Saturday, December 12, 2015

Finding Your Voice Through Podcasting

The University of Maryland, College Park Dietetic Internship is one of the only programs with a nutrition informatics emphasis. I am very happy to be a UMD Dietetic Intern, especially because I have so many opportunities to enhance my technology and communication skills. Whether I am learning about different coding languages such as HTML, managing an e-portfolio, or rotating through different facilities like the Center for Nutrition Policy and Promotion (CNPP) or a long term care facility, I always run into nutrition informatics in every areas of the dietetics practice. 

During technology days at UMD, Interns work on e-portfolio websites, learn about different tech tools, listen to guest speakers present on topics related to informatics, and more! Every couple of weeks interns have to meet e-portfolio milestones which includes things such as adding content about rotations, posting a resume, or embedding twitter widgets to personal websites. One thing I have never done before this internship began was record a podcast. As a part of our e- portfolio milestones, we have to record a podcast on an interesting topic and post it to our websites.

The homepage of my e-portfolio website

My first podcast is on the current malnutrition issues in Ghana, West Africa. This was a great learning opportunity for me especially because it allowed me to research and gain more knowledge about malnutrition and how it affects not only mothers, but children as well. Researching this topic exposed me to the many international public health organizations and how they work together to combat malnutrition in Ghana and other developing countries. I enjoyed it, and can't wait to record my next one!

There are many kinds of audio recording softwares to choose from, but UMD interns choose to use Audacity. Audacity is a free, easy to use multi track audio editor and recorder for Windows, Mac, and other operating systems. For a beginner like me, this is a great software to use.




Here are some podcast pointers before you get started:

Inspiration. Listen to successful podcasts. This is helpful for those just getting started.

Provide information of value. Value can come in the form of education, information, inspiration, motivation. Record on a topic that is trending in the dietetics world!

Time. Create a podcast that is not too long or not too short. Give listeners a reason to come back.

Be enthusiastic. Find your voice, add some excitement to your podcast, be energetic not monotone.

Market yourself. Post your podcast on your website, mention it in your email signature, promote on social media.

Whether or not podcasting is your thing, it gives you a chance to practice your communication skills; a skill necessary in the world of dietetics. Research a topic that excites you, find your voice and give it a try, you never know who is listening.




Listen to my first podcast, Malnutrition in Ghana!
Follow my Internship experiences on Twitter at @ValerieAgyeman



Tuesday, December 8, 2015

Choosing My Own Path


 
         The UMD Dietetic Internship is composed of many different rotations.  Some weeks you'll be in Baltimore City and the next the heart of DC.  So be prepared to travel, sit in the wonderful DMV (DC, Maryland, Virginia) traffic, and download podcasts to listen to or find your favorite local radio stations.  While I'm not a fan of long commutes, I found the multiple locations in this program allowed me to have a wide range of experiences.  My first few weeks consisted of community based rotations.  A week at DC School Lunch and one at the Department of Aging.  My final community rotation was set to be at DC Food Bank.  While it sounded like a fun rotation, being a Baltimore girl at heart, I wanted to complete one of my community rotations closer to home.  I knew the organization Moveable Feast was one interns had rotated through in the past, so with an email to Phyllis and a few days of crossed fingers, I was on my way to Moveable Feast for a two week rotation. 

       Moveable Feast is a non-profit organization that was created in 1990 to provide meals for people suffering from HIV and Aids in the Baltimore Metropolitan area. Along with meals, clients receive groceries, transportation to medical appointments, and nutrition counseling. The organization has expanded to helping people with other life challenging conditions throughout the counties surrounding Baltimore all the way to the Eastern Shore. While here, I worked with three dietitians, two which happened to be University of Maryland College Park dietetic intern graduates. Alongside the dietitians I was able to observe in-home nutrition assessments and I completed phone nutrition assessments of clients. Every day amazed me, hearing new clients' stories and seeing how much of a difference these meals made to their nutrition.
        My time at this rotation allowed me to see how great the need is for dietitians in the community setting.  Anyone can provide others with food, but a dietitian can provide nutrition that helps support and heal.  While many of our rotations are set in stone, we have the opportunity to work with different programs because we are not a site based internship. If there is a specific community site you want to work with talk with Phyllis (way ahead of time of course), and see what she can do. Remember this is your internship experience and you have to get as much out of it as possible. Work with organizations that excite you, network like crazy, and allow yourself to be open to opportunities you never thought were possible.








