So we realized that by the end of this rotation that erhmahgerd. We only have 8 WEEKS LEFT OF INTERNSHIP. Freaking. The eff. Out.
But, we'll get into the next steps in a bit. First, internship recap of the last 5 weeks at my community health centre (CHC) rotation!
I've been working at a CHC located about 2 blocks away from where I live, which has been just excellent because a) I can walk to work and have only used the subway maybe five or six times the whole rotation to get to offsite meetings, and b) this is my neighbourhood, and it's been super interesting to find out the demographics of people who live here and the food insecurity issues still present, even in a neighbourhood that appears generally to be quite affluent. CHCs have a reputation for being health centres only for the poor and marginalized, food insecure, recent immigrants, single parents, and people with other barriers to accessing health care at all. Certainly, that's how the CHC model began - to remove barriers preventing people from accessing health care and connect with communities to work on deeper underlying issues (such as housing, employment, food security). But, today's CHCs aren't places for only these marginalized and socially underserved groups - anyone can be served by a CHC. And, many have allied health professionals such as dietitians on staff, which you don't need a doctors' referral to see. However, CHCs do still focus on breaking down barriers and being accessible to people who would otherwise have limited access to health care, and provide many programs and services to clients for free.
One such program is the Kids Cooking Club, which I've been running for the last 5 weeks! I have a group of 8-12 year olds who come in once per week for 2 hours to learn basic cooking skills and basic nutrition. We have a focus on one food group each week (fruit/veg, grain, milk, meat/alternatives), and prepare 3 recipes focusing on those groups. The kids learn kitchen basics like handwashing and food safety, basic knife skills and food preparation (peeling, mashing, etc) and use the stove/oven to prepare meals that they can also make at home. We also strongly encourage the kids to try new foods - if they don't like it then that's fine, but we ask that they at least try once. After they eat their tasty treats, we have a nutrition lesson where I chat with the kids about the food group, how many servings per day they should aim for, what a serving size looks like, and how to make it fit into a day. My preceptor says that this year's group has been much less knowledgeable and more shocking than previous groups... their nutrition knowledge was near zero when they first started (most couldn't name all 4 food groups, for example), they were reluctant to try anything that wasn't meat and rice, their favourite healthy food on day one was blue KoolAid, and one 10 year old girl had never tried a tomato before in her entire life. Amazingly by week 4, we made a green salad (which I expected would end very badly with this group...), and they not only ate their portion, they lined up asking for more salad!!!!!!!!! SHOCK!!!!!!!!!!!!!!!!!!!!! We gave the kids a knowledge questionnaire before the sessions started, and again on the last day to see what they had learned - I was very pleased to see that all but one kid scored substantially higher on the quiz on the last day :) *proud*
Other than the cooking club, I also worked on a few smaller projects, gave a 2 hour presentation to mostly older adults about nutrition myths, and did a lot of networking with other health professionals and people working at other CHCs. I didn't get too much patient care experience here, but despite that I still feel like I learned tons. Being in this environment taught me the importance of considering a client/patient's needs from all sides - they aren't just having nutrition issues, and that nutrition issue may not be at the top of their priority list. I also got a lot of excellent experience working with different age groups - in particular, all this time I've been working with kids is going to come in really handy when I get to my first post-internship job at the CDA Camp in August!
Next up: one last research week/catch up on life, and then two more rotations: renal disease, and staff relief (also going to be in renal). And then? Well friends, then we're DONE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Thursday, June 12, 2014
Saturday, May 10, 2014
Internship recap: Week 27-29
Keep on going!
This rotation is at Princess Margaret Cancer Centre, and I couldn't be more excited about having this placement. This is the main reason I applied to my internship in the first place - a rotation in oncology from the largest cancer centre in the country, and one of the top rated in the world for treatment and research efforts. It's also the place where both my dad and my fiance's dad were treated for multiple myeloma, giving them another chance at living. I couldn't wait for the opportunity to be involved in this amazing place and give back to the hospital that has done so much for my family and thousands of others.
