Ask The Dietitian (Student Edition)

Welcome back to My RD Journey! I am finally getting into a groove of teaching and running my business. I am looking forward to the holiday break when I can work on planning some more online packages for my clients. My goal is to have a fully functional online business with products and downloadable content to lighten up my face-to-face service. All in good time.

Over the past week, I moderated two career panels with Dietitians for students at college-level. The students had a lot of great questions and it prompted me to expand more on some of the topics in today's blog. I have been thinking about doing an, "Ask the Dietitian," within my blog anyways and I figure that this would be a great topic to start with!

How do you get experience?
For both the dietetic internship (DI) and future jobs, experience is going to be key. For RDs-to-be, you can start with your local hospital. See if you can land a position as a food and nutrition aide in the kitchen. If no-one is hiring, look at volunteer positions. Can you volunteer at a hospital, long-term care facility, food bank, food pantry, soup kitchen, etc? Reach out to local RDs and see if you can shadow them or help on a project (like a class). One really awesome thing that a fellow RD said this past week was that it isn't necessarily the type of position you get, but the experience YOU gain from it and how that can be related back to dietetics. Let's say you are a server at a restaurant. You could be gaining customer service skills and food safety knowledge; all of which are critical in dietetics.

How do you deal with the monetary aspect of the DI?
Start saving now! Put away that Birthday money. Put your tips and checks right into the bank. Think twice about spending on frivolous items.  I didn't realize until my Sophomore year of college that there was a DI AND it was unpaid AND we paid them AND it was after graduation. I worked since I was 14-years-old, and I was used to putting away the money I earned, since my parents were huge on saving (thank you Mom and Dad). Besides saving, look at internships that offer financial aide, scholarships, and/or stipends. Also, do some research into scholarships from the Academy of Nutrition and your state and local groups. From what I hear about these scholarships, they often have minimal students even apply, so your chances are good!

Can you work during the DI?
Going along with the previous question, yes you can work during the DI. A lot of internships will tell you not to do so; however, it really depends on your work ethic and level of time management. I worked weekends during my DI and the occasional weeknight. I know other interns at the time, who could barely keep up with the workload, let alone a side job. If you can handle a job on the side, without sacrificing your learning experience, great. Just remember to be clear with your boss on what the DI entails. Look for positions that are flexible with hours and can accommodate a changing intern schedule. Even if you don't work during your DI, you still want to make sure you plan your time well to accomplish all of your competencies and assignments.

What are some of the top skills for the DI and career that you feel would lead to success? 
I wrote a blog on this topic a few months back; however, I want to hone in on one really key point, "Never burn a bridge in dietetics." Really though, the world of dietetics is so small! The dietitian who took my position at my last job before starting my practice full-time had interned with a Dietitian I knew and went to school with. I learned about my current teaching role from an RD I connected with about a year ago and kept in contact with on social media/listservs. I would have never known about the teaching position or maybe even gotten the job had I not been friendly with her. So, even if you don't think you will need a connection, always keep it open and professional. Save business cards. Follow-up with old preceptors. You never know when you might run into that person again!

Feel free to post a comment with your question for the Dietitian! I will answer and include in my next "Ask the Dietitian" post! 

Top 10 Tips for a Successful Dietetic Intern

I am going to switch gears for a bit from my usual Dietitian-related tips to a focus on dietetic internships. I have been a preceptor for the last 2.5 years and it has been awesome. I would highly suggest any professional to take on an intern at some point in their career. It is such an eye-opening experience when you are teaching and basically helping to mold someone into their profession.

Over the last month, I have had a lot of interns reach out to me to be their preceptor for 2017-2018 dietetic internships. Only a small handful I ended up meeting with and agreeing to become their preceptor. In the process, I had a few asking what the qualities are of a "good" intern. While I hate using the word "good," I do like thinking in terms of success. The top 10 list I complied below is a blend of tips from my own experience as being a preceptor plus what I observed during my internship (way back when).

Tip #1 - Show up on Time
This is an absolute must. There is nothing more off-putting than a late intern. Get up earlier and never assume traffic will be great (especially if you have a long drive). My practice is super busy and I am usually on a time crunch, especially if running a class that day, so tardiness just won't cut it for me. If you do happen to be running late for some reason, always contact your preceptor. Let them know why you are running behind and your estimated time of arrival.

Tip #2 - Always Dress to Impress
I am sure you have heard this one a lot, but take it seriously. I have had interns show up for meetings with me in jeans (and not nice looking ones)! It is way better to be overdressed for a meeting. For your actual rotations, always contact your preceptor and find out the dress code. For my practice, there are days where we need to get dressy for classes or seeing clients. Other days, I am just working out of my home so there is no sense in getting all dolled up to just sit around and work.

Tip #3 - Come Prepared 
One of my biggest pet peeves is when an intern shows up with absolutely no work to do, no outlines or class assignments printed (or available on their computer), or nothing to do for downtime. Whether you are heading in for an initial interview with a potential preceptor or your first day on-site be PREPARED! Have an idea of what your rotation entails. What assignments do you need to accomplish? What tasks need to be done? Don't assume your preceptor will have that information. Set aside time to speak with them to review everything. Also, make sure you have something to do when there is downtime. This could be reading journals, working on assignments, or studying for your RD exam. Again, this is a good time to ask your preceptor what the expectation is. Do they want you to be working on something for them? Do they want you to work on assignments? Lastly, don't sit on your phone while you wait. Honestly, that makes me think you don't take nutrition or the rotation seriously enough.

Tip #4 - Engage and Ask Questions
I always have interns tell me they don't want to bother me with questions. I love questions and to me, this means you are excited and passionate about nutrition. One thing about questions is to time them correctly. If your preceptor is in the middle of a call or email, that might not be the best time to ask a question. Again, find out what they prefer for this too. I had preceptors who would tell me to interrupt them with anything. I had others that told me if they are busy to let them be. Asking questions about something is not a sign of weakness at all, instead it shows me that you are willing to learn, grow, and challenge yourself. If anyone ever gives you heat for asking questions, apologize maybe for your timing, but never, ever, apologize for your curiosity and desire to learn.

