Kathryn's Life as a Dietetic Intern

From August to May I am working full time as a dietetic intern in central CA through Oakwood University's distance program. Over these 10 months I will collect 1200 hours of supervised practice in the areas of clinical dietetics, community nutrition, and foodservice management. This will allow me to sit for the exam to become a registered dietitian.

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Becoming a Registered Dietitian!

Immediately after completing my hours, I organized all of my paperwork and sent it in mid-April. If you are reading this and doing a distance program, my advice to you is to do your paperwork throughout the year as you finish rotations. I kept mine pretty up-to-date, scanning and organizing files by type, but it still took me hours and hours to get everything ready to go at the end. I still had exams to take for my internship: clinical and exit. I spent a few weeks studying and taking those. 

I also got my first job around this time - clinical nutritionist at a hospital! My boss was still signing all of my notes because I was not yet an RD, but otherwise it was a clinical dietitian position. The job is at a local hospital where I did foodservice and then a random week of clinical when I was short on hours. Had I not done that week of clinical, the job wouldn’t have been offered to me! It’s funny that a rotation being cancelled led to something even better. I am working there two days a week and it’s been a great transition to working.

By the time I got the green light to schedule my official credentialing exam from the Commission on Dietetic Registration, about a 6 weeks had gone by. I had been studying, going through the Jean Inman review and listening to the audio with it. I scheduled my exam for 2 weeks out in mid-June. 

I started going to coffee shops and studying in 4-hour blocks whenever I had free time. I also bit the bullet and split the cost of Visual Veggies software with a friend. It would have been more useful had I gotten it earlier, but I wasn’t sure I needed it. It has practice tests and lets you know how you’re doing in each domain so you know what to work on. I know some people feel it’s unnecessary, but I felt was very beneficial. When you get a question wrong, it gives a full explanation so you don’t have to search for the answer. It’s really easy to read through the Inman binder and feel like you understand - but some questions showed me what topics I didn’t quite understand. It also brought up some random things, like medications, that weren’t in Inman but did show up on my RD exam. When I first used VV I was getting 70-80%, and by the time I took my test it was more like 80-95%. This gave me more confidence about my readiness going into the exam. I spent my last couple of days making sure I knew my foodservice equations, management theories, foodborne illnesses, and vitamins and minerals.

I felt pretty at-peace going into the exam, and it helped that I had only told my parents, one friend, and my boss when I was taking it. It was still nerve-wracking to have 6 years of work and constant studying come down to 2.5 hours. The test questions are designed to be conceptual, so it feels like a long series of educated guesses with only a few questions being straightforward. The test goes one of two ways, shutting off at 125 or 145 questions. If it shuts off at 125, you either have the 25 points you need or it’s not even possible for you to get 25 points. If it goes to 145, it could go either way. Mine shut off at 125 and I was pretty sure that meant I had passed, but it was so scary waiting that minute or two for my results! I ended up passing with a 31 and actually scored higher in foodservice management/systems than food science and nutrition care which was surprising. I went to my car, sobbed a little bit, and then called and texted everyone I know! Since then it has been so freeing to not be in college, or applying to internships, or working for free, or studying for an exam! It feels brand new. I’m excited and ready to embrace being a dietitian and throwing myself into work and volunteering. Getting that R.D. at the end of my name is only the beginning.

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Elective - Community Wellness

I put off scheduling my elective for a long time. I was hopeful to find something unique, or at least different from my other rotations. I was particularly interested in shadowing someone in private practice, but private practice is scarce in my area and my one contact fell through.

I decided to schedule my final two weeks with the preceptor where I completed my diabetes/counseling hours. I was actually sick for a few days during this rotation, but she was able to work with me and give me work to do so that I could still finish on time. I mainly shadowed her and picked her brain about various aspects of community health and being a director. The diabetes program she was developing before had begun to be implemented, so it was cool to get an update on that. I helped do some of the leg work for finding a venue for a future symposium. I also helped develop a slogan, suggest activities, and choose graphics for a children’s handwashing event being held at a health fair. A friend of mine also interned here. We overlapped for my last few days so it was fun to have her there! 

