King's Daughters Medical Center: Community Nutrition, Weeks 3 & 4

Another two weeks down in my community rotation and I am still learning at just as rapid pace as I did in the first two weeks; not only learning more, but getting to experience more as well. The three main activities that I got to enjoy in these last two weeks were attending the KAND conference, attending a nutrition-focused physical exam seminar, and having the opportunity to enhance my on-on-one counseling skills with the surgical weight loss patients.

It was so nice to be able to see everyone who went to the KAND conference. I was able to meet up with my classmates and talk about how our internships were going. Some of them had more pleasant stories than others, but it was all apart of the learning process and they were hopeful for the future rotations. We were able to enjoy some amazing presenters who talked about a plethora of different subjects from dealing with IBS patients to learning how to properly taste multiple bourbon samples. There was a ton of networking and just all-around positive emotions that were spread throughout the conference. It was great to “nerd out” with fellow peers who were passionate about the same thing – food. I was also extremely surprised when I found out I had won the Outstanding Dietetic Student Award by the KAND committee. I was overwhelmed with joy and honored to receive it. This is a competency I think I did well on: CRDN 2.9 Participate in community and professional organizations.

The second activity I got to partake in was the seminar for the nutrition-focused physical exam. My preceptor and a few other of the dietitians from the hospital decided they wanted to go to earn the CEU’s and they asked if it was okay if I could tag along. So when I found out I got the green light, I was pretty pumped because this is a new field of expertise in the dietetic world. According Pogatshnik et al. (2011), a nutrition-focused physical examination (NFPE) can help dietitians create a more effective care plan and determine appropriate interventions for patients receiving nutrition support. Laboratory findings are often inconclusive, and physical assessment can help to identify nutritional abnormalities. Dietitians can increase their proficiency in clinical skills by learning physical assessment techniques. The seminar was held in Huntington, WV and lasted about 4 hours. The presenter was a clinical dietitian who has had years of experience and did an amazing job presenting and answering any questions that the other dietitians had. We got to learn about how to assess each area of the NFPE and we even got to spend some time practicing with the others in the audience. They had a case study example that we got to navigate through and try to diagnose the patient provided. It was a fun day and we got to experience a ton of good information that we can put into practice as this subject starts to become more and more of the norm.

Finally, the last activity I was able to participate in was the surgical weight loss counseling. In the last two weeks, the dietitians on staff let me shadow them and sit in on sessions with their patients. I didn’t usually say much and I got to soak in all the information because it was all new for me, too. However, this time I got to perform the initial assessment on the bariatric patients that came in for surgery. These are the patients who were there for their very first time and all I basically had to do was ask questions about their history. These questions could be about what diets they have tried before, why they want to do the surgery, if they’re ready for long-term changes, etc. This task was just hard enough for me to get my feet wet with handling a counseling session by myself. The goal is to eventually go through an assessment all by myself, but there is still a lot of material for me to go through in the surgical weight loss handbook, so I will need a little more time before I can flow through the entire hour-long assessment without any other guidance. This is a competency I would like to improve on: CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.

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It still flabbergasts (love that word) me how quickly these weeks have been going by. To think that I am already more than halfway through my second rotation of this internship is astounding. It has been such a great time and I’ve enjoyed learning from my preceptors immensely. I am excited to finish this rotation up and enter into what comes next – foodservice. 


References:

1. Pogatshnik, C, Hamilton, C. Nutrition-focused physical examination: skin, nails, hair, eyes, and oral cavity. Support Line. 2011;33(2):7-13.

King's Daughters Medical Center: Community Rotation, Weeks 1 & 2

Starting at a new rotation can always be scary, but two weeks in and I already feel at home here at King’s Daughters Medical Center. I am currently with the surgical weight loss team, who also specializes in non-surgical weight loss and diabetes counseling. The team has been extremely helpful and welcoming to me. Being the only guy in a team that consists of all females has been a fun experience already, and they like giving me a hard time, but it’s been fine because I have no issues returning the favor. ;)

