Friday, February 27, 2015

A Day in the Life of a Clinical Dietitian (An Intern's Version)

Throughout the last five weeks I have had the opportunity to work with three RD's at Meritus Medical Center in Hagerstown, MD. There are five RD's at MMC, and each cover different units. Also, three of the dietitians work at outpatient facilities such the Wound Center, the Weight Loss Center, and the Cancer Center. These dietitians play many roles, which keeps every day interesting!
While interning I have noticed that the RD's follow a certain schedule, but since all patients have unique cases, there is always wiggle room!
A typical day at Meritus Medical Center goes something like this....

Investigative Work 
In the morning, the patient nutrition screening report is printed. This document informs the dietitian which patients to visit that day based off of certain criteria. 
Patients can be screened for:
  • Low BMI
  • Poor PO intake
  • CVA
  • Pressure Ulcers
  • CHF
  • Missing Data
  • Bariatric Surgery
  • And many more!
Once the dietitian sees what patients have screened on their floor, they print out their nutrition care record. This record contains the patient's diagnosis, height/weight, past medical history, and all recent lab values. Then the investigative work comes in. It is important to look through each patient's medical record to find any information that may be helpful to the dietitian when they do the assessments.

Meritus Medical Center in Hagerstown, MD

Going to rounds is surprisingly fun! Rounds are when the doctor, pharmacist, care management team, social worker, RNs and RDs gather to talk about each patient on the floor and their future plan of care. It is also a great time for the intern (me) to learn about medications and disease states/conditions. I always keep a pen and paper handy to write down terms that I did not know before hand.

Visiting Patients
This is always the most rewarding part of my day (depending on the patient, of  course). I have talked to a variety of patients, both interested in talking to me and those who are not. When I go to visit patients I gain a better idea of how they are eating, if they need snacks or supplements, or if they are interested in any additional education pertinent to their condition. I have had some great conversations with patients who really do desire to learn more about nutrition. It's great to use all of the information I learned in MNT in college!
I was able to try a nectar thickened supplement, not that bad!

Document, document, document!!
Documenting may be the most critical part of the job. Without stating what you did and why in the medical record, you might as well have looked at Facebook all day! Filling out nutrition assessment notes allows other members of the health care team know what the RD's are doing to help patients with their nutritional needs. Learning the verbiage used in nutrition notes is probably the most difficult part  of documentation. There are so many abbreviations to learn, but with writing more notes everyday it is becoming a lot easier. 

Although a typical day at every hospital is very different, this is what I have taken away from interning at Meritus Medical Center. The key to being a clinical dietitian is flexibility! This week marks my half way point in clinical, and I am so excited to learn much more!
Me and the Registered Dietitians

Tuesday, February 17, 2015

Attention: Applicants!

During the last few weeks the current interns and I have been receiving multiple questions about the internship from current applicants. While the interns and I enjoy talking and communicating with the applicants, I thought it may help to answer the most common questions!

1.  What is the average time it takes you to drive to a rotation?
This really depends on what site you are rotating through. For  example, my clinical rotation was in D.C., which is where I live, therefore it was on  average a 10-15 minute drive. As for other sites that are closer to Baltimore this can take me anywhere from 45-50 minutes. This year, interns live in pretty spread out areas around Maryland and D.C. therefore some interns spend the night at other interns apartments who live closer to the rotation site!

      2. What is a typical class day like?
Class days can range from conferences to lectures to technology training's to homework review sessions or a mixture of all! If we are not attending a conference, our class days are typically held at the National Agricultural Library or Harbor Hospital. During the class days at the National Agricultural Library we typically spend part of the day learning about technology applications, databases or programs such as Weebly, Trello, and Prezi. We also work on upcoming technology projects such as podcasts, Weebly videos and Weebly milestones. During class days at Harbor Hospital we participate in lectures, which gives us a general review of clinical terminology and clinical care.

 3.  How many hours do you usually spend on assignments outside of the hours at the rotation sites?
This also depends on the specific rotation you are in. During my clinical rotation I found myself spending about 1-2 hours a night to complete the weekly homework. I did find if I competed a portion of the homework over the weekend I would only spend about 1 hour a night over weeknights. During the rotations that did not assign  specific homework, I still found I myself spending about 1 hour on internship projects, assignments or milestones to keep on track with  the internship's work load. 

 4. Where is the best location to live?
I am not sure there is a “best” location to live because finances, location and personal preferences may rank differently for everyone. I know last year interns recommended living in Silver Spring MD. or College Park MD. because these are pretty central locations to most of the rotations sites. This year a few interns, including me are living with family members, which may increase the distance to rotation sites, but decreases the total expense (not having to pay monthly rent). Therefore, I believe picking a location to live depends on the intern and how they feel they can manage their travel and expenses!