This was the perfect final rotation. I got along so well with my preceptor that it didn’t even feel like work. She was also extremely respectful of my time and abilities. She treated me to a celebratory lunch on my last day. 1200 hours in 9 months! I feel like a completely different person from when I started. I gained knowledge and experience, but also a huge amount of confidence. I tend to be afraid of the unknown, of things I can’t anticipate. After completing 15 different rotations, walking into 9 different work sites, with many different bosses, I learned to be flexible and unafraid. I learned that you can never be fully prepared for anything, but if you go into it ready to work hard, you will gain respect and learn quickly. A dietetic internship (especially a distance program) comes at a great cost, but the chance to take apply the book knowledge from your degree is very worth it. I am so much more prepared to begin working than I was a year ago! 

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Additional Acute Care

Toward the end of my internship I ended up needing a few more clinical hours in any area. My main clinical preceptor was unable to take me for another week, so I went back to the hospital where I did foodservice (my very first rotation). This time I was in the clinical dietitian’s office seeing patients. I already knew the RD there, we became friends when we were both applying, and then interning, at the same time and in the same geographic area. I appreciated the atmosphere. Being a smaller hospital, it’s easier to get to know the staff and the dietitian was well-respected by the interdisciplinary team. I also used this time to seek out some additional experiences, such as viewing a pressure wound dressing change, and trying all of the oral supplements we order for patients. It was really beneficial to see how another hospital system works and also helped me refresh basic clinical skills that I hadn’t really used in a few months. I noticed a level of confidence had developed that I didn’t have when I started my original clinical rotation.

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Eating Disorders

A rotation in eating disorders was added to our clinical schedule this year. I have always been extremely interested in the treatment of EDs and it was my original plan for my elective hours. Sadly there is only one residential treatment center in the central valley, which was unavailable, and around here there is no other form of treatment that utilizes an RD. I really wanted the experience of the inpatient setting, so I stayed in southern CA with family for a week to get experience at a residential treatment center.

This center was specifically for children and teens, and it was at max capacity of 6 while i was there. All of the residents were girls, though they take boys too. Most of them were 13-17 years old. The main types of EDs were represented - anorexia, bulimia, and binge-eating disorder. One of the days I was able to visit a similar treatment center for girls with other types of mental health issues. I mostly shadowed the RD since most of the work done there is most effective after some rapport is built.

Menu planning and the exchange system were utilized to teach and enforce ‘normal’ eating. All food was measured and portioned, but nutrition information was not known to keep from an obsession over calories or another nutrient like fat or sugar. The girls were expected to finish their meals, and if not, they were supplemented with a drink. They also had “kitchen skills” when they get to prepare food, and “fun food” where they eat a particularly challenging or unhealthy kind of food. I also got to sit in on group counseling and one-on-one sessions. 

The main team consists of counselors, an MFT, and the dietitian. They hold a weekly meeting to update each other on the girls’ progress and discuss the treatment plan. If the girls are doing well, they get a pass to spend a few hours with their family. They also participate in challenges meant to get them out of their comfort zone and improve self-control. We took the girls to a restaurant to combat the fear of other people seeing them eat. This is also confronted when they have a family meal. They also may have individual challenges, such as putting a person who struggles with binge-eating in a room alone with their binge foods.

Overall, seeing this process was absolutely fascinating. It’s a very specialized area of dietetics and as a student/intern you don’t receive any training related to it unless you seek it out. My heart broke for the girls and their situations. It was hard to leave after getting to know them. Even with intensive therapy and constant treatment, many won’t recover. Some were even in treatment for the second time at the age of 14. Some girls arrived very committed to recovery, and others had no desire to recover even if it resulted in death. Insurance coverage was also a major barrier and often meant treatment was shorter than it needed to be. It’s an intense job, but I hope I am able to experience it at some point while my life is flexible enough to allow for something so demanding. I’ve discovered that I’m very passionate about diet culture and the way we talk about weight, and how it affects children and teens. It truly is important work and I hope we can expand resources for diagnosis and treatment moving forward.