Tip #5 - Be Organized
For anyone that knows me personally, they know I am highly organized. My expectation for organizational skills is probably much higher than most professionals; however, it is for good reasons. My practice involves just me. I do all the scheduling, client-seeing, billing, follow-ups, emails, etc. I need to be organized to make sure everything gets done in a timely (and good quality) manner. While I don't expect my interns to be like me, having some sense of organization will really suit you well.

Tip #6 - Give Good Quality Work
If your preceptor gives you an assignment or task to work on, take it seriously and take your time to produce good quality work. Don't just slap something together to get it done. Do the research, invest the time, and don't be afraid to ask for help.

Tip #7 - Respond to Emails (Professionally)
As I mentioned earlier in the post, I have had a lot of interns reach out to me as a preceptor in the last month, yet I only interviewed a few for my practice. A lot of this was due to that first impression I received via email. Frantic and desperate emails were red flags for me. I questioned if they prepared at all for the internship (i.e. finding preceptors). Again, are you taking this seriously? This makes me think about lack of organizational skills. Also, if students reached out for a clinical rotation with me or with incorrect information about my practice, another red flag went up. Obviously, you did not do your research very thoroughly, so this makes me think that attentiveness to detail is not a strong suit. I have also had potential interns reach out to me, interview with me, not get matched and never let me know (though they said they would). While this doesn't seem like a big deal, I spent the time setting up an interview with you, filling out paperwork and blocking your rotations in my calendar. At least have the decency to let me know if you will actually be coming. I had these same students reach back out again later when they did get an internship and needless to say, I was hesitant to work with them. While some of my perceptions could be totally off from the actual reality of the situation, that first impression is everything for me in choosing an intern that will work well in my practice. After all, this is my business and I rely on it for my income.

Tip #8 - Be Aware of Preceptor's Time (Assignments)
Your preceptors are taking the time to work with you during your internship, so as much as you can make that process easier for them, the better. This means being on-top of your assignments and tasks, which goes along with being organized. Plan out when you will do your assignments and don't wait until the last minute and then expect your preceptor to work it all out for you.

Tip #9 - Be Open to Learning
You might not love every rotation and you might already have an idea of which area of dietetics you want to go into. This doesn't mean you should just do the bare minimum for your other rotations. Even if you know clinical is not for you, engage and ask questions. You never know when you might find a new passion or learning something exciting.

Tip #10 - Be Open to Feedback 
One of the most important pieces of any profession is getting and giving feedback. Feedback is crucial since it can help to shape you into a better professional. Always be open to getting feedback from your preceptor, even if it is negative. After such, do something about it! If your organization is slacking, how can you improve? Get used to giving feedback as well. Don't just say everything is great when it isn't. You can always attempt to improve a situation (or work environment) by giving constructive feedback. Are you frustrated with the lack of time your preceptor is giving you for questions? Are you not learning enough from them? See if you can compromise or come up with a solution that will work for the both of you. I always say that the worst that can happen is someone says, "no" but at least you know that you tried.

I hope this list helps any current or potential interns out there to enhance their experience in the dietetic internship. Good luck to everyone beginning their internships and leave a comment to let me know how yours is going!

For more tips on Preparing for Your Internship, check out the BLOG 
For more information on joining the AND Preceptor Database, click the LINK.

Working with Eating Disorder Patients

I can finally see the light at the end of the tunnel as I finish my last 2 weeks of my dietetic internship! I can't believe how fast the time went already! In my last leg of the internship, my outpatient rotation, I am in a facility with eating disorder patients (both inpatient and outpatient). The hospital also has a couple other wings with patients suffering from mood disorders (adolescents and adults), which I also get to work with occasionally for consults.

This is my first time working so closely with eating disorders (ED) and it was a bit overwhelming the first couple of days. I never realized how much time the RD spends counseling and how important it is. The patients see the RD 1x/week for a session; however, the RD ends up seeing and talking to some of them almost every day. The RD will walk onto the unit and patients start calling to talk to her about their weight, their meal plan, etc. It takes a lot of reassuring and challenging of eating disorder thoughts. Some of the patients will become so upset if you need to up their meal plan 200 calories due to not gaining weight or weight-loss that it is hard to calm them down. You have to be patient and understanding when giving news that they will not take lightly.

Some of the best lines I learned in counseling were, "How do you feel about what I said," "Where do you think your weight is," (They find out their weight 1x/week and that phrase is asked prior to them knowing) and after a patient says something so absurd "Reality check does eating an orange really make you fat." You can't be afraid to challenge an ED thought, you just need to know how to phrase it towards each person.

One of my biggest fears with ED is saying the wrong thing. I'm always thinking that I will say something that will trigger one of the them or make them upset. I learned that besides practicing, the key things you need to do are: be empathic, don't downplay how they feel, always give praise when you can (for finishing a meal, etc), let the session be guided by the patient, ask "why they feel that way" when they have something to say about their body image or weight, and ask as much open-ended questions as you can.

There are also a ton of meetings every day with MDs, RNs, social workers, etc. The care team needs to really collaborate on the treatment plan, not only to aid the patient in recovery, but to provide a united front. Some of the patients are very sneaky and will lie to your face about purging or hiding food. It is really helpful to have team meetings to see if what the patient says, or doesn't say, is consistent (they tend to slip up when they lie). Seeing the food rituals some of the patients have is crazy. Some of them tend to be very OCD (they have to have even numbers of foods or eat in a certain manner) and you can definitely tell when you observe their meal times.

Some of the comments/situations I heard this week that will show you how distorted some of the thoughts ED patients have are:
1. I am morbidly obese and I am concerned about breaking the chair. (Patient is underweight).
2. RD: "If your BMI is in that range, you will be considered emaciated". Patient: "That's okay with me."
3. Scales don't apply to me. (Patient stated after saying her family is genetically modified to need less food than everyone else),
4. Since I got my menstrual cycle, I know I gained too much weight. (In case your not familiar, patients with eating disorders tend to lose their cycle. Some patients have not had 1 in over 5 years).
5. I'm concerned with getting diabetes from eating all this food.  (1600 calorie diet that is).
6. I don't need to eat to live.
7. I don't know why I am here. I am fine. I just purge after each meal and when I drink water.

