Dietetic Internship

Dietetic Internship, (healthy)Vittles&Bits

The Penn State Dietetic Internship graduating class of 2013 🙂

Welcome to my Dietetic Internship journey!  I thought I would just take a minute and explain how the process of becoming a Registered Dietitian (RD) works, because it’s a bit confusing.  If anyone out there is interested in nutrition and dietetics and is thinking of becoming an RD, I am happy to answer any questions you may have about college classes, applying for internships, the internship itself, or the exam.  Here’s what it takes to become an RD:

– completion of a Didactic Program in Dietetics (DPD) from an accredited institution (this usually a B.S. in Nutrition in Dietetics, but doesn’t necessarily have to be if you have a different degree and just want to take all the required pre-requisite classes)
– completion of a Dietetic Internship that is accredited with ACEND (Accreditation Council for Education in Nutrition and Dietetics)
– pass a rigorous registration exam
– keep up to date with your required continuing education credits

That’s it in a nut shell, but of course each of these steps is challenging and confusing in its own way, haha.  I think that the most unfamiliar aspect of this journey for most people, is the Dietetic Internship, which is one of the reasons I wanted to write a blog page about it.  When you tell people you’re doing an internship, they tend to think that you 1) are getting paid (which your not–in fact you’re paying to work full time) 2) have flexible hours (you do not.  You have to be there early and stay late.  And there’s no such thing as sick days–unless you’re seriously contagious, then you stay home but make up your hours later) 3) don’t have homework (wrong. You have a lot of homework. At least I felt like I had a decent amount of homework, but I’m sure it varies from program to program).  This is one of the reason it’s great to have other interns to chat to–because no one else will really understand what you’re doing.  All the internship programs vary, but as an ACEND requirement, they all have to have at least 1200 supervised practice hours.  I finished mine with 1700 hours in 11 months, so you see, it’s a serious year of hard work. But you end up with a lot of great experience that you just can’t get anywhere else.  I started documenting my journey back in September of 2012 (even though I started the program that July), so if you want to read from start to finish, scroll down to the last post on this page and start reading upwards!

Week 49…

GRADUATION!!!!!!!  There were just a couple of forms and presentations we had to do on Monday and Tuesday of this week, and then Tuesday night we graduated.  Wait, let me say it one more time….We graduated.  This was definitely one of the greatest and proudest moments of my life.  During the internship, everything gets kind of zoomed in–like you have a magnifying glass in front of your face all the time.  And all you can see are the challenges and obstacles immediately in front of you.  But graduating allows you to step back and say, “Damn.  Look at what I just did!!!”  I won’t lie and say that this was an easy year, or that I loved every minute of it.  It was a very hard year.  And there were certainly some moments that I didn’t love. But, in all, it was a really great year.  I have never been so stressed, so exhausted, and yet so excited and happy to be learning new things each day.  It also really helped me to figure out what parts of the field of dietetics that I love and what parts I would rather not make a career out of, haha.  Also, I made some amazing new friends.  One of the great things about PSU’s DI program, is that there are 10 interns.  That’s 9 new friends, 9 shoulders to cry on, 9 people to eat lunch with, 9 people to bounce ideas off of, 9 professional connections for your future career.  And I must say, I think that we were a great group of interns 🙂

(healthy)Vittles&Bits

Me and my 9 fellow interns, the weekend before graduation.

Now all that’s left is to study, study, study and take the RD exam so that I can make it official and put those two coveted letters behind my name!

Weeks 45-48…

This was my last month of the internship–can you believe it?!  I sure can’t.  For the last month of the Penn State Internship (called the Enrichment Rotation), they allow you to choose where you want to work/learn.  Knowing that I someday want to own my own private practice, I figured I should get some business and marketing experience under my belt.  Boy was that the right decision!  I was lucky enough to be able to intern with Anne Deeter Gallaher, CEO/Owner of the Deeter Gallaher Group.  This was such a great experience, I wrote an entire blog post about it,. which you can read by clicking here. I also wrote a blog post about Anne’s new book, Women in High Gear.   I am actually still working part time for the Deeter Gallaher Group, while I study for the RD exam, which is great because every day I’m there I learn something new.  It has really been a privilege to watch Anne work.

Week 44…

This week was my staff relief week!  I chose to do my staff relief at the Surgical Weight Loss Clinic I had been at for my outpatient rotation.  I just really loved working with the bariatric population, and I learned so much about counseling from that week, that I decided to go back for more!  This time though, I pretty much got to act as the RD and see 90% of patients, which was awesome.  This was another fantastic week.