I'm working with head and neck cancers, including oral, sinus, pharyngeal (throat) and tongue cancers. Most patients are receiving radiation therapy, and some receive chemo and radiation in combination. The patients who I see are mostly those who are undergoing more intensive treatment: chemorads (combo therapy), or accelerated radiation treatments (instead of going once a day for 5 days/week, they go twice a day for one or more of those days), who are automatically scheduled to see a dietitian weekly to help manage the side effects of their treatment, and keep their weight as stable as possible. This often requires them to have a gastrostomy tube inserted so that they can receive nutrition supplement feeds, water/hydration, and take medications without using the throat. We also see patients on a regular radiation treatment schedule if they or their doctor request it. Usually these are the patients who had a history of alcohol abuse or severe weight loss prior to the treatment starting and are at greater risk of malnutrition and poor treatment outcomes.
It. Is. Awesome.
I was honestly a bit worried coming into the rotation that it might be kind of overwhelming, given my dad's current situation. But, it's been totally fine - it's a completely different type of cancer and very different kind of treatment. I'm doing fine emotionally with being here, but it is admittedly hard to be empathetic without feeling sorry for my patients. In particular, the ones with similar stories to my dad - middle aged men with young families, no history of smoking or alcoholism or much other medical history, who suddenly find themselves receiving radiation for throat cancer. Sometimes cancer just can't be explained, and it can be very sad. But, I know it's my job to make their journey just a little easier, and have one more person they can rely on to provide support, encouragement and hope.
By my second day, I was leading outpatient clinic visits with my preceptor in the room, and week 2 I was completely on my own. I led both the outpatient clinic and managed an inpatient load independently for the majority of my time here, with minimal help from my preceptor. Sure I made mistakes, but she gave me room to make them, learn from them, and correct them (mind you, the mistakes I made were never life threatening or anything, just maybe better advice or a better supplement regimen could have been chosen for the patient and could be corrected the next time they were in). In this rotation, I felt the most comfortable, confident, and competent that I have in any other rotation. Nurses referred to me as "the dietitian" and asked a couple of times if the regular girl (my preceptor) was on vacation or something. When I said I was her student, they looked aghast and said I was "legit" (their words :P). Patients told me they were grateful for the intervention of a dietitian to help them through the journey, and my last few were even a bit sad when I told them that I was leaving and they'd be followed up by someone else. It was truly rewarding to know that I was making a big difference in these people's lives, and I am so, SO grateful that I was able to have this experience in my internship.
Next up - 5 weeks in a community health centre! This rotation is super convenient - I live like 3 blocks away. I won't have to pay subway fare for over a MONTH! And when you're an unpaid intern, that's like, a super huge deal.
This rotation is at Princess Margaret Cancer Centre, and I couldn't be more excited about having this placement. This is the main reason I applied to my internship in the first place - a rotation in oncology from the largest cancer centre in the country, and one of the top rated in the world for treatment and research efforts. It's also the place where both my dad and my fiance's dad were treated for multiple myeloma, giving them another chance at living. I couldn't wait for the opportunity to be involved in this amazing place and give back to the hospital that has done so much for my family and thousands of others.
I'm working with head and neck cancers, including oral, sinus, pharyngeal (throat) and tongue cancers. Most patients are receiving radiation therapy, and some receive chemo and radiation in combination. The patients who I see are mostly those who are undergoing more intensive treatment: chemorads (combo therapy), or accelerated radiation treatments (instead of going once a day for 5 days/week, they go twice a day for one or more of those days), who are automatically scheduled to see a dietitian weekly to help manage the side effects of their treatment, and keep their weight as stable as possible. This often requires them to have a gastrostomy tube inserted so that they can receive nutrition supplement feeds, water/hydration, and take medications without using the throat. We also see patients on a regular radiation treatment schedule if they or their doctor request it. Usually these are the patients who had a history of alcohol abuse or severe weight loss prior to the treatment starting and are at greater risk of malnutrition and poor treatment outcomes.
It. Is. Awesome.
I was honestly a bit worried coming into the rotation that it might be kind of overwhelming, given my dad's current situation. But, it's been totally fine - it's a completely different type of cancer and very different kind of treatment. I'm doing fine emotionally with being here, but it is admittedly hard to be empathetic without feeling sorry for my patients. In particular, the ones with similar stories to my dad - middle aged men with young families, no history of smoking or alcoholism or much other medical history, who suddenly find themselves receiving radiation for throat cancer. Sometimes cancer just can't be explained, and it can be very sad. But, I know it's my job to make their journey just a little easier, and have one more person they can rely on to provide support, encouragement and hope.