If you every work with eating disorder patients, be prepared to hear comments like the ones above. Some of the ones I hear every day are centered on feeling fat or bloated and being disgusted with themselves. It seems silly to think about a 100lb person being fat; however, these patients truly believe that the distorted thoughts they have are in fact real. It definitely takes a lot of patience and empathy to work with EDs every day. While I love being in this rotation and learning so much so quickly, I can say that this is not the field of nutrition I would want to work in at all :)

First Week of LTC

Today, I finished the first of my 2 weeks of long-term care! I can't believe I am 4 weeks away from graduating from my internship. I'm at the point now where I am really starting to focus on studying for the RD exam (key word "starting"). So far, I have been making index cards from Inman's Review to add to my stack of RD in a Flash cards. Since I have had such long commutes, I have been listening to the Inman CDs in the car on the way to my rotation. I just can't stand her voice any longer after a whole day at my internship. Anyway, I feel like it's been working well so far.

This week was an interesting experience. I went from being in my IPC facility where everything was computerized and organized to paper charting (huge binders for each patient) with utter chaos. Also, when you are in a hospital, you focus more on diet education and the occasional people not eating well. In the LTC facility, there are no educations! It is all about getting residents to eat, giving them supplements, checking weights, and doing wound assessments (and giving supplements to them as well). Did I mention it was very supplement based? Some patients are on diets, but it is much more liberalized than in an inpatient hospital. I mean if someone is 95 years old and wants some cake, she'll get her cake...and eat it too.

One of the toughest things this week was getting used to another facility's format. I felt like a chart-writing pro at my last facility. Now, I feel like I am starting from scratch with someone else's preferences and their facility's rules. I am very glad that I did my inpatient clinical rotation first because I feel like you are flying solo a lot more in LTC. Also, with paper charts, you have to sift through everything and find what is important (knowing medical terminology is helpful!).

I think my favorite story of the week happened when I was doing fluid restriction audits. I had the job of checking to make sure each patient on a fluid restriction had a palm tree picture outside their door and above their bed. As I went into one patient's room, this was the conversation that occurred:
Me:  Hi, I am just checking to see if you have a palm tree on your wall.
Resident: What? (very hard of hearing)
Me: I am looking for a picture of a plant on your wall.
Resident: Oh, that isn't on my wall, it's in my bathroom.
(So, I just think this lady is crazy; but, proceed to check in the bathroom. There in her shower was a huge plant.)
Resident: See, I told you I had a plant.
Me: You sure do.
Resident: Now, will you get someone to hang it up for me already.

Lesson learned: Sometimes the residents aren't as crazy as you think! Definitely my good laugh for the day.

Final Days of Staff Relief

Tomorrow marks my final day of staff relief and my final day of my IPC rotation! I will be starting on Monday at my long term care facility.

My past 2 weeks of staff relief have been crazy, but really good. I started off feeling a bit overwhelmed; however, as time progressed, I became very comfortable out on my own. Although this rotation was stressful at times, I wouldn't have changed a thing. The situations I was put in tested both my knowledge and my patience. Some days went very smoothly; however, other days I was ready to leave at 10am. It was the days that I was ready to leave at 10am that I now appreciate the most. Being able to accomplish what needs to get done on stressful days has made me a stronger dietetic intern than when I first started back in August.

One of the things I will miss the most being at my IPC facility, besides the free breakfast and lunch I got each day, is having another intern with me. I had interns that came during my last couple rotations; however, they would come after I was already there. Sure, we bonded, but I was never with them long enough to really get to know them. This rotation was the opposite. I started my first day with another intern so we got through that first scary day together. I could not have asked for a better person to spend my rotation with. Besides the fact that she had awesome notes and charts I could copy (and cookies to feed me), she was sweet and always there to listen and vent to (as I was able to do for her some days, haha). We shared stories about our internships, patients, boyfriends, and frustrating situations. I used to think it would be crazy to share my internship rotation with another intern; however, I think having that experience (and becoming so close) made it all the better. Now ends the sappy part of my blog :)

Although there were people and things I will miss now moving on to my next rotation, there are certainly things I could live without. This refers to my 1.5 hour drive each way to my rotation, the long drive being mixed with snow, the obnoxious amount of potholes on the roads I take, and the 2 sets of train tracks I seem to hit every other day on my drive home.

Some of my favorite, interesting, funny, not-so-funny patients of the week consisted of:
1. A patient who overdosed on 270 pills.
2. A patient with a BMI of 54.4 (also unemployed and adamant that they were fine in their diet <-- my favorite part).
3. A patient who had uncontrolled diabetes who told the nurse that he felt short of breath at home, so he took some cocaine. This same patient told me he does not take his blood sugar at home because he gave his machine to a friend...sure.
4. A patient (came in as an overdose) who threatened to pull out his IV if he didn't receive pain meds (the nurse told him he could sign himself out AMA if he wanted, and he became very quiet).
5. Seeing x-rays with a collapsed lung, fluid in lungs, and blood clots.
6. A patient (next door to the patient I was visiting) who was screaming that the nurses were trying to kill him.

Some things I found to be useful during my rotation were:
1. A sheet with lab values and what it means to be high and low.
2. A sheet with common diseases (cirrhosis, diabetes, cardiac, renal failure, pancreatitis, etc) and the accompanying diets (for the ones I wasn't familiar with).
3. A sheet with TF formulas used in the facility.
4. A cheat sheet of when to use certain formulas (Nepro-renal, Glucerna-Diabetes, Isosource-low blood pressure).
5. Knowing that I needed to be confident in my recommendations for a diet!
**Don't stress too much over not knowing things about clinical. I felt the same way going into my rotation; however, by my last few weeks, I felt like I knew so much and how to appropriately apply the information.