During the first week, it consisted of me shadowing the dietitians and sitting in on their sessions with patients. For the most part, I didn’t really say much until I was more comfortable with the dietitian I was working with and after I figured out the “flow” of how each of their sessions would typically go. Then, once I was comfortable, I would slowly start to chime in a little more during the counseling sessions when I thought I could add to the information the dietitian was providing. It worked out well because we could bounce ideas and suggestions off one another to help the patient better reach their intended outcome. It was also neat because my preceptor and I got to discuss some critical thinking questions once the patient had left, which usually resulted in digging through some scientific research to gain some clarity on our discussion. I feel like the current body of literature is constantly evolving, so this is a competency I would like to work on -- CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice. One research meta-analysis I ended up looking at was by Cheng et al. (2017), who looked at the comprehensive summary of surgical versus non-surgical treatment for obesity. The pooled results of primary endpoints (weight loss and diabetic remission) revealed a significant advantage among surgical patients rather than those receiving non-surgical treatments (P < 0.05). Furthermore, except for certain cardiovascular indicators, bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters (P < 0.05).

Towards the end of the first week, my preceptor and I got to sit down and plan out my goals and what I could possibly experience while I was working here.  We were able to fill out my competency fulfillment plan and make sure I knew exactly what I was doing while I am at the facility. I felt like this is a competency I did well on because I am very open to new experiences and communicating what shortcomings I believe I have at the moment that could be improved on while I’m here at KDMC-- CRDN 2.12 Perform self-assessment and develop goals of self-improvement throughout the program.

I have really enjoyed trying to keep up with everything the dietitians tell their patients, because a lot of it is new information for me to learn as well. Specifically, a lot of the information on diabetes patients was new to me. I have a general understanding of diabetes and how it works, but in these sessions we get into the nitty-gritty details of how to time your insulin, where to inject it, when to eat, how many times to eat, etc. For one patient, I got to sit in on their session with the nurse and with the dietitian so I could follow along with them through the counseling experience.

Finally, the last activity I got to experience was sitting in on the behavioral health class for the pre-operation patients about to forego bariatric surgery. This class covered all the mental health aspects of how the bariatric surgery will impact your life. Some topics discussed included dealing with friends and family around the surgery, dealing with emotional hunger, hormones, learning healthy behaviors, etc. I am very interested in the psychological side of obesity and it’s been fun for me to witness first-hand what is going on inside the mind of these patients living through it.

The first two weeks have been a complete success and I’ve already learned so much when it comes to an outpatient setting. I couldn’t ask for a better team and better environment, so I’m excited for the weeks ahead. 

  Just a candid shot of me working SUPER hard.

Just a candid shot of me working SUPER hard.


References

1. Cheng, J., Gao, J., Shuai, X., Wang, G., & Tao, K. (2016). The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget, 7(26), 39216–39230.

Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Week 9-10

It blows my mind that I am currently typing my final blog post as my first rotation comes to an end. It feels like yesterday I was just trying to navigate through the massive snow storm on my first day to find out where the dietitian’s office was even located. Then, today was my first day at my new rotation.

Talking with the patients, assessing their needs, and actually seeing your care help the patients was extremely gratifying. Being in the hospital is almost never fun for these patients. Often, they’re sick, hurt, impatient, scared, and just want to feel better so they can go home. Knowing this, when you see that you’ve made a positive impact on their lives, it can mean a lot to both of you. It’s how I felt after helping this one patient who was obese and was having bowel issues – she just couldn’t keep any food down, but she finally had her surgery. However, she was afraid to eat whole foods again due to the fear of not being able to tolerate them. She expressed her issues with me and I wasn’t 100% sure on how I should approach the situation. So, I told her I would go discuss with the other dietitians and come right back up to her room. After discussing, I returned back to the room with a full low FODMAP that she may be able to tolerate and she was so filled with joy. Seeing someone being relieved of their worry because of you is one of a kind. I feel like this is a competency I did well on because I had to go the extra mile to figure out what was best for this patient - CRDN 2.7 Apply leadership skills to achieve desired outcomes.

After I took this patient their handout for the low FODMAP diet, I wanted to review up on some of the available literature on the effectiveness of this treatment. To my luck, I found a recent meta-analysis from 2016 that included 6 RCT’s and 16 non-randomized interventions on the effects of a FODMAP diet on IBS, IBD, and other gastrointestinal symptoms. This analysis concluded that there was a significant decrease in IBS symptom severity scores, significant improvements in the IBS quality of life scores, and FODMAP diets significantly reduce symptom severity for abdominal pain and overall symptoms. Overall, the analysis supported the efficacy of FODMAP diets in the treatment of gastrointestinal symptoms (Marsh, et al., 2016).

