Here are 4 essential tips to make sure you do well in the dietetic internship. Let’s take a look at each one and how they’ll help you succeed.
Worried you're not doing well in the dietetic internship? Start here.
It’s no secret that the dietetic internship is hard. Hard to get into, hard to get through, and hard to figure out what you’re supposed to know once you’re on the other end of it.
It’s even harder when you’re starting without a solid foundation in clinical nutrition.
What makes it worse is all the things you need to know that aren’t found in your clinical nutrition textbooks or taught in your MNT 101 course.
And you’re not alone. I really struggled when I was starting out, especially in my dietetic internship.
When I started my DI program, I didn’t know anything about clinical nutrition. I also had no real idea about what I was supposed to know.
And most of the conversations I had with my preceptors reminded me of how far away I was from being good at so much of it.
It took me a while to start getting the hang of clinical nutrition. But now, as a grad professor of nutrition, and as someone who’s taken many interns over the years, and as a dietitian who’s made it a priority in my career to help you be better than I was.
So let’s talk about some tips that will make sure you have it easier than I did.H
4 key things to know to help you do well in the dietetic internship
This list will help you start thinking outside the textbook definitions you’ve learned and begin to focus on the 7 essential things that will help you do well in your dietetic internship.
- PES statements
- Assessments
- EMR review
- Preceptor personalities
Let’s take a look at each of these.
#1: PES STATEMENTS
Writing a reasonable PES statement that makes sense is not hard. Writing PES statements that everyone can agree on is a lot trickier. It’s also a mandatory part of being able to do well in the dietetic internship.
A big part of this is that nutrition is subjective. There’s almost always a slightly different way two different dietitians can look at a patient, evaluate their needs, and then make a priority call on their situation.
So when it comes to PES statements, the way you phrase them is a bit flexible. That’s why you might have one preceptor telling you something looks great and another telling you there’s only one way for it to be correct.
The heart of writing great PES statements comes when you clearly understand each part of this short sentence.
Let’s take a closer look:
P – the biggest problem your patient is dealing with. Or another way of looking at this, is what’s their most acute issue and the one thing that you want to focus on to help their health status improve. This might be malnutrition, it could be inadequate intake, or even increased nutritional needs (protein).
E – the etiology is just a fancy name for why it happened. You need to identify where that big problem comes from and what can you point to that will make anyone who reads it very clear on that answer. Maybe it’s advanced age and dementia with inability to self-manage care and feeding, anorexia 2/2 recent dx of stomach CA, or impaired skin integrity.
S – the symptoms of the problem you just said were so important is last. Yes, the etiology will tell you why the big problem happened but the symptoms are how you know the problem is really a problem — and how the etiology shows up for your patient. Something like intake <25% of all meals and ONS refusal, or feelings of fullness and nausea after 2-3 bites of meals/Ensure with wt loss of 23 lb / 14% x 3 months, or mult stage 4 pressure injuries.
#2: ASSESSMENTS
Just like PES statements, the hardest part is writing an assessment that everyone can agree is a good assessment.
What makes it harder as a new RD, is that you’re charting under another dietitian’s name. And that dietitian probably has a very specific way they like to format, phrase, and structure their notes. Anything else will often mean they won’t want to sign off on what you wrote.
Not because you did a bad job or because you got something wrong. But because you didn’t write their note the way they like their notes to be written.
This is the reason you can work under 5 dietitians and every single one of them tells you something different. Because nutrition is designed to be flexible to make sure patients all get the most individualized care, it also means all RDs (you included) will have a slightly different take on each patient you see.
So how do you get around this?
You smile, nod, and give each preceptor what they want.
Take notes on how one preceptor likes their assessment summaries formatted. Then take notes on how another likes to document medications. Take notes on how a third likes to use bullet points instead of complete sentences.
Is this nutrition? No.
Will it help you do well in the dietetic internship so you can write your notes however you want to write them? Yes.
#3: EMR REVIEW
There’s a lot of information crammed into the medical charts. And if you make it your mission to read every single note in there, you’ll never get anything done.
Instead, get more strategic with how you use the EMR.
Before you even open the chart, have a list of every piece of information you need or think you might be missing about your patient. And then go straight to the notes you know will give you the information you need.
Don’t make this harder than it sounds.
You don’t need to know every detail about your patient’s life history, or their medical history.
What you need is to know exactly what their most acute nutritional issues are, have some justification for why you believe that’s true, and then have a few straightforward ways of providing support to improve those issues.
How do you do that?
Start with a list of questions about your patient that you know you need answers to.
Things like:
- Their usual weight and the weight when they were admitted
- Any changes to their medical condition
- How are they eating and what do they usually eat
This list of questions can be different for everyone. It’s up to you to come up with the things you need to know about before you dive into the chart.
You go straight to the sources that have the information you need.
- You ask your patient
- You ask the nurse
- You check their meds and their labs for anything that looks notable
- You read the primary medical notes (ie: the internal med doctor, the specialist who’ll be consulted on their medical challenges like a nephrologist or an endocrinologist or a surgeon)
- You skim the chart for any indication of things that can change everything like wounds, edema, medical changes, and weights
What you don’t do is read every note the nurses have written.
Instead, look for ones that are longer than just a recap on vitals — and then skim the notes for anything that might help you check a question off your list.
#4: PRECEPTOR PERSONALITIES
Personal opinions about writing assessments aside, dealing with the personalities that come along with each preceptor is a whole other thing.
Some preceptors are great. Easy to get along with, willing to sit down and answer questions whenever you have them, patient when you make a mistake or get stuck.
When you land a preceptor like this, hold on to them. Stay in touch. Keep them in your network for the long haul.
Other preceptors are harder to get along with. They’re too busy to spend time on questions they think you should already have answers to. They don’t like explaining things twice. Others simply have tough personalities to get along with.
Unfortunately, when you’re in a position where you’re asked to deal with a preceptor you don’t get along with know you’re going to have to just push through.
Dealing with difficult preceptors is not easy.
As life generally teaches us, the best way to manage interactions with people who you don’t get along with but need to work with is to put your head down and do what needs to be done.
In this case, you will not get through your dietetic internship without sign-off from your preceptors. All of your preceptors.
So short of reporting them for truly inappropriate behavior, the best plan of action is is smile, nod, and give your preceptors exactly what they’re asking for.
Obviously, this isn’t ideal.
But it is a foolproof way to get through your DI. Then once you’re an RD, you can do nutrition however you think is best.
And That’s It!
When you want to do well in the dietetic internship, the amount of things you need to remember and do can be overwhelming.
Start with these four key tips and you’ll have a strong handle on exactly where to start and what to focus on.
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.