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Outpatient Dialysis

After a few weeks in other domains, I was back on the clinical side of things. For 2 weeks I worked at an outpatient dialysis center, where people with end-stage renal disease go 3 times a week to have their blood filtered now that their kidneys no longer function adequately. I had been warned that renal nutrition is the most complicated clinically, so I studied a lot in the week before starting. 

Rather than calculating needs, or determining specific diets, the RD’s role is primarily to help the patient’s crucial labs stay within range. This includes encouraging high biological value protein intake, and explaining how to limit potassium and phosphorus in the diet. Part of my responsibility was to deliver the monthly labs to each patient (over 100) and explain the abnormal lab values. I also did complete assessments on unstable or new patients. Someone I have known for many years was actually starting dialysis during my rotation, so we both enjoyed seeing a familiar face.

This rotation ended up being my favorite clinical rotation. It was all of the good parts of medical nutrition therapy without the extra fluff. The renal RD is able to get to know the patient, and is involved with all parts of their care. They are definitely viewed as an important member of the team. The RD works closely with techs, RNs, social workers, nephrologists, and family members to manage the whole patient. I also had the opportunity to develop and teach a lecture about renal nutrition to a group of ~40 CNAs. I still dread presentations, but I am glad when I have a chance to polish that skill and my nerves are much better than they used to be.

I also felt like this rotation allowed me to use my skills and enter confidently. I have consistently gotten feedback that I am knowledgeable and a hard worker, but hesitant. This rotation was the first one where I got direct feedback about my willingness to jump in and function as if I worked there. I give credit to my preceptors for being realistic, willing to teach, and willing to give responsibility.

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Head Start

Head Start is a government funded early childhood education program for preschoolers. Nutrition is an important part of the child’s care. They are served nutritious food, but also taught about nutrition. I was excited because the director of nutritional services had never had an intern and was completely on board. There is a consulting RD for the program, and she served as my preceptor. It was extra fun because this RD happened to be my teacher for the first nutrition class I ever took in community college. Going to her office hours and talking with her is what set me on the path to be a dietitian rather than a preschool teacher, so this rotation was the perfect combination of the two.

I got to visit multiple centers, including those out in rural areas amidst the orchards. Most of the centers had prep kitchens and the food was made fresh for the children. Part of my job was to audit the meals for compliance, appeal, and appropriateness for the age level. It had a stark contrast to the food served at the school district and was much more like a homemade meal. I was impressed by the quality and appeal of the food. One of my favorites aspects of Head Start is the fact that they do sit-down meals. The children learn table manners, how to serve themselves, and ultimately eat much better and are more willing to try new foods because they are having social interaction. One of my assignments was to create mini-lessons that could be used to teach the children about food and nutrition during meal time. They included things like describing the food, answering questions about the food, and being taught to be mindful of their hunger and satiety.

I also compiled bilingual resources to be used by the RNs when counseling the parents of obese children. These handouts focused on nutrition, child involvement during meal time, and being physically active. In addition, I decided to create a resource for the RNs. It gave guidance for approaching the topic with parents, and counseling respectfully in a way that will elicit trust and lead to change.

My preceptors were kind enough to set up meetings with some of the organizations they work with. The director of a local nonprofit gave me a tour of their new facility, which now has a huge warehouse, fully functional teaching kitchen, and a garden. I got to go out and help distribute the food. I also met a woman who works locally with autistic children and discussed how they handle food aversions. And finally, on the last day, I attended a training program for a new nutrition curriculum that will be used with the preschoolers.

I had been looking forward to this rotation for months and it was just as fun as I expected. Being able to develop materials for the program that will be used for the foreseeable future was extremely rewarding. I loved working with the kids and I hope to be able to do work like this in the future, whether it be full-time, consulting, or volunteering!

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Long-Term Care, Take Two

I found myself in need of some more clinical hours after a hospital had to back out of providing a rotation. Thankfully I was able to go back to the skilled nursing facility I rotated through in the fall! It worked out perfectly because when I was there last time, they went into survey and I didn’t get to learn all of the skills I was supposed to.

