BRIGHAM YOUNG UNIVERSITY
DIETETIC INTERNSHIP
Medical Center
Clinical Rotation
Preceptor Handbook
2010
TABLE OF CONTENTS
Master Schedule ................................................................................................................. 1
Before Coming to You ....................................................................................................... 3
Undergraduate Course Work Summary ......................................................................... 5
The Big Picture (overall objectives) ................................................................................. 7
Terminology for ADA Competency Statements.............................................................. 9
Objectives and Learning Activities ................................................................................. 11
Clinical Study Guide ......................................................................................................... 15
Examples of In-service ...................................................................................................... 17
Case Study ......................................................................................................................... 19
Tips for Dietetic Technician Rotation ............................................................................. 21
Tips for Management/Supervisory Rotations ................................................................ 22
Tips for Clinical Dietitian Rotations ............................................................................... 23
Daily Post-Clinical Conferences/Reports ........................................................................ 24
Scheduling.......................................................................................................................... 25
Sample Schedule................................................................................................................ 25
Evaluations (Information) ................................................................................................ 27
UDEC Tips for Effective Precepting…………………………………………………….29
Before You Start ...................................................................................... 29
A Teaching Model .................................................................................... 30
Evaluation ................................................................................................. 31
Supervised Practice Site Evaluation................................................................................ 33
Clinical Evaluation............................................................................................................ 35
MASTER ROTATION SCHEDULE – 2010
DATE
Jan 4-Feb 4
Feb 8-11
(Feb 16-18)
Feb 22-Mar 4
Mar 8-11
Rebecca
Yorgason
Mar 22-25
Mar 29- Apr 8
Apr 12-15
Apr 19-May 13
May 17- 27
Mngt
PCMC
Option
SITE AND ROTATION*
INTERN
Anne
Woodbury
Mar 15-18
Clinical
McKay-Dee
Rotation C
Clinical
IMC
Rotation C
Extended
Care
Rotation E
Extended
Care
NDFS
637/638
Field Trips
T, Th
Break
Rotation E
State Health
Dept
SLC WIC
Rotation D
Rotation D
State Health
Dept
SLC WIC
Rotation D
Rotation D
SLC Aging
Public
Policy
Workshop
Rotation D
SLC Aging
Rotation D
Community
Option
Rotation D
(UDA)
Break
Rotation C
Rotation E
Community
Option
Rotation D
Mngt
PCMC
Option
(UDA)
Rotation C
Rotation E
Apr 12-15
Apr 19-May 20
May 24-27
Break
Clinical
McKay-Dee
Rotation C
DATE
Jan 4-14
(Jan 19-21)
Jan 25-Feb 4
Feb 8-11
(Feb 16-18)
INTERN
Annie
Davies
Janelle
Connell
Feb 22-Mar 18
Mar 22-25
Mar 29-Apr 8
SITE AND ROTATION
State
Health
Dept
Rotation D
State
Health
Dept
Rotation D
SLC WIC
Community
Option
Rotation D
Rotation D
SLC WIC
Community
Option
Rotation D
Rotation D
SLC Aging
Rotation D
SLC Aging
Rotation D
NDFS
637/638
Field Trips
T, Th
Break
Mngt
IMC
Rotation C
Option
Rotation E
Public
Policy
Workshop
Mngt
IMC
(UDA)
Option
(Rotation E
Clinical
PCMC
Rotation C
(UDA)
Rotation C
Extended
Care
Rotation E
Extended
Care
Rotation E
DATE
Jan 4-28
Feb 1-11
(Feb 16-18)
Feb. 22 – 25
Mar. 1 – 18
INTERN
Emily
Vaterlaus
Mngt
PCMC
Option
Rotation E
Mngt
PCMC
Option
Rotation E
Rotation C
*See
Mar 29-Apr 8
Apr 12-15
Apr 19-29
May 3-6
May 10-13
May 17-27
SITE AND ROTATION
Rotation C
Brianna
Rhodes
Mar 22-25
next page for facility legend
NDFS
637/638
Field Trips
T, Th
Break
Extended
Care
Rotation E
Extended
Care
Rotation E
Clinical
IMC
Rotation C
Clinical
PCMC
Rotation C
Public
Policy
Workshop
Clinical
IMC
Rotation C
State Health
Dept
(UDA)
Rotation D
Clinical
PCMC
Rotation C
(UDA)
Holidays (shorter week noted by dates in parentheses)
January 18
Martin Luther King Day
February 15
President’s Day
1
February 3
April 8-9
Break
State Health
Dept
Rotation D
SLC WIC
Rotation
D
SLC WIC
Rotation
D
SLC Aging
Rotation D
SLC Aging
Rotation D
UDA Legislative Day (morning)
UDA Annual Meeting – Weber State University
Schedule is subject to change
Community
Option
Rotation D
Community
Option
Rotation D
SUPERVISED PRACTICE SITE LEGEND
ROTATION A
UVRMC
Utah Valley Regional Medical Center
ROTATION B
FPML
Food Production Management Lab
ROTATION C
PCMC
Primary Children’s Medical Center
McKAY-DEE
McKay-Dee Medical Center
IMC
Intermountain Medical Center
ROTATION D
State Health Dept
Utah State Health Department
SLC WIC
Salt Lake County WIC
SLC Aging
Salt Lake County Aging Services
Community Option See Option Directory
Rotation E
Extended Care
Avalon Healthcare
Option
See Option Directory
2
BEFORE COMING TO YOU . . .