I'm excited to start the next part of my RD Journey. T minus 5 weeks until graduation!

Beginning of Staff Relief

T minus 6 weeks and 4 days until I am done my internship! 1 week and 4 days until I move to a new rotation!

This week, I started my staff relief at my inpatient rotation. It was kind of crazy the way everything panned out. Last week, I was still with the RDs, only seeing about 4-5 patients on my own. While it was great to be with the RD in the beginning, it was tough bouncing between 2 RDs and their styles of teaching. I really wanted to find what worked best for me (while including all the necessary components of a good assessment/education). I brought my concerns up to my preceptor and discussed with her what my staff relief entailed. I was really glad that I spoke up and talked to her.

Today, I came in and was handed 17 patients to see on my own. I really felt like I went from 0 to 100!  I felt a little overwhelmed as I started to look through the patient sheets. I had 2 initial visits, 15 follow-ups, a low-fiber/weight-loss education, a TPN, and 17 charts to do on my own. As I started to work through the patients, I began to "chill-out" and go with the flow. I knew I would have the time to see everyone and I just needed to have confidence in myself that I was ready to do this.

My first day of staff relief went really awesome. I got everyone done and had 1.5 hours to work on my own assignments. There were 2 patients I saw today that really touched me. The first patient was  consult for low fiber education/weight-loss. She was very interested and asked me a ton of questions! I was nervous at first, because I kept thinking she would ask me something I didn't know and I would look really dumb. Once I started to talk to her, however, the answers just came pouring out. I ended up spending about 45 minutes with this patient and I didn't even realize it. One of the best things about the visit, was what she said at the end: "You are really good at what you do. I really appreciate all the time you spent explaining everything to me. I wish you so much luck in finishing your internship." The second patient I saw had colon cancer. She was the most lively, elderly lady I have seen in a while. She was very informed about nutrition and was telling me about her journey as an RN in her past years. At the end of the visit, she had asked me for my number so she could call with questions about her nutrition. I explained to her that I was only an intern, didn't have my own card, and would give her a card for the RDs at the hospital. Her response to that really made me smile: "You are not just an intern, so don't say that."

One of the things I liked best about staff relief, was being able to really connect with the patient. I loved spending time with them and not having to rush through a visit because I was working with someone else. I also loved being more of an authority figure. Sometimes, when I was with the RD, I would do the talking and educating, yet some patients would ignore me and talk to the RD. It was a way different ball field being alone!

Some of my favorite/interesting/funny patients of last week and today were:
1. An autistic, elderly patient who aspirated a tooth into his lung (and I got to see it on the x-ray!).
2. A patient who overdosed on a gallon of antifreeze. I don't know about you, but I wondered how anyone could get it down! Well, I googled it and found that antifreeze has a sweet taste (some companies are making "less sweet" versions to deter kids from drinking it)...go figure.
3. A type 1 diabetic who ran out of insulin, so ended up in diabetic ketoacidosis. She then tried to sign herself out of the hospital, with no more insulin at home.
4. A patient, in his 40s, who fell asleep mid-conversation with me.
5. An 88-year old woman who decided to jump out her bedroom window, thus breaking her femur.
6. A patient who stops breathing (they had to call code blue 2-3x on this guy) every time he falls asleep.

No matter what the day is, there is always someone/something interesting going on at the hospital!

Week 3-4 of my Inpatient Clinical Rotation

I'm almost through my 4th week of my IPC rotation! Last week, I rotated with the RD in the ICU. This week, I rotated with the RD on the general patient floors. I'm not sure which one I like better at this point.

The ICU rounds are really intense! We (myself and the RD) rotate patient rooms with nurses, pharmacists, the intensivist, and a speech therapist. It is really interesting to talk so in depth about a patient. The intense part is when they start talking about medications, interactions, and using big medical jargon. I definitely take a lot of notes! The one thing about ICU, is you don't get to interact with patients much. You look at a ton of labs and do ventilation calculations (calculating energy requirements for a patient on a ventilator, taking into account the medications they are on). You also write a lot of TF or TPN recommendations, but that's about it.

When I rotate on the patient floors, I get to do a lot more educations (Coumadin, CHO-controlled diet, Renal diet, etc). You really get to chat with the patient about their home eating and the diet they are on. You might recommend/initiate a supplement and you track what the patient eats as well. Some patients are way more talkative and inviting than others. Also, don't judge anyone by their age. I met a patient today, who was in her 90s, still living on her own and cooking all her meals. She was lively and in relatively good health. Later today, I went on a home care visit and met a lady in her early 60s. She was using a walker, had uncontrolled diabetes (BG levels in the 500-600s), and was achy and in pain. She was an "interesting" visit, to say the least. Some of my favorite quotes from her were, "I only buy pork chops to chew on the bone," "Why do I even have to eat protein?" and my favorite, "I may eat some spar-a-grass tonight (aka asparagus)."

Some of my other favorite moments/quotes of the week were:
1. "My weight has been stable at home, but high. But that is because I eat a lot. I eat cake cookies, candy. I know I shouldn't but I do anyway." (Patient had: T2DM, CHF, Obesity, Renal failure etc)
2.  "Your name sounds like a nice soft kitty." (From an 80 year old patient to me. What she meant, I don't know).
3.  Patient: "You won't believe me when I say why I am here. The KKK are after me and my neighborhood and I can't believe it is not covered on the news yet." (enough said).
4. Meeting a 3 year old patient in PEDs with a PEG tube in. He was so cute and sweet! He was born premature, but looked as normal as could be now.  He was my first PEDS patient thus far :)

So far,  I really like the rotation. It is very busy! I come in and do research on patients (medical/food and nutrition history, diet orders, etc). I calculate TF and calorie/protein/fluid requirements on a daily basis. I do all of the nutrition assessments when I rotate with the RD and I have been doing most of the patient educations. I feel like I am getting to know some things like the back of my hand. I really like the fast paced nature of the hospital. It is always different and there are always, always interesting patients to see :)

End of FSM Rotation

Last week, I finished my first rotation of my dietetic internship (Foodservice management and school nutrition education)! It felt like the 13 weeks flew by!