This time around I got to have a lot more resident interaction. I mostly did assessments of the residents. Since they are followed on a much more long-term basis, there is more opportunity to make an impact. The goal was to give them a diet safe for their condition, but liberalized it as much as possible to encourage intake and weight maintenance. I got a more in-depth look at the supplements used for wound healing. I also learned about the medications prescribed to promote a better appetite and when these are appropriate.

One of the residents I assessed was actually someone I saw as a patient in the ICU in the fall. It was a funny coincidence since I wasn’t given a huge number of residents to assess, and I had originally seen him in another city! It was interesting to be able to follow-up with him and seemed to lift his spirits that I had seen him before. Most of the residents were extremely sweet. I’m really glad I was able to go back and get a proper experience!

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School Foodservice

For this rotation I spent 2 weeks with the school district I attended as a child. I worked with the foodservice director and her assistant, the head of operations. It’s a large district of about 40 schools. There is a food production center, but in addition to that the high schools have cooking kitchens that distribute to the middle and elementary schools.

This rotation included a lot of observation. I watched the preparation and serving process for breakfast and lunch at several schools. The purchaser was kind enough to show me her procedures and explained how the bidding process is followed through to delivery. I visited an abandoned school site that will be used again soon and participated in figuring out how the space could be used for meal service. I watched a taste test with ~50 kids who tried 4 different pizzas. I also attended a district director’s meeting, a safety committee, and a meeting with all of the lead cooks from the school sites. 

I happened to be with the program during two out-of-town events. The first was to Super Co-Op. This is a convention for foodservice directors from all over central California. There were over a hundred booths where vendors had set up their products to be tasted and reviewed for possible use. Most of the items were compliant with the required meal pattern, taking out some of the work for directors. We had a list of items that needed to be replaced in the upcoming year and focused on finding suitable options. The next convention was CASBO (California Association of School Business Officials) and there we met with vendors, and listened to presentations on marijuana and the potential repeal of the affordable care act.

Unfortunately this rotation didn’t allow for very much hands-on learning. My preceptor was reluctant to give assignments or responsibilities (which I knew because 3 intern friends have already rotated through there). I spent a lot of time reading through resources, regulations, and asking questions about the entire process in order to learn and to meet my competencies. It seems to be a trend in my foodservice rotations that they aren’t really sure what to do with an intern, so I have a lot of down time. 

What made this rotation interesting was exploring how regulated and hotly debated regulated school meals have become. Do we give the kids the healthiest food, or food we know they will eat? How do we reduce waste? Is it better to cut costs and provide food to more kids, or cook from scratch at greater expense? Ultimately I think directors have a lot of regulations to navigate and kids are not easy clients. Anyone who claims to have the solution doesn’t understand the problem. There is no one-size-fits-all for American children. That being said, I would like to see less packaged foods served and a return to more foods that are prepared rather than reheated. Vegetable requirements are often met by raw vegetables, but I think kids should also be offered cooked vegetables. It would be easier to meet meal requirements in a palatable way if more combination foods were served rather than trying to provide food groups separately. It was clear that school food will never stop evolving and I am interested to see how it changes in the future.

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Cardiac and Pediatrics

Since I am in a clinically-focused internship, we are required to do rotations related to specific disease states and people groups in order to get well-rounded medical nutrition therapy experience. One of these areas is pediatrics, and it turns out that is not very easy to find in the central valley. I was finally accepted at a hospital in Bakersfield that already had a contract with Oakwood. They also accepted me for some cardiac-focused hours, resulting in a 2-week rotation.

When I set this up I was prepared to commute, but it is about an 80 minute drive one way. Thankfully, a friend from CSULB is interning in Bakersfield and let me stay at her apartment during the week! This was especially significant because some days I started as early as 7:00 am and would have been leaving Visalia at 5:30. Being away allowed me to focus on my work and get enough sleep. It was also extremely fun to be able to catch up with a friend and swap stories with someone going through similar experiences.

My first week was cardiac-focused. This was a lot like doing med/surg patients since cardiac issues are so common, so the first week was mainly a time for me to adapt to a new facility and learn my way around. They charted differently from what I had been doing so it was good to be exposed to a different system. I also got to start on pediatrics toward the end of the first week because pediatric patients can be sparse and they happened to have a few of them.