Another activity I got to partake in in the last two weeks was the use of a calorie count consult from the MD. It was actually for a homeless patient who was recently admitted into the hospital and diagnosed with severe protein calorie malnutrition. I had to work with the PCT for 3 days to get an accurate calorie and protein count of how much he was taking in each day. Then, I had to compare his average calorie and protein intake to what his estimated needs were. Since he was taking in slightly less than we wanted, we had to add a supplement to each meal to bump up his intake.

Finally, the last activity that really stood out to me was my presentation of my case study to the  other dietians in the office. I had a fun time creating and presenting this patient I had been following for such a long period of time. The other dietitians offered awesome feedback to what I should keep and what I should consider including for next time. Their main points were focused on the assessment of the patient and the overall understanding of his case of the disease state, so I think a competency I could work on would be CRDN 1.6 Incorporate critical-thinking skills in overall practice. I would say the coolest (but also sad) part of the entire case study is what happened on my very last day of my internship. This patient was initially admitted in January and then discharged towards the end of the month. Well, I return to work on my final day and look down at my list of patients for the day and it just so happens the guy I did my case study on was readmitted into the hospital due to relapsing. It was a very real moment for me and also sad just because I know he had high hopes last time he was discharged, but his struggle continues. 

  Great 10 weeks. :)

Great 10 weeks. :)


References:

1. Marsh, A., Eslick, E.M. & Eslick, G.D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 55: 897. https://doi.org/10.1007/s00394-015-0922-1.

Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Week 7-8

Another 2 weeks down and it flies by just as fast as the others have. It’s honestly hard to believe that I only have 2 weeks remaining until I am finished with this clinical rotation and begin my community rotation. I’m still learning at an extremely rapid pace and finally starting to refine my skills in a clinical setting.

I am still rotating each week with a different dietitian and this week I was with the oncology department and the behavioral unit. There were three main activities that stuck out to me: getting to sit in on some outpatient counseling, giving a nutrition seminar to the behavioral patients, and getting to fill in for some of the other dietitians who were gone this past week.

One of my biggest interests as a dietitian is to help counsel people in a one-on-one setting and this week I got to do exactly that. Well, I didn’t do the majority of the counseling, but I got to observe and add in my two cents when appropriate. I have had some experience counseling people in the past, but this time was completely different because of the type of person who came in for help. This person was not motivated at all to make a change – didn’t like any fruits or vegetables, had a myriad of diseases, and was over 300 lbs – so it was interesting to see how the dietitian I was shadowing handled it. We were able to set a few goals for them, but it would be surprising if they actually followed through with any of them. It showed me that a core competency I want to work on is [CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.]

There were also some of the dietitians who were sick or out of town this week, so it was a new experience for me to help out and take on some of the work load for their patients. This ranged from anybody who had a broken foot in the orthopedic unit to a patient who was in ICU that had overdosed on a new drug called Flakka and was on the ventilator. Because of being fairly successful at this, I think a competency I did well on was [CRDN 2.4 Function as a member of an interprofessional team.]. We also decided to have a little empathy for our patients and all the dietitians decided to try the Ensure and Glucerna shakes that we gave our patients. Some tasted better than others. :) 

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I also got to work with a different group of individuals in the behavioral unit (detox and acute). These are people who struggle with alcoholism, behavioral disorders, and/or substance abuse. I was able to conduct a nutritional seminar for these patients, for those who were interested in coming. To my surprise, they had some solid questions for me and most of them were actually eager to learn something. The environment was much more laid back than my normal classes I put on for the cardiac and pulmonary rehab classes. It was basically a question and answer the entire time and completely informal. I had a blast talking to them and I think they really enjoyed my help.

It was after I got done talking to some of those individuals with alcoholism when I came across one of them who was at risk for refeeding syndrome. Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness. I had learned about refeeding syndrome in class, but I wanted to dig a little deeper. I found some great information from Stanga et al. (2008) that determine the following as main points: always be aware of the circumstances in which the syndrome is likely to develop; refeed slowly and build up the macronutrient content of the feed over several days; monitor the patient frequently; anticipate the additional requirements, particularly of phosphate, potassium, magnesium and thiamine; and minimize salt intake, unless the patient is salt depleted.

Next up is the final home stretch at my last rotation. I am pumped to see what lies ahead.