By my second day, I was leading outpatient clinic visits with my preceptor in the room, and week 2 I was completely on my own. I led both the outpatient clinic and managed an inpatient load independently for the majority of my time here, with minimal help from my preceptor. Sure I made mistakes, but she gave me room to make them, learn from them, and correct them (mind you, the mistakes I made were never life threatening or anything, just maybe better advice or a better supplement regimen could have been chosen for the patient and could be corrected the next time they were in). In this rotation, I felt the most comfortable, confident, and competent that I have in any other rotation. Nurses referred to me as "the dietitian" and asked a couple of times if the regular girl (my preceptor) was on vacation or something. When I said I was her student, they looked aghast and said I was "legit" (their words :P). Patients told me they were grateful for the intervention of a dietitian to help them through the journey, and my last few were even a bit sad when I told them that I was leaving and they'd be followed up by someone else. It was truly rewarding to know that I was making a big difference in these people's lives, and I am so, SO grateful that I was able to have this experience in my internship.
Next up - 5 weeks in a community health centre! This rotation is super convenient - I live like 3 blocks away. I won't have to pay subway fare for over a MONTH! And when you're an unpaid intern, that's like, a super huge deal.
Friday, April 11, 2014
Internship Recap: Week 22-25
Diabetes education program!!!
I was super stoked to come into this rotation, because diabetes education is an area I'm really, really interested in working in professionally. And, this is my first outpatient rotation (where people are coming in to see us from home, rather than us barging in on their hospital room).
The centre I'm in is part of a family health team in downtown Toronto, and we provide education for diabetes management to people who have been diagnosed with Type 1, Type 2 or pre-diabetes. This includes people who are managing their diabetes through oral medications only, insulin, or through lifestyle modification alone (so no gestational diabetes, and no Type 1 using insulin pumps). Our clients come to the centre to meet with nurses and dietitians for assistance with managing their diabetes, including diet and lifestyle modifications, insulin adjustments, and recommendations to alter medications (which need approval from a doc). We also offer a huge number of classes to explain the condition to newly diagnosed people (different classes for each type), and to help them manage their condition (such as physical activity classes, label reading classes and supermarket tours).
The first week was really more an orientation to diabetes education, shadowing my preceptors (there are two dietitians working at this centre, so I kind of float between the two of them depending on whether their clients are comfortable having a student there), and starting to get more involved with client visits by taking diet histories. I also spent lots of time with the nurses to learn about using glucometers and reviewing the types of oral medications and insulins that our clients are taking. We need to be very familiar with these medications, as their effects will greatly influence how we provide care to clients! For example, if a client is on a medication that has a high risk of hypoglycemia, the recommendations I make for them will be very different than what I would offer to someone who has little risk of hypos. By the end of the week I was feeling pretty comfortable with the process and ready to start taking charge more in client meetings (considering that I had just come from a rotation where I was operating pretty much independently) -- but, I had so few clients to see!!! I told my preceptor that I'd like to start working more independently with the next clients we were expecting at the end of the week, and they agreed - but then the appointments all cancelled! D'oh... This is the unfortunate reality of outpatient clinics -- people have the choice as to whether they want to come see you or not. Even if they confirm their appointment, there's still no guarantee that they are actually going to show up!
By the end of week 2 I was taking charge much more often in appointments, and led part of a group education class (I taught people about the complications of unmanaged diabetes and some management strategies), and in the last week I was running pretty well independently again, though my preceptor was much more involved than the previous rotation. This was really more by my request than anything else, because I was still getting used to the outpatient environment where clients come up with very random out-of-the blue questions on a regular basis! For example, one client came in for their regular RD follow up, but actually wanted to talk about issues with IBS and her upcoming colonoscopy to investigate her for diverticulitis. Though I have some knowledge on these topics (particularly being a fellow IBS sufferer!), it was helpful to have my preceptor there to rely on for specific questions she had. I've also had several clients with psychiatric and emotional issues affecting how we conduct the appointment, which I've never really worked with before, so I was grateful for my preceptor's support!
It also struck me recently that OMG - THERE'S LESS THAN FOUR MONTHS LEFT!!!!!!!!! In four months, I will have my temporary licence and be able to legally practice with the letters "RD" behind my name!
Not only that, but I also got amazing news during this rotation: I HAVE MY FIRST POST-INTERNSHIP JOB LINED UP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! AAAAAAAAAAAAHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Mind you it's very temporary, only a week long gig, but I will get PAID!!!!
