For many interns, the clinical rotation is the holy grail of the dietetic internship. It’s the time in which we put those long semesters spent in biochemistry, physiology, and medical nutrition therapy to use. And, since many dietitians enter the workforce in the clinical arena, it’s a great opportunity to gain both work experience and valuable connections.
While I was excited to start my 8-week clinical rotation, I wasn’t really sure what to expect from it. By the time my first day rolled around, I’d only made it halfway through the Scrubs series on Netflix, and I hadn’t even started to binge watch Grey’s Anatomy. How was I supposed to know how a hospital worked?! Within 5 days of walking into my hospital placement, though, I had a firm base level of knowledge and a decided level of comfort.
I spent my first couple of days shadowing my preceptor(s) but, after that, I was seeing patients on my own. My preceptors were always there to answer questions, work through complicated cases, and co-sign notes, but it’s one of those swim or swim type of things. You will learn most efficiently from your own experiences, so it’s best to start gaining them right away. Then, if and when you mess up (spoiler alert: you will mess up), your preceptor is there to help steer you in the right direction.
Most people, including my pre-internship self, don’t have a good grasp of what the role of a clinical dietitian entails. When asked, I give the following spiel:
Every patient who enters the hospitals where I interned received a nutrition risk score from 0 through 4 based on their answers to questions regarding appetite, unintentional weight loss, current BMI, etc. Their score decided how quickly and how often they needed to be seen by a dietitian.
The ensuing dietetic consultations varied based on the patients’ needs. For example, a newly diagnosed type 2 diabetic will need education on how to regulate his or her blood glucose through diet. Someone who just started chemotherapy and has lost his or her appetite could benefit from a high calorie, high protein supplement, and some tips for increasing intake upon discharge. Some patients will be eager to learn and improve their health; some patients will only tell you how much they hated last night’s baked chicken; some patients will show absolutely no interest in anything you have to say.
While I mentioned my more philosophical takeaways from my foodservice rotation, the overarching lessons I learned following clinical had more to do with the job itself. From what I observed and experienced, I’ve come to believe that complacency is the enemy of the clinical dietitian. Despite all of the interactions I mentioned above, there were times when things felt monotonous. When you see anywhere from 5 to 15 patients a day, everything begins to run together. And while the role is expanding, dietitians are still fairly limited by what they can do autonomously in the clinical setting. For example, only recently were dietitians granted the ability to independently prescribe therapeutic diets without MD approval. It takes someone who is motivated, confident, and knowledgeable to connect with and earn the respect of doctors, nurses, and other specialists. It is these individuals whose notes are read and followed. And, from what I’ve gathered, it is these individuals who most positively impact their patients and enjoy their jobs the most.
This likely goes without saying, but all of the views I’ve expressed are mine alone. That being said, I’d love to hear from you all about your experiences during your internships or careers. And, as always, please feel free to leave any questions in a comment below!