Some of the things I did during my rotation included:
-Menu planning: created a 6-week cycle menu for the school district; input menu items into PrimeroEdge system (similar to that of NutriKids); assigned menus for the district; created new recipes (and taste tested them); ran nutrient analysis of the menu items to ensure that they met the guidelines for SLP.
-Kitchen work: observed/participated in ordering, inventory, serving, food prep, temperature/sanitation check, etc.
-Lesson planning: taught a 3-day lesson for 6th grade students; taught a fitness/nutrition lesson for 1st and 2nd graders; in-service for staff members.
-Research project: I created a new chickpea salad, had it taste-tested, and put it on the menu. I was trying to determine if increasing student involvement in the planning of new items and implementing the changes they made, would increase consumption.
-Miscellaneous work: answered phone calls in the office; organized nutrition materials, made posters for events, etc.

Things I learned throughout my rotation:
1. Always, always, always ask questions! Sometimes, I felt like I was bothering people asking them; however, everyone was really friendly and there to help. The internship is to help you learn more about nutrition, so asking questions about things you are not sure of is needed.
2. Be confident in what you know and how you speak about it. If you sound unsure, people won't trust what you say. I've said it before and I'll say it again, you know more than you think!
3. Before a food service rotation (in a school district), brush up on food safety, the school lunch program, and food science (I definitely didn't study much on food science until I realized I needed to know some for my rotation).
4. Nurses would call a lot about carbohydrate counts for menu items in order to give insulin to the kids with diabetes. If you find yourself answering these types of questions be sure to have menu nutritionals on hand (I found nurses to be calling last minute and frantic).
5. Get as many resources as you can from the RD or FS manager. My RD had a SafeServ book, Inman's Review, and miscellaneous lesson/training binders, which will all be helpful in studying for the RD exam. She also mentioned she only used Inman's Review for the RD exam and passed the first time.
6. Take the initiative on projects and tasks whenever you can. Not only will this give you great experience, but, it will also show the staff you are committed and a team player. Even doing small tasks without complaint are noticed.
7. If you find downtime in your rotation, read food service related materials (I found this to be helpful when taking my comprehensive exam) and/or ask what else you could be doing to help.
8. Be flexible! Things will not always go to plan. Just roll with the punches and do what you can to make the situation run smoothly.
9. Accept the changes that happen. This kind of goes along with number 8. One day you may have planned to do x, y, and z; however, you may get something new thrown your way. An employee (or 5) might call out, and you need to help in the kitchen. A truck may have broken down and you need to drive the manager around. Anything can change in foodservice! (By the way, these things have all happened in my rotation).
10. Be ahead/aware of all your assignments/tasks. You never know when something will come up that relates to an assignment. It really helps to have your assignment sheet on hand.

Overall, I had an amazing rotation. It was stressful at some points; however, in the end, I wouldn't have changed anything. I really feel like I developed/fine tuned my leadership and interpersonal skills.

Hopefully, my experiences will help you in preparing/finishing your food service rotations!

FSM Week 9: My Nutrition Promotional Event

Starting on Monday, I will be in my 10th week of my FSM rotation of my dietetic internship. This past week has been so fun and exciting; definitely one of my favorite parts of the internship (besides teaching).

October 14-18th was National School Lunch Week. I decided to run my nutrition promotion event (part of one of my rotation assignments) during that week. My event theme was NSLW: Fun with Fruits and Vegetables! I highlighted the featured vegetables and fruits on the menu.  Since my facility was in between RDs and my new preceptor was super busy, I planned most of the event on my own. I spent a lot of time coordinating with the elementary school I would running my event in, talking to staff members, getting the PR coordinator involved, holding meetings, and creating materials/prizes for the kids. I started planning my event about 1 month in advance. I created bookmarks for the students (laminated them as well), brochures to send home to the parents, flyers for my table, and recipe cards for teachers and support staff. I also made posters highlighting the different fruits and vegetables with fun facts and nutrition information. Monday, Wednesday, and Friday I just hung posters at the elementary school. Tuesday and Thursday I was at the school running different contests (guess the bean content of the jar and trivia questions) and giving out stickers/bookmarks for students who had a fruit or a vegetable on their tray.

One of the posters I created for the lunchroom.
One student told me that I should be an artist :)

About a week prior to the event, I discovered that the office I was working in had costumes in their closet; a pea pod and a banana. I was way too excited about wearing them! I also found out that the press would be coming on Thursday to interview me and take pictures!

My first day, Tuesday, of my event went so well! It was a bit crazy because the 1st, 2nd, and 3rd grade lunches overlapped. I felt like I was running around crazy (in a pea pod costume) trying to get student guesses for my bean costume. I also ran a lucky tray, in which 1-2 students from each lunch had a sticker on the bottom of their trays indicating they won a prize. Even with all of the craziness, the event went better than I could have hoped. The kids got so involved! One of my favorite parts was reading what the kids wrote on their guessing slips for the bean jar. One first grader wrote for a guess, "200, or 198." Other students wrote the #1 followed by as many zeros as would fill the line. (Total bean count for the jar was 16,438).

Day 1 Table Set-Up

Pea Pod Costume!

Thursday ran a lot smoother than Tuesday did. Since all of the kids had guessed the beans on Tuesday, I spent time taking pictures, handing out prizes, and asking trivia questions. The kids were so excited about the costumes, contests, and prizes. One student said, "You should wear that banana costume all the time, so I always know where you are." Another student said, "We should do stuff like this each week. Put it on the agenda." A lot of the students asked when I was coming back and what costume I would be wearing. It was so exciting to see the kids smiling and having a good time, all in the name of healthy eating!

Day 2 Table Set-Up

Picture Time!

Banana Costume!

While I was running around the cafeteria in my various costumes, teachers were saying things like, "Wow you must have drawn the short end of the stick," "Oh, the joys of being an intern." That was exactly the opposite of what I was thinking! I was more than excited to be prancing around in different costumes. I chose to wear the costumes (in place of a colored shirt). Seeing the kids' faces get excited was priceless to me. I wished they had more costumes for me to wear :)

After all my hard work, the story was put into 2 different newspapers! It was really exciting to have such good publicity for not only the school district, but also my internship program!