 


       

Friday, December 4, 2015

Conferences Galore


                Variety is the spice of life, right? Turns out variety can be the spice of an internship too. So far, I am twelve weeks into the UMCP dietetic internship, and I have already visited 31 different locations! I love being able to see the incredibly wide variety of places that dietitians work.  As a part of my rotations, I have been able to attend many different conferences, workshops, and seminars which were great for learning, networking, and having fun. Many dietitians seem to be constantly learning and improving their skills. I’ll describe a few of the events I’ve been able to attend.
                At my school lunch rotation, I got to go to a briefing called the State of Obesity 2015, at the Capitol building! My partner and I acted nonchalant as we walked in, but it was really exciting to be there. The talk was mostly focused on childhood obesity and how we will need to use many different approaches to combat obesity and promote health. I was surprised to learn that the DC Healthy Kids Act actually has goals for nutrition behavior, physical activity, and emotional health for every grade level from pre-K through high school.  Some of the speakers were a principal of a NYC public school who has exercise bikes in the classroom and a researcher who described the trends and statistics related to childhood obesity.
                At one of my technology rotations at the International Food Information Council, I was sent to a two-day conference at the National Academy of Sciences building in DC. It was co-hosted by Institute of Medicine and AARP, and the event was focused on changing nutrition needs for the elderly and how to meet them.  I think I learned so much on this day that my brain must have grown! From 8-5:30 on the first day, there was a steady stream of 20 minute lectures by experts from around the country in a wide range of topics.  I typed up 26 pages of notes for my preceptor, who was at a different conference that day.  One of the most interesting topics was hearing how they are preparing for the new 100-120 year old segment of the population which is rapidly growing and expected to be over 1 million people by year 2050. 
                I also got to attend an FSNE (Food Supplement Nutrition Education) conference in Annapolis. This was a class day event, which meant that all ten interns were invited to come (although two did not because they were doing their clinical staff relief rotation). This day kicked off with a lecture by a pediatrician, followed by talks about SNAP, childhood education, and text messaging services to spread nutrition education. This was the most interactive conference I’ve been to; there were a lot of different activities like walking around the room to write on posters, moving to a new table to discuss a case study with somebody new, and coloring in a blank puzzle with qualities that nutrition educators should try to exhibit with young children.  All in all, I really appreciate the opportunity to see so many different events and experience the wide scope of the dietetics profession. 


- Maria Pittarelli
follow me on twitter @beyondlettuce

Tuesday, December 1, 2015

Nutrition Education in the Digital Age

So far our intern blog has showcased a handful of experiences my fellow interns have had – many of them in a clinical setting. But of our 10-month long internship, the UMD College Park dietetic interns spend two-thirds of it outside of a hospital setting. The rest of our time is spent rotating through food service, community and technology sites. 

My rotation partner, Valerie, and me at CNPP

My clinical rotations do not start until early 2016. I’ve spent the past three months in six different rotations. So far I’ve done five weeks at the USDA Center for Nutrition Policy & Promotion (CNPP), three weeks at the International Food Information Council (IFIC), one week at Maryland’s Food Supplement Nutrition Education (FSNE) program, three weeks at UMD Dining Services and this week doing a sustainability rotation on the UMD campus. Throughout these very different rotations, there is one thing I’ve done a lot – WRITE.

Each rotation I’ve been through has required me to produce written content for a variety of audiences. At CNPP and FSNE, the content needed to be written to reach low-literacy readers, while content for IFIC has targeted a more science-minded audience. At Dining Services, I developed content for two very different audiences – undergraduate students and the kitchen staff.

Our internship has a focus on “information technology” but what that really means is that we use the tools that newer technologies provide in order to communicate nutrition information with a broad reach. For example, we write blog posts, website content, and compose Facebook and Twitter messages. Each platform offers us a means of spreading accurate nutrition content to a larger audience than the more traditional one-on-one patient to dietitian relationship.