I'll be working with a dietitian at a summer camp for the Canadian Diabetes Association with kids with Type 1 diabetes! The super cool part of this job (besides the paycheque) is that since I'll officially have my licence (even a temporary licence still counts), I can count all of the hours I work at the camp towards getting my Certified Diabetes Educator certificate, which you need 500 hours to qualify for. An overnight camp will let me rack up loads of hours in a pretty short period of time!
Oh yeah, and not only will I be able to be employed in four months, but I'm also getting MARRIED IN 8 MONTHS!!! It's sneaking up fast, but so far the panic hasn't set in yet: we have a date, a venue, a photographer, a DJ, and I got my dress already :D
By the end of week 2 I was taking charge much more often in appointments, and led part of a group education class (I taught people about the complications of unmanaged diabetes and some management strategies), and in the last week I was running pretty well independently again, though my preceptor was much more involved than the previous rotation. This was really more by my request than anything else, because I was still getting used to the outpatient environment where clients come up with very random out-of-the blue questions on a regular basis! For example, one client came in for their regular RD follow up, but actually wanted to talk about issues with IBS and her upcoming colonoscopy to investigate her for diverticulitis. Though I have some knowledge on these topics (particularly being a fellow IBS sufferer!), it was helpful to have my preceptor there to rely on for specific questions she had. I've also had several clients with psychiatric and emotional issues affecting how we conduct the appointment, which I've never really worked with before, so I was grateful for my preceptor's support!
It also struck me recently that OMG - THERE'S LESS THAN FOUR MONTHS LEFT!!!!!!!!! In four months, I will have my temporary licence and be able to legally practice with the letters "RD" behind my name!
Not only that, but I also got amazing news during this rotation: I HAVE MY FIRST POST-INTERNSHIP JOB LINED UP!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! AAAAAAAAAAAAHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Mind you it's very temporary, only a week long gig, but I will get PAID!!!!
I'll be working with a dietitian at a summer camp for the Canadian Diabetes Association with kids with Type 1 diabetes! The super cool part of this job (besides the paycheque) is that since I'll officially have my licence (even a temporary licence still counts), I can count all of the hours I work at the camp towards getting my Certified Diabetes Educator certificate, which you need 500 hours to qualify for. An overnight camp will let me rack up loads of hours in a pretty short period of time!
Oh yeah, and not only will I be able to be employed in four months, but I'm also getting MARRIED IN 8 MONTHS!!! It's sneaking up fast, but so far the panic hasn't set in yet: we have a date, a venue, a photographer, a DJ, and I got my dress already :D
Next week is a well-deserved vacation week (though I'll be spending most of it on finishing up my research, as our abstracts are due for submission in a couple of weeks too :/). After that, the rotation I've been waiting for since I first applied to this internship: ONCOLOGY!!!! Most of the reason I applied to this internship was to work at Princess Margaret Cancer Centre, one of the leading cancer centres in the world, and the place that gave my dad a second shot at life after his multiple myeloma diagnosis. I'm so excited to have the opportunity to contribute to this organization and give back in whatever way I can to help support other patients through their cancer journey.
Tuesday, March 18, 2014
Internship selection day
Monday, March 10th was internship selection day here in Canada. This is the day that all internship applicants both look forward to and dread at the same time, as this is the day that decides whether you get to be a dietitian or not. A program that you applied to and interviewed at has decided that they want you in their program, or the programs have decided to pick your classmates instead.
You check your email at 9am on the dot and see an email from DC. Take a deep breath. Click it. And find out your fate.
This is probably the most stressful time of the entire internship application process (not to say that the rest of it was any easier :/). This is the moment where you find out how you will spend your next year, whether you will need to go through the whole process all over again next year (if you even want to go through it all again), and whether you'll be able to be an RD by next year. Then you get to go to school with your fellow applicants later that day, because school doesn't actually end till April, and see the awkwardness. No one says a word. No one dares look at anyone else, because you'll be able to tell the instant you catch their gaze whether they got the "successful applicants" email or not. Or, you show up to class and only half of you are actually there. You can bet dollars to donuts that the people in class are the ones who got in. The ones who aren't there may be too devastated or embarrassed to deal with everyone else's excited and teary face.
In other words, it's a really, really crappy time. Even for the successful applicants, it still sucks. You want to be able to share your news. You want to be happy for your friends who got in. You want to be excited because you got in!!!. And yet, you don't say a word. You try hard to stifle your excitement and go about your business as though nothing happened, because you don't want to be the jerk who gets excited and jumps up and down with your friend, who you worked on your application with and who was your rock throughout the whole journey, only to find out that their dream was crushed by an unfair selection system.
