guests at the door, checked in members at the registration desk and helped with anything else that needed to be done for the day to run smoothly. These tasks not only allowed us to practice our public speaking skills in front of a large audience, but also gave us the opportunity to meet the speakers one-on-one and talk to them about their presentation or topic. 

My classmates from right to left; Abby, Grace and Amy working the registration table at MD DHCC

The first speaker of the day, who I got to introduce, was Pam Curerton.  Pam spoke about Celiac Disease (CD) and Irritable Bowel Syndrome (IBS). This is currently a hot topic and members were very receptive and had many questions. This presentation gave me a better understanding of the disease and treatment methods that are being used. CD can be very complex in terms  of the different antibodies involved, and what the levels  of each antibody mean in a person. Many patients are miss diagnosed with CD and mislead on what they are supposed to do to manage their disease. I felt this presentation cleared up many points of confusion and was beneficial to anyone seeing patients with CD. 

Pam and me at the MD DHCC fall workshop

 A lot of work went into preparing the program for the fall workshop. I was very impressed with all of the speakers and the program as a whole. Sitting at a table with other dietitians gave me the chance to talk with them about their jobs and their specific areas of practice. They were also excited to learn about our internship and our rotations. It was fun to connect with them! One of the presenters for the day spoke on the new insurance guidelines and how that was going to affect dietitians pay rate and the way charting was done. I did not know anything about how this was done before the presentation, but the two dietitians at our table were very familiar with this topic and were able to tell us about their jobs in dialysis and long-term care and how this specifically affected them. 

Not only did this event give me public speaking experience, it also allowed me to connect with other dietitians in the field. I am looking forward to the spring workshop where we will get to present our posters to the whole group. Overall, I was very pleased with the entire day and learned a lot from all of the speakers.  

9 to 5 The Musical Sequel: Starting the Dietetic Internship

By: Abigail Stultz

If you are familiar with the musical (and/or film) 9-to-5, you’ll understand when I say I felt a little bit like Judy Bernley upon starting my first dietetic internship rotation: lost, overwhelmed, unsure. It sounds silly, but truly a few of the songs from this show have lines that have become my mantra in life. I use this reference because I find the show to be overall uplifting and empowering, sans the dramatized and satirical storyline. I am talking about Judy’s stirring character development, the overarching themes of self-discovery, and the power of mindset to change difficult circumstances. For those unfamiliar with 9-to-5, it is a movie turned Broadway musical that follows the main character, Judy Bernley. Judy finds herself in a situation where she has to go to work, though she hadn’t before (this takes place in the 40’s). Feeling lost and defeated, she eventually befriends two other women who in the end team up to rise above the story’s villain. As the plot thickens, so does Judy’s skin: she learns to rise up from adversity by refusing to succumb to failure and discouragement, thereby harnessing the capabilities and power she possessed all along. And, as expected, she goes on to live a successful, fulfilling life. While there is no villain in my internship rotation story, I still can relate to how Judy adapted to the workplace and how she embraced her inner strength in 9-to-5.

 

Beginning the dietetic internship was a larger adjustment than I anticipated. I expected my learning in rotations would be structured similarly to how it was in college: a pre-scheduled list of projects, assignments and experiences. Now that I am just over a month into the internship and finished my first rotation, I realize why my expectations were not only incorrect, but, quite frankly, unrealistic. The lack of the structure I was so used to was a big adjustment and the reason I initially felt lost and unsure. Unlike college professors, whose job is specifically to support and educate students, my preceptors are working professionals with personal job responsibilities. They have graciously volunteered some of their time to supervise my practice hours and be a mentor, not a teacher. That’s not to say I did not get an orientation to the site or my preceptor wasn’t available to help when I needed. I simply mean as far as projects, assignments and experiences go, the only “structure” I was given were the ACEND competency requirements and UMD dietetic internship program requirements. How I completed these requirements and what I would take with me beyond this program was entirely in my hands. 

 

“What to do and where to start?” (1)

 

My first rotation was Food Service Management for a 6-week duration. My partner, Alexis, and I were placed at Charlestown Retirement Community in Catonsville, MD. Our preceptor was the head chef of the community’s largest restaurant on campus. He had never taken on dietetic interns before, nor had we ever been dietetic interns! 

