Table of Contents
Master Schedule 1
Before Coming to You 3
Undergraduate Course Work Summary 5
The Big Picture (overall objectives) 7
Competencies and Learning Outcomes 9
Clinical Study Guide 13
Examples of In-service 15
Case Study 17
Tips for Dietetic Technician Rotation 19
Tips for Management/Supervisory Rotations 20
Tips for Clinical Dietitian Rotations 21
Daily Post-Clinical Conferences/Reports 22
Scheduling 23
Sample Schedule 23
Evaluations (Information) 25
UDEC Tips for Effective Precepting…………………………………………………….27
Before You Start 27
A Teaching Model 28
Evaluation 29
Supervised Practice Site Evaluation 31
Clinical Evaluation 33
An electronic copy of this handbook may be found at: http://dietetics.byu.edu/Preceptors/Handbooks.aspx)
Master Rotation Schedule – 2011
Date6 weeks
Jan 3-Feb 10 / 2 weeks
Feb 14-24 / 1 week
Feb 28-Mar 3 / 1 week
Mar 7-10 / 2 weeks
Mar 14-24 / 1 week
Mar 28-31 / 4 weeks
Apr 4-28 / 1 week
May 2-5 / 1 week
May 9-12 / 3 weeks
May 16-June 2
Intern / Site and Rotation*
Annelies
Lang / Clinical
(McKay) / State Health Dept / SLCo WIC / SLCo.
Aging / Davis School District / Break / Mngt
(PCMC) / Extended Care / Renal
(Cindy) / Leadership
Erica
Hansen / Clinical
(PCMC) / State Health Dept / SLCo WIC / SLCo Aging / Davis School District / Break / Mngt
(IMed) / Extended Care / Renal
(Jill) / Leadership
Erinn
Meyer / Clinical
(PCMC) / Canyons School District / SLCo Aging / SLCo WIC / State Health Dept. / Break / Mngt
(IMed) / Renal
(Marcia) / Extended Care / Leadership
Robyn
Dillon / Clinical
(IMed) / Canyons School District / SLCo.
Aging / SLCo.
WIC / State Health Dept. / Break / Mngt
(PCMC) / Renal
(Suzanne) / Extended Care / Leadership
Date
2 weeks
Jan 3- 13 / 1 week
(Jan 18-20) / 1 week
Jan 24-27 / 2 weeks
Jan 31-Feb 10 / 4 weeks
Feb 14-Mar 10 / 1 week
Mar 14-17 / 1 week
Mar 21-24 / 1 week
Mar 28-31 / 6 weeks
Apr 4-May 12 / 3 weeks
May 16-June 2
Intern / Site and Rotation*
Katie
Bond / State Health Dept / SLCo WIC / SLCo.
Aging / Davis School District / Mngt
(PCMC) / Renal
(Barbara) / Extended Care / Break / Clinical (McKay) / Leadership
Brittany
Borchert / State Health Dept / SLCo WIC / SLCo.
Aging / Davis School District / Mngt
(IMed) / Break / Extended Care / Renal
(Jill) / Clinical
(McKay) / Leadership
Marissa
Boaz / PenCourt / Mngt
(IMed) / Extended Care / Renal
(Suzanne) / Break / Clinical
(PCMC) / Leadership
Olivia
Hoopes / PenCourt / Mngt
(PCMC) / Extended Care / Renal (Cindy) / Break / Clinical
(IMed) / Leadership
*See next page for facility legend Holidays (shorter week noted by dates in parentheses)
January 17 Martin Luther King Day February 9 UDA Legislative Day (morning)
February 21 President’s Day Mar 31-Apr 1 UDA Annual Meeting – Ogden Eccles Conference Center
Schedule is subject to change
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Supervised Practice Site Legend
Clinical/Renal
PCMC Primary Children’s Medical Center
McKAY-DEE McKay-Dee Medical Center
UCR Urban Central Region
Renal Various dialysis centers
Management/Extended Care
PCMC Primary Children’s Medical Center
UCR Intermountain Urban Central Region
Extended Care Crandall Corporate Dietitians
Community
State Health Dept Utah State Health Department
SLCo WIC Salt Lake County WIC
SLCo Aging Salt Lake County Aging Services
School District Canyons School District
Davis School District
Leadership
Leadership Rotation Variety of sites
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BEFORE COMING TO YOU . . .
FALL SEMESTERNDFS 521
Utah Valley Regional
Medical Center
Seven Weeks / •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-on-one 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
NDFS 522
BYU Food Production
Management Lab
Seven Weeks / 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
Clinical
Six Weeks / •Primary Children’s Medical Center, McKay-Dee
Hospital, or Intermountain Urban Central Region
Management
Four Weeks / •Primary Children’s Medical Center or Intermountain Urban Central Region
Renal
One Week / •Various outpatient dialysis centers
Extended Care
One Week / •Crandall Consulting Dietitians
Depending on when in the 21-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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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
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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 Advanced Management in Dietetics
NDFS 638 Advanced Clinical Nutrition
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The Big Picture
The Clinical Rotation has several overall objectives beyond the specific clinical 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 / GENERAL•Pharmacy (esp. PN
formulation)
•Discharge planning
•Social work
•Speech Pathology
•Occupational Therapy
•Medical library
•Rounds
•Surgery
•Team conferences
•Physical Therapy
•Child Life (where
available) / •Committee meetings
•Quality management
•UDA activity
•Legislative activity
•Product shows/demos
•Policy & Procedure
revision/review
•Joint Commission 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.
