Tuesday, April 22, 2014

Three Different Rotations and A Whole Lot of Experience



The past two months I have been rotating between three different rotations. Although these rotations were different in many ways they had one thing in common; a diverse population in need for nutrition care.  
During my pediatric rotation at Children’s National Medical Center, I worked in outpatient clinics counseling diabetic and obese children. While counseling young patients and their families I learned about the specific food preferences of Hispanic and African American culture, such as enjoying a simple, fat free dessert of mango coated in lemon juice.  Their unique preferences taught me the importance of tailoring specific nutrition messages.
After the two week rotation at Children’s’ National Medical Center, I started my long term care rotation at Charlestown Retirement Community run by Erickson Living Communities. It was ironic to me that exactly a week prior I was advising children to replace their fruit drinks with water, while at Charlestown I assisted residents in determining any type of hydration. From working with obese children and counseling them to lose weight, I was advising the older residents to eat frequent meals to prevent weight loss.
I then transitioned to a Davita Dialysis clinic where I again was met with a population with unique nutrition needs.  From liberating diets and encouraging fluid intake at Charlestown, I was counseling dialysis patient to limit their fluid intake. Most of my time was spent counseling patients about how to limit their potassium, sodium, and phosphorus intake.
Throughout the three different rotations in four weeks, the challenge of working with a diverse population taught me so much. I learned the nutrition needs, food preferences and cultural values and beliefs of patients in different age and ethnic groups. Moreover, I was able to practice how to tailor my nutrition messages to different audiences which has helped me become a more culturally competent future dietitian. 

Monday, April 14, 2014

Mental Stamina Required!

I didn’t have any experience in outpatient care before my internship began.
Zero.
None.
I hadn’t “been there.”
I hadn’t “done that.”

You might already know where this is heading... (that’s right) I recently spent a very educational week in outpatient care, as part of my rotation at Children’s National Medical Center. A week in outpatient pediatric obesity piggybacked a week of inpatient pediatric GI care.

During my week of inpatient care, I became well aware that MNT for infants and adolescents is nothing like MNT for adults. Also, parents, as part of the whole picture, mandate a different approach to patient care. Lastly, being the mother of 2 preteens added a unique level of sympathy and empathy to my reflection. 

Given what I learned during my first week, I felt prepared for outpatient pediatrics. I was  confident with my general nutrition and weight loss knowledge, yet I looked forward to tying it all together while improving my interview and counseling skills. I’ve become keenly aware of the mental stamina required in clinical nutrition; the outpatient setting added a couple twists.

Each appointment must be greeted with a fresh, sincere “Hello”; that’s a simple, basic, human courtesy and it’s what we do, as professionals. Most often we met with a parent/child pair. Sometimes both parents were present. Sometimes all the siblings were present. Regardless, for this intern, a sincere fresh “Hello” became an opportunity in the making after meeting with the first 3 or 4 parent/child pairs of the day. Throw into the mix a few hunger pangs and the opportunity for growth became exponential! Don’t get me wrong, I mastered the skill; but the first time this happened was eye opening. Talk about putting it all aside and giving more than you’ve got. That nails it on the head!

And, no matter what’s going on in the room, we have to stay on track and maintain a consistent train of thought. I was an observer when I first experienced the need for this skill, and for that I’m so grateful! I can’t highlight a particular experience because each was so unique; however, can I say with certainty my RD was absolutely amazing! I don’t know if I was outstanding when my opportunity to shine was presented, but, I know I was successful!

Saturday, April 12, 2014

Then & Now

This past Tuesday, the UMD interns attended the 2014 Spring Workshop hosted by Maryland Dietetics in Health Care Communities. I had previously attended their 2013 Fall Workshop back in October, and I can’t help but reflect on how far I have come since then.

Then: I was only a couple months into my internship and attending conferences was a new experience for me. Heck, wearing business professional attire was a new experience for me! I was basically the equivalent of a freshman. I was overwhelmed by all of the lectures throughout the day and furiously wrote down every single word each of the speakers said. All of the information was new and if I was going to be a good dietitian one day, I was going to need to know all of it. Our preceptor discouraged the interns from sitting together in order for us to network better. While I understood her intention, I was simply too intimidated to talk to any of the RDs. I mean, I was just an intern, what could I possibly say?

Now: This time I didn’t attend the conference as just an intern, I attended as an invited speaker. I, along with the rest of my internship class, was given the opportunity to present to over 94 registered dietitians and other health care providers about up-and-coming technology tools that can be used in the field of dietetics. The tables turned as the RDs were the ones furiously writing down notes instead of me! They came to me to ask questions and praise me for giving such a great presentation. During the other lectures, I didn’t have to jot every little word down. I understood a majority of the clinical concepts they discussed and could nod my head along with the other registered dietitians at my table. I met new people, networked and collected business cards. I even recognized faces from the fall conference. I went from a freshman to a senior all in a matter of months. I’m so proud of myself and amazed at the confidence and knowledge I have gained!


