It's clinical time!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I know I'm way too excited about this. And I know it's probably going to wear out eventually. But for now, let's all just rejoice in the fact that clinical rotations have started and are making me happier than a basketfull of puppies. And I would just looooove a basketfull of puppies.
My first clinical rotation was General Internal Medicine, in which I was with a dietitian who works primarily in the stroke and neurovascular wards/clinics. She also does some work on medical floors, so we saw some stuff outside of stroke as well. I did this rotation with a fellow intern who had also just come out of the foodservice rotation, so it was the first clinical rotation for both of us. Because our primary focus on this unit was stroke and neurovascular disorders, we dealt a lot with dysphagia (swallowing difficulties), enteral feeding (tube feeding when swallowing isn't working), and many, many cognitive challenges with our patients including speech difficulties and language barriers (both because of the stroke and the patients' ability to understand us/respond appropriately, as well as language barriers because the area we are in is primarily Portuguese and Italian). It's been super interesting. Like, ridiculously so. Every day is different, every patient's situation and plan is unique, and every nutrition support plan you make for a patient can change on a dime.
I.
LOVE.
It.
!!!
So since I didn't blog throughout the rotation, I'll give a general overview of the last 3 weeks...
First week of clinical was "orientation week", which really means that we had a half day or so orientation to the unit and common things to watch for before being tossed into it! Within the first 3 hours of the first day, we had already participated in neurovascular medicine rounds, and had a family meeting with a patient who was to be discharged back home with support from several community health services. The next day we were reviewing charts for medications affecting nutritional status and calculating enteral nutrition feeds for a patient who was scheduled to receive a G-tube (a feeding tube that is surgically implanted into the stomach, rather than the kind that goes up the nose and down the throat). By Thursday we were charting our own assessment and follow up notes, and calling for consults with other disciplines. It's all been very fast, and the first day or two was very overwhelming, but the pieces are starting to come together and make more sense. The more we get immersed, the more we're learning and becoming better able to work independently.
The really cool thing about general medicine, and particularly stroke/neurovascular medicine, is that several disciplines are involved in just about everything the patient does. Almost every patient (depending on their situation and how they were affected by their stroke) has a doctor, a physiotherapist, an occupational therapist, a speech language pathologist (SLP), a dietitian, a social worker, and maybe others who follow their case. Everyone meets every morning to discuss every case in the unit to keep each other updated on patient conditions, and collaborate to determine if other disciplines should get involved to better care for the patient. This also gives us interns a great opportunity to learn from these other disciplines, who also have their own students and are usually more than happy to have an extra couple tag along to observe their work. We've watched a few swallowing and language assessments from SLPs including two barium video fluoroscopies (where the patient drinks/eats something with barium in it, and their swallowing is x-rayed so that the SLPs can watch the video back and see whether the person is swallowing correctly).
Over the last 3 weeks, I've seen a lot of progression and growth - both my own, and my patients. It's been really cool to see stroke patients progress in their treatment and eventually get to go home. In the first week we met a man who was a retired physician and had had a stroke. He was receiving feeds through nasogastric tube (the up-the-nose down-the-throat kind) and wasn't making much sense when he talked. His language skills had been greatly affected - speech slurred, having difficulty finding the right words to use. When he could speak coherently, his cognitive ability seemed to be pretty impaired. This week he was eating pureed and thickened foods (a BIG deal to graduate from feeding tube to swallowing your own food!) and was talking clearly, and able to respond to questions coherently. He told us about his practice as a physician, and was able to participate in his care. Amazing. In my own growth, I've gone from having absolutely no confidence to speak to patients independently and being unsure of everything, to easily walking into patient's rooms and projecting confidence, empathy, and able to provide education to patients without my preceptor even being in the room with me. I'm also doing my own chart notes directly in the patient records, and just needed my preceptor's sign off (because we're students and can't legally sign off our own charts or write orders).
I'm now heading into clinical rotation #2 in musculoskeletal rehab, dealing with spinal cord injuries and disorders affecting muscular or neurological function (like Parkinsons, cerebral palsy and MS). Update to come!