Utah Valley Regional
Medical Center
Seven Weeks
BYU Food Production
Management Lab
(FPML)
Seven Weeks
Community
Six Weeks
Management
Four Weeks
FALL SEMESTER
•One day per week spent with various foodservice
managers and technicians in overview of foodservice in
health care system
•Three days per week spent in clinical, working one-onone with clinical dietitians – The majority of the time was
spent on Medical/Surgical and Cardiac/ICU, with shorter
experiences in Psych, TCU, Outpatient, and Rehab
•One morning a week in the Nutritional Assessment Lab
at BYU – including anthropometry, biochemical (finger
sticks and urine analysis), nutrition focused physical
assessment, indirect calorimetry, vital signs, and nutrition
interviewing
The FPML serves approximately 200 meals per day. As
undergraduates, the interns had all experienced the three
production/service and one management rotations.
As Interns, each one had full responsibility in one of the
following roles:
•Procurement Manager
•Production Manager
•Service/Sanitation Manager
Daily management meetings allowed sharing of
experience and information.
WINTER/SPRING SEMESTER
•State Health Dept.
•SLC WIC
•SLC Aging Services
•Two week community option
•Primary Children’s Medical Center or Intermountain
Medical Center
Depending on when in the 18-week winter/spring schedule the interns are with
you, they will have completed some or all of the rotations listed above.
The following pages outline pertinent dietetics courses the interns had as
undergraduates (in other words, what they should be familiar with and/or able to
do as they come to you).
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4
UNDERGRADUATE DIETETICS COURSE WORK SUMMARY
Food Production Management
 Principles of quantity production applied to meats, dairy products, baked goods,
vegetables, soups, fresh produce.
 Types of foodservice systems and delivery/service.
 Recipe expansion and costing.
 Eleven weeks (8 hrs/wk) lab experience in conventional foodservice operation, rotating
through all production and service areas, equipment use.
Foodservice Systems
 Overview of systems theory and the foodservice system
 Detailed examination of functional subsystems: procurement, production,
distribution/service, and sanitation/maintenance.
 Product selection, including value analysis and sensory analysis.
 Vendor selection and purchase specifications.
 The marketing channel and “value added” concept.
Management in Dietetics
 Group dynamics and work group formation.
 Principles of effective communication.
 Decision making and tools used in decision making.
 Planning, organizing, directing, and controlling functions of managers applied to
dietetics.
 Principles of human resource management.
 Performance appraisal.
 Theories of management/leadership and motivation.
Essentials of Human Nutrition, Nutrient Metabolism, and Nutritional Biochemistry
 Normal nutrition, from very basic to nutrition at the cellular level
Clinical Nutrition (I & II)
 Medical terminology
 Principles of and rationale for medical nutrition therapy in disease states
 Basics of nutrition support; supplements, enteral and parenteral nutrition
 Basics of nutrition counseling
Community Nutrition
 Community resources
 Program planning and evaluation
 At-risk populations and special needs
 Cultural/ethnic food patterns
 National Health Objectives
 Group and individual counseling
 Legislative and political process
5
Nutrition of Growth and Development
 Nutritional needs in pregnancy, lactation, infancy, and childhood
Nutrition Assessment Lab
 Antropometric, Biochemical, Clinical, and Dietary assessment procedures
Teaching Methods in Dietetics
 Establishing learning objectives, concepts, and lesson plans
 Utilization of a variety of teaching methods
 Support of learning through visual aids
Research Methods in Dietetics
 Types of research and their appropriate use
 Resources for research and reports
 Proposal preparation
 Interpretation and evaluation of research reports in the literature
Advanced Dietetics Practice
 Hypermetabolism and nutritional assessment in critical care
 Nutrition support in critical care, home care, and extended care facilities
 AIDS
 Thermal injury
 High risk pregnancy and infants
 Pediatric diseases, inborn errors of metabolism
 Budgeting, cost/benefit analysis
 Menu engineering, pricing
 Foodservice department set-up
In addition to the courses taken prior to the internship, interns will be enrolled in two
graduate courses between January and June:
NDFS 637
NDFS 638
Advanced Management in Dietetics
Advanced Clinical Nutrition
6
THE BIG PICTURE
The Medical Center Rotation has several overall objectives beyond the specific
clinical and management objectives. In addition to gaining proficiency in the
clinical setting, the intern is expected to explore the broader picture of the health
care environment and the role of the dietitian in it. This can be accomplished only
by having the intern interact with key people and committees outside of the Food
and Nutrition Care Department. In most cases the visits will last no longer than
half an hour.
