UNC DIETETIC INTERNSHIP
ROTATION EVALUATION
CLINICAL ROTATIONS
Intern Name
Date(s) of Experience
Experience Site
Preceptor / Evaluator
Performance Standards (as defined in Competency Evaluation Guidelines):
4 = Exceptional
3 = Proficient
2* = Needs Improvement (Intern will need to repeat the experience)
1* = Deficient (Intern will need to repeat the experience)
PRECEPTOR INITIAL ON EACH BULLETED ITEM WHICH IS APPLICABLE TO INDIVIDUAL ROTATION
Individual activities are organized under appropriate Competencies as required by ACEND.
One rotation evaluation will be used for all required activities and evaluations. The intern will keep the evaluation form until all
competencies have been evaluated during rotations at multiple facilities, if necessary.
Competencies*
(CRD 1.1/ CRD 4.6) ) Select indicators of program quality and/or customer service and
measure achievement of objectives / Analyze quality, financial or productivity data and
develop a plan for intervention:
Has the intern…
 Identified components of quality management in a clinical setting.
 Participated in the collection and evaluation of quality management data as
identified in the department quality management plan.
 Completed one administrative study of one component that is measurable by
measuring a specific component and providing recommendations for
improvement.
COMMENTS:
(CRD 1.2) Apply evidence-based guidelines, systematic reviews and scientific literature (such
as the Academy Evidence Analysis Library and Evidence-based Nutrition Practice Guidelines,
the Cochrane Database of Systematic Reviews and the U.S. Department of Health and
Human Services, Agency for Healthcare Research and Quality, National Guideline
Clearinghouse Web sites) in the nutrition care process and model and other areas of dietetics
practice
Has the intern…
 Applied evidence to nutrition care plans in clinical case studies.
COMMENTS:
4
3
2*
1*
(CRD 1.3) Justify programs, products, services and care using appropriate evidence or data:
Has the intern…
 Conducted a cost benefit analysis of the use of medical nutrition therapy for a
particular diagnosis in a clinical patient
COMMENTS:
(CRD 1.4) Evaluate emerging research for application in dietetics practice:
Has the intern…
 Completed a scientific research module on identifying quality research, and
submit to preceptor a written critique for a research article published in a nutrition
related publication.(Clin, FS, or Comm)
 Discussed with preceptor articles from professional literature regarding new
aspects of medical nutrition therapy intervention on topics of interest.
COMMENTS:
(CRD 1.5/CRD 4.4) Conduct projects using appropriate research methods, ethical procedures
and data analysis / Conduct clinical and customer service quality management activities:
Has the intern…
 Conducted an acceptance survey to evaluate the clinical service related needs
of a target market. Written a report that includes an analysis, conclusion, and
recommendations; given report to preceptor.
COMMENTS:
(CRD 2.1) Practice in compliance with current federal regulations and state statutes and rules,
as applicable and in accordance with accreditation standards and the Scope of Dietetics
Practice and Code of Ethics for the Profession of Dietetics:
Has the intern…
 Demonstrated understanding of the Code of Ethics and Standards of Practice of
the Academy, HIPAA and Joint Commission in reference to patient care.
 Identified and discussed with preceptor local, state and federal regulations that
influence and affect care in long term care facilities (Clin or FS)
COMMENTS:
.
(CRD 2.2) Demonstrate professional writing skills in preparing professional communications
(e.g. research manuscripts, project proposals, education materials, policies and procedures):
Has the intern…
 Demonstrated ability to use computer hardware, software technology, webbased resources and the Internet to complete assignments and experiences and
communicate effectively in a clinical setting
 Followed facility format and guidelines when developing documents
COMMENTS:
(CRD 2.3/CRD 2.4) Design, implement and evaluate presentations to a target audience. / Use
effective education and counseling skills to facilitate behavior change. (considering life
experiences, cultural diversity and educational background of the target audience):
Has the intern…
 Created appropriate education materials, conducted and evaluated an in-service
training for employees. (Clin, FS, or Comm)
 Used the Academy Evidence-Based Library and develop a written patient / client
material in a clinical or community setting. (Clin or Comm)
 Participated in counseling for acute and non-acute conditions with
patients/clients in a variety of age groups and cultures.
COMMENTS:
(CRD 2.5/CRD 2.10) Demonstrate active participation, teamwork and contributions in group
settings / Establish collaborative relationships with other health professionals(physicians,
nurses, pharmacists, etc.), and support personnel to deliver effective nutrition services:
Has the intern…
 Interacted with other healthcare professionals.
 Participated in information sessions with care givers.
 Attended patient care conferences as available
 Discussed diet instructions as needed with team members.
COMMENTS:
(CRD 2.6/CRD 2.8) Assign patient care activities to DTRs and/or support personnel as
appropriate. (considering the needs of the patient/client or situation, the ability of support
personnel, jurisdictional law, practice guidelines and policies within the facility) / Apply
leadership skills to achieve desired outcomes:
Has the intern…
 Provided clinical RD staff relief (40 hours minimum).
 Reviewed methods of prioritizing patients for nutritional care in clinical setting.
COMMENTS:
(CRD 2.7) Refer clients and patients to other professionals and services when needs are
beyond individual scope of practice:
Has the intern…
 Used appropriate judgment and referred clients and patients to other
professionals and services when needs are beyond individual scope of
practice.(Clin or Comm)
 Investigated and developed material detailing available resources in the
community. (Clin or Comm)
COMMENTS:
(CRD 2.9) Participate in professional and community organizations:
Has the intern…
 Attended meeting(s) of professional organizations as available. (Clin, FS or
Comm)
COMMENTS:
(CRD 2.11) Demonstrate professional attributes within various organizational cultures
(showing initiative and proactively developing solutions, advocacy, customer focus, risk taking,
critical thinking, flexibility, time management, work prioritization and work ethic:
Has the intern…
 Used appropriate judgment when initiating change and improving quality in the
organization.
 Used critical thinking, flexibility, and time management skills when completing
projects within the organization.
