Dietetic Internship Prep: Summer Guide

The only dietetic internship prep guide you’ll need this summer. This checklist of 7 items will set you up for DI success.

Dietetic Internship Prep: Summer Guide

You landed a spot in a dietetic internship. Congratulations!

Feels like the hard part is over, right?

But what happens between now and Day One of your internship?

That’s a lot of time for you to forget everything you learned in school.

It’s also a great time to do some dietetic internship prep and be fully ready for your first day.

Instead of waking up the day before your internship starts and feeling the panic set in, you can start here and review a few of the things that will help you keep your head above water.

Those things that will make sure you start your internship feeling confident, instead of overwhelmed.

Here are 7 things we’re going to start thinking about right now:

Preceptors Part 1: An Introduction
MNT to Review
EMR Focus Areas
Diet Orders
Talking to Patients
Writing the Assessment Summary
Preceptors Part 2: Managing the Differences

Let’s get started.

7 Tips to Doing Dietetic Internship Prep (the right way)

#1: PRECEPTORS PART 1: AN INTRODUCTION

In school, we’re taught that there’s a single or simple way to manage everything in nutrition.

But your internship will show you the drastically different ways a single medical condition can present itself in different people.

And what your preceptors will teach you is that every RD has a slightly different way of doing the same work to support those different people.

The flip side of this means you’re going to suddenly be exposed to the range of answers that are all generally acceptable along the continuum of clinical nutrition.

And each time you sit with a new preceptor, you’re going to be expected to learn that dietitian’s preferences.

So, how do you prep for your dietetic internship?

Go with it.

Take notes on how each preceptor likes to do things.

When you read their previous notes, keep track of the way they phrase PES statements, the way they document weights, the way they note patient education.

Then just follow their lead.

It might be tedious. And it could mean you won’t have a chance to develop your own style as an intern.

But it will get you through your internship.

And once you’re a registered dietitian, you’ll be able to chart in any way you feel most comfortable.

In the meantime, dietetic internship prep is all about getting through your DI.

#2: MNT TO KNOW

Maybe the biggest question students have during their dietetic internship prep is what you should buy to be ready for Day 1.

Don’t worry about having the right pants, or a storage clipboard that will keep your notes cleanest.

Those things are definitely fun to shop for, but they aren’t going to make a lick of difference for your internship.

Now’s the time to start thinking about the kind of clinical nutrition you’re going to be asked to do when you hit that core part of your DI program.

So, what does that look like?

You need to know your medical nutrition therapy basics really, really well.

Here are some of the most important things to know on Day One of your clinical rotations:

Therapeutic and dysphagia diets, when to use them, and how to write them to completion
Evaluating weight status, how to complete NFPEs, and identifying malnutrition status
Choosing enteral nutrition formulas and writing those diet orders
Understand the basics of PN, but out of all the clinical nutrition you should be focused the least on this
Knowing what labs are important and how to use those values to write your assessment

These fundamentals are by no means an exhaustive list. But they are a great start.

Obviously, you can’t know it all.

As a student, there’s no reasonable reason you SHOULD be expected to know the ins and outs of every medical condition out here.

It’s easy to stumble on a diagnosis you’ve never heard of.

But when you know these clinical basics, you’re going to have the starting point you need to ask better questions and know what you’re looking for in a medical chart.

And that is going to help you write better assessments, faster.

#3: EMR FOCUS AREA

Knowing MNT on paper is one thing.

It’s a totally different ballgame when you have to start pulling clues about a patient out of a jam-packed medical chart.

And then assemble them like a magical jigsaw puzzle.

With so much information, it’s so easy to feel like everything is important.

Like every note should be read. Every lab should be reviewed. Every medication needs to be addressed.

But in reality, you’re going to have to move a whole lot faster than it takes to read an entire medical chart on a patient from front to back.

And with the minimum expectation of notes to complete for most interns, that means you’re going to have to find a better system.

You’ve got to know what to look for, what information is actually relevant, and be able to assemble your information in a way that’s clear and precise.