Some examples of activities to be included in the rotation are:
CLINICAL
•Pharmacy (esp. TPN
formulation)
•Discharge planning
•Social work
•Speech Therapy
•Occupational Therapy
•Medical library
•Rounds
•Surgery
•Team conference
•Physical Therapy
•Child Life (where
available)
GENERAL
•Committee meetings
•Quality management
•UDA activity
•Legislative activity
•Product shows/demos
•Policy & Procedure
revision/review
•JCAHO preparations
Decide early on who will make the appointments, i.e., will you call or will you
give a list of names and numbers to the intern, who will then make appointments.
7
8
TERMINOLOGY FOR THE ADA COMPETENCY STATEMENTS
FOR SUPERVISED PRACTICE COMPONENT OF DIETITIAN EDUCATION PROGRAMS
Competency statements specify what every dietitian should be able to do at the beginning of his
or her practice career. The core competency statements build on appropriate knowledge and
skills necessary for the entry-level practitioner to perform reliably at the verb level indicated.
The minimum performance level for the competency is indicated by the action verb used at the
beginning of the statement. The action verbs reflect four levels of performance. The higher
level of performance assumes the ability to perform at the lower level.
►
►
►
►
assist – independent performance under supervision, or
participate – take part in team activities;
perform – able to initiate activities without direct supervision, or
conduct – activities performed independently;
consult – able to perform specialized functions that are discrete delegated activities
intended to improve the work of others, or
supervise – able to oversee daily operation of a unit including personnel, resource
utilization, and environmental issues; or, coordinate and direct the activities of a team
or project workgroup;
manage – able to plan, organize, and direct an organization unit through actual or
simulated experiences, including knowing what questions to ask.
If the verb “manage” is used, it assumes that the student will progress from “supervise” or
“perform/do” the activity while in the program. Students may demonstrate that they can manage
or supervise through such activities as quality improvement audits, systems review, or directing
an activity coordinating others.
Accreditation Manual for Dietetics Education Programs
Revised Fourth Edition, 2000, page 45
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10
MEDICAL CENTER ROTATION C
CLINICAL – OBJECTIVES AND LEARNING ACTIVITIES
#
1
2
3
Objective
By the conclusion of the Medical Center
Rotation, the intern will:
CD 1: Perform in accordance with the Code of
Ethics for the Profession of Dietetics
CD 3: Participate in professional activities
CD 4: Perform self assessment, prepare a
portfolio for professional development, and
participate in lifelong learning activities
CD 8: Provide dietetics education in
supervised practice settings
CD 9: Supervise counseling, education and/or
other interventions in health promotion/
disease prevention for patients/clients needing
medical nutrition therapy for common
conditions, e.g., hypertension, obesity,
diabetes, and diverticular disease
CD 2: Refer clients/patients to other dietetics
professionals or disciplines when a situation is
beyond one’s level or area of competence
CD 39: Refer patients/clients to appropriate
community services for general health and
nutrition needs and to other primary care
providers as appropriate
CD 10: Supervise education and training for
target groups
CD 11: Develop and review educational
materials for target populations
Learning Activities
Clinical
•Comply with facility policies and procedures
•Accept responsibility for decisions and actions
•Participate with preceptor in professional activities
•Complete goal setting at beginning and self evaluation form at end of rotation
•Prepare a professional portfolio reflecting knowledge and skills gained
•Group and individual patient education
•Use of appropriate referral systems
•Coordinate technician involvement in patient education for MNT
•Involvement in community projects/health fairs sponsored by facility
•MNT in-service presented to clinical staff, medical residents, team conference, etc.
•Group and individual patient education
•Review and develop patient education materials
11
4
CD 6: Use current technologies for
information and communication activities
CD 13: Interpret and incorporate new
scientific knowledge into practice
5
CD 7: Supervise documentation of nutrition
assessment and interventions
CD 37: Coordinate and modify nutrition care
activities among caregivers
CD 14: Supervise quality improvement,
including systems and customer satisfaction,
for dietetics service and/or practice
CD 15: Develop and measure outcomes for
food and nutrition services and practice
CD 16: Participate in organizational change
and planning and in goal-setting processes
CD 22: Supervise the integration of financial,
human, physical, and material resources and
services
CD 18: Supervise the collection and
processing of financial data
CD 20: Participate in human resources
functions
CD 45: Participate in coding and billing of
dietetics/nutrition services to obtain
reimbursement for services from public or
private insurers
CD 19: Perform marketing functions
6
7
8
•Use current scientific literature in relation to patient care
•Use Medical Library
•Inclusion of research question in conjunction with case study
•Computer technology integrated throughout clinical experiences – nutrient analysis,
charting, food/drug interaction, etc.