Tuesday, April 1, 2014

Clinical Experience at a Veterans Affair Medical Center

With less than 3 months until graduation from the UMD Dietetic Internship, it is hard to believe that I am 3 days shy of completing staff relief at my clinical site. For the past 10 weeks, I have been interning at the DC Veterans Affairs Medical Center (DCVAMC). My experience has been quite unique and different compared to my classmates, as I have gotten to experience both inpatient and outpatient.  At the DCVAMC, there are 16 Registered Dietitians; for my primary 8 weeks I was with a different dietitian each week. For my first month, I started with the outpatient RD’s who specialize in diabetes education and management, weight loss, cardiac rehab, and oncology. I began my second month working with the inpatient RD’s in the Medical Telemetry Wards and in the ICU/Critical Care Units. Prior to starting my clinical rotation, I was very nervous and slightly intimidated as I wasn’t exactly sure what to expect. All my worries and fears dissolved within a day as I quickly adapted to the fast paced environment and grew confidence within myself while interacting with patients and writing nutrition notes. The weekly homework assignments and weekend quizzes helped hone my knowledge, skills and application of different disease states and treatment so that I could better assess, diagnosis and create a nutrition intervention plan for a patient.
Fortunately, I was able to celebrate National Nutrition Month at the DCVAMC where every Wednesday, the Nutrition Department hosted a themed health fair in the atrium for the staff and general public. The health fair themes consisted of: Diabetes Management and Prevention, Weight Management, Bone Health, and a Heart Healthy Diet. I was able to participate in the Heart Healthy fair and educate the public on ways to lower their cholesterol and reduce their sodium intake, all while enjoying complimentary fruits and vegetables and handing out prizes to participants who answered game questions correctly.
During my time at my clinical site, I have been able to witness and experience firsthand different tasks a registered dietitian is responsible for—I even had to opportunity to watch a modified barium swallow and endoscopy! My rotation at the DCVAMC has been nothing less than rewarding as I feel I have strengthened my clinical skills all while being able to make a true and positive impact on the patients I have seen.


Learn about Heart Healthy Tips with RD's: Donna, Jeff and Ryanne
                                       
Spin the wheel to select a heart healthy question for your chance to win a prize!
                                      

Wednesday, March 19, 2014

Interns in Annapolis


This past week the University of Maryland College Park Dietetic Interns traveled to Annapolis to witness the Maryland government in action. We began our day with a video of the bill creation process and how a bill becomes a law. We then received a tour of the state buildings and a brief history of the many aspects of Maryland. Did you know the Maryland State House is the oldest state capital still in legislative use?

We then watched the Senators and House Delegates of the Maryland General Assembly in action; as bills were vetoed or passed into law following heated debates and discussions. It was fascinating to see these minds in action, each with the intention to better the lives of their fellow Marylanders. We were given the unique opportunity to witness the presentation of a specific bill to hopefully be passed into law in Baltimore County, MD. This law will positively impact the lives of many children and families in the Baltimore County communities, and I anticipate to learn the outcome of the constituents' efforts.

Finally we met with Senator James Brochin, who explained some of the bills he's involved with and passionate about throughout this Assembly. He and his team opened our eyes to chairmen/ chairwomen, council members, lobbyists, and the many other members of political action. We learned the roles each play in bill and law creation, and how many of their actions impact our everyday lives. As a clinician, I compare it to ICU rounds; me as a lobbyist, advocating for nutrition support to a physician, a chairmen, who is hesitant to begin enteral feeds.

Fresh from completing my rotation at the Center forNutrition Policy and Promotion, this day in Annapolis was extremely interesting to me. I already knew the importance of adequate policies to generate change toward a healthier America; however, I didn't realize the small initiatives I as an individual (both clinician and civilian) can create to ignite change. In addition to voicing my opinion and creating change for a healthier America, I can voice my opinions regarding the direction of my profession and the laws that specifically impact my future practice. As a future dietitian I will be able to advocate for my profession and for the greater good; a basic civic privilege.

Sunday, March 9, 2014

What's Cookin?


Ever wonder what kids are eating at school these days? In just one week, I learned the intricate details of how the lunch program of Montgomery County operates and serves its clientele. 

With over 200 schools in the county, the central production facility must always be one step ahead and prepared for anything. I admired the diligence and work ethic of everyone who contributed to the program; from the food prep workers all the way to those who serve the meals.

Although I was only there for one week, I was able to learn a lot and to help out in many different ways. I had a front row seat to the meal preparation process through a tour of the central production facility, allowing me to see how everything is handled and prepared. I was then able to assist on the other end of the food service spectrum, by preparing lunch at one of the county middle schools. I enjoyed working with the kitchen manager; it was obvious that she loves her job and loves the students.

One of my favorite aspects of the rotation was surveying the elementary school children during their lunch. My partner Becky and I asked the kids about their meals and what they thought of the school lunches. It was a great opportunity to get feedback and hear their suggestions about what they would like served. I was impressed that several of the children requested fruits and vegetables, such as pomegranates and eggplant.

Overall, I was encouraged to see how much time and effort goes into providing these children with a healthy lunch. 

Korean BBQ Theme Meal at Riderwood Village


I can’t believe our 6-week foodservice rotation at Riderwood Village is almost over!  A large portion of our time was dedicated to creating a Korean BBQ theme meal for the seniors, which was particularly exciting for me because my family is from South Korea.  Not only was I thrilled at the chance to cook my favorite dishes but many residents shared stories with me about living in Korea and loving the food.  Christina and I spent the past few weeks learning our way around the kitchen, bonding with the dining services staff, advertising our event and perfecting the menu for our theme meal. 

In the blink of an eye, our first four weeks were over and our production week began. We chopped, skewered, grilled, and marinated our way to the big day, and it was a huge hit!  More residents attended than we had anticipated, and more than once, we thought we were going to run out of food.  But with the quick thinking of the chefs and cooks and the great service provided by the RAs and wait staff, we were able to provide a taste of Korean cuisine to 160+ residents.

Now that the chaos and excitement is over, I can sit back and reflect on what a wonderful time I’ve had so far.  From the moment we started our rotation at Riderwood, Christina and I received an enormous amount of support and encouragement from the residents and staff.  I learned a great deal about planning ahead, preparing for the worst, and the importance of having strong communication skills.  I also learned a few new tricks in the kitchen that I look forward to using at home.  I couldn’t be happier with how our theme meal turned out, and I am so grateful for the opportunity to intern at Riderwood Village.