Food Service Management Rotation: Tips and Information

This Monday, I will be heading into week 8 of my Food Service Management rotation of my Dietetic internship. It seems as though the time is flying by! I can't believe I am halfway through my longest rotation of my internship. Things have gotten a little more stressful; however, I found that being able to manage my time efficiently has worked to my benefit.

Throughout the past few weeks, I really had to step up, in terms of leadership and initiative. My old preceptor (an RD) had left to join the Navy. My new preceptor was the General Manager, who had a ton of things to do already. My new preceptor would run errands around the schools in the morning and attend various meetings. This left me alone in the office for the majority of the time. I found myself becoming the RD for the school district. All of the carb counting and menu nutrition questions came to me. I also sat at the RD desk and answered various parent and employee phone calls. Some of the calls were pretty basic (how do I load money on my child's account) while others required a lot more thought and time (child allergies and special diets).

The school district I am working with uses a program called PrimeroEdge, which is similar to NutriKids, just way more in depth and complicated. This program was where you inputted ingredients, recipes, and cycle menus for the district. It was my duty to create the menus in the system, and assign them to the schools in the district so they could complete their production records. The program is a very useful tool; however, the first few weeks were very difficult, as I was teaching myself how to use it. Once I mastered certain aspects of the program, things ran a lot smoother. One thing I had to consider was the slowness of the program. It is internet-based, so it gets very overloaded at certain times of the day (mid morning and late afternoon). Just adding in 1 ingredient to 1 day often took 5 minutes because of the webpage loading time. I had to plan when I would input and assign menus, so that I would not be using the program at its slow times.

The past few weeks were very stressful; however, the experiences I had strengthened my leadership and conflict negotiation skills. I also got much better at handling employee issues and multi-department management. I had to make a lot of decisions, so it was important to trust my knowledge and use good judgement. Management was very impressed with my work ethic and ability to handle what was thrown at me. I just did what I needed to do because at some times, no one else had the training I had to do it (answering carb or specific nutrient questions). It felt really good when upper management talked about me so highly to other administrative employees. I wasn't just an intern working there anymore. I had gained a lot more respect than that. When the new RD came in, I found myself training her. It was a very weird feeling for me, the intern, to be training someone in a higher up position, none-the-less, an RD. Much of what I trained her on was office procedures, PrimeroEdge (she had been using NutriKids), kitchen location, etc.

During her first week, the new RD had brought in a lot of materials for me to look through; including her RD test review binder, teaching resources, and a ServSafe training manual. The ServSafe book was a better resource for me than my college food service textbook. It laid out everything in a short and simple format. I would definitely suggest adding this to your resource library. She also brought in a book called "Strengths based Leadership." I haven't gotten a chance to read the whole book yet; however, after glancing through a few chapters, it is well worth the read.

Another major portion of my time over the past few weeks was spent on various lesson plans, presentations, and building promotional materials. My next blog will be on the lessons I taught and tips for teaching various age groups.

Tips for FSM Rotation
1. Whether you are in a distance or on-site program, it is really important to plan out your assignments at the beginning of your rotation. Try to knock out the easier assignments/tasks in the beginning. Since I needed my preceptor's help with scheduling things for other assignments, I tried to do what I could on my own.
2. Give your preceptor an updated assignment list after you have gone through a few weeks. My preceptor needed to be reminded of my assignments on a daily/weekly basis. He was very busy with other duties of his own, so this was pretty typical. It helped to scale down my assignment sheet to things that just dealt with him. It made it easier to work through assignments and get things planned ahead of time.
3. Be flexible! As much as planning is helpful, always be prepared to change up what you are doing. An employee might call about an issue that needs to be handled ASAP; you might have to switch up dates for meetings or presentations. Expect change to happen and roll with it. It will just make everything run a lot smoother.
4. Be able to multi-task. A lot of times I would be working on something (making a poster, writing a lesson) and I would get phone calls, or questions handed to me. Being able to handle multiple tasks, without stressing out, will really help your rotation run smoothly.
5. Work on negotiation and conflict resolution skills. If you haven't had much training or read a lot on these 2 topics, do so. I found myself researching them a lot as I moved through the leadership portion of my rotation.

Lastly, if you are still working at a job during your internship, kudos to you! If you are thinking about whether or not you should keep your job, know that it is manageable with the internship. I still maintain my position at a YMCA teaching nutrition. I have 7 different classes during the week that I teach. I am lucky, in that I was able to schedule the classes at a certain time that worked best for me. My earliest class starts at 4:45pm. This gives me enough time to get from my internship to the teaching site. While my weeks are very busy, it is manageable with proper scheduling and time management!

The First Day at My FSM Rotation

Today officially marks the start of my rotations! I started my dietetic internship in Food Service Management at an elementary school. The food service company I am working with has a contract with the whole district, which includes 16 different schools from grades K-12. I was lucky to begin in FSM before the school year started. I felt as though I was able to ease into the rotation, rather than just being thrown in mid-stream.

Going into my first day, I was pretty nervous. I wasn't sure what to expect of the managers, schedule, or workload. (Just a side note, I was so worried about being late that I got to my rotation site an hour early. My preceptor had a good laugh about that one. :)) Everyone I worked with today, my preceptor and additional staff members, were really great. My preceptor lead me on a tour of the school, gave me little tips about the co-workers and what to expect on a daily basis, and allowed me to ask as many questions as I needed. She also had tons of resources in her office for me to refer to when I worked on assignments.

I really felt that it was helpful to have all my assignments printed out for quick reference. A lot of times when my preceptor was talking, she would touch on a topic that related to an assignment I had. My director had suggested that I sit down with my preceptor in the first week to review the assignments and get a plan together on how to tackle them. Today, my preceptor and I worked through my assignment list very thoroughly. This really helped us both to understand all the assignments better and bounce ideas off of one another. My preceptor was open to any ideas that I had, which helped me feel more comfortable about what I was doing.