Tuesday, February 25, 2014
Thursday, February 20, 2014
A guide to internship interviews
Many of my former classmates have been contacting me lately asking for advice to get through the next phase in internship applications: the interview. Undoubtedly, this was the most stressful part of the internship application process, but it doesn't have to be a terrifying experience!
Internship interviews are basically just really stressful job interviews. You've applied for a job as a dietetic intern (you know, the kind of job where you don't get paid). These organizations are interested in you because your application package - including your cover letter, resume, and references - were impressive! Getting an interview on its own is a huge feat, and something you should be super proud of yourself for. As I recall, one hospital I interviewed at last year said that they had received about 100 applications, and interviewed only 30. Lucky you!
The Obvious Questions
Consider how you would prepare for a job interview. You would think of some answers to the obvious questions, like "why do you want to work here", "why should we hire you", and "what are your strengths and weaknesses". Same thing goes here: the obvious questions include "why did you choose this organization to apply to", "why do you want to be a dietitian", and, similarly, "what are your strengths and weaknesses". You must, must, have an answer to these questions. If you do not know why you want to be a dietitian, or why you chose this program, you might not get too much farther in the interview!
No one likes the "strengths and weaknesses" questions, but they're inevitable. A great idea is to frame this question in a positive light - talk about your strengths as they apply to dietetic practice, but your weaknesses don't have to be a negative topic. I answered this question by explaining that I considered these as "areas for improvement or development" rather than weaknesses, and gave examples of how I would work to improve. For example, if you're not very strong in public speaking skills, you can talk about what ways you can improve your confidence speaking in front of groups. If you feel that you could improve your communication skills in general, you can talk about how you would like to gain strength in this skill by gaining more experience communicating (written, oral, etc) with diverse groups of people, and work on active listening skills.
Situation Questions
Pretty much every job and internship interview I have ever been to has asked a situation question. "Tell me about a time when you ...", "What would you do if ...", "Explain how you did..." questions are your opportunity to shine! Before going in for your interview, consider what skills are important to the organization you are interviewing for (which are often found in the brochure, the kind of skills that were important to write about in your cover letter). These skills usually include communication, interpersonal skills, leadership and/or teamwork skills, organizational/time management skills, accepting and giving feedback, and conflict management. Try to think of a few concrete examples that you can provide that demonstrate how great you are at these skills!
When you answer a situation-type question, tell it like a story with a beginning, a middle and an end. In the beginning, you explain what the issue or situation was; the middle is where you explain how you resolved it with your great skills; the end is where you explain how everything came together thanks to you. For example, in a "tell me about a time when you demonstrated leadership/teamwork", you could talk about that time when you did a group project at school. "In my ___ class, we were assigned a group project where we were asked to meet X, Y and Z requirements. I took a leadership role in this project by determining the goals and clearly stating objectives of the project with the team, deciding on timelines to meet those objectives, and worked with my team to delegate responsibility. We were able to complete the project on time and everyone in the team was very satisfied with the end result".
Type of interviews
Each internship program structures their interviews a bit differently. Some are standard panel interviews like you might normally have in a job interview, where there are a few hospital people and you in a room together. Some programs use group interviews, where you and several other applicants meet together with the panel. Others use something called Multiple Mini interviews. In these interviews, there are multiple rooms with different interviewers in each. Each room has a different focus (such as a foodservice focus, clinical focus, research focus, communication/interpersonal skills focus, etc), or might have an activity (like a written portion, or watching a video and answering questions about what you observed). Internship programs like to use this type of interview because its thought that it makes the interview less stressful for the applicants - you can mess up entirely in one room, and start over fresh in the next room with a completely different interviewer. In reality, I personally found the multiple mini interviews the most stressful - mostly because I had never had them before and wasn't comfortable with the format, but also that the "starting fresh" idea didn't really work for me. I just kept dwelling on how I messed up in the last room, which then affected me in the next one!
If you're able to, find out what type of interview your organization uses. Talk to their previous interns or other students who have interviewed there, or you can ask the internship coordinator if you feel comfortable with it. The type of interview might affect how you answer questions - for example, in a group discussion, you might want to have more than one example of situations on hand so that it doesn't sound like you're just duplicating someone else's similar experience.
Breathe.
The most important thing - try not to freak out. Impossible, I know. But try. If you're scared, it will show in your interview. Be yourself, and let your personality shine! In most interviews, who you are matters a whole lot more than your resume or grades.