•Supervise nutrition assessment procedures, including documentation of actions taken
as performed by technicians
Supervise the nutrition care process among caregivers
•Participate in chart audit, other QA measures in clinical care
•Develop and administer patient survey
•Use outcome measures of clinical effectiveness
•Participate in JCAHO preparation
•With preceptor, participate in employee interviewing, hiring, training, evaluating, and
scheduling
•With preceptor, participate in the coding and billing procedures for reimbursement
for nutrition services
•Promote National Nutrition Month activities
•Market classes or programs
•Marketing efforts in out-patient, other clinical areas
12
9
10
11
12
CD 23: Supervise production of food that
meets nutritional guidelines, cost parameters,
and consumer acceptance
CD 24: Supervise development and/or
modification of recipes/formulas
CD 25: Supervise translation of nutrition into
foods/menus for target populations
CD 26: Supervise design of menus as
indicated by the patient’s/client’s health status
CD 27: Participate in applied sensory
evaluation of food and nutrition products
CD 30: Supervise nutrition screening of
individual patients/clients
CD 31: Supervise nutrition assessment of
individual patients/clients with common
medical conditions, e.g., hypertension, obesity,
diabetes, and diverticular disease
CD 32: Assess nutrition status of individual
patients/clients with complex medical
conditions, e.g., renal disease, multisystem
disease, organ failure, and trauma
CD 33: Design and implement nutrition care
plans as indicated by the patient’s/client’s
health status
CD 34: Manage monitoring of patient’s/
client’s food and/or nutrient intake
NT2: Integrate pathophysiology into medical
nutrition therapy recommendation (perform)
•Use menu as a teaching tool when appropriate
•Oversee formulary
•Modify menus as necessary for special diet orders
•Computer evaluation of recipe changes
•Evaluate and select formulae for facility
•Tray study, sensory evaluation
•Supervise screening activities of technicians
•Utilize technicians for assessment of patients with common conditions
•Perform in-depth nutrition assessments
•Develop and implement nutrition care plans, using principles of pathophysiology
•Monitor implementation of plan
13
13
14
14
15
CD 35: Select, implement, and evaluate
standard enteral and parenteral nutrition
regimens, i.e., in a medically stable patient to
meet nutritional requirements where
recommendations/adjustments involve
primarily nacronutrients
CD 36: Develop and implement transitional
feeding plans, i.e., conversion from one form
of nutrition to another, e.g., total parenteral
nutrition to tube feeding to oral diet
NT4: Select, monitor, and evaluate complex
enteral and parenteral nutrition regimens, i.e.,
more complicated health conditions in select
populations, e.g., in patients with renal disease,
multisystem organ failure, or trauma (perform)
NT6: Conduct counseling and education for
patients/clients with complex needs, i.e., more
complicated health conditions in select
populations, e.g., those with renal disease,
multisystem organ failure, or trauma
CD 37: Coordinate and modify nutrition care
activities among caregivers
CD 38: Conduct nutrition care of component
of interdisciplinary team conferences to
discuss patient/client treatment and discharge
planning
CD 40: Refer patients/clients to appropriate
community services for general health and
nutrition needs and to other primary care
providers as appropriate
CD 42: Provide nutrition care for people of
diverse cultures and religions across the
lifespan, i.e., infancy through geriatrics
•Participate in nutrition support activities, including feeding transitions
•Consult with speech therapist on swallowing impairments
•Participate in nutrition support activities in an Intensive Care setting
•Provide nutrition counseling as necessary in the clinical/acute care setting
•Visit with members of health care team (see list)
•Department Staff Meetings
•Participate in medical rounds, discharge planning, team conferences
•Use appropriate referral systems
•Participate in nutrition care in a variety of clinical services
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BRIGHAM YOUNG UNIVERSITY
Department of Nutrition, Dietetics and Food Science
Dietetic Internship
CLINICAL STUDY GUIDE
Medical Center Rotation
Name:_________________________
Date:__________________________
Facility:________________________
The following experiences and questions will help you draw information from your clinical
experience.
1.
Case Study: present an in-depth case study at a scheduled staff meeting (this will be the
same patient used for the FSN 638 oral and written case study).
2.
Present an in-service lesson on some aspect of Medical Nutrition Therapy at a clinical
meeting such as a staff meeting, medical resident’s meeting, team conference, etc. (This
should be to a clinical audience outside of the department)
3.
Complete a staff relief (functioning as the dietitian) rotation of 2-4 days during one of your
clinical rotations.
4.
If possible, schedule time during your rotation to do the following:
Date completed
__________ A.
__________ B.
__________ C.
__________ D.
__________ E.
__________ F.
4.
Spend 2 hours with the pharmacy department observing the mixing of
nutritional support solutions.
Spend 2 hours observing surgery (thoracic or abdominal)
Spend 2 hours observing the dietitian in the Newborn Intensive Care Unit
(if available)
Teach at least one outpatient class
Counsel at least 2 outpatient clients.
Go on rounds at least once (if available)
What are the institution’s policies regarding:
A.
Screening for Nutritional Risk (who does it, criteria, protocol for intervention)
B.
Nutritional Assessment (protocol)
C.
Nutrition Diagnosis (if being used)
C.
Outcome Measures/Monitoring Process (success measures, follow-up procedures)
D.
Protocols for specialized units (any variations from routine protocol)
E.
Charting Protocols (requirements, format, frequency, etc.)
15
F.
Discharge management and referrals
G.
Ordering Nutritional Supplements
H.
Reimbursement for nutrition services
I.
Job descriptions for clerks, techs, and dietitians. How are these changing in
response to changes in the health care system?
5. What aspects of the Nutrition Care Process and Model are being implemented in this
facility?
4.
How are food/drug interactions handled?
5.
Besides “floor coverage”, what other services are offered by the clinical department?
6.