References:

1. Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Z Stanga, A Brunner, et al. European Journal of Clinical Nutrition volume 62, pages 687–694 (2008)

Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Weeks 5-6

During this rotation, I have been working with 4 other dietitians. Each week I get to shadow/work with a different dietitian, which is really cool because each one has their own floor that makes up a separate disease state/patient condition.

Since this was week 5, I have had the chance to work with every single one of the dietitians and now I am back to the beginning with my main preceptor. She has the 3rd floor, which is mostly the pulmonary patients. This includes a lot of patients with pneumonia, flu, CHF, COPD, etc.

Working with her meant I also got the chance to teach a pulmonary rehab class. If you read back in my last blog post, you’ll see that I got to teach the cardiac rehab patients and I really enjoyed speaking with all of them. This one was around the same amount of people, around 10 to 12, but this time I had to speak on the importance of having good nutrition with the COPD disease state. When you have trouble breathing, it can complicate a lot more issues than you would expect while eating. I didn’t have much experience teaching on this subject so it was a little challenging for the first class I taught. However, the second time rolled around later that afternoon and it went much smoother. Speaking in front of people always gets better with more reps.

During the 6th week, I got to work with a separate dietitian who had the ICU patients. These are patients who usually can’t tolerate eating much at all and typically need tube feedings. This is one competency that I do think I have improved on, which is [CRDN 1.6: Incorporate critical-thinking skills in overall practice.]. I say that I have improved because during the first time around with this dietitian, I had to ask many more questions about the tube feedings and how to go about caring for these types of patients. This time I think I had a much better handle on things. However, I still realize that I do need more clinical knowledge as a whole, and I think this competency is something I could do better on [CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.].

Since I need to improve, I wanted to dive a little deeper into the research on a problem we faced in ICU throughout the week. We had a patient who wasn’t tolerating the tube feedings (diarrhea) and we were trying to figure out what the best option was. I decided to look up if there was any difference between intermittent tube feedings and continuous tube feedings. Ciocon et. al found that patients tolerated intermittent tube feedings better than continuous, specifically in terms of diarrhea. I found this super useful and made a note of it for future reference.

Finally, this last week, we also got to participate in Legislative Day in Frankfurt, KY at the Capital. There were multiple speakers on various topics and I think everyone left with a better perspective on Bill 200. It was cool to meet some of the legislators and to tour around the Capital building. My group got to meet up with the Owensboro Representative, DJ Johnson. He said he was on board with Bill 200 and thought it made a lot of sense to make sure the food waste was minimized as much as possible.

From the look of this pic, I think it was a successful trip. :)

DHN Legislative Day.jpg

References:

1. Continuous Compared With Intermittent Tube Feeding in the Elderly Jerry O. Ciocon, MD, Daisy J. Galindo-Ciocon, PHD, RN, Charlotte Tiessen, RD, Diana Galindo, MD. 1992. Journal of Parenteral and Enteral Nutrition. Vol 16, Issue 6, pp. 525 – 528.

Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Week 2-4

This last Friday, as I was filling out my time sheet, I had to stop for a second and ask one of the other dietitians if this was actually the end of my fourth week of my internship. I actually had to stop as I was filling it out to check with them and make sure I wasn’t being an idiot. These first four weeks have absolutely flown by.

During the first two weeks, I was basically shadowing along with the other dietitians and helping out with the charting notes. But these last two weeks I have been like a baby bird leaping from the nest – I was starting to go into rooms by myself, asking questions, and gathering information all on my own. I’m perfectly fine talking to people, but this interview-style of talking to people is new for me. I have to make sure I ask the appropriate questions for this particular patient. Not only do you have to ask the appropriate question, you have to make sure you speak loud enough and listen very intently or else you can miss something important for your notes. I also got to perform my first nutrition-focused physical exam.

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One competency I did well on was designing, implementing, and evaluating a presentation to a target audience (CRDN 3.4). I was lucky enough to give two different presentations on incorporating a high-fiber diet and why getting enough fiber is important. The class was for the cardiac rehab patients. This was new for me as well; all the presentations I’ve given up to this point have been for a younger audience. I found myself having to be careful about my word selection to make sure I used words and phrases that appealed to their level of nutritional understanding. The response I received from my audience was positive overall, so this felt great.