This is a big part of doing prep for your dietetic internship.

**So, what should you pay attention to?**

Start with figuring out where most of the useful information is kept.

Some facilities like everything to be documented in formal assessments and evaluations.

Other facilities have their staff write most of their updates as progress notes.

Next, find out where past medical history or admitting documentation is kept.

If you’re in an acute care setting, it’s where can you find the paperwork for new admits from the ED?

If you’re working in sub-acute or long-term care, where can you find the discharge paperwork from the hospital they’re being sent from?

Lastly, know what you’re expected to document on so you can keep a sheet that lets you easily jot down information as you find it in the chart.

When you have all the key points you’re looking for in front of you, it’s a whole lot easier to look for that specific information in a chart instead of reading through a million important-looking evaluations.

#4: WRITING DIET ORDERS

This should be pretty straightforward.

You’ve spent a lot of time in school getting clear on what common therapeutic diets are and when to use them.

And if you’re comfortable using those on paper, you’ll be just fine assigning them to real people with real health issues.

But when you get to your internship, there might be a couple of things that are a bit different than the simplified versions you learned in school.

So, what might be different about writing diet orders in your internship?

First, expect some potential differences in the names of common therapeutic diets.

You might see something like:

Cardiac might be called heart healthy
CCD might be called anything from Diabetes Diet to a sugar-restriction
Instead of a renal diet, maybe there’s only a liberalized renal diet (whatever that is)

Sounds strange, but anything is possible.

The same goes for dysphagia diets.

Not all facilities have caught up with the new IDDSI guidelines.

So be ready with some flexibility in identifying and documenting consistency changes.

Second, remember that you’ve got to include everything in a diet order for it to be a complete diet order.

This includes the therapeutic diet + any consistency changes + all supplements currently ordered.

String these together in any way you want. Just make sure they’re all present when someone reviews your note for a diet order.

Third, it might be harder than you think to implement any therapeutic diet order that isn’t in the top 4 common diets (regular diet, diabetes diet, cardiac diet, renal diet).

It’s always great to want to get someone a low (or high) fiber diet, a gluten-free vegan diet, or a high (or low) protein diet in some cases.

But the reality is, large-scale facilities have standardized menus for a reason. And getting exceptions to the rule might take a bit of hustle.

You might need to get a little creative, a little scrappy, and a bit innovative to get some of the diet recommendations manifested onto a diet order tray for 3 meals a day.

Not that this is impossible. It’s never impossible.

But it will likely be more of a challenge than writing your last case study will have you believe.

So get your gloves on, and be ready to fight for what your patients need, when the time comes.

#5: TALKING TO PATIENTS

Never forget, our patients are the entire reason we’re dietitians.

It’s easy to forget that when you’re completely consumed with writing the perfect assessment or digging through an EMR for one piece of information.

But the truth is you’re not here to only write diet orders and evaluate medications (even if it feels like that sometimes).

As a registered dietitian, your job description is built around being able to successfully support your patients.

And that means, at some point, you’ve got to get really good at having great conversations with them.

If the idea of walking into a room and having to tell someone three times your age what they should and shouldn’t be doing makes you nervous, you’re not alone.

So, how do you do nutrition counseling without sweating through your scrubs?

There are a few things that will make it easier.

Get really good at asking questions
Come in knowing what you want to talk about
Spend most of your time with people who are actually interested

Is this the whole story?

Of course not.

You’re still going to need to know what to say.

And maybe more importantly, know how to say things.

Presentation of your education materials can be the difference between your patient feeling judged and immediately tuning out the conversation.

…Or feeling like there’s finally someone who actually cares and is invested in seeing them get healthier.

#6: WRITING THE ASSESSMENT SUMMARY

When you’re doing dietetic internship prep, this is the hardest part to think through.

Until you actually see it in real life.

But this is where all your hard work comes together:

The medical nutrition therapy you’ve linked to what you found in the medical record
The information you got from talking to your patient
The diet order you’re planning on assigning to your patient

Nutrition Assessment templates are usually long with a lot of click boxes and specific places to put specific information.