 

“Still I have to take a chance, putting fear and doubt aside, had no warning in advance, nothin’ left to do, but try… But I just might make it work!” (1)

 

The first week was full of uncertainties; the entirety of each day was not spent doing hands on things and our preceptor didn’t assign us a list of tasks, which as I aforementioned, came as a surprise to me. Again, we did have the support of our internship director, but we wanted to stand on our own feet as much as possible. We realized we needed to embrace the independence and get ourselves organized so that we could make the most of our opportunities and learn all we could during this rotation. We started thinking about the projects and began to plan, all the way down to which day we would ask our preceptor to meet with us to discuss our ideas.

 

“If you don’t take the reigns, it’s gonna stay the same, nothing’s gonna change if you don’t change it!” (2)

 

As the weeks went on, we became more comfortable in our role there and were more vocal in our needs. We finalized our big project idea, “Panini Paradise,” which ended up being a hit with the residents. We got in contact with the in-house TV studio and pushed to have a commercial filmed and broadcasted to the residents advertising our project. We got in contact with other staff in the community, outside of the dining area we were in, to set up meetings and discuss other aspects of food service management. For example, Alexis and I met with Amy and Tina from Human Resources, who talked to us about how the hiring and termination process operates at Charlestown. We even got involved with the catering team and helped to set up events! We not only developed a strong rapport with many of the other managers and staff and learned some valuable insight, but we got to know so many awesome people. 

 

panini paradise pic

My partner, Alexis (right), and me sampling our speciality Panini’s!

“There’s a great new world out there for those who care to claim it… A better day is on the way, only you can change it!” (2)

 

I think about these few quotes often, but the one above has truly become my perception of life. When things seem impossible, I remind myself that my future is in my hands. There is truly a lesson in every experience. With this rotation, I had all the resources I needed and quickly learned that I would get out of it as much as I put into it. I leave this rotation with an arsenal of “soft skills,” which includes utilizing creativity, problem-solving, adaptability and flexibility, and other teamwork skills. These skills are invaluable, and I challenge myself to continue to grow and develop them.

 

Not to mention, I learned how to skin a salmon filet and plate desserts like a pro!

salmon pic

One of the chefs taught us how to skin salmon with our bare hands!

dessert tray pic

A dessert tray I made for a catering event.

 

Citations:

(1) “I Just Might.9-to-5 – The Musical (Original Broadway Cast Recording). Various Artists Soundtrack. 2009. Link: https://youtu.be/0vBssNHJUFE

(2) “Change It.” 9-to-5 – The Musical (Original Broadway Cast Recording). Various Artists Soundtrack. 2009. Link: https://youtu.be/aFoDD-1Uggo

A True Community Experience

By: Moira Cain

My partner and me on our last day at Food and Friends

Finally, I was going to start my dietetic internship! I made it through orientation, and was on my way to my first rotation at Food and Friends. As I prepped for this rotation, I realized that I did not know why a food bank would have so many dietitians. Food and Friends is a not-for-profit located in NorthEast Washington that delivers either pre-cooked meals or groceries to clients in Washington DC, Virginia and Maryland. The pre-cooked meals are delivered three times per week, and the groceries are delivered every two weeks. During my time at Food and Friends, there were three aspects that I spent the most time on: a booklet for their clients, nutrition assessment calls and a cooking class.

My main project was revamping a booklet for their grocery delivery program. The booklet explains what foods will be coming each week and includes recipes that include many of those items. I worked on the booklet during the full two weeks, using Canva to create graphics for it. I learned how important it is to select recipes that are simple and have few ingredients. This is especially important because, while the intent is that Food and Friends provides supplemental foods to clients, sometimes the delivery is the only food a client receives. Therefore, it is important to make sure that the recipes have very similar ingredients to what is being delivered. I also got the chance to test a recipe for lentil meatballs before it was added to the booklet. I modified an existing recipe to better meet clients’ needs and wanted to make sure it still worked. And it did! I was proud to contribute so much to the booklet.

One thing that I had not expected to be involved in at Food and Friends were nutrition assessments. It was a surprise to me that nutrition assessments were included in the program. There are 3 community dietitians and the Nutrition Services Director who all perform nutrition assessments on their clients. I learned many things over the two weeks, but learning to speak to community clients was one of them. It was very interesting to hear the different dietitians speak to their clients. Since the dietitians speak to clients every one to six months, one dietitian told me to start by asking if there were any changes since they had last spoken. This is important to help build a rapport with the clients and help them engage with their nutrition. After listening to the nutrition assessment calls, it became apparent that building rapport is the most important thing we can do. The Food and Friends clients often have life challenging illnesses, like HIV/AIDS and cancer. I was told that for this population, appetite, weight and digestive issues are the three most important factors. Since the dietitians are speaking to these clients over the phone, it is vital that they listen for key words to determine if the client has a potential for malnutrition.