What is the division of responsibility among the clinical dietitians? What multidisciplinary
teams are they a part of?
7.
How is QA accomplished?
8.
Where does the clinical dietitian “fit” in the framework of the hospital system? How could
this be improved?
9.
How are clinical nutrition services being marketed? (Both to the patient/client and the other
medical personnel.)
10. How does the chief clinical dietitian help the staff stay current and improve their
performance? If there is no chief clinical dietitian, how are these issues handled?
11. How are computers utilized in clinical nutrition care?
12. Is the concept of Medical Nutrition Therapy being promoted? Other ideas on how it could
be?
16
Examples of MNT In-Services Given in Past Years

Physical Therapists, Occupational Therapists, and Speech Therapists
•Feeding Children with Special Needs
•Nutrition for Wound Healing

Nurses
•The Carbohydrate is Right
•Inpatient Diabetes Management: Treating Hypoglycemia
•Medical Nutrition Therapy: Nutrition and Burns
•Overview of Nutrition Care and Nursing Relationship
•Carbohydrate Counting and Label Reading
•Dysphagia Diets and Thickened Liquids
•Calorie Count Procedures
•Renal Diets

Other Hospital Staff Members
•Alternative Medicine
•Mixing Specialized Formulas

ICU Nurses
•The Importance of MNT in the Critical Care Setting

PICU Nurses
•Nutrition and Spinal Muscle Atrophy

Radiology Department
•Herbal and Nutritional Supplements and Cancer
17
18
NDFS 638
BRIGHAM YOUNG UNIVERSITY
Department of Nutrition, Dietetics and Food Science
Dietetic Internship
Advanced Clinical Nutrition
Winter/Spring 2010
CASE STUDY
For the clinical case study, use the format in the Intern Handbook for both the written and
the oral presentation. The expectation for the written case study, however, is a considerable level
of depth into the clinical issues involved, beyond what is able to be presented orally.
(Convince me that you really KNOW the issues regarding your patient and the
implications of the nutritional intervention.)
As addenda to your Written Case Study, include the following:
Appendix A: COST SAVINGS OF MEDICAL NUTRITION THERAPY
The “Cost Savings of Medical Nutrition Therapy” is a separate paper about the patient which
includes:
1. Patient Medical Diagnosis
2. Nutrition Diagnosis (according to the Nutrition Care Process Model)
3. Physician’s Nutrition Orders
4. RD Recommendations
5. Did physician follow the recommendations? Why or why not?
6. Analyze the Cost Benefit ($$) to the nutrition intervention. This can include (but is not
limited to):
a. Length of stay
b. Time in ICU
c. Medication costs
d. Surgery costs
e. Nutrition Support costs
Communicate with the Billing Office regarding general costs of room stays, ICU
rooms, surgeries, TPN, etc. HIPPA may prohibit the availability of specific costs
related to your patient.
7. Analyze the Cost Effectiveness to the nutrition intervention (utilizing measures other
than financial).
8. Summarize your findings, was appropriate action taken, would other actions have
increased either the cost benefit or effectiveness for the patient?
A maximum of 2 pages
Appendix B: RESEARCH QUESTION
After completion of the case study, the research question is a separate paper in the following
format:
RESEARCH QUESTION: (Pose a clinical question/potential research study related to
your case study)
1. Brief literature review
2. Sample selection
3. Research design
(Refer to your research text for methodology)
A maximum of 3 pages
19
20
DIETETIC TECHNICIAN ROTATION
The purpose of the Technician Rotations is for the interns to explore the complexity of
foodservice operations in a health care environment. Among the points the interns should
grasp are the interface of clinical and foodservice needs, and the role of each member of the
nutrition care team in effective patient care and the successful operation of the department.
In preparation for working with the interns, you might want to think through the following
questions and be ready to discuss (and show) the answers with/to them.
►
What are my primary responsibilities?
►
What skills are most important for me to carry out my responsibilities?
►
How does my work contribute to the desired outcomes of the department?
►
To whom do I report? How does that interaction take place?
►
How do I “keep up” with my area of responsibility, how do I learn about new
developments, methods, products, etc.?
►
What are the key interactions I have outside of the department?
►
How do I handle “sticky situations” with members of other departments with whom I
interact?
►
What are the most enjoyable and most challenging parts of my job?
• When working with interns, begin with an orientation to your position and responsibilities.
Perhaps walk them through a typical day, and some of the “critical control points” you check on
at various points in the day. You might have some of the reports, forms, etc. you generate
available for them to see and explain their purpose.
• Of course, the time is too short to “do” your job, but if there is one task you could show the
interns how to perform, explaining its purpose, and let them work on it for 1-2 hours, they would
gain a feel for at least a piece of your role.
• See Tips for Effective Precepting (pages 25-27) for tips on helping the interns learn
new skills.
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MANAGEMENT/SUPERVISORY ROTATIONS
One purpose of the time spent with managers and supervisors is for the interns to explore
the complexity of foodservice operations in a health care environment. Among the points
the interns should grasp are the scheduling of patient feeding with cafeteria and catering
functions, the interface of clinical and foodservice needs, and the role of each member of
the management team in successful operation of the department. The time is short, so the
expectation is for overview understanding, not in-depth performance.