My pediatric patients consisted of anyone under the age of 18 and the babies in the NICU (neonatal intensive care unit). Most children are hospitalized for appendicitis or pneumonia, so I did more with the NICU babies. Infant nutrition is completely different from all other clinical work, and it's not really taught in school, so there was a ton to learn. Luckily my preceptor had a pediatric specialization, 15 years of experience, and is a college professor! She was the perfect person to teach me.

Every day we would visit the babies to see what kind of treatments they were receiving and get information about their TPN (total parenteral nutrition) from the hard chart. All of the babies I saw were premature and so we would calculate their needs and determine if they were getting enough nutrition. Once stable, the babies began receiving breast milk through a feeding tube along with the PN. I was required to do a pediatric case study presentation and had a much better experience than last time. It was a powerpoint only (no formal written report) and I was given work time to put it together. My patient was a premature NICU baby with respiratory distress syndrome. I learned a lot from doing research and analyzing feeding practices. I got great feedback on the presentation and was even able to teach the RD team some new things since not all of them work in pediatrics.

Overall this was a great rotation! I really liked the work environment. The RDs had large offices, good managerial support, and they got to wear scrubs. I could also tell they were valued by the doctors, nurses, and pharmacists. I was able to focus on learning and applying new information.

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Diabetes and Community Wellness

Following my ICU rotation, I remained with the same hospital for another two weeks, but in a different department. My preceptor was the community wellness director. The focus of the rotation was diabetes management, but rather than putting me in an office to do counseling for 2 weeks, she allowed me to participate in multiple aspects of community wellness and administrative activities.

A lot of the focus was put on a pilot program being planned for certain clinics. It would involve doctors having certain days in which they see all of their high risk diabetics. The visit would then be coordinated with seeing the dietitian to improve upon the current no-show rate. The staff would also be trained to offer peer-led classes.  I drove all over the central valley and helped pitch this idea to providers and discuss the feasibility.

The department is experiencing some restructuring and the director was kind enough to let me in on her strategic planning. We discussed program creation and removal, along with staffing and what would be most valuable to both the organization and the community.

I went to several coalition/non-profit/support group meetings that focused on topics such as homelessness, diabetes, nutrition, smoking cessation, and community advocacy. Other activities included sitting in on an interview for a new doctor, participating in webinars for continuing education, a phone interview for a newspaper, and a few meetings to discuss legal issues. I also updated the organization’s facebook page daily.

A few days were spent with the outpatient counselors, both of whom are RDs. They saw patients for issues such as diabetes management, bariatric surgery, weight loss, and hyperlipidemia. I also counseled some patients myself. After spending time with the outpatient RDs, the director and I had some great conversations about counseling approaches. We have similar styles focused on understanding patients and meeting them where they are to bring about change that will be most meaningful to them.

I was given a project to create a cycle menu for a women’s shelter. They have a great cook, but some guidance was needed to provide more balance to the meals. I made a three-week cycle menu that included three meals and three snacks per day. It was great to be able to create something that will be used over and over again.

This rotation was my favorite so far. I got to do new things each day, learn from someone with tons of experience, and my contributions were valued. The work we did affected so many areas of the community, and I dream of someday having a position with that much impact!

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ICU and Nutrition Support

I spent 4 weeks assessing ICU patients at the same facility where I did my med/surg patients. My patients consisted of whoever was in the 11 bed ICU. Usually only a few were due on any particular day, but they usually took longer to assess.

Since I was covering the ICU, I went to the rounds every morning. This consisted of the ICU doctors, nurses, respiratory therapists, speech therapists, wound care specialists, along with representatives from the microbiology lab and case management. They would give an update on each patient and discuss the plan of care. Occasionally they would request tube feeding recommendations or ask a question about someone’s diet, but mostly dietitians just went to be updated. I loved this part of the day! I learned so much about diseases and how people work together to manage each case. It was also interesting to be able to follow the same patient consistently and see how they progressed, rather than having a completely new set of patients each day.

