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Intern Diary

The FAN Club followed the progress of former student, Elsa Nicholson through her dietetics internship with Virginia Tech. Throughout the year, Elsa wrote diary entries to give us an insider's view into her internship experience.

August 31, 2004

My name is Elsa Nicholson and I graduated from the University of Maryland in May 2003. Since then I took a year off to work at a non-profit community clinic in Langley Park, Maryland, called Spanish Catholic Center (SCC) managing their diabetes program. I had the wonderful experience working with medically underserved, low income Hispanic/Latino clients. This population is in much need of nutrition and community outreach. This experience also gave me the chance to practice my Spanish. I have also participated in food preparation and as a lab tech with a USDA black tea study as well as conducted dietary interviews for the National Health and Nutrition Examination Surveys (NHANES). I had no life for much else!

I'm doing my internship at VT, so I actually moved down to the northern Virginia area so I can be closer to school (located in Falls Church, VA) and the hospital where I will be doing most of my clinical rotations, the VA Medical Hospital in D.C. VT was my first choice because they have a really good community program and my interests lie within the community and public health arena. Some of my clinical rotations will also be out at the INOVA Diabetes Center working with Diabetes outpatients.

Now we are in the second week of orientation so I don't have many goodies to tell yet, but I'll definitely keep you posted. The internship consists of 15 weeks in clinical, 8 weeks in community, and 6-8 weeks in food service management rotations. I'm hoping that throughout the internship I can continue to build on my past work experiences and continue to work with diabetic patients but also so I can have exposure to other aspects of dietetics as well.

So the key thing is here when I look back with going to U of M, juggling my part-time jobs with USDA and NHANES and volunteering with Spanish Catholic Center--it was worth it because those real life experiences are really helping me now at the hospital -- where they treat you more like an employee and less like a student.

Also when I volunteered with the diabetes program at SCC as a student is when they extended the Diabetes management position within the adult medical clinic of SCC upon graduating from Maryland. Taking the year off was great too...and it gave me time to find areas of dietetics that I wanted to focus my attention on (which is now with diabetes). So don't think volunteering is a waste of time --you may not only find what you like---but also getting paid for it is even better!

If you want more information about the VT internship visit http://www.hnfe.vt.edu.

September 20, 2004

I just finished my first clinical rotation last week. The rotation involved working out of one of the hospital's CBOC (Community-Based Outpatient Clinics) located out in Greenbelt and S.E. Washington D.C. Going to the S.E. clinic was nerve-racking considering the location, which is predominantly high crime, but even the roughest looking of characters show the utmost respect for the medical staff. The Greenbelt location was more pleasant. There I saw many patients that had the whole enchilada-diabetes, HTN, obesity and hyperlipidemia. So it was a good mix. I felt more in my element because I was counseling patients in an outpatient type setting, which was similar to the environment I was used to back when I worked for SCC (Spanish Catholic Center). This rotation was great because I am not necessarily working with sick people (per say) and they are more receptive to the counseling and education given to them than say in an inpatient (in the hospital) type setting. So starting my clinicals in an outpatient type setting really worked well for me.

My preceptor was great. She's the hospital's community dietician and knows the patients well. In an outpatient type setting there is a lot of f/u (follow up) so you get to know the patients on a more individual basis. Also, I didn't feel like I had to cram in so much information during one session with the patient. As long as they had at least one take home message I was happy. What I didn't like was that we see so many patients in one day, up to 10-13 patients in a day, which from what I am hearing from other interns is quite common. So my preceptor and I had a new patient every half an hour so time management was KEY. The other issue is charting and documenting once the patient had been seen. The VA hospital uses a computerized medical charting system called CPRS and DHCP. So that makes things a little easier for charting and documenting SOAPs for each patient. It's almost impossible to chart immediately once the patient has been seen due to the large work load so we use what are called print screens, which are like little worksheets we keep handy while we are talking with the patients.

This week I am starting my Infectious Disease (ID) rotation, meaning the majority of the patients I will be working with will have HIV. Medical nutrition therapy (MNT) for HIV is not a strong point of mine so I have been reading journal articles and reading notes from my MNT class to brush up on it.

Well, that's all I have for now. I'll keep you posted once my ID rotation is done in about 2 weeks.

October 6, 2004

I finished my Infectious Disease rotation last week. It was rough at first, but it was just a matter of easing into the inpatient type setting. In the beginning, I would get nervous while my preceptor stood over me, watching my every move, but then it becomes like second nature. Lately, the preceptors are getting more comfortable in my abilities to go up to the floors and talk with patients so I am able to work more independently.