Some people continued to get news throughout the week. If an applicant was accepted to more than one program or got a grad school as well, they need to turn at least one of those programs down to select the one they'll take, meaning that their spot opens up for the next person on the list. Now that a week has passed, most of these people have received their email, but there are still 60-70% of applicants who didn't get anything at all.
So now what?
I'll post up some blogs later about the next steps, no matter what your result was. For now though, whether you were a successful applicant or not, you should be very, very proud of yourself. Those who didn't get a spot - you went through one of the toughest application processes out there. Yes, it sucks that you won't be spending your next year in internship, but here's the thing: you now get an extra year to gain more experience, build an even more stellar application package, be extra prepared for interviews because you've already done it once, and work to build up enough savings to actually make it through a whole year of unpaid internship next time. You'll be able to get the inside scoop on internship programs from your friends who did get in, helping you to decide if that's really the right place for you to apply to. You might actually end up in a better position than the people who got in their first time around!
Those who did get a spot, you should be proud of yourselves too! Of course you're feeling excited, you told all your non-dietetic friends and family - but have you said anything to your classmates and colleagues yet? Hmm. Didn't think so. Even though you're excited and proud, there's still a sense of shame that goes along with getting into internship because you don't want to hurt your friends' feelings. I get it. I was that person too. In those first few weeks, I was DYING TO TELL PEOPLE, but only told the friends who didn't apply that year, and maybe one or two of my absolute closest friends who did apply. But even when I told them my news, it was very quietly and almost shameful to say that I was in, because I knew that there were so many deserving people who didn't. The reality is that you are among about 30% of applicants who managed to get a spot, and you should be incredibly proud of yourself for that accomplishment!
No matter what your news was, BE PROUD OF EACH OTHER. Support each other. This is the time when, regardless of your news, you need a hug really, really badly. Be there for your classmates/fellow applicants and don't be ashamed to share your news!
You check your email at 9am on the dot and see an email from DC. Take a deep breath. Click it. And find out your fate.
This is probably the most stressful time of the entire internship application process (not to say that the rest of it was any easier :/). This is the moment where you find out how you will spend your next year, whether you will need to go through the whole process all over again next year (if you even want to go through it all again), and whether you'll be able to be an RD by next year. Then you get to go to school with your fellow applicants later that day, because school doesn't actually end till April, and see the awkwardness. No one says a word. No one dares look at anyone else, because you'll be able to tell the instant you catch their gaze whether they got the "successful applicants" email or not. Or, you show up to class and only half of you are actually there. You can bet dollars to donuts that the people in class are the ones who got in. The ones who aren't there may be too devastated or embarrassed to deal with everyone else's excited and teary face.
In other words, it's a really, really crappy time. Even for the successful applicants, it still sucks. You want to be able to share your news. You want to be happy for your friends who got in. You want to be excited because you got in!!!. And yet, you don't say a word. You try hard to stifle your excitement and go about your business as though nothing happened, because you don't want to be the jerk who gets excited and jumps up and down with your friend, who you worked on your application with and who was your rock throughout the whole journey, only to find out that their dream was crushed by an unfair selection system.
Some people continued to get news throughout the week. If an applicant was accepted to more than one program or got a grad school as well, they need to turn at least one of those programs down to select the one they'll take, meaning that their spot opens up for the next person on the list. Now that a week has passed, most of these people have received their email, but there are still 60-70% of applicants who didn't get anything at all.
So now what?
I'll post up some blogs later about the next steps, no matter what your result was. For now though, whether you were a successful applicant or not, you should be very, very proud of yourself. Those who didn't get a spot - you went through one of the toughest application processes out there. Yes, it sucks that you won't be spending your next year in internship, but here's the thing: you now get an extra year to gain more experience, build an even more stellar application package, be extra prepared for interviews because you've already done it once, and work to build up enough savings to actually make it through a whole year of unpaid internship next time. You'll be able to get the inside scoop on internship programs from your friends who did get in, helping you to decide if that's really the right place for you to apply to. You might actually end up in a better position than the people who got in their first time around!