Weeks 41-43…

After my four weeks in outpatient, I went back to the hospital for my Pediatrics rotation.  I will admit that having absolutely zero experience with kids and babies, I wasn’t exactly looking forward to this rotation.  Nutrition for kids/babies is very different than nutrition for adults.  However, I ended up having a great time.  I spent one week working with pediatrics, and then two weeks working in the NICU with a dietitian named Coleen.  She was one of my absolute favorite preceptors.  I felt like she really understood how I learned and she challenged me each day.  I was also blown away by how freaking smart she is!  Seriously. This woman knew everything.   Working in the NICU was super fascinating.  It’s just crazy to me how they can do such elaborate and complex procedures on such tiny humans.  I mean, really, they are the tiniest humans you will ever see.  It was a great two weeks in the NICU with Coleen.  I learned sooooooo much.

Weeks 37-40…

After renal, I moved to my Outpatient rotation.  This was a fantastic rotation for me.  I really discovered my love of nutrition counseling during these four weeks.  Each week of this rotation I spent at a different location.  For the first week, I was with an RD named Taryn.  She had a really interesting job because she covered A LOT of different nutritional areas.  When I was with her we saw patients for nutritional counseling for gestational diabetes, type 2 diabetes, liver transplants, cancer, HIV, inflammation, pregnancy, and Celiac disease.  I learned so much from this week.  I was also amazed at how Taryn could easily switch from topic to topic when doing her counseling sessions.  She also teaches classes to the med students about nutrition, which I think is awesome.  A lot of doctors really don’t have any nutrition background (I think they are only required to take 1 nutrition class in med school), which is sad because nutrition is so important to the prevention and treatment of disease.

The second week, I was with an RD named Theresa, who worked mostly with type 1 and type 2 diabetics.  This was another great week because I learned a ton about diabetes.  I discovered that I really enjoy working with diabetics and teaching people about carbohydrates and how what they eat affects their blood sugar.  I still need a lot more training on working with insulin though.  That is definitely a area that I will continue to study.

The third week, I went to the Surgical Weight Loss Center.  This was definitely my favorite week of outpatient (and of the whole clinical rotation in general probably).  At the SWL clinic we saw bariatric patients who were either in the program to get weight loss surgery or who were just trying to lose weight the good old fashioned way!  I so enjoyed working with the bariatric population.  Everyone has such interesting stories, and I really loved trying to get to the root of the behavioral issues that were affecting their eating habits.  I think one of the reasons I liked this so much, was that it is a real challenge.  It’s one thing to have the knowledge, and just to give that knowledge to someone else to make the right choices.  But it’s a whole other ball game to work with someone and really figure out the behavioral issues that are preventing them from using the nutrition knowledge.  I got sooooooo much better at counseling during this week.  A lot of that was due to my awesome preceptors, Jackie and Janelle, the bariatric RD’s that worked at the center.  I’m definitely going to look for a bariatric position when I start applying for jobs.

The fourth (and last) week of my outpatient rotation was spent at an eating disorder clinic.  This was a very interesting week for me.  I shadowed the two RD’s that worked at the clinic.  I didn’t do any actual counseling due to the delicate nature of this condition, which was fine by me.  The last thing I wanted to do was to say the wrong thing and mess up someone’s treatment.  I’ve always had an interest in eating disorders, and have thought in the past that I would like to work with the ED population someday.  After this rotation, I think that is still a true statement.  I feel so strongly about the ridiculous pressure our society places on women to be young and thin.  I would love nothing more than to be able to help young girls and women to feel healthy and beautiful, no matter their size, and to help them restore a healthy relationship with food.  But, for right now, I think that I would like a lot more counseling experience before I pursue this as a career option.  This is something I will keep in my mind for years down the road.

Weeks 35-36…

After four weeks of Nutrition Support, I moved on to my Renal rotation.  Renal = kidneys.  This was a really great rotation.  The renal dietitian works mainly with patients receiving dialysis – meaning that 3 times a week they come to the hospital (or a dialysis center) and sit in a chair for 3-4 hours while all their blood is taken out, cleaned by being run through a dialyzer (which is basically an artificial kidney), and then put back into their body.  How awesome is that?  It took me a few days to really wrap my brain around it.  I mean how cool is it that we can do that? We can literally take someone’s blood out and clean it and then put it back into their veins.  Science is awesome.  If you’re wondering why this is necessary, it’s because the kidneys are responsible for filtering our blood and removing all the waste products that we end up peeing out.  When your kidneys aren’t working anymore, you can’t filter out the waste products, and you can’t excrete them in your urine.  So people on dialysis have to come pretty much every other day, because they end up holding on to all that fluid and waste that you or I would just pee out.  This is why people on dialysis need a dietitian.  They have to be really careful how much potassium, phosphorus, and fluid they take in.  They also have to make sure they’re eating enough protein.  The dialysis removes protein from the blood as well, so it can be challenging for dialysis patients to eat as much protein as they need.  I really enjoyed this rotation.  It’s great to work on an interdisciplinary team.  We went on rounds with doctors, nurses, and social workers.  We would collect patient lab data, review all their numbers, and then review their labs with them and go over any nutritional changes that they could make.  I think that this rotation fit so well for me because it involves a lot of different aspects of nutrition – science and physiology, nutritional counseling, and working on an interdisciplinary team.