Many of the patients were on ventilators and couldn’t eat a PO (by mouth) diet. A large part of my time was spent calculating tube feedings. There were a few instances where parenteral nutrition was needed, but it wasn’t common.I enjoyed the more complex nature of the patients. There was less patient interaction, but it seemed like there was more impact on their condition.

One of the most challenging aspects of this rotation was the clinical case study. I had some misunderstandings with the clinical nutrition manager as to the expectations and due date, so I didn’t have as much time as I anticipated to complete it. I also had to pick from the available patients on a certain week, and ended up with a particularly difficult one. The purpose was to find a nutritionally relevant condition and do a detailed analysis of the patient and cite relevant research. I chose enteral nutrition feedings in a patient with end-stage renal disease. The patient had been in the hospital for over 50 days and had numerous co-morbidities. Aside from a few stray hours, I did the whole thing at home after work and on weekends/Thanksgiving. My report ended up being 26 pages long. I also gave a one hour presentation summarizing the report. 

I did a total of 8 weeks at this facility and it was so nice to be able to settle in a little bit. After a few weeks, I could mostly work on my own and felt like a normal employee. I was able to really get to know the other RDs that work there and see the various positives and negatives that exist in any work place. 

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Acute Care

I am now in my main clinical acute care rotation at the hospital. I’m doing 4 weeks of medical/surgical and then 4 weeks of ICU. This is the rotation that I was most nervous for because I’m not super comfortable in hospitals and it’s also the most technical and knowledge heavy. So I’m really grateful to have started! The first few days were a huge learning curve. Finding my way around, navigating the medical records system, learning their way of charting, brushing up on abbreviations... it was a lot to take in. Once I understood how things worked and gained some confidence, everything got a lot easier! 

I just finished up 4 weeks of med/surg. It’s amazing how much I learned each day. I retain so much more information when I am putting into use and seeing it within the context of a patient. It also feels really good to be able to stay in one place for longer than a couple of weeks. I have been able to get into a routine and start to feel closer to a normal employee.

My preceptors seem to think it’s all going pretty well, too. At the beginning I asked how many patients I should be doing in a day, and they said 7-8 at the end of my 8 weeks. I did 8 patients in one day during my 2nd week! Right now I’m averaging about 5 so I want to get up to 8 consistently. I also recently got a really good progress report from the clinical nutrition manager. She said I seem to already be at entry-level and that I naturally see the full picture of what’s going on with the patients. That was pretty exciting. Like my other rotations, I’ve had to remember that I have too high of expectations for myself and I need to relax a little, so I try to take my time. 

Now I am moving on to ICU/critical care which involves a lot of enteral nutrition (tube feeding) and parenteral nutrition (IV feeding). I enjoyed learning all of the nutrition support calculations in college so I think I’m going to like the challenge!

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Long-Term Care

Last week I completed my long-term care rotation, which is a part of the clinical domain. This was only a one-week rotation and I did it at a skilled nursing facility. SNFs are very different from hospitals because there is long-term monitoring and weight changes are critical. I had expected this to be a nice introduction to clinical dietetics before moving on to a hospital, but it turned out to be very different from what everyone expected!

An hour into my first day, 6 state surveyors arrived, including a state RD. The staff was caught off guard and it suddenly became a pretty high-stress environment. State RDs are known for being especially ruthless when inspecting the kitchen. My preceptor was the only RD in the facility, so she was in charge of both the nutrition and foodservice areas. Observing the survey showed me the critical areas of kitchen management and how you need reliable staff to carry out their responsibilities. There are an incredible number of small things that can go wrong, and it is especially critical that this population get proper nutrition according to their specific situations.

Since my preceptor’s role shifted during my time there, I mostly observed the different aspects of her job. Having an audit occur during a rotation is something I never could have planned, so even though it changed what I did, I’m grateful for the unique experience. I am hoping to have the time to do some more hours there in the spring!

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Three more weeks have gone by, and I have completed my rotation with WIC! For anyone who doesn’t know, WIC stands for Women, Infants, and Children. It’s a government program that provides nutrition counseling and food/formula vouchers to low income families. 