One of the major topics for today was the school lunch program. With all of the new guidelines in place for the school year, my preceptor has to work to update the menus to fit all nutritional requirements. I had reviewed the school lunch program prior to starting; however, it was very helpful to go in depth with my preceptor. I was able to look at menu templates and the programs they used for their schools.  I had a little bit of down time (expect that when you begin your FSM rotation), so I was able to get working on my school lunch menu planning assignment. Planning a school lunch menu with all of the new guidelines is a lot more complicated than I thought. It helps to have charts printed out of all the grade group requirements and food component regulations for quick reference.

I was surprised at how many phone calls the office received when I was there today. It seemed as though the phone never stopped ringing with parents asking questions about the school lunch program, new employees asking about trainings, and potential employees calling about positions and job offers. With the students starting next week, a lot of food ordering had to get placed today too. I expect that I will be a lot busier once next week rolls around.

Overall, today was quite a success. Over the next few days, I will be meeting the principals, managers, and employees from other schools in the districts at the meetings and trainings they have scheduled. I am very excited to continue my journey to RD status!

I now leave you with my "laughable moment of the day":
I packed a lunch and some snacks for today which consisted of: carrots, celery, dressing, chickpeas with ranch, 1/2 sandwich with natural peanut butter and nutella, turkey jerky (made in my dehydrator), an apple, raw cashews, and 2 rice cakes. Now, I don't know about you, but besides the sandwich and jerky, I picked some noisy food. Let's set the scene. While the phone does ring a lot, when it doesn't ring, the office is dead silent. So, lunch rolls around and I break out my sandwich and my veggies. Starting with my quiet food first, I have no problems.  I then move onto my carrots and celery sticks, which are not very quiet foods. I begin laughing because all I can hear is the obsessive crunch when I bit into my food. Let's face it, there is no quiet way to eat celery and carrots. Anyway, I don't think anyone else notices, or cares that I am crunching and chomping. I, however, begin to crack up at myself, and proceed to choke on my food. This wasn't a heimlich maneuver type of choke; however, I had one of those slight panic moments where you suck in too much food with air and do a cough-cough-large swallow. I think tomorrow I will will be packing cucumbers and grapes :)

 

My Dietetic Orientation Experience

Once you are accepted into a dietetic internship program, you will need to go through orientation. Some orientations are a few days, others are a week. It will all depend on the type and location of your dietetic internship.

Since my internship was a distance program, I flew out to Utah for 4 days. I wasn't expecting much out of the orientation.  I figured that people had their friends and cliques and it would just be awkward. I couldn't have been more wrong about it.  

Orientation was probably one of the best experiences I have had. It is such an amazing feeling to be in a room with 60 other interns who come from all over the US, but, have similar goals as you do. I really got to bond with my fellow interns and my internship directors. While some lecture was involved, the atmosphere was still open and relaxed. We had multiple team-bonding activities, which really had a positive impact on me (And I am sure other interns).

During lunch and other free times throughout the day, the interns would get to share where they came from, excitement about rotations, and goals for their future career. Although everyone was ultimately there to pursue their RD status, we all had very different paths that we wanted to take.

One highlighting moment of the week for me was when I went hiking up the mountains with a few other interns.  As we started our hike, I felt pretty good. The trail we took was tough and very slanted. About 20 minutes into the hike, I was trailing at the end huffing and puffing. As I looked ahead at the other interns, none of them seemed at all phased by the stifling air or hot sun. (Utah is already a higher elevation than I am used in Pennsylvania). I, on the other hand, felt out of shape and close to passing out. I was surprised at myself. I mean, I go to the gym, walk, do resistance training, yet, I was panting like a dog. I kept thinking to myself that I should just give up, walk back, and wait for the driver to come. I didn't want to hold anyone back, and I felt embarrassed that I couldn't keep up.

As more of a lag formed between the other interns and I, one stopped. She offered me her water, which I of course forgot to bring. That perked me up for a few more minutes. As we continued uphill, I was ready to quit and I stopped. Then, something happened, which I felt was pretty amazing. They all stopped with me for a break! Everyone was so nice, offering me water and telling me that if I needed a break they would all stop. Although many people might think this is trivial, it really had an impact on me. Here was this group of women who don't even know me. They could have laughed at me or joked around at my laborious breathing; however, they did exactly the opposite. They were caring and understanding. Something they didn't realize, was that they motivated me to keep going. A few minutes after we continued walking from our break, we reached flatter ground and it was much easier to continue the hike.

We hiked for about an hour and a half up to 9,000 elevation. The view from the mountaintops was absolutely amazing. I felt amazing, like I conquered the mountains (yes, that's very cheesy). I was so glad that I kept going and was able to experience the beauty around me. This was just one moment that really made me feel close to the other interns.



I never would have expected to form such a strong bond with some many people, so quickly. We talked like we had known each other our whole lives. It felt great to be able to have such a strong support system behind me for when I started my rotations.

My orientation was such an amazing experience. The conversations, events, and nightlife were something I will always remember.

If you already had orientation, share what positive experiences you had!

Tips for Finding Dietetic Preceptors

If you decide to go with a distance dietetic internship, you will need to find your own preceptors prior to the application process. Finding preceptors is a very difficult and lengthy process. I would definitely suggest starting early! Not only are there a lot of paperwork and meetings involved; however, you are competing with other possible interns for those positions. Some facilities will only take 1-2 interns per year.

Before you begin to search for facilities and preceptors, review your possible internships. Find out what facilities they will allow you to use. The most important factor is your clinical rotation. Most, if not all, internships will want you to have a inpatient clinical facility set before you even apply. They want this because the inpatient clinical rotation usually the hardest rotation to set. For your food service management rotation, internships will want you at a school location, hospital kitchen, or both. Again, this is important to review before you start your search for preceptors.