My partner and me chopping vegetables in preparation for the cooking class

I was lucky enough to be there when one of the dietitians was conducting a cooking class. I helped prep the food the day before and during the class. The class was centered on the mediterranean diet, so we made salmon cakes, tzatziki, and chickpea salad. The dietitian had handouts on each table with the different parts of the mediterranean diet. However, she did not push the information on anyone. She briefly touched on it, but then let the participants cook. Nutrition education was provided to those who wanted to know more. This was very different than my prior experiences with nutrition education.

Showing off the salmon cakes that were made during the class

Overall, I had a fantastic time at Food and Friends. I learned so much during this rotation! Building rapport over the phone, setting up and managing a cooking class and deciding what was appropriate material opened my eyes to a new part of community nutrition. While I previously had not considered this type of work, after this experience I would consider this as a potential career.

A New Perspective

By: Claire Pomorski

When someone says they are a “health coach” I wonder what qualifications they have. I have been trained to be skeptical. Dietitians receive years of school training and at least 10 months of intense, supervised training as an intern. Additionally, we must pass a board certified exam in order to practice as a dietitian. I have been told that there are not strict regulations for health coaches, so buyer beware. Yet, many holding a self-proclaimed health coach title on the internet have others around the world following their advice. Until I began this internship, I thought people wanting advice on maintaining a healthy lifestyle should simply consult with a registered dietitian. Was there really a need for health coaches? When I realized that my preceptor was not only a registered dietitian, but a national board certified health and wellness coach, I knew I had been missing something. My rotation at Wellness Corporate Solutions (WCS) in Bethesda, MD gave me a whole new perspective

When I stepped in the door at WCS I was warmly greeted by a woman in leggings and a workout top; she was my preceptor. At this point, I looked down at myself wearing business casual (but more casual) clothes and thought, “Yep, I definitely missed the memo on just how casual this place is.” I soon realized that I not only missed the mark on my clothing choice, but my initial assumptions of this company were totally skewed as well. In a little orientation about WCS, I quickly learned that this company is quite literally filled with registered dietitians (RDs) working remotely across the country, but here’s the kicker…they’re called “health coaches.”

In order to get a clearer understanding of the competencies of the WCS’s health coaches , I needed to pick my preceptor’s brain a bit. Here’s what I learned that week. Wellness Corporate Solutions provides health coaching either in person or telephonically to their client’s employees through their wellness programs. Employees have the opportunity to talk to one of these health coaches, who are all registered dietitians, about more than just their diet and weight loss. This is where the distinction is made; the health coach’s role is to provide a holistic, goal-oriented approach that includes mental, physical and emotional health. So, instead of primarily tackling a client’s dietary habits, a health coach’s approach is more broad and wellness focused. The “Wellness Wheel” depicts the eight dimensions of wellness which better describes the approach of a well trained health and wellness coach. An example of seeing this approach play out was a coaching call I observed where the coach advised a client on their physical activity and the mental and emotional barriers for the entire session and helped set new goals for their next meeting.  Another example of this approach that I encountered during my time at WCS was volunteering at two health fairs where I engaged with participants on smoking cessation and practicing the act of being grateful in pursuit of a more fulfilling lifestyle. I learned through these experiences that health coaches have knowledge in several aspects of wellness and are equipped to help clients pursue a healthier lifestyle by focusing on mental, physical and emotional challenges.

A WCS Health Coach is at the center of this “Wellness Wheel” which shows the 360 degree approach that these RDs take with each of their clients

Being healthy involves more than just what you eat, and the path to living a healthy lifestyle is not linear. There is so much more that goes into a person’s relationship with food, exercise, and overall wellness than just what we eat and how often we move. The health coaching approach that is used by WCS takes all of this into consideration and attempts to work towards overall lifestyle changes with each of their participants. After listening to several coaching calls, it finally clicked for me. I was listening to people come up with their own answers, finding what will actually work for them based on where they are in life. The health coach was there to gently guide the participants towards accomplishing these goals with all aspects of their health in mind. It was a journey for each individual to figure out where they really needed to make these life adjustments. Whether it was actually related to their diet or something completely different, the coach knew the resources and techniques to guide them through a process.

My partner and I engaged with individuals at a wellness fair about smoking cessation resources and led an activity to get people moving!

My perspective on the health coach title has changed. I still think dietitians are the best ones to provide nutritional advice, but I have a greater appreciation for how well-rounded and knowledgeable a health coach who is also a dietitian must be to go beyond their job as a dietitian to focus on the bigger picture and lifestyle goals of each individual client.