Weeks 31-34…

After my 5 weeks in the MedSurg rotation, I moved on to my 4 week Nutrition Support rotation.  For those who are unfamiliar, nutrition support deals with enteral and parenteral feeding (aka tube feeding).  So for people are unable to meet their nutrient needs by mouth, we step in and help them stay nourished using either enteral feeding, which is feeding through a tube that goes into their stomach or their small intestine, depending on the condition they have, or through parenteral feeding, which means feeding directly into a patient’s vein – so we bypass the digestive system completely and just provide nutrients into the bloodstream.  Pretty cool, huh?  For the first two weeks of this rotation, I really enjoyed it.  I learned something new every minute of every day, and it’s all about science–which I love.  However, I will admit that the last two weeks of this rotation my enthusiasm died down a bit.  Not that it wasn’t super interesting–it still was–I just really began to miss interacting with people.  Nutrition Support is a lot of sitting in front of a computer doing calculations, which is great, but after a while, I really started to feel like I wasn’t working with food anymore.  And you’re not working with food really.  Most of what you’re doing involves either formulas for tube feeding or working with the specific, broken down nutrients in TPN.  As a real foodie at heart, I missed food.  So if you like working by yourself all day and plugging in numbers and doing interesting calculations, then this might be a great fit for you.  For me though, it was a great experience, but not what I want to do for a living.  I’m hoping to find a job that involves counseling and cooking 🙂

Weeks 25-30…

Thus began the clinical rotation (spoken in a low, ominous voice….)  Haha, just kidding.  I had actually really been looking forward to the clinical portion of the internship because I’ve always been fascinated by science and physiology.  The first six weeks of the clinical rotation was our MedSurg rotation.  This rotation is kind of hard to describe, but MedSurg kind of refers to a hodgepodge of areas.  There are 3 MedSurg dietitians at the Hershey Med Center, each of them focusing on their own area (heme/onc, cardiac, liver, neuro, etc).  We spent two weeks with each of the dietitians, learning how to check the master list, find patients that needed to be screened, and then how to go and talk to them and get the information we needed to complete the screen.  I learned loads about different diseases, conditions, and even different surgical procedures.  After collecting all our information from the patient, we would make our recommendations and then write the notes.  It was pretty cool to feel like I actually made a difference.  It was really rewarding to catch the cases of malnutrition that had been overlooked previously.  Also, the learning opportunities were endless.  Just when reading charts I would have to look up about a million words, conditions, procedures, etc.  Okay, a million might have been an exaggeration, but in truth I did spend a ton of time looking up medical terms I was unfamiliar with.  Sometimes I spent a little too much time learning new things and had to remind myself that there were patients to see!

Weeks 23-24…

Christmas Break!!!!!!!!!! Can you believe we got a two week break?  It was so amazing.

Week 22…

This week was Business Plan week.  Cierra and I worked together (in collaboration with the Hershey High School FoodService Director) to come up with a very elaborate Business Plan for introducing a made to order flatbread sandwich station into the High School’s lunch line.  It was actually a pretty fun thing to do, even though it was a pretty daunting assignment – especially for two interns who didn’t know anything about business or finance, but we made it work.

Weeks 17 – 21…

After GIANT I went to Masonic Villages in Elizabethtown for the remainder of my Management rotation.  I will admit that this was definitely not my favorite rotation, but I did learn a lot of valuable things.  One thing I learned for certain, is that I do not want to work in foodservice, haha.  I did a lot of little projects here, including memos on sanitation procedures, HACCP, product changes, quality assurance, etc.  The big, giant project I did here, was to create a Theme Meal with the other intern (the lovely and talented Cierra Neiswender).  Our theme meal was “Deceptively Delicious”.  The idea came about when we heard the employees complaining about only having french fries on the menu once a week (they started a French Fry Friday in an attempt to be a little bit healthier).  So Cierra and I figured we could serve them delicious food without them realizing that everything was packed with veggies and actually good for you.  Cierra and I had to do absolutely everything for this meal.  We did all the planning, forecasting, procurement, recipe development, recipe testing, marketing, nutrition education, decorations, and of course, the cooking.  And it was A LOT of cooking. We made enough food to feed 100 employees – no small task for two interns.  There were a lot of times when I felt like this:

Stressed Out.

