Bowling Green State University
Dietetic Internship Program
Rotation: WIC Clinics
_____ Readings completed
_____ Complete WIC works on-line module
_____ Pre-rotation self-assessment journal entry
_____ Complete CDC growth chart module
_____ Affiliation Agreement signed and submitted
______Health documentation submitted to site as needed
Intern:
Facility:
Goal/Objective
initial
Planned Experience
Comments/Alternative Experiences
DI 4.4 Participate in public policy activities, including both legislative and regulatory initiatives.
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Identifies federal, regional, state
and local governmental
structures and regulations that
influence the WIC program.
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Identifies political/regulatory
considerations involved in
agency planning and decision
making.
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Evaluation of competency
Review information on the Child Nutrition and
WIC Reauthorization Act.
Review laws and regulations related to WIC:
Subpart C 331-346, Subpart D 349 – 359, Subpart
E 359 – 363 and any state specific information.
journal entry - how is program funded?
discuss funding issues as they apply to current
legislation if appropriate with preceptor
review regulations that effect program
administration - summarize in journal entry
discuss with preceptor, director to review
journal entries
Review WIC Authorized Food Lists – discuss how
change in foods has impacted agency – journal
entry
Discuss key players responsible for
agency/program planning with preceptor – make
journal entry.
Review organizational chart – note where RD’s are
located.
Review agency policy manual if possible.
discuss with preceptor, director to review
journal entries
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern rating
DI 4.9 Obtain and analyze financial data to assess budget controls and maximize fiscal outcomes.
Analyze financial information
relevant to program operations.
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Evaluation of competency
review qualifying financial criteria on-site
review program application form
discuss the following with preceptor if possible mean income of participants, other forms of
assistance they may be receiving - journal entry
review budget with preceptor (note: salaries are
proprietary information - make journal entry
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
discuss with preceptor, director to review
journal entries
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern rating
DI 2.2 Demonstrate professional writing skills in preparing professional communications (e.g. research manuscripts, project proposals,
education materials, policies and procedures).
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Identify educational needs of
target population, including
cultural considerations.
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Develop educational materials
that meets needs of population.
Evaluation of competency
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review know your learner, low literacy or cultural
references as needed
review WIC Works Sharing Center web site for
ideas on classes, other resources for this audience
review “Early introduction of solid foods among
urban African-American participants in WIC.
discuss classes offered – how were topics
determined? Journal entry
discuss with preceptor, director to review
journal entries
under preceptor direction, develop handout or
bulletin board to be used in counseling or as part
of a class if needed
add to portfolio
reviewed by preceptor
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern rating
DI 3.1a. Assess the nutritional status of individuals, groups and populations in a variety of settings where nutrition care is or can be
delivered.
Identify general needs and
characteristics of WIC
population.
Review normal nutrition needs
of this population (pregnancy,
lactation, infancy, early
childhood)
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Screen/assess WIC clients
according to facility criteria
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Evaluation of competency
review WIC Participant and Program
Characteristics
review WIC formulary, foods available on voucher
program
discuss with preceptor
review relevant chapters in Nutrition in Diagnosis
Related Care, Nausea and Vomiting of Pregnancy,
Picky Eating: A Toddler’s Approach to Mealtime
as needed
review positions of the American Dietetic
Association – Nutrition and Lifestyle for a Healthy
Pregnancy Outcome and Breaking the Barriers
Toward Breastfeeding as needed
discuss with preceptor
review VENA (Value Enhanced Nutrition
Assessment) Guidelines – appendices provide
guidelines for specific populations or site specific
method for assessment of clients
complete the CDC Growth Chart On-Line Training
Module
review policies and procedures regarding client
assessment including forms
observe WIC personnel assess clients
under supervision of preceptor assess clients
assess clients independently, if possible
journal entry summarizing 3 cases – include PES
statements for each one
preceptor to assess counseling skills, director
to review journal entries
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern Rating
DI 3.c Plan and implement nutrition interventions, to include prioritizing the nutrition diagnosis, formulating a nutrition prescription,
establishing goals and selecting an managing intervention.
DI 3.d Monitor and evaluate problems, etiologies, signs, symptoms and impact of interventions on the nutrition diagnosis.
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Develops and implements care
plan based on nutritional status.
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Evaluation of competency
with preceptor assistance analyze and interpret 24
hour recalls, food frequencies and anthropometric
measures
independently analyze and interpret 24 hour
recalls, food frequencies and anthropometric
measures
develop care plan for client using food package
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
preceptor to assess counseling skills
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern Rating
DI 2.3 Design, implement and evaluate presentations considering life experiences, cultural diversity and educational background of the
target audience.
Assess educational needs of
target audience.
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Develop and present class based
on assessed needs.
Evaluation of competency
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Review limited resource client module from intro
course and cultural diversity module as needed
review existing classes
discuss with preceptor
develop learning objectives and class on topic
given by preceptor, develop educational materials
as needed
present class if possible - summarize experience in
journal entry
self-evaluate using program evaluation form,
preceptor to evaluate class presentation
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern Rating
DI 1.4 Evaluate emerging research for application in dietetics practice
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review Pediatric and Pregnancy Nutrition
Surveillance System web-site. How does this state
compare to surrounding states regarding
breastfeeding practices and LBW babies? – journal
entry
review research studies described on the WIC
website
review research aspects of clinic programs (if any)
with preceptor and assist in data collection, if
applicable
discuss role of nutrition in treatment and recovery
from chemical dependency
Discuss research aspects of
clinic programs
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Evaluation of competency
1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
discuss with preceptor, director to review
journal entries
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
Intern Rating
DI 4.1 Use organizational processes and tools to manage human resources
Applies resource management,
including grant application,
identifying funding sources and
reading fiscal reports.
Uses management principles for
effective community
assessment, program planning,
implementation and evaluation
and applies them to communitybased public health nutrition
programs.
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review financial statements for agency as available
assist with writing grant application or review
existing applications as available –journal entry
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participate in strategic planning if possible discuss with preceptor
journal entry
observe and interview various members of the
multidisciplinary team - journal entry
identify criteria for implementing Quality
Assurance plan for the local agency and/or
community
participate in conducting a community needs
assessment, including socioeconomic data or
review needs assessment if available - journal entry
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Utilizes referral process and
makes appropriate community
referrals.
Evaluation of competency
Were competencies generally met?
identify related agencies appropriate for client
referral -summarize in journal entry
makes appropriate referrals
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1= competency attempted, minimal success
2= competency partially met
3= competency nearly met at entry level
yes
discuss with preceptor
4= competency met at entry level
5=competency surpasses entry level
NA = not attempted or observed
no
Comments:
Preceptor Signature:
Date:
Intern Signature:
Post rotation checklist:
Goals and objectives signed by preceptor and intern to be mailed or faxed to director
Post rotation evaluation form completed by preceptor, signed by intern, to be mailed or faxed to director
Submission of journal entries to director via mail or electronically
Evaluation of distance internship program by preceptor (under resources, preceptor web page)
Complete intern feedback form and submit electronically. (under course documents, evaluations folder)
Intern Rating