My routine is to come in early in the morning and screen patients on our "LL" list (the list of patient that the preceptor and I need to see for the day). By screening, I mean I go through the chart and extract pertinent information before I go speak with the patient. This would include reason of admission, diet order, past medical history, weight history, medications and labs. I feel like the medical chart tells a story and I'm the detective trying to pull the pieces together. Then, the preceptor and I go up to the floors and do meal rounds and assess new patients.

When I'm up on the floors, what I enjoy most is talking with patients. The patients we serve at the VA Medical Hospital are predominately middle-aged male veterans, so as you can imagine, many have some interesting war stories to tell. Besides this, they also tend to be quite sickly, hence, the reason why they are in the hospital. I see a lot of patients going through ETOH (alcohol) withdrawal, drug abuse, cocaine dependence, mental illness and homelessness. It's important to take note on these psychosocial economic factors because it does sometimes have an impact on nutrition. There are physical features as well, such as teeth, hair and nails that can also tell a story about somebody's nutritional status. Some of our elderly veterans are edentulous-a new word I learned today meaning-no teeth. So it's important to give them diets that are easier to chew and swallow.

These past few weeks I've been pretty stressed out, but I ended this last rotation with an epiphany--sound angels singing--which made it all better. One of my patients last week made a special effort to shower my preceptor with compliments about me. I'm usually not one to take compliments well, but it felt nice to have some recognition. This event gave me some reaffirmation that WOW maybe this is what I was meant to do -- become a dietitian. It sounds corny, but it's true.

October 28, 2004

Wow, so much has happened since I last updated everyone. I'm currently doing my diabetes rotation at the INOVA Diabetes Center. This is what I love and why I got into the profession. The center is an outpatient clinic. I see a lot of group educations for patients with diabetes. Just to give you some background information they use a program called BASICS for Type II Diabetes which is a 6 month program for newly diagnosed patients with type 2 diabetes which includes four sessions over a period of six months. I also see individual education sessions for type I and gestational diabetes. Last Friday I taught my first class for BASICS-Session 2 for a small group of type 2 diabetes. Since, I did not have previous experience working with type I diabetes I made it one of my objectives to work as much as I can with this. I'm currently working with a 77 year old female patient who has type 1 diabetes. She came to our center because the doctor recently sent orders for insulin pump. I will be presenting this patient as one of my case studies for the internship. A definite plus for this rotation is calculating individual meal plans, determining their carbohydrate to insulin ratio, insulin sensitivity factor and carbohydrate counting.

Yesterday, I attended a conference for "Diabetes-In the Acute Care Setting" at the INOVA Fairfax Hospital. I learned two key concepts: it is not appropriate to refer to patients as diabetics and as non-compliant. Instead, they prefer to be referred to as someone with diabetes and identifying the problems and issues first.

In addition, I am taking advantage of this experience to investigate what it takes to become a CDE (Certified Diabetes Educator) considering everyone at this facility is a CDE. So, I am fortunate and privileged to be working with accomplished professionals and I am looking forward to the rest of my stay at the INOVA Diabetes Center.

November 24, 2004

I'm on my week break for the Thanksgiving holidays so I am looking forward to some serious R&R. I'm also taking this time to knock out some internship projects. I recently finished two case studies; one was on Congestive Heart Failure (CHF) and the other on type 1 diabetes. Now I'm working on my Medical Nutrition Therapy (MNT) project. The topic of my project is "Diabetes in the Hispanic/Latino: A Culturally Sensitive Approach". The purpose of this project is to promote cultural awareness among dietitians with the Hispanic/Latino population. In my research I have found that the majority of resources available are more targeted towards the Mexican population and in the DC Metropolitan area there has been an increased growth of Salvadorans and other Central and South American subgroups. Once I have finished my research, I will create a guide for dietitians so that they can provide nutrition interventions that are culturally sensitive to meet the needs of their Hispanic/Latino clients. If any of you are on any of the major ADA listservs you have probably seen my survey. I'm trying to rally dietitians in our area to fill out this survey so I can collect some good data for my project. So, working on all these projects and going to the hospital everyday has felt like having a full time job and going to night school. To top it all off my parents are leaving to go to Chile, so I'm really stressing out.

I just finished my critical care rotation last week. I was able to work with patients who are on tube feeding, but unfortunately none that were on TPN. Last week I also attended a workshop on Gastroenterology. This was really helpful for my critical care rotation since I saw a fair amount of patients with liver diseases and digestive disorders. I would encourage all of you attend various workshops in our area because you can learn so much. Next week, I will do my renal rotation and the week after is my 1-2 weeks of staff relief --YIKES! But I am really looking forward to finishing my clinical rotation and starting my community rotation.