It is always best to contact preceptors via phone call first. I found that with email, I was either getting overlooked or spammed. I often didn't know who the head person was to email anyway. Also, emails tend to get pushed by the wayside, as compared to phone calls. Prepare a little blurb of what you want to say on the phone prior to calling. I tend to have a mind blank, so it was helpful to have an outline of my name, why I was calling, how long the rotation was, and a callback number. You will be surprised at what you forget after calling a multiple facilities. I first started off with a list of about 60 hospitals. If you were wondering, I called them all...twice...at least. Calling hospitals for an inpatient clinical rotation was quite difficult. I found many facilities: 1. Had contracts with other schools for interns, 2. Had contracts with companies like Aramark and Sodexo and didn't take other interns, 3. Didn't have enough dietitians on staff for more than 1 intern, and I was too late for that spot, 4. Never called me back from the 3 voicemails I left. That being said, I did find my needed facilities, it just took a lot of patience.

After you get through to a preceptor, they will want to meet you. It is best to be clear, prior to any meeting, what your needs are for the internship. You don't want to drive all the way out to meet a preceptor and find out that they can't have you come for the full rotation time. Also, I found that my potential preceptors liked that I sent the internship forms to them prior to the meeting. This gave them a chance to either fill it out beforehand or review it to ask me questions when I was there. Most of this meeting will consist of paperwork, basic interview questions, and a tour of the facility. Dress to impress! Usually, if a preceptor wants to meet you face-to-face, they already are set on having you use their facility as part of your rotation. They need this time to make sure they understand everything that is needed, the time you will be there, forms you and they will have to fill out, etc. They also want to make sure you are not crazy :)

Don't give up on finding preceptors! If you really get stuck, head to the yellow pages! Also, some internships will give you suggestions on facilities prior interns had used. (This is usually a last resort). Lastly, be persistent but not pushy. You may need to call a facility more than once. Just be sure to give them a week to get back to you before you call again. Preceptors are already very busy, so be respectful of their time.

As always, good luck!

Tips for Incoming Nutrition/Dietetic Undergrad Students

There were many moments in my dietetics undergrad career that were prefaced with"I wished someone had told me that." From classes to work experience to joining clubs, I found a lot of information given to me was both helpful and downright useless. Hopefully, my experience as a dietetics undergrad student will help you as you begin (or continue) yours!

Class Scheduling
As an dietetics undergrad student, you will be taking classes like Anatomy/Physiology, Chemistry, Biochemistry, and core nutrition classes. Although you have certain pre-requisites for classes, I would not suggest taking ORGANIC CHEMISTRY WITH ANATOMY or taking BIOCHEMISTRY WITH ANATOMY 2. Those were the worst 2 semesters of my college career. Anatomy 1 is mostly memorizing information and Anatomy 2 is applying everything you memorized. Throw those classes in with any type of chemistry and you will surely fry your brain. There were many dietetics students that had no problem with taking these classes in 1 semester. I, however, struggled with a horrible teacher and a lack of understanding of chemistry to begin with. I found myself ordering "Organic Chemistry Demystified" off of Amazon and attempting to teach myself.

If you find yourself in this situation, YouTube has online lectures that are helpful and the simplified books off Amazon help to breakdown the scientific blubber. Another option is to take Anatomy at a community college and transfer the credits to your university.  I hear it is much easier. You could also take Anatomy or Chemistry over the summer to lessen your course load. These classes are very important for internship opportunities later on. Internships will ask you for your DPD GPA (GPA from all nutrition classes) and science GPA. A tip for taking Anatomy 1: you will be doing practicals in lab where you get bones or muscles and have to name them. What I found to be useful was to take pictures of the bones/muscles in lab and study from the picture instead of the book. In my lab, the models in class were used on the practicals. It made studying much easier. (This I figured out my last practical unfortunately). Lastly, don't feel bad about having to retake any of the science classes! I retook Anatomy and got a full grade higher the second time around. I also understood the material much better. Many people don't fail (like I did) and retake the class just to have a better grade on their transcripts.

Dietetics Experience
If you don't have a job in the dietetics field already, get one! Get yourself in at a hospital or long-term care facility as a diet or food/nutrition aide. The pay is pretty good and you really need the experience in the long run. Other options are to shadow a Dietitian, work/volunteer at WIC, or volunteer at a dialysis clinic. Not only good for experience, but also good for networking. Getting experience is vital for when you apply for internships or grad school.

My internship needed a minimum of 1040 hours of dietetics related volunteer or paid experience. This may sound like a lot, but if you were to work 20 hours a week for a year, you would meet the requirement. I worked for 4.5 years as a food and nutrition aide at a hospital. I worked for 8 years at the YMCA; however, only 2 of those years were dietetics related. (I taught nutrition programs). Getting experience also helps you to figure out what you want to do with your career. I discovered I hated working in a hospital. People didn't want my help. They just wanted to eat bacon and go home. I found that I loved working with kids and families where I could create my own program and pilot it to the members. By volunteering/working in different fields of nutrition, you will discover what your niche will be.

College Involvement
Get involved at school! One club to get involved with is Student Dietetic Association (or whatever your college calls the nutrition club). Some SDA clubs just let you join without any stipulations. My university was much more strict. We needed 20 hours to get inducted, then we had to keep up with 10 hours to stay a member. Adding up hours was very complicated. If you did an all day event (which were only on the weekends) you would only get 3 hours max. But selling 20 cookies was worth a half hour. Let's just say I was inducted, then on probation for my last year :)

I worked 2 jobs in college (both on the weekends). I lived at school but commuted back and forth for work. It was hard for me to keep up with the hours needed for the SDA club. Your university may be different and a lot more relaxed. SDA does offer a lot of information regarding the dietetics profession and tips for internships, so it is a good resource.

If you are involved with more than one club, I would suggest getting involved enough to gain a leadership position. I was Public Relations Officer for Habitat for Humanity my sophomore year and President my junior and senior year. Not only did this look good for my resume, but it also taught me a lot about how an organization should be run, time-management, patience, conflict resolution, and much more. I also got much better at public speaking. All of these qualities can be used in other aspects of your life. They are also important qualities for internship candidates.