Stressed Out.

And we had to come up with some very creative ways to prepare all that food….

IMG_2078But in the end it all got done, and the Theme Meal Day was a lot of fun (albeit a lot of work.)  Everyone seemed to enjoy the food we made and we got a lot of nice comments from employees and residents alike.

Cierra and I with our Theme Meal of Parmesan Pasta with Cheesy Meat Sauce,  Winter Fruit Salad, and Succulent Succotash. Also (not featured) we made a Loco Cocoa Pie with Raspberry Ribbons and an Isn't it Cran-tastic Holiday Spritzer.

Cierra and I on our Theme Meal Day. We served  Parmesan Pasta with Cheesy Meat Sauce, Winter Fruit Salad, and Succulent Succotash. Also we made a Loco Cocoa Pie with Raspberry Ribbons (which is what we’re holding in the picture) and an Isn’t it Cran-tastic Holiday Spritzer.

All in all, it was a good experience, but I’m glad it’s over.  Foodservice is not for me, haha.

Weeks 15 – 16…

These next weeks I spent at GIANT food stores.  The first week was spent at a very big GIANT (kind of a super-GIANT). I worked with the in-store dietitian, Sylvia.  It was great (except for that whole hurricane Sandy thing….).  I did a Spot Talk on Produce, where I made some pumpkin hummus and cut up some jicama to serve with it. Then I gave out samples in the middle of the store. It was awesome.  I had a great time talking to people about what jicama is, lol.  No one knew.  I had actually never tried it before so it was cool to get to try something new.

Here I am doing my Spot Talk!

Here I am doing my Spot Talk!

I also did an assignment with Gluten Free menus which was cool cause it’s a topic I’m not super familiar with.  Then for the second week of this rotation I went to the Ahold Corporate headquarters in Carlisle (Ahold owns GIANT) and worked with the corporate dietitian there, Sylvia Emberger.  I did a lot of writing this week.  I did a recipe for their website (turkey and mushroom meatballs) and then I also did an article about “Healthifying Comfort Foods” for the New Year.   Both were really great experiences.

Weeks 11 – 14…

I realize that I’m posting this way after the fact now, but the internship has just been so crazy that I really haven’t had much free time in the last couple months.  Anyway…after Cooperative Extension, I began my School Foodservice rotation.  This was definitely one of my favorite rotations.  I was assigned to Donegal School District in Mount Joy, PA, and my preceptor was Jeanne Kandra – one of the greatest preceptors ever.  I had such a great time working at the school.  The lunch ladies there were are so wonderful.  Sandy and Sue are two of the coolest lunch ladies on the planet.

Here they are, hard at work!

Here they are, hard at work!

The food was also awesome.  I remember the food I had in high school and it was no where near as delicious as what these kids are getting.  I did a lot of projects for Ms. Kandra.  I did a student satisfaction survey, where I made an online survey that kids filled out at lunch – pretty cool I thought. I certainly never had anyone at my school ask me how I liked the food.  I made up some recipes for their webpage.  I entered tons of their recipes into an online database to see if they were in compliance with the new School Food regs from the Healthy, Hunger-Free Kids Act.  I created a label book for them of all the products they use.  I also did a lot of samplings with the kids, where I would go out during lunch and give away free samples to the students a day or two before we put a new menu item on.  This was so cool to me.  No one ever did that in my high school.  Also, it was remarkable how many kids had no idea what Asian Pears are.  That was one of the samplings I did and so many of those kids looked at me like I was nuts when I offered them a piece of Asian pear. The looks they gave me – you would think I was trying to poison them or something!  Another sampling that I did was with a pumpkin pie parfait.  I sampled this with all the schools, so I made what felt like A MILLION little parfait samples:

This was probably like one tenth of how many I made.

This was probably like one tenth of how many I made.

