Looking Forward to Elective Week Rotation!

By Joyce L. Hornick, Dietetic Intern

I can’t believe I am almost at the end of my internship and that means elective week is just around the corner! The elective week is an opportunity for interns to explore any realm of dietetics they want. Some interns explore a new opportunity they didn’t get to experience during the internship, such as private practice. Since some rotations are only a week long, some interns return for a more in-depth experience. Some interns choose an elective where they may have a direct connection for a job opening or to expand their networking. The possibilities to explore are vast. 

I decided that I wanted to return to where I first started the internship, Moveable Feast, a nonprofit organization that provides meals and groceries to people with HIV/AIDS, breast cancer, and blood cancers. Even though it was a 3 week rotation, I wanted to go back to learn more. When I was there in September, I got the opportunity to counsel patients via telephone interviews. I was very uneasy at this since I had only done “counseling” in the classroom in role play simulations. Most interns go to Moveable Feast after they’ve done their clinical rotation, so they’ve been able to hone their assessment skills over 10-12 weeks. I hope to do some phone interviews again to see how I’ve grown in my ability to perform assessments. I know I will be more confident, will be able to take what the client tells me to quickly make suggestions for change, and help set goals to help maintain or improve their nutrition status. 

I am also looking forward to new learning opportunities available at Moveable Feast. Back in September, due to funding constraints, Moveable Feast wasn’t doing home visits. Going back now will give me the opportunity to perform this valuable nutrition evaluation for their clients. Grocery deliveries were also very limited in September, so I will also get the opportunity to assist drivers on home grocery and meal deliveries this time. Other plans are to visit patients while they are making their HIV/AIDS outpatient visits at Park West Clinic, helping AIRS clients with a grocery store tour, and hopefully, getting to work in the Moveable Feast community garden!

The Difference Between Counseling and Telling People What To Do

For the past 20 years, I’ve been telling people what to do. I teach an aerobics class. At least twice a week, I’m telling 20-30 people what to do for a whole hour, and they listen. I say ZigZag forward left and they do it. I yell at them to do 4 more oblique crunches – and they do it. I encourage them to keep going. I say great job. They go home and they come back again for more.

I became a Mom. I now had new people to tell what to do. This one’s a little tougher. They don’t listen as much. But, I still tell them what to do – over and over and over again. Sometimes they act right away. Sometimes they’re a bit more stubborn. Sometimes I have to threaten to take something away. Sometimes I actually have to take something away. Bottom line is – they do what I tell them to do.

This past week, I got a new opportunity to tell people what to do. It wasn’t nearly as easy. I found it rather difficult. I started my first Dietetic Internship rotation at Moveable Feast in Baltimore. This nonprofit organization provides meals and groceries to people with HIV/AIDS, breast cancer, and blood cancers. They could easily give all of their clients the same balanced meals over and over again solely based on their medical conditions, but they don’t. They make home visits and call their clients. They perform nutritional assessments for their clients. They get updates about their medical conditions. They ask them how they are feeling. I got the opportunity during my rotation to help the Dietitians make phone calls to clients to perform nutritional assessments and then do a follow up counseling session. This was the hard part. In school, you get to practice going through the process of how to collect someone’s nutritional information to make an assessment of their diet, but you never get to counsel anyone. You may get the chance to perform simulated counseling through role playing or give dietary suggestions to someone you know, but this is nothing like telling someone you don’t know how they should eat or make changes to their diet. Helping someone with their food choices is completely different then telling somebody to do sit ups or clean their room.

Counseling is much more than telling someone what to do. If you approach it as just telling someone what to do, you won’t be good at it. As someone who has lots of experience telling people what to do, it would be easy to continue in this mode. To be good at counseling, I will have to step out of my comfort zone of just giving orders. I will have to learn to collect information while mentally making an assessment at the same time. This is not the same as forming a stereotype about the person or assuming they fit a certain eating personality. I have to build a rapport and trust with the person I am counseling. This is difficult in a face to face counseling session and even more difficult over the telephone. Counseling about dieting can involve quite a bit of detective work. You have to find out what the person is willing to change and what they will not. You have to make the goals very small to make the change as easy as possible. You need to be part detective and part psychologist.

I look forward to learning all of the nuances of effective counseling and I can only hope that I find the zone I need to be in to be good at it. I am comforted to know I will have a lot of good teachers along the way to help me.