Have a Happy Thanksgiving!

January 20, 2005

Hello, everyone. I hope you all had wonderful holidays. Well of course so much had happened since I last updated you. I'm done with my clinical rotation at the VA and my departure was bitter-sweet.

Now I am doing my community rotation at Fairfax County Head Start. This site wasn't one of my top 3 picks, but it is in an ideal location and my commute has been a dream. This place has been really growing on me and it turned out that I was a good fit for this site.

Just to give you some background info at this site. Head Start is a comprehensive child development program that serve children from birth to age 5, pregnant women, and their families. It is a child-focused program that has an overall goal of increasing the school readiness of young children in low-income families. Working at this site has been a refreshing change. I went from working with middle-aged adult males at the VA to working with kids.

My focus at this site has been educating parents of young children. This has been a challenge because many parents have English as second language. So far I have conducted two workshops with the parents. One was on "Diabetes in Adults" and the other on "Low Hemoglobin Workshop". At the end of the month, I plan to do a workshop on "Obesity in Children".

Yesterday, I did "My First Food Guide Pyramid" class with the kids, which was so cute. I had a puppet called Mr. Chef. The kids and I had a great time. Well, this is all I have for now.

February 24, 2005

I recently completed my 2nd community rotation with the Fairfax Area Agency on Aging (FAAA). Just to give you some background information, I work for the Meals on Wheels (MOW) program. It was interesting to see, first hand, how the process works. I even had a chance to meet some of the (saintly) Meals on Wheels drivers.

Working at Head Start was child's play "literally" compared to this site. Right off the bat, my preceptor had a long list of activities to do, so it was overwhelming at first.

During my time with FAAA, I worked on a grant to help them hire a part-time RD to work exclusively with the frail, elderly MOW participants. Through the MOW program, participants receive nutritious meals but many suffer from chronic disease common in older adults. It was clear to me that the MOW participants could benefit from nutrition interventions provided by an RD. I conducted a community assessment by submitting a "Nutrition Interest Survey". Then, I developed an implementation plan which included a program protocol, action plan, and budget.

This concept of hiring a RD to specifically work with MOW clients is somewhat of a novelty in our area so I contacted Dietitians that exclusively work with MOW in Virginia, Nebraska, Florida, and Washington State. It was tough but I learned a lot from their knowledge and expertise. Many of them I contacted using listservs so I highly recommend to get on one if you haven't already because it is a great way to make connections.

In addition, I wrote an article about "Diabetes Awareness" which was published in the Golden Gazette. This is a publication that is distributed on a monthly basis to older adult residents in Fairfax County.

Once a year, my preceptor conducts satisfactions surveys to MOW clients so my job was to distribute the surveys to a specific meal route in Falls Church, collect and compile the data and report my findings.

Oh yeah, I also taught some classes too. I conducted a Nutrition and Aging workshop for a group of LPN students at Falls Church High School. I also conducted a "Diabetes Awareness" at the Reston Senior Center.

Wow busy, busy, busy. Next week I am going to the Public Policy Workshop (PPW) on Capital Hill so I will fill in you in about that later.

March 9, 2005

Hello all! I just started my first week of Foodservice rotation at TC Williams High School -- Home of the Titans! Once upon a time, I actually went to high school in Santiago, Chile. So, I am amazed to have a second chance to walk the halls of an all American high school.

I'm so excited about this rotation because I'm doing this rotation with another intern. The rotation is going to be two months long and our preceptor has lots of projects lined up for us. We will be able to work on most of the projects together, which is a refreshing change. Unfortunately, the other intern is leaving next week to go to a Cancer seminar for one week. So, I will be by my lonesome :(

One of the projects that I am currently working on is to create an entree with an international flare for the high school students. The idea is to do a Taste of Thai theme. My preceptor says that the kids like spicy so we are trying to do something creative and flavorful.

One of the biggest projects is the Theme Meal. Last weekend I was frantically looking for my Food Operations (NFSC 350) notebook to use as a reference. As a suggestion, keep all your nutrition books and notebooks because they do become helpful for the internship. When I took NFSC 350, I created a traditional Chilean meal as my theme meal. I think for this theme meal I want to do something with a spring theme or something with a Latin flare.

Wow, I can't believe in two more months, my internship will be done and over with. I just have to make it through this last piece of the home stretch. Ok this is all I have for now. Take Care.