During my fourth week, I was with the behavioral unit the entire time with one of the other dietitians. As I said in my last blog post, this is where the patients with psychiatric disorders usually end up. In short, these patients can be quite unpredictable and you have to treat them a little differently than patients within the other hospital units. Specifically, with how you negotiate with them. This was a competency I want to improve upon (CRDN 2.8) because I can do fine when I have to talk to patients who are predictable. But when working in behavioral, you need a certain toolkit of skills that are most appropriate when dealing with these types of patients.

To elaborate further and demonstrate something new that I learned, I’ll use a certain patient who had an opioid addiction as an example. I learned that opioid use can be linked with constipation. According to Schwarzer et al., “It is mainly caused by linkage of the opioid to the peripheral mu-receptors in the bowel and may increase as a result of certain concomitant circumstances, such as poor intake of fluids or electrolyte disorder.” This was important to know because the patient was also abusing laxatives, possibly bulimic, and severely malnourished. Clearly a very complex case and I think gaining more experience will allow me to handle these situations and this competency better in the future.

After these first four weeks, I am immensely more prepared than when I first entered into this rotation. I am learning at an extremely rapid pace and I have loved working with the other dietitians. Most importantly, I feel like I am making a difference and starting to contribute to the health of the patients. I can’t wait for the weeks ahead. 


References:

1. Schwarzer, A., Nauck, F. & Klaschik, E. Schmerz. Strong opioids and constipation. (2005) 19: 214. https://doi.org/10.1007/s00482-004-0325-3

Our Lady of Bellefonte Hospital, Medical Nutrition Therapy: Week 1-2

Before the internship started, the rotation that I was most worried about was this one – my medical nutrition therapy rotation.

I was most concerned about this rotation because it is probably my biggest weakness when it comes to my gaps in knowledge and I feel as though the stakes are the highest. My mind went to the worst; I was going to hurt somebody by giving them the wrong tube feeding or I was going to look like an idiot in front of the others because I didn’t understand what certain labs or disease states represented.

After the first two weeks have come to an end, I can happily say that this was not even close to the reality. I have an amazing preceptor and the rest of the dietitians on staff have been more than welcoming. Oh, and I’ve learned a TON already just by paying close attention to how the other dietitians work.

The first activity they put me through was my training on the Epic computer charting system. I didn’t have this training for the first couple days as I was shadowing my preceptor and as she was explaining through the system I thought that I was never going to figure it out. She was puzzling this together with that and this told us this thing so we had to do something else…it was overwhelming. But after I got the training and started sifting through the program myself, the process started to become more and more natural. I’ve now began to chart and make notes on patients all by myself and it is a refreshing feeling. [CRDN 3.1 Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.]

The second activity they put me through was my experience with the Behavioral Unit in the hospital. If you’re unfamiliar with Behavioral Unit’s in hospitals, they are the unit’s that deal with psychiatric patients and emotional and behavioral disorders. To say the least, it is a very different experience than working with patients on a regular hospital floor. You get a wide variety of patients and a wide variety of temperaments. There was an older lady there who was the sweetest little 96 year old I’ve ever met and there was another younger guy there who had a long history of substance abuse. The old lady called me handsome and the younger guy accused me of being a cop and said “I looked familiar.” So, like I said, this was an interesting experience, but fun.

Finally, the last activity and the activity that hit the closest to home with me was my experience in the Intensive Care Unit. If there is one thing that has stood out to me more than anything else during my first two weeks here, it is the perspective I have gained on the preciousness of life. The disease, pain, illness, and hardship that these patients and their families go through rocks me at my very core. It is the main reason why I have avoided the medical nutrition therapy side of dietetics. I can’t stand to see people suffer, but it is a necessary reality for so many of these patients and I’ve had to push out of my comfort zone a little to accept this. It gives me a higher appreciation for the doctors, nurses, dietitians, and everyone else on the supporting staff.

After spending a couple days in the ICU, there was an interesting topic that came up amongst myself and the other dietitians. It was about advanced directives and dementia patients and the ethics behind it. I basically learned about how having dementia can cause a person’s body to reject food. So, there are many cases when patient’s families have to discuss with the doctors about how they wish to proceed because they have to choose to feed the sick patient and cause them harm, or to refuse giving them any more food/liquids by mouth to aid-in-dying. I decided to look up the literature on this subject and found a great study that stated “One option for ensuring that one does not live years in severe dementia is to use advance directives to withhold food and water by mouth. The driving element behind VSED is that forcing people to ingest food is as objectionable an intrusion on bodily integrity, privacy, and liberty as imposing unwanted medical treatment.” (Menzel and Chandler-Cramer, 2014). This just showed me how tricky some situations can be and how important it is to talk with family before something like this could ever occur.