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Clinical/Renal Rotations Competencies and learning Outcomes
The nature and population served differ greatly between the facilities involved in these rotations; therefore, the exact nature of the experiences will differ as well.
Competency*By the conclusion of the Clinical/Renal Rotations, the intern will: / POSSIBLE Learning Activities
DI 1.1 Select appropriate indicators and measure achievement of clinical, programmatic, quality, productivity, economic or other outcomes / Participate with preceptor in outcome data collection
D1.2 Apply evidence-based guidelines, systematic reviews and scientific literature (such as the ADA Evidence Analysis Library, 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. / Apply guidelines in all activities
DI 1.4 Evaluate emerging research for application in dietetics practice / Apply principles of evidence-based practice in performance of all clinical rotations
Use current scientific literature in all patient care activities
DI 2.1 Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the ADA Scope of Dietetics Practice Framework, Standards of Professional Performance and Code of Ethics for the Profession of Dietetics / Comply with facility policies and procedures
Accept responsibility for decisions and actions
Identify regulations that apply to facility type
DI 2.3 Design, implement and evaluate presentations considering life experiences, cultural diversity and educational background of the target audience. / MNT in-service to clinical staff, medical residents, team conference, etc.
Outpatient education where required
DI 2.4 Use effective education and counseling skills to facilitate behavior change / Utilize appropriate teaching/counseling as part of the implementation step of the Nutrition Care Process
DI 2.5 Demonstrate active participation, teamwork and contributions in group settings / Attend department staff meetings
Participate in medical rounds
As appropriate, attend patient care meetings (i.e. discharge planning, case management, team conferences)
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DI 2.6 Assign appropriate patient care activities to DTRs and/or support personnel considering the needs of the patient/client or situation, the ability of support personnel, jurisdictional law, practice guidelines and policies within the facility / Coordinate technician involvement in Nutrition Care Process as appropriateDI 2.7 Refer clients and patients to other professionals and services when needs are beyond individual scope of practice / Use of appropriate referral systems
DI 2.8 Demonstrate initiative by proactively developing solutions to problems / Meet facility timelines for patient care activities
DI 2.9 Apply leadership principles effectively to achieve desired outcomes / Effectively utilize appropriate systems for the implementation of nutritional care
DI 2.11 Establish collaborative relationships with internal and external stakeholders, including patients, clients, care givers, physicians, nurses and other health professionals, administrative and support personnel to facilitate individual and organizational goals / Participate in committees, teams, and work groups
Communicate effectively with other team members in relation to patient care
DI 2.12 Demonstrate professional attributes such as advocacy, customer focus, risk taking, critical thinking, flexibility, time management, work prioritization and work ethic within various organizational cultures / Participate as part of the medical team, being a patient/client advocate regarding nutrition care
Accept responsibility for decisions and actions
DI 2.13 Perform self assessment, develop goals and objectives and prepare a draft portfolio for professional development as defined by the Commission on Dietetics Registration / Self-evaluation of achievement of competencies and learning outcomes
DI 2.14 Demonstrate assertiveness and negotiation skills while respecting life experiences, cultural diversity and educational background / Utilize appropriate cultural sensitivity in client encounters.
DI 3.1a Assess the nutritional status of individuals, groups and populations in a variety of settings where nutrition care is or can be delivered / Follow the Nutrition Care Process guidelines in the assessment process of patient care
DI 3.1b Diagnose nutrition problems and create problem, etiology, signs and symptoms (PES) statements / Use the Nutrition Care Process Diagnostic Terminology and PES statements in patient care
DI 3.1c Plan and implement nutrition interventions to include prioritizing the nutrition diagnosis, formulating a nutrition prescription, establishing goals and selecting and managing intervention / Follow the Nutrition Care Process guidelines in establishing nutrition prescriptions and implementing care
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DI 3.1d Monitor and evaluate problems, etiologies, signs, symptoms and the impact of interventions on the nutrition diagnosis / Follow the Nutrition Care Process guidelines to monitor the effectiveness of nutrition interventionsDI 3.2 Develop and demonstrate effective communications skills using oral, print, visual, electronic and mass media methods for maximizing client education, employee training and marketing / Participate in patient education, both group and individual
Participate in employee inservice training if needed
Where possible, Promote National Nutrition Month activities, market classes or programs
DI 3.4 Develop and deliver products, programs or services that promote consumer health, wellness and lifestyle management merging consumer desire for taste, convenience and economy with nutrition, food safety and health messages and interventions / Review and develop patient education materials
Participate in outpatient education
Contribute to menu modifications where appropriate
DI 3.5 Deliver respectful, science-based answers to consumer questions concerning emerging trends / Use appropriate evidence-based communication with patients/clients
DI 4.5 Conduct clinical and customer service quality management activities / Participate in chart audit, other QA measures
DI 4.11 Complete documentation that follows professional guidelines, guidelines required by health care systems and guidelines required by the practice setting / Comply with facility policies and procedures
Appropriate documentation of all activities in each clinical/renal rotation
DI 4.12 Participate in coding and billing of dietetics/nutrition services to obtain reimbursement for services from public or private insurers / Where possible, participate with preceptor in coding and billing for patient care services
*Competency requirements established by the Commission on Accreditation of Dietetics Education, American Dietetic Association