 Participated in activities to promote the dietetic profession and advocate for clients
and/or consumers. (Clin, FS or Comm)
COMMENTS:
(CRD 2.12) Perform self-assessment, develop goals and objectives and prepare a draft
portfolio for professional development as defined by the Commission on Dietetic Registration:
Has the intern…
 Begun work on the Commission on Dietetic Registration’s Professional Development
Portfolio Process.
COMMENTS:
(CRD 2.13) ) Demonstrate negotiation skills (while respecting life experiences, cultural
diversity and educational background of other parties):
Has the intern…
 Participated in supervisory decision making while completing clinical staff relief
COMMENTS:
(CRD 3.1.a.) Assess the nutritional status of individuals, groups and populations in a variety
of settings where nutrition care is or can be delivered:
Has the intern…
 Interviewed patients/clients and gathered information appropriately to complete
an assessment and subsequent direction of nutritional needs)
 Conducted general screening and assessment using lab values, other
measures, and facility check-sheets as needed.
 Demonstrated understanding of Global Nutrition Assessment for interpreting
degree of risk.
 Conducted nutrition assessment of individual patients/clients with uncomplicated
instances of common medical conditions, e.g., hypertension, obesity, diabetes,
diverticular disease.
 Completed case studies relevant to common medical conditions.
COMMENTS:
(CRD 3.1.b.) Diagnose nutrition problems and create problem, etiology, signs and symptoms
(PES) statements:
Has the intern…
 Applied and interpreted lab values for appropriate patient / client evaluation.
 Assessed nutritional status of individual patients/clients with complex medical
conditions, e.g., renal disease, multi-system disease, organ failure, and trauma.
 Completed case studies relevant to complex medical conditions.
COMMENTS:
(CRD 3.1.c.) Plan and implement nutrition interventions to include prioritizing the nutrition
diagnosis, formulating a nutrition prescription, establishing goals and selecting and managing
intervention:
Has the intern…
 Developed nutrition intervention plans for a variety of acute and non-acute
experiences and given an in-service presentation to clinical staff on a selected plan.
 Conducted nutrition care component of interdisciplinary team conferences to discuss
patient/client treatment and discharge planning.
 Coordinated and modified nutrition care activities among caregivers
 Charted as is appropriate in the clinical setting.
COMMENTS:
(CRD 3.1.d.) Monitor and evaluate problems, etiologies, signs, symptoms and the impact of
interventions on the nutrition diagnosis:
Has the intern…
 Managed monitoring of patients’ / clients’ food and / or nutrient intake.
 Achieved an entry level of competency in this area through the activities of case
studies, diet instructions, menu modification, calorie counts and other monitoring
practices during the course of the internship.
 Selected, implemented and evaluated standard enteral and parenteral nutrition
regimens.
 Achieved an entry level of competency in this area through the activities of case
studies and client monitoring.
 Followed at least one client / patient as the individual moves from one nutrition
support to another, e.g., total parenteral nutrition to tube feeding to oral diet.
COMMENTS:
(CRD 3.1.e) Complete documentation that follows professional guidelines, guidelines
required by health care systems and guidelines required by the practice setting:
Has the intern…
 Written notes for medical records and reviewed with preceptor.
 Used appropriate abbreviations for documenting patient/client medical records.
. COMMENTS:
(CRD 3.2) Demonstrate effective communications skills for clinical and customer services in a
variety of formats (using oral, print, visual, electronic and mass media methods for maximizing
client education, employee training and marketing:
Has the intern…
 Used the SMOG or similar readability formula effectively for developing written
materials for patient, client and general populations.(can also be completed in Comm
or Nutrition Education concentration)
 Participated in a community awareness activity (i.e., health fair, published an article)
(Clin or Comm)
COMMENTS:
(CRD 3.3/CRD 4.9/ CRD 4.10) Develop and deliver products, programs or services that
promote consumer health, wellness and lifestyle management (consider health messages and
interventions that integrate consumer desire for taste, convenience and economy with
nutrition, food safety) / Analyze financial data to assess utilization of resources / Develop a
plan to provide or develop a product, program or service that includes a budget, staffing
needs, equipment and supplies:
Has the intern…
 Written an employee schedule for one cycle. (Clin or FS)
 Participated in a community based health promotion/ disease prevention program.
(Clin or Comm)
 Revised and distributed a modified recipe for consumers or clients. (Clin or Comm)
 Reviewed organizational chart of hospital to see how clinical nutrition services relates
to other departments.
 Reviewed budget for clinical nutrition services
. COMMENTS:
(CRD 3.4) Deliver respectful, science-based answers to consumer questions concerning
emerging trends:
Has the intern…
 Identified an emerging trend of concern for consumers and developed a client/patient
fact sheet to answer commonly asked questions. (Clin or Comm)
. COMMENTS:
(CRD 3.6) Develop and evaluate recipes, formulas and menus for acceptability and
affordability that accommodate the cultural diversity and health needs of various populations,
groups and individuals:
Has the intern…
 Demonstrated competency in this area by revising individual patient menus. (Clin or
FS)
 Written a cycle menu for a target population. (Clin, FS, or Comm)
. COMMENTS:
(CRD 4.1) Participate in management of human resources:
Has the intern…
 Reviewed departmental policy / procedure manual, employee manual, job
description and personnel policies regarding recruiting, interviewing, hiring,
orienting, training, appraising and terminating employees in the clinical setting.
 Participated in human resources activities, as the experience becomes available.
. COMMENTS:
(CRD 4.5) Use current informatics technology to develop, store, retrieve and disseminate
information and data:
Has the intern…
 Reviewed and discussed with preceptor computer resources and applications
specific to clinical dietetics, i.e., patient medical charts, laboratory data, financial
management
. COMMENTS:
(CRD 4.11) Code and bill for dietetic/nutrition services to obtain reimbursement for services
from public or private insurers:
Has the intern…
 Participated in billing functions for clinical nutrition services with clinical nutrition
manager or other responsible individual.
. COMMENTS:
How does the intern:
Interview