Internship interviews are basically just really stressful job interviews. You've applied for a job as a dietetic intern (you know, the kind of job where you don't get paid). These organizations are interested in you because your application package - including your cover letter, resume, and references - were impressive! Getting an interview on its own is a huge feat, and something you should be super proud of yourself for. As I recall, one hospital I interviewed at last year said that they had received about 100 applications, and interviewed only 30. Lucky you!
The Obvious Questions
Consider how you would prepare for a job interview. You would think of some answers to the obvious questions, like "why do you want to work here", "why should we hire you", and "what are your strengths and weaknesses". Same thing goes here: the obvious questions include "why did you choose this organization to apply to", "why do you want to be a dietitian", and, similarly, "what are your strengths and weaknesses". You must, must, have an answer to these questions. If you do not know why you want to be a dietitian, or why you chose this program, you might not get too much farther in the interview!
No one likes the "strengths and weaknesses" questions, but they're inevitable. A great idea is to frame this question in a positive light - talk about your strengths as they apply to dietetic practice, but your weaknesses don't have to be a negative topic. I answered this question by explaining that I considered these as "areas for improvement or development" rather than weaknesses, and gave examples of how I would work to improve. For example, if you're not very strong in public speaking skills, you can talk about what ways you can improve your confidence speaking in front of groups. If you feel that you could improve your communication skills in general, you can talk about how you would like to gain strength in this skill by gaining more experience communicating (written, oral, etc) with diverse groups of people, and work on active listening skills.
Situation Questions
Pretty much every job and internship interview I have ever been to has asked a situation question. "Tell me about a time when you ...", "What would you do if ...", "Explain how you did..." questions are your opportunity to shine! Before going in for your interview, consider what skills are important to the organization you are interviewing for (which are often found in the brochure, the kind of skills that were important to write about in your cover letter). These skills usually include communication, interpersonal skills, leadership and/or teamwork skills, organizational/time management skills, accepting and giving feedback, and conflict management. Try to think of a few concrete examples that you can provide that demonstrate how great you are at these skills!
When you answer a situation-type question, tell it like a story with a beginning, a middle and an end. In the beginning, you explain what the issue or situation was; the middle is where you explain how you resolved it with your great skills; the end is where you explain how everything came together thanks to you. For example, in a "tell me about a time when you demonstrated leadership/teamwork", you could talk about that time when you did a group project at school. "In my ___ class, we were assigned a group project where we were asked to meet X, Y and Z requirements. I took a leadership role in this project by determining the goals and clearly stating objectives of the project with the team, deciding on timelines to meet those objectives, and worked with my team to delegate responsibility. We were able to complete the project on time and everyone in the team was very satisfied with the end result".
Type of interviews
Each internship program structures their interviews a bit differently. Some are standard panel interviews like you might normally have in a job interview, where there are a few hospital people and you in a room together. Some programs use group interviews, where you and several other applicants meet together with the panel. Others use something called Multiple Mini interviews. In these interviews, there are multiple rooms with different interviewers in each. Each room has a different focus (such as a foodservice focus, clinical focus, research focus, communication/interpersonal skills focus, etc), or might have an activity (like a written portion, or watching a video and answering questions about what you observed). Internship programs like to use this type of interview because its thought that it makes the interview less stressful for the applicants - you can mess up entirely in one room, and start over fresh in the next room with a completely different interviewer. In reality, I personally found the multiple mini interviews the most stressful - mostly because I had never had them before and wasn't comfortable with the format, but also that the "starting fresh" idea didn't really work for me. I just kept dwelling on how I messed up in the last room, which then affected me in the next one!
If you're able to, find out what type of interview your organization uses. Talk to their previous interns or other students who have interviewed there, or you can ask the internship coordinator if you feel comfortable with it. The type of interview might affect how you answer questions - for example, in a group discussion, you might want to have more than one example of situations on hand so that it doesn't sound like you're just duplicating someone else's similar experience.
Breathe.
The most important thing - try not to freak out. Impossible, I know. But try. If you're scared, it will show in your interview. Be yourself, and let your personality shine! In most interviews, who you are matters a whole lot more than your resume or grades.
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