Overall, my first two weeks have been a crash course on how things work in the hospital. How teamwork, knowledge, and empathy for patients can all be combined to save people every single day, one person at a time.


References:

1. Menzel, P. T. and Chandler-Cramer, M. C. (2014), Advance Directives, Dementia, and Withholding Food and Water by Mouth. Hastings Center Report, 44: 23–37. doi:10.1002/hast.313

Orientation Week

Ahhh, the first week of orientation for our 2018 dietetic internship has ended, which means that our own personal chaos is about to begin.

I use the word “chaos” because we are essentially stepping into a part of our lives that is unknown. None of us have done this before and it is (hopefully) going to force us to produce “order” out of this chaos once we succeed.

We are about to take on one of the most difficult tasks of our professional lives. One that will bring us a step closer to our ultimate goal – the actual internship that will allow us to become a Registered Dietitian.

And in order to prepare ourselves for what is to come, this orientation was absolutely necessary, in my opinion. It served many purposes and allowed us to partake in several activities that should make the transition into our internship a little easier.

One of those activities included our discussion of The Energy Bus, which was a self-help book on becoming more positive and why it is a good idea to carry this into our respective internships. If this book had the capabilities of spewing sunshine and rainbows from it’s pages, I would not be surprised. This is not to take-away from the lessons of this book and I thought that it was actually an extremely fun read that allowed us all to come together and elaborate on the principles within.

This discussion forced me to see the internship in two ways: in a way where I put in minimal effort, begrudged every second, and did just enough to get by, OR in a way where I tried to enjoy what I was going through and as a result get stronger as an individual. I have to do the internship either way, and the latter of those two seems much more promising to my happiness. Luckily, I feel I’m already more of a positive and optimistic person in general, so this was a competency I felt I did well on. [CRDN 2.12 Perform self-assessment and develop goals for self-improvement throughout the program.]

The next activity included something new to me: the nutrition focused physical assessment. This was exciting to learn about because it provided us another tool in our professional toolbox to aid in the overall goal of a more accurate nutrition assessment to better help our patients. It was also introduced on the first day of class, so it was an…interesting…way to take a “hands-on” approach to meeting our fellow peers. I was completely unaware of the physical assessment, so due to my lacking knowledge I believe this is a competency I need to work on in the future.

The third activity that really stuck out to me was during the last day as we learned about the Code of Ethics as an RD. When I first received the packet, I didn’t think much of it because I already considered myself a person of integrity and a person who would always do the right, “ethical”, thing during my practice. After Mrs. Combs went over different scenarios where we had to discuss as a group whether or not the person was being ethical, I had to take a step back. I realized there were certain grey areas where the answer is not so cut-and-dry. It was an eye-opening experience.

Finally, the last activity I enjoyed had to do with an area I am familiar with, but not anywhere near an expert – research, with Dr. Plasencia (who was WONDERFUL, for the record). Most of the time when I think of research, I think of using objective data; facts, numbers, statistics, graphs, etc. But Dr. Plasencia assigned my group a research study that went against the grain and measured more subjective data. Specifically, human responses and words from each individual that took part in the study. This was necessary due to the main objective of the study which was to assess the learning experience after students were immersed into case-based learning for nutrition courses (Harman et. al, 2014). To quote the study, “Case-based learning has been widely used in law, business, medicine, and science education, but has only recently gained popularity in the health sciences field.”

What they found is that it worked. It worked because case studies prepare students for the multi-faceted problems they (we) will face in professional practice. I thought that this was a uniquely interesting study that expanded my knowledge on the current body of evidence.

Overall, I believe the orientation was a complete success. It was overwhelming, for sure, but I believe it will aid me and my fellow peers as we trek off into the unknown of this dietetic internship. Out of all the activities and lessons we learned throughout the initial orientation and as I come to a close with this first blog post, one thing I DO know about what is to come – it will all be worth it.

 This pic just about sums up the week. :)

This pic just about sums up the week. :)


References:

1. Harman, T., et. al. (2014). Case-Based Learning Facilities Critical Thinking in Undergraduate Nutrition Education: Students Describe the Big Picture. J Acad Nutr Diet. 2212-2672.