In addition to what you’ve seen on the blog, here are a few other examples of what has been written by our intern class for a variety of platforms (look for our names near the bottom of several):


If you’re applying for an internship this upcoming February, and you want to develop and exercise your nutrition communications skills – this program could be a great fit!

In fact, you can learn more about our program by visiting an open house. If you can’t make it in-person or to a live online open house, soon a recorded open house will be available to view on the Dietetic Internship webpage. You can also get in touch with any of the current interns – we would be happy to answer any questions you may have about the program!

Tuesday, November 24, 2015

Hands On Experiences in the Community


                Our internship director, Phyllis, works with FSNE to educate low-income seniors in a senior housing apartment building.  In several class days so far, we have learned about how to tailor a curriculum to the audience of a presentation.  In this case, it is extra important to have an engaging and fun presentation since otherwise people will choose not to come back!
On our first visit, we were helping out with a class about how to garden at home. The goal was to teach them easy ways to grow fresh fruits, veggies, and herbs in their apartments, with limited budget and space.  On an earlier week, they had started seeds in a moist cotton ball in each finger of a plastic glove (center of the photo), which is a simple way to keep them wet until they begin to sprout. 

On the day we visited, we helped them pick the largest sprouts and transplant them into pots. This was a really fun way to help them feel like an active participant and give them something they can keep in their apartment in the future. Turnip seeds were the most popular plant, but we also had beets, lettuce, basil, and parsley available for those who had missed the earlier class and still wanted to garden. After we interns helped clean up the soil on the tables, we moved on to the nutrition education piece. There was a lesson on how to keep the plants in sunlight, when to pick them, and how to cook with them. A few very proudly showed us their flourishing basil plants! We handed out a sample of pasta with basil so they could see how to use spices to increase the flavor and palatability of their home cooking without adding a lot of salt.

On another day, we went back to introduce them to new ways to add fruit into their diet.  The attendees gathered around six tables, with an intern or two at each table to socialize and answer any questions.  Phyllis talked for a bit about how to eat different types of fruits, and how they could be mixed with yogurt also.
Photo is blurred for privacy reasons
Meanwhile, I was in the kitchen with Cassie and Kelda prepping our food samples!  We sliced up some more typical fruits like bananas, pears, grapes, and canned peaches.  But we also wanted to introduce them to some new tastes, so we added sliced Asian pears, canned pineapple, and canned papaya.  In bowls on the side, we served a bit of low-sugar yogurt and a bit of low-fat yogurt so they could try both and decide which they preferred.  Overall, the fruit was a big hit! I think about half of them said they loved the Asian pears and would buy them in the future.  Part of the reason we did this demonstration was to educate them on the availability of food resources, such as a government-subsidized grocery delivery service that they can order fruit, yogurt, and other things from.  All in all, I think these activities have been a great way for us to learn what it’s like to work hands on in a small group setting to see meaningful changes in people’s health.

- Maria Pittarelli
follow me on twitter @beyondlettuce

Thursday, November 19, 2015

Inpatient vs. Outpatient Care

During the past two weeks I was given the opportunity to shadow several dietitians within a variety of settings. I shadowed recent UMDCP Dietetic Internship alumni at Franklin Square Medical Center & Surgical Specialists of Anne Arundel Medical Center; inpatient vs. outpatient. Could there really be a clear favorite for dietitians?

Franklin Square Medical Center (photo courtesy medstarhealth.org)
First up was Franklin Square, a hospital that held significantly more beds than my first rotation at Carroll Hospital. I immediately assumed I would be overwhelmed with the influx of patients. Half of my day was spent rounding with resident physicians in the intensive care unit. As a lowly intern and student, I felt like an outcast among the many intelligent physicians surrounding me.  I was brimming with questions and unable to participate due to my lack of knowledge. However, as I was observing the residents interacting with patients, they too struggled to provide answers. I soon realized that everyone is constantly learning, and no one can fully grasp every branch of medical care. The RD was requested for brief education, diet advancement, enteral feeding, parenteral feeding, and supplementation. As the day progressed and we saw more patients, it became apparent that the intention of the RD is to provide immediate nutritional support to warrant better outcomes so patients can go home as soon as possible.

