Are you failing clinical nutrition rotations in your dietetic internship? It’s not the end of the world. Let’s talk about it.
Are you failing clinical nutrition rotations? It happens.
It actually happens to a lot of new dietitians.
It’s easy to find yourself starting your clinical rotations and somehow realize that you just don’t know enough clinical to get the job done.
It’s not your fault. The things we learn in school don’t always match what we’re expected to know in the real world.
And once we’re in the internship dealing with real-world patients and their problems in your clinical nutrition rotations, it can be hard to hide what you don’t know.
If you've been told you're failing clinical nutrition rotations, start here.
When you find yourself starting to slip or you begin getting feedback from preceptors saying you need a better understanding of the clinical nutrition subject. There will likely be an opportunity from your internship to get a better handle on clinical.
This kind of brush-up while you’re mid-program is generally understood as a remediation program. It’s generally offered before any next steps are taken to let you go. Which gives you a great chance to wrap up all the hard work you’ve already committed to and completed.
Clinical nutrition remediation programs is not the end of the world.
It’s also in the best interest of both you and your dietetic internship. They WANT you to get through your rotations much more than they want to report that one of their students didn’t complete a rotation. And obviously, you want to finish your internship so you can leave it all behind and move on to passing the RD exam.
There are a lot of reasons why you might be struggling in your dietetic internship clinical rotations. And most of the time, it’s not because you’re bad at what you do or will be a terrible dietitian in 10 years…even though that’s exactly what it feels like.
Here are a few reasons why you might find yourself failing clinical nutrition rotations during the internship.
- You spend more time working alone than being supervised
- Having a strong textbook bio-chem understanding but no real-life patient care understanding
- Working through the EMR too slowly or going so fast you make additional mistakes
What’s more, a lot of the dietetic internship hinges on your preceptors and how much time or energy they have to share with you.
Maybe you’ve experienced this:
- Do they have time to stay engaged with you during your rotations with them?
- Can they give you the attention you need when you’re stuck on something?
- Are they by nature more anxious or impatient, and their frustrations have little to do with you?
- Will they walk you through their decision-making process when you’re considering a solution to a problem?
Remember that their ability to teach you the nutrition they know has nothing to do with you or your ability to be a good or great dietitian.
And just because this is where you are right now, doesn’t mean it’s where you’ll end.
5 tips to get better when you’re failing clinical nutrition rotations
Here are some solutions to common problems that will help you make sure you come out of this better than you went in.
- You’re moving too slowly.
Quick Tip: Focus on the notes that matter in the EMR (and stop spending time reading the ones that don’t) - Your preceptors aren’t supportive.
Quick Tip: Find preceptors who you work better with (hard to do but a game changer) - You don’t how you’re evaluated.
Quick Tip: Get a clear list of objectives you need to improve on, and how you’ll be evaluated - You don’t know what your preceptor wants.
Quick Tip: Mirror your preceptors - You’ve tried everything and you’re still failing clinical nutrition rotations.
Quick Tip: Join Clinical Bootcamp!
Let’s take a closer look at each of these and how they can help you when you’re failing clinical nutrition rotations.
PROBLEM #1: You’re moving too slowly
There’s a lot of information in the EMR. And if you’re spending most of your time trying to read through it all to make sure you aren’t missing anything, you’re wasting a LOT of time.
It’s easy to always feel like you’re going to miss something if you don’t read everything.
But the truth is, if you DO try reading everything you’ll never get anywhere. You’ll simply move too slowly and never hit the number of notes your preceptors want you to be writing.
SOLUTION: Focus on the notes that matter
Spend your time looking for only the information that’s directly relevant to your patient’s nutritional needs.
Figure out what questions you have, and then direct your attention to finding those answers. This will likely be things like weight status, intake history, labs and possible reasons for altered lab values, skin integrity, and any other significant medical notes from specialist doctors.
Skip nursing notes on vitals, medication dissemination details, social work notes, and anything else that does not directly relate to helping you write your nutrition assessment.
Get clear on what you need to know, and find that in the chart.
PROBLEM #2: Your preceptors aren’t supportive
This is something you don’t have control over.
You can’t change your preceptor’s personality, their time management, or their daily available time. And you can’t make them want to be helpful or support you more than they’re formally tasked to do as a work requirement.
For most preceptors, taking interns is part of the job description rather than something they opt into. Many preceptors see their interns as support staff, rather than an opportunity to provide educational support.