 5. Have you found the workload to be difficult to manage?
I have not found the workload to be difficult to manage. I do find that it is important to stay on track with the workload and to complete small amounts each night. I currently find it very helpful to make a list each week of objectives to complete and I try to stay on track with the list to ensure I do not fall behind with the completion of assignments and projects. Our director and preceptors are also always available for questions and are extremely punctual with responding therefore, I find it very easy to ask our director or preceptor’s questions that may arise!

      6. The website explains that interns must take technology classes, what are technology classes?
Technology classes are during class days and can range from learning about social media databases to learning about new technology applications to completing assignments and milestones. We have learned about social media databases, which allow us to market ourselves as RD’s such as Weebly, Twitter and Pintreset. During technology classes we have also learned how to create podcasts and videos for our Weebly account. Lastly, during technology classes we have learned about new applications that can be used for organization skills and presentation development!

7. What recommendations do you have during the internship?
I believe my number one recommendation during this internship is to be flexible! As I have been told, driving in Maryland is difficult due to traffic and weather conditions therefore it is always
a good idea to leave 20 minutes earlier than expected to account for any driving complications!

Monday, February 9, 2015

MyPlate: Behind the Scenes as an Intern

A few weeks ago, I completed a 5-week rotation with the Center for Nutrition Policy and Promotion (CNPP), better known as the brains behind USDA’s MyPlate.  Working with and learning from the creators of MyPlate was an amazing experience that showed just how rewarding and diverse a career in nutrition informatics can be.

The mission of CNPP is to “improve the health of Americans by developing and promoting dietary guidance that links scientific research to the nutrition needs of consumers.”  CNPP carries out this mission to improve the health of Americans through its various projects such as the Dietary Guidelines for Americans (DGA) and SuperTracker.  I was extremely lucky to be able to work with this government agency in the weeks leading up to the much anticipated release of the new 2015 DGAs (which was a pretty BIG deal since they are only released every 5 years!).   I was even invited to sit in on DGA planning meetings filled with health and nutrition professionals from all over the country. 

My rotation with CNPP was one of my favorite rotations thus far.  I truly felt that I fit in with the staff and my opinions and work were well appreciated.  The staff were gracious enough to let me assist with a large number of current projects and promotions.  I gained a true appreciation for each and every member of the CNPP team after sitting in on many of their meetings.  I now understand just how much work it takes to keep a successful government agency running smoothly. 

In the five brief weeks I was at CNPP, I learned a few valuable lessons that can be applied to any dietetic internship rotation:
  •  Don’t be afraid to ask questions.  Opportunities like this only happen every so often.  Ask as many questions as possible to learn as much as you can while you are there. 
  •  Be organized and independent.  The fast-paced nature of this rotation taught me about the importance of being organized and working efficiently.  Without organization, I would never have been able to complete the many project I was involved with in a timely manner.  Working efficiently also helps to speed up the completion of projects, without having to sacrifice any effort, leaving more time to explore all that the rotation has to offer!
  •  Be a team player.  Every aspect of this particular rotation involved active participation and teamwork.  It is more important to show that you have the ability to work well with others than to prove you are the best intern ever created.  By respecting other people’s input and dividing the work evenly, I was able to successfully complete all of my projects. 
I hope the CNPP team learned as much from me as I have learned from them.  The experiences I gained from this rotation will follow me throughout my future career as a Registered Dietitian. Thank you to everyone who helped make this rotation so memorable!

Monday, February 2, 2015

Infographics for the Internship!

An infographic I created for the
International Food Information
Council Foundation
Dietetic interns and students are always searching for ways to make them stand out to a prospective employer or director. Step ahead of the competition by creating infographics!

Infographics in the Internship

As a dietetic intern with UMD, we are required to create one infographic to post on our e-portfolios. The infographic can be on any topic or one we originally created for a certain rotation. I have made infographics in almost every rotation so far; including clinical, IFIC, and FSNE. Infographic generators are also useful to overlay text on pictures, which I have used in rotation specific and personal blog posts.
Tips for Creating Infographics

Effective infographics keep the reader engaged and facilitate recall of information. Prevent information overload and start creating your own awesome infographics with my top 5 tips and tricks!

1) Play around with different platforms
I am partial to Pictochart, its easy to use and free! There is a Pro option for $29/month with more graphics and templates available. Other options include or Venngage
2) More pictures, less text
Use a variety of graphics and design elements to portray your point. Only use text to push your main points! If you have statistics, illustrate them with graphs and charts!