WIC employs a lot of RDs, both in management and direct service positions. I had the opportunity to work with both. I gained experience in budgeting, staffing, and department collaborations. I also got to refresh my knowledge related to pregnancy, breastfeeding, and children, and strengthen my counseling skills.  I have always been very interested in working with children and low-income populations.

Here are the activities I did in my 3 weeks with this program:

Observed and counseled both high-risk and low-risk appointments

Observed classes: Enrollment, Rethink Your Drink, Introduction of Solid Foods, Baby Behavior, Baby Behavior Pt. 2, Breastfeeding, and Breastfeeding Pt. 2

Taught the Rethink Your Drink class 5 times

Gave a 30 min. probiotics presentation at the inservice

Learned WIC MIS computer system and practiced enrolling participants

Created a bulletin board for the upcoming class to be used at every site in the county

Wrote a newsletter article about benefits of breastfeeding for the mother

Attended meetings:

Lindsay Healthy Start Service Providers

Meeting with public health manager

Nitrates in well water program

CNAP planning

Dietitian II meeting

Central Valley Nutrition Education & Training Consortium

Nutrition Education & Obesity Prevention

HPA Training - Take Time, Talk!

Regional Breastfeeding Liaison budgeting

Reviewed statistical data

Observed the front desk

Observed counseling sessions in Spanish

Helped run the Tulare County Fair baby café tent

Read the journal of Clinical Lactation

Attended a webinar on motivational interviewing

Every day was a little different, and everything I did was interesting. The staff really took the time to teach me the different aspects of the job so that I got an idea of what it’s like to work there. 

WIC was not a knowledge-heavy rotation. A lot of the information that you give to clients was provided to you. I had an advantage because I was already so used to working with kids, and I enjoy counseling and talking with parents. Once I understood the style of WIC counseling, I was able to practice it with more confidence. It’s much more about supporting parents and guiding them toward good decisions, rather than correcting behavior. 

I definitely had to get out of my comfort zone. There was one day where I felt overwhelmed by what they were asking me to do, so I had to ask to take a breather and try it again the next day. That was really hard for me because I have high expectations for myself and felt like I had failed. It turned out that I was in the early stages of getting sick, which is probably why I was feeling overwhelmed. It was a reminder that I can’t be perfect at everything the first time, and this internship is about learning and trying new things.

I had a lot of opportunities to practice public speaking. I presented at the staff inservice to ~50 people, and I also taught a class to WIC participants five times.This made me realize how much my public speaking skills have grown. In the first few years of college, I could barely make it through a presentation and there was no skill involved - I said the words and I sat down. At WIC, I was nervous but I don’t feel like I let it interfere with my job. More than one person told me I seemed like a natural, so I hope I can continue to improve in that area. I also had the opportunity to use my creativity, an area in which I am not at all secure, by making a bilingual bulletin board (pictured above). It goes along with their upcoming 3-month class and will be replicated at all of the sites in the county. 

The thing that made this rotation so enjoyable was the staff. Everyone was abundantly kind and welcoming from the start. There were four different people training me, and each one made me feel extremely supported. The dietitians went on walks together on their breaks, and that really made the day go by faster. I hope I can work in an environment like that someday. This rotation is the one I had looked forward to the most, and it did not disappoint!

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Hospital Foodservice

My first rotation has come to a close, which means I am 10% of the way through my internship! The days were long but the weeks went by fast. I was surprised at how much I got to know the staff, how gracious they were toward me, and how much I will miss working with them. This rotation was out of my comfort zone because I have never worked in foodservice, never worked in a hospital, and I felt that my education in this area was lacking.

This rotation was more relaxed, and I felt that I learned the most by observing and seeing how management dealt with problems as they came up. Management is unique because it deals less with nutrition, and more with running a business and keeping patients satisfied.