And this means it’s often easier for them to expect you (the intern) will have your clinical skills intact on day one of the DI. Rather than being prepared for the natural learning curve that we all go through.
SOLUTION: Find a new preceptor
Obviously, this is easier said than done.
And it should go without saying, this is a final option. You find a new preceptor only when nothing else has worked and you’re staring down the option of failing your rotation or moving on with some remediation.
Finding a new preceptor means tapping into every single resource you have available to you and that you can find. It means reaching out to dietitians you know, and those you don’t know.
Some ideas of where to start include:
- Posting requests on Facebook groups for RDs
- Reaching out to dietitians you follow on social media, especially Instagram and LinkedIn
- Asking old professors, other RD2Be you went to school with, someone you met at FNCE…it all counts
Don’t be shy. Everyone knows this is a struggle, and most RDs are extremely sensitive to that fact (whether or not they can help).
The bottom line is the more people you reach out to, the better your chances are of finding someone who knows a dietitian who can help.
PROBLEM #3: You don’t know how you’re evaluated
Your dietetic internship probably reviewed this once. And there’s a good chance you didn’t dig in deep when you were handed that chart on the first day of your internship or closely examine exactly how you’ll be evaluated.
That’s normal. It’s normal to focus on the broad strokes rather than spend time getting overwhelmed by the specifics of what you need to know and how you’ll be graded.
But when you’re faced with a less-than-stellar feedback form, it’s a good time to get really clear on what everyone is looking for from you.
SOLUTION: Make a clear list of everything you’re being evaluated on
Write it out. Highlight the parts you know you’re struggling with. Compare that with the feedback you’re getting and see what things your preceptors are making notes on.
Then review exactly those things. Don’t review an entire textbook. Don’t double down on the things they didn’t mention.
Dig into things that have been mentioned and put all your time and attention into those things.
When you find something that you’re stuck on or you just don’t know the answer to, ask. Ask either your dietetic internship program for support or get advice from someone who has gotten through it already.
For the issues you think are more subjective, like how things are phrased in an assessment or PES statement, keep reading and follow #4.
PROBLEM #4: You don’t know what your preceptor wants
This is not uncommon. Being completely confused about what your preceptor wants is normal.
Especially when you have more than one. Everybody seems to have their own special way of doing the same things. Each preceptor tells you one thing and insists it’s the only correct solution. Then your next preceptor asks who taught you to do it all wrong.
It’s an impossible ask to be able to know who to pay attention to, who’s answer is correct, and when to push back when you don’t feel confident about anything.
SOLUTION: Do whatever each preceptor does
Mirroring what each preceptor does will make your life much, much easier.
It will help even more if you’re dealing with some negative feedback around things. Like writing nutrition assessments or putting together PES statements.
When you’re juggling a few different personalities and styles, the only way to give them what they each want is by copying what they’re already doing.
Read an assessment that the preceptor has written and copy their format. Find a PES statement they’ve written that has a similar problem to a patient you’re working with, and use that as your template for your next PES statement.
Don’t try and figure things out on your own when you’re getting feedback that can derail you. Follow what your preceptors are already doing to a T and give them the kind of note that sounds like something they wrote themselves.
PROBLEM #5: You’ve tried everything and are still failing clinical nutrition rotations
When you’re finally at the end of the road and you’ve officially been told it’s time to get help. Before you don’t get credit for your clinical rotations and don’t complete the dietetic internship, you need to find a remediation program.
Start with your internship. See what they recommend. Figure out if they’ll support you in getting additional help or if you’re responsible for paying for something additional.
And then, if you’re left out on your own to find something to get you, start here.
SOLUTION: Join Clinical Bootcamp
Clinical Bootcamp will make sure you have everything you need to rebuild your confidence in doing clinical nutrition and be able to do it on the level you’re preceptors expect you to know it.
All the basics of medical nutrition therapy, including how to understand what to do and when to do it.
This doesn’t replace mirroring your preceptor’s assessment style or copying a PES statement that works really well.
What it does is make sure you know exactly what information you need to know based on your patient’s situation and how to use that information to write strong nutrition assessments.
Ready to join Clinical Bootcamp? Check it out here. Then email me at shani@nutritioncheatsheets.com if you’ve got questions.
And That’s It!
This is how to use Nutrition Cheat Sheets to support your as you learn and grow in your clinical nutrition career.
If you feel like you’ve got to start one place, make it Clinical Bootcamp. 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.