April 10, 2005

Hello all, it's that time of month again. Nothing really exciting going on at this point into my internship. In March, I had somewhat of a personal problem so the internship (unfortunately) took a back seat in my priorities list. Now I feel like I'm behind on all my little internship projects; which I am trying to hammer out this weekend. It's hard to be inside working hard when it's so beautiful outside. Plus, my hubby's birthday is this Monday and mine is the next. Both of which, I feel like I will working hard on my internship projects :( My preceptor has been really supportive so that is a big help.

Right now, I am working on a small project about Home Meals vs. School Meals where I need to cost out and do a nutrient analysis on a typical home-prepared meal and compare to school lunch. Interviewing little K-3rd graders was so cute. They appear to be so intelligent; more intelligent than I ever thought I was at the age.

I also just wrote an article in Spanish about the benefits of school meals. I am currently inquiring to see if one of the local Spanish newspapers would be interested in publishing my article. In addition, I have been translating some other school meals brochures into Spanish so that they will have some Spanish information to post on their website.

Next, I think I need to work on the write up for my theme meal. In the end, the other intern and I decided to just run with the Taste of Thai theme. The recipe we wanted to test out with the kids was a Pineapple Chicken Curry dish. We did our first taste panel in March. It didn't go as smoothly as we expected, so there was a lot of kinks to work out. We just completed our 2nd taste panel. We learned from our mistakes and the recipe turned out a lot better. We only expanded the recipe for 25 servings for both taste panels but in "real life" the school would need to expand this recipe to 100 servings. Unfortunately, they will not be able to incorporate the new recipe to the school menu until next year, since all the menus for the year have been made out already.

May 9, 2005

Happy Mother's Day! Well, so much has happened since I last updated everyone. One of my latest internship projects included developing an educational promotion to increase dairy intake of kids to three servings a day. In mid-April, we launched the 3-A-Day Education Marketing Campaign in George Washington Middle School . I recruited the sponsorship of Shenandoah's Pride (milk vendor), National Dairy Council, and Partner for Healthier Kids to help donate promotional-themed items and prizes to ensure a successful marketing campaign. The middle school students took part in the campaign by participating in the GW "Got Milk" 2005 Poster Competition. The students illustrated the benefits of milk by creating a poster with background information and a slogan. The winner of the poster competition won a $50 gift certificate to Landmark Mall. To increase student participation, milk mustache photos were taken on the second day of the campaign. The campaign was set up to meet the nutrition and educational needs of the students. The campaign activities were outlined in the action plan. A promotional budget plan was prepared to estimate overall costs for promotional activities. Overall success of the pilot program was evaluated based on student participation during promotional activities, during poster design competition, increased dairy sales during the promotion week, and ability to stay within the allocated budget. We promoted the campaign at the school for two days and during both days, milk sales increased by 25%.

This was a surprise, since foodservice is not my forte, but leaving this rotation was sad. I really connected to the staff and I felt like I made really good connections. My preceptor is launching a new computer software called Nutri-Kids and she wanted me to stay after I graduate to help do some data entry and to get the program rolling. It's a paid position, but its only available for the summer.

After my food service rotation, I did my elective rotation, which included learning how to conduct cooking demonstrations. This was by far my favorite rotation. I went to two cooking demos where I learned how to make "Light and Healthy Spring Time Recipes" and "Desserts that will Impress Your Guests". Then I went to the Capital Area Food Bank in DC where I completed my training.

I just graduated on May 6th. I can't believe that it is all over!! It's bitter sweet. It's nice to be done and have all my projects completed, but on the other hand it's time to find a real job. So far I have received three job offers just through working at my sites and rotations. I got offered to work as a nutrition consultant for Primary Care Coalition, to work as a prn (as needed) diabetes educator to work with women with gestational diabetes, and to work in a management position at Head Start.

I felt that I came into this internship with emphasis in working with diabetes, but looking back, I feel like the experiences I have gained have made me well-rounded. Now I am able to work the full age spectrum from very young kids (Head Start) to middle aged military men (VA Medical Center) to elderly at-risk MOW participants (Area Agency on Aging). I strongly feel my professional, internship, and volunteer experiences will help me achieve my short term goal of becoming a dietitian and providing services to the medically underserved Hispanic community. My long term goal is to attain a Masters Degree in Public Health and to become a certified diabetes educator.

I hope these diary entries gave you an insider's view into the dietetic internship. Good Luck with finals and I wish you all the best in your future careers. Enjoy! Good Luck! Take Care!

For more information, contact nfscinfo@umd.edu

Last updated: 09/10/2007