Those who did get a spot, you should be proud of yourselves too! Of course you're feeling excited, you told all your non-dietetic friends and family - but have you said anything to your classmates and colleagues yet? Hmm. Didn't think so. Even though you're excited and proud, there's still a sense of shame that goes along with getting into internship because you don't want to hurt your friends' feelings. I get it. I was that person too. In those first few weeks, I was DYING TO TELL PEOPLE, but only told the friends who didn't apply that year, and maybe one or two of my absolute closest friends who did apply. But even when I told them my news, it was very quietly and almost shameful to say that I was in, because I knew that there were so many deserving people who didn't. The reality is that you are among about 30% of applicants who managed to get a spot, and you should be incredibly proud of yourself for that accomplishment!
No matter what your news was, BE PROUD OF EACH OTHER. Support each other. This is the time when, regardless of your news, you need a hug really, really badly. Be there for your classmates/fellow applicants and don't be ashamed to share your news!
Saturday, March 15, 2014
Internship recap: Week 18-21
We're HALFWAY DONE THE INTERNSHIP!!!!!!!!!!!!!!!!!!!!!!!!!!!!
The last three weeks I've been at a rehabilitation hospital working in the musculoskeletal rehab unit. This is a completely different world than the acute care setting I was working in with my last rotation - in rehab, patients are medically stable. No one is ill, no one is on IV fluids/medications, and the patients are fully conscious, participatory in their care, and very mobile. Most of the patients in the musculoskeletal rehab unit are there for rehab for hip fractures, hip replacements, and knee replacements, though we also have about 8 beds available for oncology patients needing rehab after cancer treatment (usually because they lost way too much weight and need to rebuild muscle mass). I also spent 2 days a week at a different site of this hospital in spinal cord injury rehabilitation, where most patients are paraplegic or quadriplegic. Most of these patients have spinal cord injuries from motor vehicle accidents, sports injuries, "stupid" injuries (like trying to jump off your roof for some reason), or have a condition that affects neuromuscular function such as multiple sclerosis.
The first week here was like orientation all over again. Though this hospital is part of the network that I'm interning with, it's the most recent acquisition and hasn't quite made a full transition yet to the practices and technologies available at the other sites. So, it took me the whole first week to figure out where to find things, how patient caseloads are managed, how chart notes are organized and written, and who to ask/where to find information. I had a lot of bad days. Days where I felt like I'd completely lost all the independence and competence that I thought I had from the last rotation, and felt super dumb because I didn't know how to do most things. My preceptor challenged me a lot - which is a good thing really, but I often felt dumb for not knowing the answer to questions that seemed like they should have been obvious. But I was determined to manage this rotation, and spent most of my "free time" in that first week doing readings and practicing doing assessments and chart notes to get more familiar with the process at this hospital compared to the last rotation.
By the second week, things were much smoother. I think my preceptor and I kind of figured each other out a bit more and learned how we worked best together, how I learn best and how she could help me get the most out of the rotation. By mid-week I had my own caseload and was visiting patients independently to complete assessments and do follow up work. My preceptor and I caught up once or twice a day so I could review what I'd done and make sure that my care plans were appropriate for the patient, and get her to order new diet orders or supplements I recommended (because as an intern, I can't sign for my own orders yet). I even attended a family meeting by myself with other team members to coordinate a patient's discharge planning. I gave the family information and offered education to help them achieve his nutritional goals (gaining/maintaining weight) while managing his other symptoms and comorbidities (low appetite, managing diabetes). By the end of the rotation, I felt much, much more competent and independent, felt comfortable to manage my caseload and develop a care plan/follow up with patients solo, and felt that my preceptor trusted my judgement and rationale for the care plan I had chosen.
This rotation also gave me my first case study! In this internship, we have two case studies to complete during the clinical portion of the program: one in the first half, one more complicated case in the second half. To qualify as a patient for these case studies, we need to have been the primary dietitian working with the patient, and have seen them from admission onward (to complete an assessment for the patient ourselves, rather than having them transferred from another dietitian's care plan). This patient was admitted early in my second week for rehabilitation following cancer treatment, where he'd unfortunately had a rough experience with severe mouth sores, nausea and vomiting, GI issues, and very large weight loss. I followed him pretty well completely independently from his admission through to discharge, created a care plan, followed up with him regularly, collaborated with other team members to get the "bigger picture" of his care, created a discharge plan for him, and provided diet education specific to his particular needs (of which he had many because of the cancer itself, side effects of the treatment, and other medical issues he had prior to hospitalization). I'll be delivering my case study presentation sometime later this month!