3) Tell a story
Infographics should flow from one thought to the next. Introduce the topic and gradually go into more detail towards the end.

4) Style and color matters!
Look up paint swatches and color schemes to get an idea of what colors go together. If the platform does not have the colors you want, look up the HTML color codes for more options.

5) Be creative
Infographic generators are not just for infographics! I have used Pictochart to create pictures, mini-infographics, and even the logo for my blog. Mini-infographics are great for social media posts on Instagram or Twitter. You can also create engaging handouts and PowerPoint presentations with Pictochart.  

Here are some more examples of images I created with Pictochart, hopefully they inspire you to create your own!

Why your Brain Craves Infographics

Tuesday, January 27, 2015

My Clinical Experience in a Rehabilitation Hospital

I recently finished my second clinical rotation at MedStar National Rehabilitation Network (NRH) in Washington, D.C. MedStar NRH provides inpatient and outpatient services to patients with disabling illness or injury, such as stroke recovery, spinal cord injury and brain injury. One of the things I enjoyed most was about working at NRH was the strong focus on diet education. I had the opportunity to provide both individual and group nutrition- education sessions to patients on a variety of topics, such as weight management and diabetes.

I was so excited to teach my first lesson to a group of patients on the basis of MyPlate, healthy cooking techniques, and a heart healthy diet. Keeping it simple is key to nutrition education, especially since these patients have varying levels of cognitive, neurological, and behavioral function. To make the lesson more interactive and fun, I brought in MyPlate paper plates, provided handouts on each topic, and used colorful posters. The patients were so involved and interactive throughout the lesson; it was such a rewarding experience!

I also enjoyed participating in the Wellness Cooking Demo featuring January’s super food of the month: citrus. The event featured five delicious and healthy recipes using citrus as the base ingredient and incorporating other foods such a salmon and Brussels sprouts with fennel. The registered dietitians and I handed out samples and recipes to patients, staff members and visitors in the cafeteria. Although some were hesitant to try the recipes, many others were pleasantly surprised by how yummy everything tasted!

During my two-week rotation at NRH I learned so much about the integral role nutrition plays in the rehabilitation process. I thoroughly enjoyed the time I spent at NRH and have developed so many new skills working with an amazing team of registered dietitians!

Wednesday, January 21, 2015

Theme Meal Troubleshooting

Almost all dietetic internships require the interns to complete a theme meal. At the University of Maryland dietetic internship, the theme meal takes place at a retirement home. The foodservice rotation requires the daunting task of the interns to create a theme meal for 200 people.

The requirements of the meal included:
  • Soup
  • Salad
  • Two Vegetable Side Dishes
  • Two Starch Side Dishes
  • Beef Entrée
  • Chicken Entrée
  • Fish Entrée
  • Vegetarian Entrée
  • Two Desserts
  • Beverage

The week leading into the theme meal was spent entirely in the kitchen. Prior to that we researched our theme, tested recipes, made flyers, talked to residents to promote the event and even filmed a commercial. Considering we are organized individuals who like to have everything planned out, we created a schedule for the week outlining the steps to complete each recipe. Even with all the planning and preparation the weeks leading up to the event, there were challenges we could not prepare for.

Time Management
One of our biggest challenges was not accurately determining how long each task would take. For example, writing we need to chop onions for the soup doesn’t seem like a task that would take a lot of time until we started. The recipe called for 50 onions, which we thought would take 30 minutes with two people chopping. Two hours later – with tears rolling down our faces – we had sliced 50 onions for the soup. From that point forward, we knew each task would take much longer then originally planned.

Andie cooking the onions in the soup kettle.
Food Ordering
Another challenge faced was the correct amount of food we requested on the grocery list was not ordered. We needed sweetened condensed milk to make the toffee bars, and it was not ordered. We started making the recipe before gathering all the ingredients, so we discovered we didn’t have the milk until all the other ingredients were already mixed together. Luckily, another kitchen on the campus had enough cans to finish making the dessert.

I am making the toffee cookie bars.

Temperature Check
The morning of the theme meal was very stressful. My partner and I needed the help of two chefs to get every menu item ready in time for the event. Even with their help, we faced problems. We discovered our brisket was raw when we went to carve it and it had to go back in the oven. We had just enough time to cook it and have it carved for the meal. Now, we know to ask someone to double check the temperature of the meat before assuming it is done just by cooking it in the recommended amount of time.

Knowing these simple precautions in advance could have saved us time and stress during the preparation of our theme meal. Even with facing challenges every step of the way, our theme meal was a success.  We had about 100 guests and minimal food waste.