In preparation for working with the interns, you might want to think through the following
questions and be ready to discuss (and show) the answers with/to them.
► What are my primary responsibilities?
► What skills are most important for me to carry out my responsibilities?
► How does my work contribute to the desired outcomes of the department?
► Who reports to me and to whom do I report. How do those interactions take place?
► What do I look for when hiring employees, and how do I handle the interview?
► What type of training do I give to the employees in my stewardship?
► How do I “keep up” with my area of responsibility, how do I learn about new developments,
methods, products, etc.?
► What are the key interactions I have outside of the department?
► What laws, regulations, codes, etc. are important in my work?
• When working with interns, begin with an orientation to your position and responsibilities.
Perhaps walk them through a typical day, and some of the “critical control points” you check on
at various points in the day. You might have some of the reports you generate available for them
to see and explain the purpose of the reports.
• Discuss with the interns some of the personnel issues you deal with, how you inspire good
performance from your employees, and how you carry out evaluations. Interns would be
interested in some of the ongoing problems you deal with and some of the solutions you have
implemented.
• See Tips for Effective Precepting (pages 25-27) for tips on helping the interns learn
new skills.
22
CLINICAL DIETITIAN ROTATION
The purpose of the clinical rotation is for the interns to gain experience in/exposure to the
various areas of nutrition care in the medical center, and to build speed and judgment to
the point of effective staff relief.
In preparation for working with the interns, you might want to think through the following
questions and be ready to discuss (and show) the answers with/to them.
► What are my primary responsibilities?
► What skills are most important for me to carry out my responsibilities?
► How do I “keep up” with my area of responsibility, how do I learn about new developments,
methods, products, etc.?
► What are the key interactions I have outside the department?
► How do I communicate with other members of the patient care team, with the other
dietitians and technicians, with foodservice managers?
► How do I prioritize my activities each day?
► What resources do I use (people, texts, media, etc.) when I need help in completing
a task?
► What “tricks of the trade” do I use to help me accomplish various aspects of my job?
•
•
When working with interns, begin with an orientation to your position and
responsibilities. Perhaps walk them through a typical day, and some of the “critical
control points” you check on at various points in the day.
As opportunities arise, model various activities you perform, such as assessments,
diet instructions, charting, physician interaction, etc. Then, allow the intern to
perform the same activities under your supervision. As competency develops, the
intern’s work load can be increased and more complex tasks assigned.
• See Tips for Effective Precepting (pages 25-27) for tips on helping the interns learn
new skills.
23
DAILY POST-CLINICAL CONFERENCES/REPORTS
As part of the learning process and accountability for performance in patient care, each intern
should be responsible for a “post-clinical conference/report” with his/her preceptor at the
conclusion of each day. Brevity will be emphasized, with reports lasting approximately 15-20
minutes.
Ideas for this may include:
1. Report on nutrition care activities provided for each patient
2. Patient report should be in the format of the Nutrition Care Process:
a. Assessment
b. Diagnosis (interns should practice the Nutrition Diagnostic Terminology – PES
Statements – whenever applicable)
c. Intervention
d. Monitoring and Evaluation
3. In-depth report and review on any patients that provide a “good learning opportunity”.
Preceptors may utilize this time to provide additional insights/training based on their
clinical experience.
4. Review of medications, labs, or clinical procedures that are unfamiliar to the intern
5. The intern will be responsible to see that all information regarding follow-up with
assigned patients is communicated completely – both in oral and written format
6. The intern will be responsible to complete the Basic Competency Check List –
communicating with his/her preceptors regarding competencies still to be achieved
24
SCHEDULING
The key word to remember in scheduling is FLEXIBILITY. Please develop a “skeleton
schedule” that directs the intern’s time, but feel free to alter it as unique opportunities arise in
either the clinical or management arenas. The intern’s week, and occasionally even day, may
certainly be split between types of activity if something noteworthy occurs.
The enclosed schedule is simply a sample of what can be done, and includes some of the
enriching activities.
Interns should expect to work 32 hours per week, Monday through Thursday, with one Saturday
scheduled (with a weekday off to compensate). University holidays should be observed, and
they are shown on the schedules.
SAMPLE SCHEDULE
WEEK
POSSIBLE SCHEDULE OF ACTIVITIES
1
Orientation, Clinical (One day with Technicians/Clerks)
2
Clinical
3
Clinical (Three days in Nutrition Support, and one day with Foodservice
Management Team)
Mid-point Evaluations
4
Clinical (Time in out-pt and other clinical specialties)
5
Clinical (Staff relief and Clinical Case Study)
Days Off 2010
January 18, 2010 – Martin Luther King Day
February 15, 2010 – President’s Day
UDA Legislative Day (morning) – February 3
UDA Annual Meeting – April 8-9
Reminder: During clinical experiences, intern should schedule time to visit: pharmacy (TPN formulation),
discharge planning, social work, speech therapy, physical therapy, occupational therapy, medical library, etc. Intern
should also go on rounds, observe surgery, attend team conference, etc.
Please schedule one clinical in-service (generally with an audience outside the department).