Anne Arundel Medical Center (photo courtesy of aahs.org)
The following days were spent at the Weight Loss and Metabolic Surgery Program of Anne Arundel Medical Center. The switch from an inpatient setting to an outpatient setting made me uneasy. I initially wondered how interesting it could possibly be providing the same lecture to every patient. After coming to the realization that RD’s do more than just lecture, I realized how wrong I really was. RD’s assess patient progress, physically and emotionally gauge patients to determine the most effective motivation strategy and focus on how to reach the goals of their patient. Education was more in depth, focusing on supplements, diet, and exercise throughout the phases of pre- and post-operation.


The real takeaway for inpatient vs. outpatient settings is that no matter what, the delivery of care is tailored towards the patient. Inpatient care is immediate and provides some education when necessary to prevent the patient from returning to the hospital. Outpatient care allows you the opportunity to build relationships with your patient as you educate them to enact lifestyle changes. No matter which setting, the RD is a vital part of a patient’s success.

A Dietitian's Important Role in Bariatrics

INOVA Bariatrics' most popular surgeries are bypass and sleeve,
only one LapBand surgery has been performed in the last year.
Heading to my second hospital rotation, I had mixed feelings about how a dietitian can fit into Bariatric Care. I was mostly excited – I love the out-patient setting. You have the opportunity to get to know patients over a course of visits, receive patient feedback on progress, and tailor nutrition interventions along the way. But in some ways, the position felt backwards. As na├»ve as it sounds, I’m the kind of learning dietitian who believes my job is to help every patient lose weight before they need something as drastic as bariatric surgery. But the fact of the matter is that’s not realistic, and not possible for many patients. Nutrition is just one factor in the treatment of obesity, that is growing so rapidly in this country. Patients have trouble losing weight for reasons much more complicated than “eat more fruits and vegetables” – genetics, diseases, psychological disorders, emotional eating, and unsupportive environments can all play a role in a patient's weight loss journey. After shadowing my first bariatric appointment, it was overwhelmingly clear how important a Dietitian is in this setting.

Here are three of my biggest “shockers” from my 2-week rotation

ONE: Smaller than small portions sizes
It’s hard to imagine, but a starting meal fits into a 2oz plastic cup. Even as a dietetic student, I asked myself what does a 2oz plastic cup even look like? Here at the center, we give condiment containers as a guide. So the little cups you put ketchup in - That’s a meal for a bariatric patient the first 3 months following their surgery. No wonder the weight drops so fast (that is if you’re following the rules!). Portion sizes grow over a year period, but in small amounts and peak at 1 cup per meal for the rest of a patient’s life.
Condiment containers are provided to patients as measuring tools
for meal size.
TWO: No bread, rice, or pasta
This is something I have never recommended for other patients in the past, but eventually made sense to me in the bariatric setting. If you put bread into a cup of water, it absorbs and swells. When a patient’s stomach is reduced to the size of a thumb, a few bites of bread can swell and fill the entirety of the stomach. For many patients, they learn the hard way – they eat the bread they have been craving, and then experience abdominal pain, nausea, or sometimes vomiting. A portion of bariatric patients can tolerate these foods after a year, but still may cause discomfort. All those healthy and vital B vitamins patients are missing out by skipping the grain products are made up through daily supplementation.

THREE: Calories… not really that important
Dietitians are trained to focus primarily on the nutrient content of food when making recommendations, and to not always get caught up in calories. However, our profession revolves around calculating energy expenditure, and knowing that eating less than that estimated number equals weight loss. After bariatric surgery, the stomach acts as a physical calorie counter. And by that, I mean it would be hard for a patient to eat enough calories to exceed their energy expenditure without feeling nauseatingly full.  A stomach after bariatric surgery keeps portion sizes small enough that calories aren’t the major problem. That is why most of diet counseling focuses on what kinds of nutrient dense foods are patients putting into those small meals that help them receive optimal nutrition. 