Some of what I did included:

Participating in meetings with the regional chef about overhauling their retail menu

Learning to use the databases that house the menu, nutrition information, and recipes

Helping with a themed catering event that benefited the hospital

Conducting various audits related to patient experience and food safety

Conducting tray accuracy audits

Counting and documenting the cash deposit each day

Visiting patients daily to see if they were satisfied with their meals

Shadowing the different foodservice positions to gain an understanding of their daily tasks

Learning about HR issues, such as dealing with a late reporting of a workman’s comp claim and ensuring that all paperwork was on file

Calculating statistics and inputting QAPI (quality assurance/performance improvement) data

Coming into this rotation my math skills were strong, so I caught on quickly to the statistics and recipe costing. I lacked knowledge about special diets, so I used some of my time there to research them because it was helpful for my management work and they will be important during clinical rotations. I only had book knowledge about the function and flow of a kitchen, so I got to see that in action. I need to work on not seeming too serious but remaining professional, because I can seem unhappy when I am nervous or concentrating. My overall takeaway was that I didn’t get to do a lot of creative problem-solving or hands-on implementation, but I did learn a lot about how to keep a facility running smoothly.

[ryntern]

Orientation

After a cancelled flight that caused a 6 hour delay, I made it to Alabama! The first day of orientation was great, but I was exhausted. A combined 8 hours of sleep for 2 nights made it pretty hard to stay awake for a 9 hour class day. But, it was really cool to meet the other 27 interns from all over the country. There’s something really encouraging about being around people who understand what you’ve done to get to this point and what the next year holds.

The next few days were much better since I had some rest. We visited some facilities, but my favorite part was visiting a community wellness center and hearing about what the dietitian does there. She basically teaches various targeted classes (for cardiac patients, bariatric surgery patients, things like that) and does individual counseling as well for everything from sports nutrition to eating disorders. It was exactly the type of thing I can see myself doing someday, so I really liked hearing from her. Back at the school we got to hear from various speakers and also have short refresher courses on things like tube feeding, chronic kidney disease, functional foods, and diabetic diets. Aside from the lectures and workshops, I received a lot of clarification about documentation for the upcoming year and a more detailed description of the hours I need to complete.

For 6 days I shared a hotel room with two girls who also went to CSULB. We didn’t really know each other when we got there, but we got along so well! It really made it fun to spend the evenings together and try out new food around the city. We also got to visit the botanical gardens on our last day.

Now my task for the next few weeks is to try and find preceptors for the 400 hours I have yet to schedule. I’m supposed to start my first rotation, hospital foodservice, in 2 days. That is supposed to be one of the less challenging rotations, but I know foodservice is an area where my education wasn’t as strong. I’m nervous, but excited to finally get started. I’m feeling ready to stay focused and tackle these next ~10 months.

[ryntern]

Beginning

I am not quite sure what this blog will become yet. I want a place to record my thoughts, document my time as an intern, and interact with other interns. I’ve found it really interesting and encouraging to read about the experiences of other interns. Rather than put that on my usual blog, I decided to make this one so that people can opt-in and it’s all in one place. 

Some context for how I got here... After time at a community college, I decided to study nutrition. I didn’t realize this was such a passion of mine, but it has turned out to be a great fit. In May I graduated from CSU Long Beach with a B.S. in Nutrition and Dietetics. My last 2 years of college were very intense, not just because of the course load, but because all of us were competing for dietetic internships. An internship is a program you must go through to become a Registered Dietitian that provides 1200 hours of supervised practice in specific areas. It’s kind of like nursing school, but for RDs. Only about half of graduates are matched to one, so to have a shot you need stellar grades, a leadership role, and lots of experience. We go through a lengthy application process, and then we all find out on the same day if we were matched to an internship or not.

I was accepted to a program in Alabama at Oakwood University. It’s a distance program, which is kind of like going to school online and allows me to complete my hours in my city. This adds an extra layer of work because I am required to find facilities that will take me as an intern, get the contracts, and make it all fit into a 10 month time frame instead of just being told where to go. The entire experience is unpaid and costs over $10k.  There are 3 main areas: foodservice, community, and clinical. Each of these is divided into areas that I must complete, so I will likely end up interning at 10+ facilities. 

This upcoming week I have orientation for 5 days! I will be flying to Alabama to meet the other ~24 interns in this program, learn what is expected of us, and get prepared to start working. I’m staying with 2 girls I went to school with and I think it’s going to be a lot of fun!