Please create a schedule for each intern showing who she will work with daily, time, and
which days will be in specialty areas.
25
26
EVALUATIONS
A very important part of the intern’s learning comes from thoughtful and honest
evaluations. A sample of the clinical evaluation form is found in the handbook.
The actual forms for you to use will be provided by the intern prior to the
evaluation.
A mid-point evaluation should be given at the conclusion of week three. This
evaluation is to help the intern know where she can make improvements in the last
half of the experience. It is also to let the intern know what she is doing well and
should continue to do. The BYU instructor will not be present at that evaluation –
the forms can be returned with the intern or mailed.
At the conclusion of the 5-week rotation, the final evaluations should be given.
The BYU instructor will sit in on this evaluation with you and the intern.
Interns will evaluate their experience at rotation sites, and the information from
your site will be sent to you. A sample of the form is included. See tips for
evaluation on page 27.
27
28
UTAH DIETETICS EDUCATION CONSORTIUM
(UDEC)
TIPS FOR EFFECTIVE PRECEPTING
BEFORE YOU START –
► Provide a clear orientation
► Establish ground rules
► Define expectations
► Be purposeful and focused
► Explain work norms at your facility
► Explain what is expected of intern
► Identify the role or importance of your work in the organization – show enthusiasm
► Solicit information – have interns:
• List and explain previous experiences
• Describe their experiences
• Describe how their goals mesh with the rotation goals
29
A TEACHING MODEL
DR FIRM (Pichert)
D:
R:
F:
I:
R:
M:
Demonstration, presentation and problem solving
Rehearsal
Feedback and Correction
Independent practice
Review
Motivate to persevere
DEMONSTRATION:
■ Early in rotation, let interns observe, and then walk them through the steps.
■ Show them (demonstrate) the shortcuts. Explain the rationale for the steps and assumptions
behind the shortcuts.
■ Don’t assume they understand the shortcuts the first time.
■ Stick to the important points and help interns develop their problem solving skills.
REHEARSAL:
■ Have interns role play your job (i.e., have them calculate the rate of an enteral formula).
■ The only way you can evaluate them is to observe their performance.
■ You can explain how to dovetail two tasks. They are often unaware of the time constraints.
FEEDBACK AND CORRECTION:
■ This step communicates your approval or disapproval and your empathy.
■ Feedback should be open, corrective, and specific.
■ Provide additional hints for shortcuts and thoroughness; subtleties frequently slip past interns.
■ Quiz them on what patients, clients, or staff may ask.
■ Emphasize thoroughness.
■ Errors should be corrected and interns should repeat task as often as you deem appropriate.
INDEPENDENT PRACTICE:
■ Time for you to let go – but interns should feel free to ask you questions as needed.
■ Place a time deadline for specific tasks and shorten the time deadlines as interns progress. Set
up times when they check with you in their “independence.”
■ Be creative. Make it fun for you and for the interns.
REVIEW:
■ Observe or have interns demonstrate their assigned tasks. Do not assume anything.
■ Mention strengths and weaknesses.
■ You may have to demonstrate again the learned shortcuts.
■ Have the interns rehearse again, if needed.
MOTIVATE:
■ Tell interns how their good work makes a difference.
■ Be specific, not general.
■ Relate it to something they feel is important (i.e., a tube feeding was initiated because of their
calculations and recommendations).
30
EVALUATIONS
► Feedback should be an ongoing process during the rotation to help interns modify their skills
and behavior.
► Evaluation is part of the learning process and can help build confidence.
► It is valuable to give interns copies of all evaluation instruments at the beginning of the
rotation, if they do not already have them.
► Midterm evaluations (without grades) provide information on how to improve and what to
keep doing.
► The evaluation at the end of the rotation tells interns how to strengthen or modify their skills
in the future. (Corrected behavior does not need to be brought up in the final evaluation.)
► The results of the evaluation at the end of the rotation should NEVER come as a complete
surprise.
► Preceptor evaluations are also helpful to you. They provide feedback to you about what you
do that makes the learning experience beneficial for the interns and what could make it better.
31
32
BRIGHAM YOUNG UNIVERSITY
Department of Nutrition, Dietetics and Food Science
INTERNSHIP
Supervised Practice Site Evaluation
Site:_____________________________________
Dates of Assignment:_______________________
Name:___________________________________
Please circle the most appropriate response to the following statements.
1. The orientation I received to the site (its policies, procedures, resources, etc.) was
1.
very poor
2.
poor
3.
adequate
4.
very good
5.
excellent
2. Because of my experience at this site, my knowledge increased
1.
very little
2.
somewhat
3.
moderately
4.
substantially
5.
dramatically
3. Because of my experience at this site, my skill improved
1.
very little
2.
somewhat
3.
moderately
4.
substantially
5.
dramatically
4. The training I received at this site helped me meet the objectives for this rotation
1.
very poorly
2.
poorly
3.
adequately
4.
very well
5.
exceptionally well
5. I understood my role and my responsibilities at this site
1.
almost never
2.
seldom
3.
sometimes
4.
frequently
5.
almost always
33
Rate the following characteristics of overall experience at this site.