Next week I'm moving into yet another research week (read : a week to catch up on all the housework and errands I haven't had time to do in the last several months, catch up on reading for my next rotation, and - yeah, do research :/) I'm super excited for the rotation that follows the week after though: DIABETES!!! I'll be working in a diabetes education centre within a family health team, which is the kind of environment that I kind of see myself working in when I'm ready to work!
Updates to come :)!
The last three weeks I've been at a rehabilitation hospital working in the musculoskeletal rehab unit. This is a completely different world than the acute care setting I was working in with my last rotation - in rehab, patients are medically stable. No one is ill, no one is on IV fluids/medications, and the patients are fully conscious, participatory in their care, and very mobile. Most of the patients in the musculoskeletal rehab unit are there for rehab for hip fractures, hip replacements, and knee replacements, though we also have about 8 beds available for oncology patients needing rehab after cancer treatment (usually because they lost way too much weight and need to rebuild muscle mass). I also spent 2 days a week at a different site of this hospital in spinal cord injury rehabilitation, where most patients are paraplegic or quadriplegic. Most of these patients have spinal cord injuries from motor vehicle accidents, sports injuries, "stupid" injuries (like trying to jump off your roof for some reason), or have a condition that affects neuromuscular function such as multiple sclerosis.
The first week here was like orientation all over again. Though this hospital is part of the network that I'm interning with, it's the most recent acquisition and hasn't quite made a full transition yet to the practices and technologies available at the other sites. So, it took me the whole first week to figure out where to find things, how patient caseloads are managed, how chart notes are organized and written, and who to ask/where to find information. I had a lot of bad days. Days where I felt like I'd completely lost all the independence and competence that I thought I had from the last rotation, and felt super dumb because I didn't know how to do most things. My preceptor challenged me a lot - which is a good thing really, but I often felt dumb for not knowing the answer to questions that seemed like they should have been obvious. But I was determined to manage this rotation, and spent most of my "free time" in that first week doing readings and practicing doing assessments and chart notes to get more familiar with the process at this hospital compared to the last rotation.
By the second week, things were much smoother. I think my preceptor and I kind of figured each other out a bit more and learned how we worked best together, how I learn best and how she could help me get the most out of the rotation. By mid-week I had my own caseload and was visiting patients independently to complete assessments and do follow up work. My preceptor and I caught up once or twice a day so I could review what I'd done and make sure that my care plans were appropriate for the patient, and get her to order new diet orders or supplements I recommended (because as an intern, I can't sign for my own orders yet). I even attended a family meeting by myself with other team members to coordinate a patient's discharge planning. I gave the family information and offered education to help them achieve his nutritional goals (gaining/maintaining weight) while managing his other symptoms and comorbidities (low appetite, managing diabetes). By the end of the rotation, I felt much, much more competent and independent, felt comfortable to manage my caseload and develop a care plan/follow up with patients solo, and felt that my preceptor trusted my judgement and rationale for the care plan I had chosen.
This rotation also gave me my first case study! In this internship, we have two case studies to complete during the clinical portion of the program: one in the first half, one more complicated case in the second half. To qualify as a patient for these case studies, we need to have been the primary dietitian working with the patient, and have seen them from admission onward (to complete an assessment for the patient ourselves, rather than having them transferred from another dietitian's care plan). This patient was admitted early in my second week for rehabilitation following cancer treatment, where he'd unfortunately had a rough experience with severe mouth sores, nausea and vomiting, GI issues, and very large weight loss. I followed him pretty well completely independently from his admission through to discharge, created a care plan, followed up with him regularly, collaborated with other team members to get the "bigger picture" of his care, created a discharge plan for him, and provided diet education specific to his particular needs (of which he had many because of the cancer itself, side effects of the treatment, and other medical issues he had prior to hospitalization). I'll be delivering my case study presentation sometime later this month!
Next week I'm moving into yet another research week (read : a week to catch up on all the housework and errands I haven't had time to do in the last several months, catch up on reading for my next rotation, and - yeah, do research :/) I'm super excited for the rotation that follows the week after though: DIABETES!!! I'll be working in a diabetes education centre within a family health team, which is the kind of environment that I kind of see myself working in when I'm ready to work!
Updates to come :)!
Tuesday, February 25, 2014
Internship Recap: Week 15-17
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!
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!
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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