They tend to be tough to read when quickly reviewing.

And sometimes the information you’re looking for is tucked into easy-to-overlook boxes.

This is why there’s a summary section (or a comment box at the end of the template).

It gives you a chance to gather your thoughts, then put them into easy-to-read statements.

So, what goes into an assessment summary?

Before we go over the details of a summary section, it’s worth saying that every dietitian does nutrition differently.

And that of course means every preceptor you have and every dietitian you work with will use this comment box differently.

Some will use the summary section in assessments to itemize their interventions and how they’ll monitor each intervention.

They’ll use lists and bullet points to document what they’re doing for their patients with nothing extra in the summary.

Or a summary section can be much more comprehensive.

Some RDs outline every part of the assessment template into a few short paragraphs.

This puts everything in the nutrition assessment in a single place, making it that much easier to find exactly the information they’ve documented on.

Remember: there’s no right or wrong way to write these. Even if a preceptor tells you they have a preference.

There’s a lot of middle ground between the simple version that only lists interventions and assessments and one that uses paragraphs and details all important information in the evaluation.

What they both have in common is clarity about what you as the dietitian have decided to focus on (the interventions) and what you’re going to pay attention to in order to make sure that actually happens (the monitoring).

And the bottom line is THAT is the only thing that’s truly mandatory in the summary section.

#7: PRECEPTORS PART 2: MANAGING DIFFERENCES

As an intern, your clinical rotations begin and end with your preceptors.

They’ll help you think through patient care scenarios.

They’ll help you learn to evaluate your patients and show you where to look for the details that can change your patient-care outcomes.

They’re also the ones who should be making sure you’re progressing properly through your internship.

And ultimately are the ones who will pass you in your rotations.

Every preceptor will have a different personality. A different set of personal requirements.

Different ways of practicing nutrition.

So, how do you deal with the differences between each preceptor?

The best way to manage your relationships with your preceptors is to make sure you’re giving them what they want.

Does this mean you shouldn’t be focusing on MNT during your clinical rotations?

Of course not.

You should be soaking up every ounce of clinical information you can during your internship.

What this does mean is that an unexpectedly significant portion of your time may be spent managing relationships.

And it’s something you should (at the least) be prepared for.

Without question, you’re going to have some amazing RDs who don’t only precept you but also support and mentor you.

These preceptors will make you feel like you could do their job in your sleep.

But there’s an equally good chance you’ll have at least one preceptor who feels like their job is to make your life hell for 3 months.

You’ll likely bounce between preceptors, trying to remember:

Who likes their notes written in complete sentences
Who wants a minimum of 3 PES statements per patient
Who needs every statement you make referenced with the date of the note you pulled that from with exactly who wrote that note

This might sound excessive. And in a way it is.

But there’s also nothing inherently wrong about this.

Every dietitian practices nutrition in their own way.

Just like YOU will practice nutrition in your own way.

But the point remains.

Every preceptor you work with will have a different way of doing nutrition.

Because they all have an obligation to make sure the assessments you write under their credentials meet their personal standards and expectations.

So your job as an intern is to give your preceptor the work they ask fo,r completed in the way they want it done.

Don’t take it personally, even if it is.

Don’t let it change the way you feel about nutrition as a whole, even if it does in the moment.

Remember that will have the chance to be exactly the kind of RD you want to be.

After your internship is over, once you’ve passed your RD exam, you then have the power to do exactly the kind of work you’ve always wanted to do in exactly the way you want to do it.

And That’s It!

Start with these 7 items as you’re preparing for your internship.

If you feel like you’ve got to start one place, make it the Acute Care Starter Guide.

You’ll get your feet wet with a solid roadmap to clinical nutrition — and you can move forward with everything on this list as you need it.

Want even more to help in clinical?
Check out The Nutrition Cheat Sheets Shop for all the nutrition education and clinical resources that will make your life easier.