This was actually really fun though because the kids when nuts. I had students chasing me around the cafeteria asking for seconds.  Ms. Kandra told me after I left that the parfaits were such a hit that they decided to them again the next month.  Looking back now (it is now February and I did this rotation in October), I really miss working at the school and having lunches with the lunch ladies.  It was so much fun, and really very rewarding when you saw a kid try something new (and healthy) and realize that they actually like it.  Also, Ms. Kandra gave me a piece of Dove chocolate one day (shhhhh! no one tell Hershey….) and the wrapper said this:

IMG_1983

And I thought to myself, you know what piece of Dove chocolate, you are so right –  I should charge for my great advice.  I just thought it was very funny and super appropriate (as right now I’m paying to give my good advice away).  Also, I plan on opening my own private practice in the hopefully not too far away future.  So I kept the wrapper. Maybe I’ll get it framed and hang it in my office some day, haha.  Dreaming of that day…..

Weeks 8 – 10…

So, my Cooperative Extension rotation is now over.  During these last three weeks, I actually came to enjoy Cooperative Extension.  I liked giving the presentations (even though that was a little nerve-wracking).  I gave my community presentation to a senior center and talked to them about “Cooking for One” – that was a super fun day.

The Ag Day tour was super awesome – see post about the best cheese in the world.   The tour of the meat industry was most definitely my least favorite day.  Really, anyone who is an animal lover wouldn’t really like that day – especially the tour of the slaughterhouse….   Anyway, I also gave two presentations to the staff at CE, and my topic was “increasing fruit and vegetable intake in families” as part of the effort to decrease the rising rates of obesity.  My last week there, I spent struggling with Adobe Presenter to try to get my presentation uploaded to the internet.  However, now I am all finished with cooperative extension (and my community rotation in general).  On to the next great adventure…..School Foodservice.

Week 7….

This week we started our 2nd rotation – Cooperative Extension.  In case any of you don’t know what Cooperative Extension is (I had no idea before i started this internship), it’s like this:  every state in the country has a “land grant university”, which is a university that the government granted a specific amount of land to, with the provision that the university focus on teaching “practical” skills to the community, in opposition to the more abstract liberal arts curriculums that were all over when this act was created (something like 1914).  So anyway, Penn State is Pennsylvania’s land grant university, which is why as part of their dietetic internship program, we spend time at the cooperative extension offices in the surrounding counties.  I am placed in Adams County.

Thus far, I can’t say I really enjoy it.  First of all, it’s an hour drive each way, which eats up a ton of time and gas.  Second of all, so far it’s been a lot of sitting at a desk staring at a computer screen writing lesson plans.  We have a bunch of papers/presentations we have to do for this rotation, and it’s basically like, here’s what you have to accomplish in the next four weeks – start calling people and setting up your presentations and visits to various places.   Not exactly my favorite thing.  Starting next week we are going to go on tours of the food bank in Harrisburg and we also have an Ag Day tour which is supposed to be super fun, so we’ll see.  Maybe by next week’s update I’ll have a completely different opinion…..doubtful, but hey, it’s possible.

Weeks 1- 6….

After viewing a fellow intern’s blog , I thought, wow what a great idea to document my journey through this internship. After all, I know there are junior and senior nutrition students out there looking for any information they can get on dietetic internships (I certainly was…). So, I’ll do my best to post updates here about my progress through the dietetic internship (hereafter referred to as the DI).

Screen shot from Match Day!!!

Screen shot from Match Day!!!

I got matched to the Penn State DI in April of 2012, and the DI started on July 23rd, 2012. Our first week was orientation (we did a really fun team-building ropes course the first day). The second week was “Didactic Week”, which one of the other interns affectionately re-named “Shark Week” hahaha. Super appropriate. It was very intense. 8 hours a day of lectures from surgeons and dietitians. Very interesting, but also quite taxing on the brain (or at least on my brain).

Then, the third week in we started our first rotation. For me, that was with the WIC program (Women, Infants, Children for those of you who may not know what that is). The first week was at the state agency, and then the last three weeks were at a local clinic.

My group of five interns with our preceptor from the State WIC Agency - Shirley Sword.

My group of five interns with our preceptor from the State WIC Agency – Shirley Sword.

I was placed in the Carlisle clinic. It was a great experience. Anyone who knows me well (or really who knows me at all) knows that I’m not a huge fan of little kids and babies (mostly cause I have no experience with them). But, I must say that I learned so much about nutrition for children and infants, as well as for pregnant and postpartum women. The staff at the Carlisle clinic was super wonderful and they helped me so much. I can’t believe it’s already over.

At the Carlisle WIC office!

At the Carlisle WIC office!

Tomorrow I begin the next rotation – Penn State’s Cooperative Extension program. I’ll be in Adams County for the next four weeks. Check back (or follow the blog!) to see how it goes….

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