Overall, my experience was:
1.
very tense
1 2 3 4 5
very relaxed
2.
very easy
1 2 3 4 5
very demanding
3.
very unorganized
1 2 3 4 5
very organized
4.
very boring
1 2 3 4 5
very stimulating
5.
very irrelevant
1 2 3 4 5
very valuable
6.
very frustrating
1 2 3 4 5
very enjoyable
7.
very closely supervised
1 2 3 4 5
very loosely supervised
Comments:
34
UTAH DIETETICS EDUCATION CONSORTIUM
Clinical Evaluation
Facility_____________________________________________ Date_____________________
Preceptor_____________________________________________________________________
Student/Intern_________________________________________________________________
Please evaluate the student/intern on the following areas of performance. Listed below each
heading are points to consider while making the evaluation.
Scale:
1 – very weak, needs more work
2 – weak, needs more work
3 – doing well, performing as expected for student/intern level
4 – above average, doing better than expected
5 – outstanding, doing much better than expected for level
N/A – not applicable to this rotation
Please circle the number corresponding to your rating and add comments in each area pertaining to
particular strong or weak performance.
PROFESSIONALISM
Personal Skills:
1
2
Comments:
3
4
5
Uses proper channels of
communication
Listens actively
Appropriate written/oral
communication
Maintains confidentiality
Culturally sensitive
1
2
Comments:
CD-32. Pertinent lab values, medications,
tests, medical terms, abbreviations,
orders, and progress notes
CD-32. Pertinent data from the nursing
hx and bedside chart
NT-4. Accurate Diet history/observation
of clinical status
3
4
5
N/A
Assessment of Nutrition Needs:
3
4
5
N/A
3
4
5
N/A
3
4
5
N/A
1
2
Comments:
CD-35. Monitor intake of patients on a
feeding tube, TPN, or prolonged
poor intake
NT-4 CD-36. Evaluate tube feeding/TPN
and make appropriate changes
PLANNING
Problem Solving:
CD-32.
CD-32.
CD-32.
1
2
Comments:
3
4
5
N/A
CD-13.
Punctual with appropriate tools
Follows through with responsibilities
Accepts consequences of actions
Communication:
Data collection:
N/A
Appropriate dress and grooming
Attitude of learning and
willingness to work
Appropriate interaction with
Patients/clients/staff
Responsibility:
ASSESSMENT
1
2
Comments:
Able to interpret data collected
Sets appropriate NCP objectives
Able to justify/support decisions
with correct information
Has and uses adequate knowledge
base
Effective Time Management:
1
2
Comments:
3
4
5
N/A
1
2
Comments:
Sets priorities
Handles increasing work load
Resource Management:
2
Comments:
CD-6. Uses reference materials; current
techniques
CD-37. Involves health care team
CD-2. Consults with preceptor/instructor;
acts within level of competence
35
1
3
4
5
N/A
IMPLEMENTATION
Site procedures:
CD-7.
CD-7.
1
2
Comments:
Completes NCP cards appropriately
Completes screening procedures
Calculations:
1
2
Comments:
3
4
5
N/A
3
4
5
N/A
CD-7. Accurate diet calculations
CD-32. Checks work for errors
CD-32. Accurate anthropometric and
nutrient needs assessment
CD-32. Calorie counts
CD-32. Nutritional supplements/support
SELF EVALUATION
Teaching:
1
2
Comments:
NT-6. Appropriate instructional materials
and methods
NT-6. Accurate and complete instructions
NT-6. Appropriate family involvement
NT-6. Appropriate teaching level for pt
understanding
CD-10. Presents MNT to other health care
providers
CD-10. Utilizes current research in formal
presentation to health professionalsand to patient interactions
CD-13. Utilizes current research in formal
presentation to health professionals –
and to patient interactions
Charting:
CD-7.
CD-7.
CD-7.
CD-7.
1
2
Comments:
DISCHARGE PLANNING – TRANSITIONAL CARE
1
2
3
Comments:
CD-36 NT-5. Can implement conversion of
one form of Nutrition Support to another
CD-36 NT-5. Can implement changes in
feeding plan from hospital to ECF or home
CD-37. Can communicate nutrition needs to
other health care team members
CD-38. Active participant in team conferences
CD-46. Participates in reimbursement coding
3
4
5
N/A
1
2
Comments:
3
4
5
N/A
4
5
N/A
CD-4. Able to set and accomplish objectives
CD-4. Able to evaluate own strengths and
weaknesses
Please comment on student/intern’s overall performance:
Strengths:
3
4
5
N/A
Areas for further work:
Uses appropriate format
Complete, concise information
Appropriate recommendations
Clear handwriting, correct spelling
EVALUATION
Monitoring pt care:
1
2
Comments:
NT-6. Evaluates pt’s level of understanding/
motivation
CD-33. Establishes and implements follow
up care: short term (in hospital),
long term (post discharge)
CD-2. Appropriate involvement of health
care team
3
4
5
N/A
Preceptor:_____________________________ Student/Intern:_____________________________
Overall performance:___________________ Total Points:______________________________
36
Thank You
For Your Willingness to Serve as a Preceptor for Interns
in the
Brigham Young University
Dietetic Internship
2010