Starting my Clinical Rotation with a Twist

Time flies when you are having fun! I am now over halfway done with my dietetic internship, and I am taking the world of clinical dietetics by storm. This week I had the opportunity to step out from the usual role as a clinician and take a part in an employee wellness program, The Biggest Loser. This program encourages the use of a well-balanced lifestyle to obtain a healthy weight. The dietitians’ at Harbor Hospital aid their coworkers on their way to success through a series of emails and lunch and learns that focus on different weight loss techniques.

            I jumped right into things my first week with a lunch and learn consisting of about 30 Harbor employees. The dietitians dedicated their talks on topics such as exercise, a well balanced diet, and fad diets that could be ineffective or dangerous. I had the opportunity to explain anthropometrics and a variety of calculations needed to determine how many calories each individual required in a day to lose or maintain weight. I quickly realized what a challenge it would be to verbally walk through some of these lengthy calculations.  After days of practice I was thrilled with the outcome! With the help of the dietitians I was able to give a clear explanation of the calculations, and come up with examples that made them relatable. After my first success I was ready to take on anything else this program had in store for me.

            This week I was able to get creative and come up with a fun message to send out to the many participants focusing on tips to lose weight. I decided to highlight one of the many aspects of Harbor I had grown to love over the past few weeks, the cafeteria! With such a wide variety of food, and an emphasis on healthy items, it was easy and fun to go through the menu and get inventive in order to identify new ways the employees could utilize their resources to stay healthy while at work!

            Working with the dietitians at Harbor I have realized what a boundless variety of activities dietitians are able to participate in on a daily basis. One day is never the same as the next. I cannot wait to see what else is in store for me during my last 4 weeks of clinical!

A Great “Day 1” Experience at IFIC

My first Information Technology rotation was at the International Food and Information Council (IFIC). IFIC is a non-profit organization located in Washington DC that communicates evidence based nutrition, and food safety information to media, educators, and health professionals.  While there, I spent time writing blogs, face book posts, tweets, creating infographics and a media campaign. In addition to a great three weeks rotation, working with an amazing group of professionals, I had a great “Day 1” experience at IFIC. 

As new interns, my internship partner and I were given the opportunity to attend the Roundtable for Obesity Solutions held by the Institute of Medicine. I was excited to be a part of a group of professions who came together to discuss the obesity epidemic, review current initiatives and highlight new ideas and solutions.

The roundtable began with sharing recent statistics presenting the obesity problem across the nation. According to current statistics, although there are initiatives in place to fight the obesity issue, these programs do not combat obesity on a universal level. Four focus groups from Early Childcare and Education, Schools, Corporate Wellness, and Health care and Insurance were part of the discussion. Each group provided brief comments on the obesity issue and presented actionable solutions. Some solutions that stood out to me included:

Corporate Wellness Initiatives like
Free fruits and vegetables for employee
Decrease Salad-Bar prices to encourage fruit and vegetable consumption
Innovative strategies to incorporate physical activity into the workplace

Health Insurance providers suggested
Greater use of behavior modification techniques to counsel patients
Higher focus on prevention, not treatment of obesity

The need for more nutrition education programs like
The Supplemental Nutrition Assistance Program (SNAP) Education
Farm-to-School
School Garden

The Need for effective polices that can
Be sustained
Be implemented into a variety of communities
Have measurable outcomes

Greater leadership in healthcare settings and communities for sustainable change by
Working closely with their community members
Setting examples for every day healthy living

As the session came to an end, I was filled with new knowledge and ideas about how to more successfully confront the obesity issue. I learned that community action such as worship center and park and recreation involvement will be needed for sustainable change. I felt inspired by a quote from Dr. Howard Koh, Director of Health and Human Services: "Health starts where people live, labor, learn, play, and pray." As a part of how to tackle obesity, I learned that change in health-care is not enough and that all aspects of peoples' lives must be involved.

It All Comes Back to the Same Thing

How time flies! I’m halfway through my internship. Behind me are months of writing blogs, tweets, articles, and Facebook posts. I’ve created flyers, posters, and table tents to spread the word. With children, I’ve spoken, sang, and danced the merits of nutrition. I’ve lead multi-week adult nutrition classes and loved every minute of every class.

I’m currently in my first clinical rotation. After the first two days of seeing patients my head was filled with all sorts of EHR screens, navigation, and procedures, as well as various types of patient information that needed to be located, documented, and considered. I was under the wing of a great RD role model, Elyse.

Elyse and I were gowning up to enter a patient’s room when she casually asked if I was ready to talk to a patient. I knew it was coming, after all it is a component of clinical nutrition. At the same time it was the last thing on my mind, which is why I was caught off guard. Rarely is a first opportunity ideal, you just go for it. Without hesitation (okay, maybe slight hesitation), my first Coumadin consult was quickly behind me.

I’m impressed at the events that transpired between Elyse’s “want to take this one?” and my “sure”: flashbacks of being at my husband’s bedside at Cleveland Clinic, flashbacks of my own local hospital stay following an accident, and the excitement (as both patient and spouse) of seeing the discharge nurse walk into the room.

It wasn’t for memories sake that I was thumbing through my past. What I wanted to gain - in a matter of 1 second - was perspective. When I was the bedside spouse, when I was the patient, when all I wanted was to see was the discharge nurse… what could a RD have said to me to get my attention? Because it was those qualities that I wanted to have right then, right there.

I knew my delivery wouldn’t be perfect; through continued opportunities, I would improve my delivery. I wanted to make a connection. Goal achieved.

What I learned is that it all comes back to the same thing: no matter the setting, we rely on our personality to engage, and our skills to translate the science of nutrition into meaningful messages. The audience and setting will change constantly, as each is unique.

I had all the skills I needed when I walked into that hospital room: sincerity, confidence, and the ability to meet the patient at her level of understanding. With practice, my presentations have become more fluid. Practice, practice, practice.

Children Are Not Little Adults…

By: Christina Kalafsky, UMD Dietetic Intern 

After completing an eight-week rotation in a community hospital, two weeks of staff relief, and another two-week rotation at a different hospital, I was pretty confident in my clinical skills as a dietitian. Until I started my rotation at the Children’s National Medical Center…

Virtually every aspect of nutrition care in the pediatric population is different from adults. When my preceptor asked me about energy needs during the stress response, I responded confidentially with, “Energy needs are increased, of course!” Wrong.  During critical illness pediatric needs are decreased and the acute stress response actually inhibits growth. While calculating a TPN regimen for a patient, I was concerned over the glucose infusion rate. In adults you typically want this to be about 5mg/kg/min; however in infants, it can go up to 15 mg/kg/min! And you don’t calculate a child’s ideal body weight using an equation; you plot it on a chart. There are different growth charts for premature infants, infants from birth to 24 months, children and adolescents aged 2-20 years old, and even for certain conditions such as trisomy 21 and cerebral palsy. What I came to realize, CHILDREN ARE NOT LITTLE ADULTS.

Infants and children are still growing and developing and therefore, require more calories, protein, vitamins/minerals and fluid per kilogram compared to adults. Pediatric patients are vulnerable to smaller changes in therapies, so even changing their continuous tube feeding regimen by 1 ml/hour can make a huge difference. With help from my awesome preceptors, I restored my confidence in my clinical skills!

In just the two weeks I got to spend at Children’s National I learned SO much. And this is one of the reasons I love clinical nutrition-you are on a constant learning curve and learn something new every day!