During my rotation I was able to teach the class
"Eating out after weight-loss surgery" to help
patients learn healthy tips to eat outside their home.
Working in an outpatient bariatric office really gave me an appreciation for how dietitians can get involved in specialized health. Careers for dietitians are vast, and understanding as many career areas as possible is already building my confidence as a soon-to-be professional. Bariatrics definitely took some getting used to, but keeping an open mind gave me the most positive and educational experience possible.

Wednesday, November 4, 2015

M&M Presents the Harvest Festival Theme Meal

Welcome to The Harvest Festival!!

Co-written by UMD Dietetic Interns Mariah Staley & Meredith Dillon (M&M)

Meredith Dillon preparing decorations for the Harvest Festival
  Did you know Harvest Festivals are celebrated all around the world?! For thousands of years countries have celebrated the harvest with ceremonies and traditions. In China there is the Mid-Autumn Festival where they eat mooncakes and light paper lanterns. Many Jewish communities observe Sukkot, a harvest festival in mid to late September, and in Southern India the harvest is celebrated by eating special foods and decorating cattle.  Here in the US, the Harvest Moon and Thanksgiving are main harvest festivals.  With our meal falling on October 30th, we thought it only fitting to celebrate the produce and flavors of fall by bringing the Harvest Festival to Riderwood!


Harvest Festival Meal Flyer
During our time at Riderwood, a retirement community, we developed our menu and recipes, worked with kitchen staff to enhance our culinary skills, and used multiple marketing techniques to advertise our meal to residents and staff.  One way we advertised for our theme meal was by creating a commercial with Riderwood's TV Studio.  Check it out here- Harvest Festival Commercial! Our main focus with this meal was to allow guests the experience of eating foods that use produce that is grown during the autumn season, while incorporating flavors from around the world.  We were able to accomplish this by using pumpkin, squash, apples, and many other produce that are all in season.  Check out this cool link to find out more produce that is in season during the fall!! What's In Season?  Our menu featured items like Roasted Brussels Sprouts with Cranberries & Pecans, Butternut Squash & Mushroom Lasagna, and Spinach & Feta Stuffed Chicken Breast.

Theme Meal Menu
The weeks leading up to our meal were busy and filled with preparing ourselves for the 150+ people we were forecasting to have attend our lunch.  With the help of Riderwood staff, especially their amazing chefs in the Windsor Room kitchen, we were able to pull off a delicious Harvest Festival Lunch for residents and staff!  
Brussels Sprouts before going in the oven


  

 Have a Happy Harvest Festival!

From the UMD Dietetic Interns Mariah & Meredith



Tuesday, November 3, 2015

Nutritional Supplements

Oral feeding is the most desirable route of feeding; feedings by mouth ensure that gut function is maintained and prevents bacterial translocation. However, for many patients in the clinical setting adequate oral intake is not always feasible. This nutrient deficiency may be caused by their need for increased calories, lack of appetite as a side effect of a disease, altered gastrointestinal function, hatred for hospital food, etc. It is important as a clinical dietitian to ensure that a patient is receiving the appropriate amount of calories for quicker recovery and shorter hospital stays.

Food is more than just a necessity; it represents a comfort for most individuals.

Throughout my short time in clinical I have ordered so many supplements for patients I feel I should be receiving commission from some of these corporations. All joking aside, these products do a lot of good. For example an elderly patient who is suffering from pressure ulcers and requires increased energy and protein needs can receive a protein modular to promote wound healing. A cancer patient that is hypermetabolic can drink high calorie supplements for weight maintenance.

It’s easy to justify why certain patients should receive specific nutritional supplements, e.g. Novasource Renal for a patient suffering from chronic kidney disease. However, when a patient asks you if drink has a medicinal flavor and you have no prior knowledge, a patient is less willing to receive the supplement and/or meet your goals of consuming the supplement.

It was thanks to my preceptors I had the joy of receiving a supplement “buffet”. By the end I had the pleasure of sampling nearly 20 drinks, powders, puddings, and ice cream.




Whether it is through a “hazing” type ritual or simply out of curiosity it is important to sample all of the nutritional supplements before recommending them to a patient. Knowing your products and how they taste makes it easy to assume whether a patient is likely to consume the supplement or not.