Prepare self for interview?

Prepare patient for interview?

Conduct interview, with skill?

Elicit current dietary habits?

Obtain social history as needed?

Obtain additional medical history?

Organize and enter written communication, including charting
 Concise?
 Correct spelling / grammar / abbreviations?
 Uses standard references?
COMMENTS:
4
3
2
1
Does the intern:
Demonstrate a working knowledge of the nutritional requirements for:
Diabetes Mellitus
 Type I
 Type II
GI disease
Cancer
Renal disease
Cardiovascular disease
Liver or pancreatic dysfunction
Enteral nutrition support
Parenteral nutrition support
COMMENTS:
4
3
2
1
Demonstrate a working knowledge of the following lab values?
Serum albumin
Serum transferrin
Total lymphocyte count
Creatinine / height index
Total urine nitrogen
Urea nitrogen / nitrogen balance
Immune reactivity studies
Glucose (blood)
Sodium
Potassium
Hematocrit / hemoglobin
Protein (urine)
Acetone (urine)
Specific gravity (urine)
Serum osmolality
Cholesterol
Tryglycerides
LDL, HDL, VLDL
TC : HDL Ratio
PT
PTT
Pre-albumin
Hemoglobin A1C
3-methylhistidine
CBC values (all of them)
Liver Function Tests; BUN or SUN
GFR (Glomerular Filtration Rate)
Urine creatinine
Lp(a)
C-reactive protein
COMMENTS:
4
3
2
1
Major Strengths for the Intern:
Suggestions for Improvement for the Intern (Required for ratings of 1 or 2):
Intern comments:
Signature of Preceptor:
Date:
Signature of Intern:
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Signature of Preceptor:
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Signature of Intern:
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Signature of Preceptor:
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Signature of Intern:
Date: