Texas A&M Dietetic Internship Program

Community Rotation Descriptions and Related Workbooks

Texas A&M Dietetic Internship Dietetic Program Community Nutrition Rotation Descriptions

WIC Community Rotations Descriptions Rotation Page

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Austin WIC Rotation Description Bell County WIC Rotation Description BVCAA WIC Rotation Description BVCAA WIC Workbook

Memorial Hermann Community Rotation Descriptions Memorial Hermann TIRR Rotation Description Memorial Hermann Texas Medical Center Cardiac Rehab Rotation Description Memorial Hermann IRONMAN Sports Medicine

VA Community Rotation Descriptions Central Texas Veterans Health Care System: Nutrition Clinic, Temple Central Texas Veterans Healthcare System: Nutrition Clinic, Waco

Texas A&M University Community Rotations Descriptions Texas A&M AgriLife Extension Service Texas A&M Student Health Services

Other Community Rotation Descriptions CHEF Rotation Description Cooper Clinic Rotation Description Excellence in Health Rotation Description San Antonio Chronic Diseases Rotation Description

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION AUSTIN PUBLIC HEALTH WIC

Location: Various clinic locations throughout Austin (Actual location(s) will be sent to intern prior to rotation by WIC preceptor)

Duration: May vary per intern (Approximately 80 hours)

GOALS: 1. To provide dietetic interns the opportunity to learn and practice community

nutrition in a public health setting.I. ROTATION PREPARATION

a. Prior to rotation, the WIC preceptor will send an orientation manual for the internto review.

II. PLANNED ASSIGNMENTSa. Complete assignment(s) assigned by preceptor (e.g. educational handouts,

presentations, group class templates, etc.)b. Observe/participate in nutrition counseling, including high risk counseling.c. Observe breastfeeding counseling.d. Learn about the WIC program and other community partners.

III. EVALUATIONa. Complete assignment(s) given by preceptor.b. Schedule and complete evaluation for last day of rotation.c. Submit completed evaluation forms to Internship Director.

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION: Bell County Public Health District WIC Program

I. WICLocation: 201 North 8th Street

Temple, TX 77802 Duration: Variable – 40-80 hours Goal:

1. Increase knowledge and skills to provide nutrition counseling and focusededucation to WIC participants with high risk conditions.

II. ROTATION PREPARATION (Complete prior to starting rotation)A. Explore the Texas WIC website to familiarize with the program

III. ROUTINE DUTIESA. Participate in high risk counseling, certifications and breastfeeding counseling sessions.B. Adhere to documentation, confidentiality, and quality assurance requirements

IV. PLANNED ASSIGNMENTSA. Complete State WIC Intern ModuleB. Observe WIC nutritionists and become familiar with WIC certification process.C. Provide high risk nutrition counseling with Registered Dietitian.D. Observe WIC Peer Counselors and become familiar with WIC breast pump program.E. Complete an intern project to be assigned by the preceptor(s). Projects Analyzing WIC

specific data, Nutrition material for newsletters, social media creations, development ofstaff training, development of Nutrition Education classes for WIC participants and WICstaff, or other projects as needed by the WIC clinic.

V. EVALUATIONA. Complete assignments as given by preceptor(s).B. Schedule and complete evaluation for last day of rotation.C. Submit completed evaluation forms to Internship Director

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T E X A S A & M U N I V E R S I T Y D I E T E T I C I N T E R N S H I P ROTATION INFORMATION: Brazos Valley Community Action Agency WIC

I. WIC Location: 3400 S. Texas Ave Bryan, TX 77802

Duration: Variable – 40-80 hours

Goal: Increase knowledge and skills to provide nutrition counseling and MNT to high risk WIC participants.

II. ROTATION PREPARATION (Complete prior to starting rotation)

A. Complete highlighted portion of the Intern WorkbookB. Review and begin case studies for high risk counseling of WIC participants.

III. ROUTINE DUTIES

A. Participate in high risk counseling, certifications and breastfeedingcounseling sessions.

B. Adhere to documentation, confidentiality, and quality assurance requirements.

IV. PLANNED ASSIGNMENTS

A. Complete Intern workbook and high risk case studies.B. Observe WIC nutritionists and become familiar with WIC certification

process.C. Provide high risk nutrition counseling with Registered Dietitian.D. Observe WIC Peer Counselors and become familiar with WIC breast

pump program.E. Complete an intern project to be assigned by the preceptor(s). Projects

include reports, development of staff training, development of NutritionEducation classes for WIC participants or other projects as needed bythe WIC clinic.

V . E V A L U A T I O N

A. Complete assignments as given by preceptor(s).B. Schedule and complete evaluation for last day of rotation.C. Submit completed evaluation forms to Internship Director

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Name: Date:

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Dietetic Intern Workbook WIC Rotation

Define these terms:

LLL:

IBCLC:

GERD:

GER:

AAP:

SIDS:

RSV:

FGR:

IUGR:

FTT:

LBW:

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VLBW:

SGA:

LGA:

SNS:

NEC:

Prolactin:

Oxytocin:

Non-nutritive sucking:

Tandem nursing:

Gravida:

Para:

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Breastfeeding overview Compare colostrum to mature milk. When should a baby be put to the breast after birth? List three breastfeeding positions and the uses/benefits of each. What is the frequency/duration of a breastfeeding session? What are the signs of adequate nursing? How do growth spurts affect breastfeeding? When do growth spurts commonly occur? How does a baby communicate hunger? How does breastfeeding affect a woman’s reproductive health?

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Distinguish between breastfeeding and bottle-feeding in terms of the following elements:

Frequency of feeding

Tongue placement and action

Lip flanging

Feeding duration

Typical stooling pattern

Under what circumstances would you recommend a mom to NOT breastfeed her baby?

What are the WHO and AAP recommendations for breastfeeding?

List three ways to deliver expressed breast milk without using a bottle.

Breast Milk versus Formula Choices Discuss signs and symptoms of physiologic and pathologic breast milk jaundice in the newborn.

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Identify the types of formula/artificial milk (ie milk based, hypoallergenic, etc.) and their indications for usage below.

Type Indication for usage

Similac Advance

Enfamil Infant

Neosure

Enfamil Gentlease

Similac Isomil Soy

Nutramigen LGG

Alimentum

Similac Sensitive

Similac for Spit Up

Under what circumstances might one use the following formulas?

Pediasure:

Isomil DF:

Enfamil AR:

Enfamil Enfacare:

Boost Pudding:

Boost Kid Essentials :

Differentiate between milk allergy and lactose intolerance. How often do these conditions occur in the pediatric population? Differentiate between primary (congenital) and secondary lactose intolerance. Is there any relationship between milk and soy allergies? What if mom says her baby is allergic to her breastmilk? Discuss the addition of other foods to the infant diet. At what ages should certain foods be introduced? What foods are included in each stage?

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How many kcals/oz does breast milk have? How do you prepare standard concentrate and powder formula? How many kcal/oz does it have?

Standard concentrate formula:

Standard powder formula: How do you prepare powder formula to 22 kcal/oz or 24 kcal/oz?

22 kcal powder:

24 kcal powder: Anemia Prevention: What are normal HCT and HgB lab values for women and children? How would you expect the following to affect H/H lab values?

Maternal smoking:

Environmental smoke exposure (smoking inside household):

Current antibiotic use:

Chronic, severe asthma:

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Sickle Cell Anemia:

Sickle Cell Trait: How and why might the following affect iron status or absorption?

Tea:

Orange Juice:

Milk (>30 oz. per day): Pregnancy/Postpartum: Discuss signs, symptoms and classic presentations of:

Eclampsia:

Pre-eclampsia:

PIH: Discuss signs, symptoms and classic presentations of:

Type I Diabetes:

Type II Diabetes:

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Gestational Diabetes

What risks or nutritional concerns might these conditions pose specifically to a woman’s reproductive status, to a pregnant or breastfeeding woman, or to her infant?

Type I Diabetes:

Type II Diabetes:

Gestational Diabetes:

Hypothyroid:

Hyperthyroid:

Cystic Fibrosis:

Cigarette Smoking:

Pre-pregnancy underweight:

Pre-pregnancy obese:

Low maternal weigh gain with weight loss:

Sudden, rapid weight gain during pregnancy:

Teenage pregnancy:

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Hyperemesis Gravidarum:

Pregnancy Induced Hypertension:

Exclusively breastfeeding:

Breastfeeding during pregnancy:

Tandem nursing:

Low Birth Weight infant:

Premature birth:

Large for Gestational Age infant:

Closely spaced pregnancies:

Multi-fetal gestation:

Inadequate folic acid intake:

Alcohol use: Overweight/Obese Status Consider the following questions when an overweight/obese child comes in for an appointment. What environmental factors might play a role in the child’s weight status? What questions might you want to discuss with the parents when addressing the weight? What dietary changes might you want to implement to affect weight status?

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What are current children’s dietary recommendations (ages 2-5) for the dietary changes addressed above? (milk, juice, food group quantities)

Underweight Status Consider the following questions when an underweight child comes in for an appointment.

What environmental factors might play a role in the child’s weight status?

What questions might you want to discuss with the parents when addressing the weight?

What dietary changes might you want to implement to affect weight status?

WIC Services/Funding

The Texas Department of State Health Services has a Breastfeeding Peer Counselor Program in which currently or previously breastfeeding WIC moms work with other WIC moms to encourage and support breastfeeding. What are the benefits to “peers” rather than using only WIC professional staff? Are there any drawbacks or risks to such a program?

If you are teaching a client about a specific topic, how would you ensure that you remained client-centered in your approach?

WIC stands for Women, Infants and Children. Are all women, infants and children eligible for WIC services? What criteria are used to determine who is eligible for WIC?

What is Rider 19? How might this affect services provided to women and children?

What agencies fund WIC at the national and state level?

How is WIC funded at the local level? (bvcaa.org is our parent company website)

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What is the current funding formula for WIC? What is the rationale for having such a formula? What recommendations would you give, if any?

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION:

TIRR Memorial Hermann Acute Specialty Rehabilitation Inpatient Experience

Location: TIRR Memorial Hermann Rotation: 3 to 7 weeks

GOALS: 1. Obtain skills and knowledge to help meet clinical dietitian entry-level requirements2. Integrate didactic knowledge into professional practice3. Utilize the Nutrition Care Process and appropriate evidence based guidelines to assess

nutritional needs and develop individualized care plan4. Monitor and follow up patients regarding effectiveness of intervention5. Provide nutrition education based on patient population, medical history, age, and

cultural background6. Demonstrate knowledge of nutritional needs in spinal cord injury, brain injury, stroke and

neurological disease patients7. Recommends appropriate oral supplements, tube feedings for patients based on a variety

of disease state8. May conduct nutrition class for brain injury patients9. Experience nutrition counseling in an outpatient setting10. To help prepare and to fulfill the requirements to take the registration examination for

dietitians

I. ROTATION DESCRIPTION● TIRR Memorial Hermann treats many conditions, including:

o Brain injury, including Traumatic and Disorders of Consciousness▪ https://www.houstonchronicle.com/local/hc-investigations/aliveinside/

o Strokeo Spinal Cord Injuryo Amputationo Neuromuscular Disorders and Multiple Trauma

● The dietitians assess all new patients upon admission and assign risk level for follow-up.● The acuity level at TIRR is the highest in the country among rehab hospitals.

o 40-50% of patients are on enteral nutritiono 80% of patients require ongoing MNT interventionso A subset of 5% of patients requires focused MNT interventions to address

malnutrition. This is accomplished by additional rounding with the Brain Injuryand Spinal Cord Injury fellows.

II. ROTATION PREPARATION: (Complete prior to starting rotation).● Contact Clinical Nutrition Manager/Lead Preceptor one month prior to the first day of the

rotation to make necessary arrangements. You will need to provide DOB, last 4 digits of

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SSN, and email in order obtain your computer login. Once we receive it, we will email your login to you.

● Complete online HIPAA courses and quizzes. See instructions below.● Prepare a written list of goals and objectives for rotation to discuss with the

dietitian on day one● Clinical Nutrition Manager/Lead Preceptor will review scheduled rotation calendar

and expectations for this rotation

III. ROTATION EXPECTATIONS AND GUIDELINES● Both Employees and Students are expected to be treated with respect at all times. If a

situation resulting in a misunderstanding occurs, the student should inform theirpreceptor, intern coordinator, or clinical nutrition manager immediately.

● You will be expected to perform with increasing competence and independence over thecourse of the rotations, to the point where you will be able to function as an entry leveldietitian.

● You will be expected to complete nutrition notes in a timely manner. Remember to keepyour preceptor updated throughout the day and give her ample time to review your notes.

● The internship is meant for supervised practice. Please let your preceptor know if youhave extra time.

1. Attendance/Schedule● You are responsible for working the same hours as your preceptor. Please confirm

your hours with your preceptor prior to each rotation.● If you are sick or running late, contact your preceptor as soon as possible. If you

need to leave during your assigned internship hours, please discuss with yourpreceptor as well.

2. Professional Appearance

You are expected to follow the Memorial Hermann dress code policy.

● You will be issued a name badge that needs to be on and visible at all times whilein the hospital.

● Hair shall be clean and neat with no styles or colors that would invite negativefeedback from a customer.

● Fingernails may not be of a length that potentially interferes with the ability tosafely perform the job.

● Nail polish must be removed if begins to chip.● Extreme or excessive makeup, cologne, jewelry or accessories are not allowed.● Visible body piercing is permitted in the ear only, and no more than two earrings

per ear may be worn. All other body piercing must be covered.● All tattoos must be covered so as not to be visible.● The following are specifically prohibited at all times:

o Denim of any color

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o Canvas sneakers or sandal-thongs/flips flops or slipperso Spandex or other form fitting/extremely tight clotheso Clothing that is distracting, offensive or revealing such as very short skirts or

low cut tops.o Clothing or footwear that is soiled wrinkled, excessively worn or in

disrepair, or any other clothing or mode of appearance that managementdetermines is inappropriate for the work environment.

o Leggings, Athletic wear, Sweat suits, Tank tops, Halter tops, T-shirts,Beachwear, Shorts, Bib overalls, Exposed undergarments, Work-out attire,Clothing that exposes the abdomen, chest or buttocks, or Clothing thatcontains sexually related references, foul language, or that suggests orpromotes the use of illegal drugs or violence.

3. Available Resources● Questions are always welcome, but remember to utilize the multitude of resources

available to look up information as well including your binder, article binder, andthe Nutrition care manual. You are responsible for this information. Do not besurprised if your preceptor says “Go look in your binder” or “Go look it up”

IV. Evaluations:

● Submit completed written assignments to the dietitian as requested.● Provide evaluation forms to the dietitians to complete one week prior to the last day

of the rotation.● Schedule final rotation evaluations.● Submit completed evaluation forms and written rotation assignments to your

preceptor by the last day of the rotation.● Complete preceptor evaluation and return to clinical nutrition manager. This will

help with program evaluation and improvement for our future interns experience.

V. HIPPA Assignment prior to rotation:● Complete HIPAA courses online prior to rotation.● Complete the quizzes and turn in to your preceptor the first day of your rotation

Find the link to the PIL website here: ● http://texasnrc.org/Regions/Houston-Galveston/MH-Pre-Clinical-Documents● Under the following session: “For educational experiences (clinical and non-clinical)

within the Memorial Hermann System, the following additional HIPAArequirements must be met.” Please complete HIPAA module 1-4 and take the quizzes.

● **If they have trouble accessing the website, the following instructions may help:http://texasnrc.org/Portals/7/MH_Accessing_PIL_From_Home_3-30.pdf?ver=2018-03-30-12312

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION

MEMORIAL HERMANN NUTRITION CONSULTANTS

MEMORIAL HERMANN HOSPITAL – TEXAS MEDICAL CENTER CARDIAC REHAB

SHARON SMALLING, MPH, RD,LD

Location: Memorial Hermann Hospital-TMC

Duration: 4 weeks or 160 hours

GOALS:

1. To provide hands-on experience in providing individualized medical nutrition

therapy to privately referred patients with a variety of diagnosis including but not

limited to HTN, HLD, DM, GI disorders, renal, Overweight/obesity, and Epilepsy

and other neurological disorders. I am also the dietitian for the Cardiac

Rehabilitation program in which all patients are seen on an individual basis as

well. Two nutrition classes for Pulmonary Rehabilitation participants (COPD;

asthma; interstitial lung disease, etc) are taught 4 times per year; often these

patients are also seen individually.

I. ROTATION DUTIES:

1. You will complete comprehensive chart notes for all patients seen beginning on the first

day using our EMR powernote

2. You will observe me doing several MTN consults and then you will begin by doing the

nutrition history recalls. I will complete the education; you will complete the chart note.

3. As you are able to observe various educations provided, you will then begin doing these

as well, often just starting with specific parts of the education eg explaining their lipid

panel to cardiac rehab patients and how what they ate affected their values; I will

complete the education; you will do the chart note.

4. By mid week 3 you will be doing most of the consults from start to finish! I am always

present during the entire MNT consult

5. Other duties as assigned☺

II. ROTATION ASSIGNMENTS:

1. Assignment #1: a recipe of the month in which you will take a recipe and make at least 3

changes to make it heart healthy; prepare for the staff to taste and approve; analyze it

(using Nutritionist Pro on my computer); make it for the patients and provide them with

copies.

2. Assignment #2: Create or update a current educational material mutually agreed upon

during your orientation the first day

3. Assignment #3: If I am doing a talk or teaching Pulmonary Rehab class you will be able

to participate in some manner with the teaching of the class

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III. ROTATION PREPARATION

1. You will need to be here by 7:30 each day. We leave no later than 5 unless something

unusual occurs. If your patient work is completed early you may leave to work on

projects at home.

2. You will have a lap top computer to use and desk

3. There is some on-boarding paperwork to complete and HIPAA modules to pass that will

be given to you by Karen Geismar up to 3 months in advance.

What do you need to know in advance?

1. Lipid panel values, what’s normal, how do you calculate a missing value if you only

have 3 of the 4 (CHOL, LDL, HDL, TG)

2. Calculation for BMI

3. Exchange List values, eg a fruit is 15 gm CHO, starch 15 gm CHO, 2 gm pro, etc

(though I teach CHO counting, knowing the exchange list will help you be able to

calculate protein, CHO, or perhaps simple sugar intake quickly from a diet recall.)

4. Diabetic diet and portion sizes for foods within each food group eg, rice is 1/3 cup, etc;

AHA/ ACC guidelines; DASH guidelines; Na restrictions

5. Pennington equation for Predicted Weight loss (google it to become familiar, I will show

you how to use it with pts)

6. I have an intern notebook, put together completely by interns, with references and

resources to assist you. Articles, sample chart notes, etc.

IV. ROTATION OUTCOMES

1. You will develop counseling skills while working with a large and diverse patient

population.

2. My goal is for you to learn how to personalize MNT to meet the needs of the patient

sitting before you.

This is a very busy rotation! But I promise you will learn a lot and the staff here is delightful to

work with! We laugh and have fun as we work hard to empower patients to improve their

health!

Hope you choose me!

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION DESCRIPTION 

Memorial Hermann IRONMAN Sports Medicine Institute 

Locations:  

• The Woodlands

• Texas Medical Center

• Sugar Land

• Memorial City

• Spring

• Katy

• Shepherd and Westheimer

• Pearland

Duration:   

8:00AM – 5:00 PM;Times will vary Weekends, nights, and early mornings are all possible. 

Preceptors: 

• Brett Singer MS,RD,CSSD,LD

• Christina Curry MS,RD,LD

• Molly Vega, MS, RD, CSSD, LD

GOALS: 

1. Our primary role as dietitians is to perform one on one counseling on sportsnutrition and general wellness. We work with a wide variety of athletes whichincludes high school, collegiate, professional, and age group athletes. We seeteam sport, endurance and ultra-endurance athletes and just about everything inbetween.

2. In addition to this, we also do consulting work at high schools, colleges,professional and club sport programs.

3. We also help market for our company by providing presentations, writing articles,performing media sessions, and going to other outreach events.

I. ROTATION DESCRIPTION:A. We are a sports medicine clinic which consists of sports medicine physicians,

surgeons, physical therapists, occupational therapists, exercise physiologists,strength coaches, athletic trainers and dietitians. During your time, you may meetor work with some or all of the above employees.

II. ROTATION PREPARATION:A. Travel: You may be expected to drive to several different locations during your

time. This may include multiple sites within one day. Parking at most of ourlocations is free, though there are possibilities that you may be required to pay forparking.

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B. Dress: Business casual. Occasionally we will wear athletic attire, but we will letyou know about this ahead of time.

C. Food: We have a fridge and microwave available at most locations.D. What you need to bring: Bring a laptop or tablet. You may also want to bring a

jacket as some of our facilities can be cold.III. ROTATIONS DUTIES AND EXPECTATIONS

A. Our responsibilities are wide ranging and truly depend on the time of year andwhat the focus is at that point.

B. Due to the brevity of most internships, our students typically shadow duringconsults and assist us through occasionally helping with presentations, performbody composition testing, create educational materials, write blog or media posts,data collection etc.

IV. ROTATION ASSIGNMENTS

A. We ask that any student who interns with us has a strong interest in sportsnutrition and a desire to one day work in this field.

B. We will require that students read and seek out information on their own, and willchallenge them on a variety of topics.

C. We expect that they come in with a strong work ethic, and the intellectualcuriosity needed to succeed.

WEB SITES: 

http://ironman.memorialhermann.org/ 

http://athletetrainingandhealth.com/ 

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION: Outpatient Clinic, CTVHCS

NUTRITION CLINIC:

Location: VA Temple

Dietitian’s office: Bld 204, 5J19

Phone 1-800-423-2111 Ext. 41999

Duration: 40-80 Hours GOAL:

1. Gain skill in assessing nutrition education needs for outpatients and planning andproviding education to meet those needs. Enhance listening, interviewing, andcommunication skills. Develop ability to translate technical nutrition informationinto patient counseling and group teaching.

I. ROTATION PREPARATIONA. Contact precepting dietitian 2 weeks prior to start of rotation.B. Complete workbook assignments and submit on Day 1 (sources must belisted).C. Prepare personal goals for rotation and submit on Day 1.D. Read articles outlined in rotation packet.E. Review nutrition education materials in outpatient clinic.F. Complete other assignments as outlined by precepting dietitian.

II. ROUTINE DUTIESA. Work hours are 7:30 AM – 4:00PMB. Provide patient diet instructions and nutrition counseling.C. Participate and provide group nutrition education.D. Complete computer documentation.

III. ASSIGNMENTSA. Quiz/Role play – Day 1 (or during down times).B. Special project (examples include bulletin board, presentation, handout, National

Nutrition Month project) as specified by precepting dietitian.

IV. EVALUATIONA. Ability to effectively interview and counsel patient(s).B. Ability to develop appropriate nutrition plan and goals for patient(s).

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C. Ability to document education in patient’s computer medical record.D. Quality and timeliness of completed assignments.E. Schedule and complete evaluation for last day of rotation.F. Submit completed evaluation forms to Internship Director.

Texas A&M University Dietetic Internship Rotation Information: Outpatient Nutrition Clinic – VA

OUTPATIENT ROTATION WORKBOOK

I. Disease Processes:

Complete all sections of the workbook prior to the start of the rotation. If you have questions, complete the assignment as best you can. We will review on Day 1 and/or as clinic allows.

II. Medications:

The following medications are commonly used to treat patients seen in the clinic. Identify the drugs as well as any food-drug interactions or any nutritionally significant

side effects. When appropriate give brand/generic names also.

Statins Gemfibrozil Coumadin LasixMirtazapineRisperidoneOmeprazole, RanitidineGabapentinMetformin Glipizide Insulin

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- Overweight/Obesity -Resources:

1. Define Obesity. Discuss etiology of overweight/obesity.

2. State the BMI range for the following: Underweight, Healthy Weight,Overweight, Obese.

3. Describe Metabolic Syndrome. How can Metabolic Syndrome be managed?

4. What is the best predictive equation to use to estimate RMR for overweight/obesepatients in outpatient setting?

5. What would be a safe rate of weight loss?

- Motivational Interviewing -Resources:

1. Describe Motivational Interviewing (MI).

2. Describe the main principles of MI (“RULE”).

3. What are the Stages of Change. Describe each.

- Diabetes -

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1. What are the criteria for the diagnosis of T1DM, T2DM, and Gestation DM?

2. What is the concentration of glycosylated hemoglobin (HgbA1C)?

3. What are the glycemic goals for diabetic patients fasting and 2 hourspost-prandial?

4. Describe the benefits of consuming a consistent carbohydrate diet for a patientwith DM. How many carbohydrates per meal should the individual consume?What is considered 1 serving of Carbohydrates?

5. What should an individual carry to treat potential insulin reactions? What is the“Rule of 15?”

Case study #1: Evaluating Intake Mr. PJ, 48 year old African American male, BMI 33, presents to clinic and reports the following “typical” PO intake. He reports he has a limited budget for groceries so he typically eats fast food. He does not exercise at this time. He takes 1000 mg of Metformin BID and 5mg of Glipizide BID; however he often takes Metformin and Glipizide after he eats.

1. Please evaluate the following dietary recall for total carbohydrates consumedwithout assistance from reference materials (give it your best guess!)

2. What interventions and recommendations would you make regarding diet andlifestyle modifications?

MEAL 1 Food Carbohydrates (g) Estimated Carbs(g): 8 oz. 2% milk1 Sausage, Egg, and Cheese Biscuit1 hash brown

MEAL 2 Food Carbohydrates (g) Foot long BLT Sour Cream and Onion ChipsLarge Sweet Tea2 chocolate chip cookies

MEAL 3 Food Carbohydrates (g) 1 Fried Bologna Sandwich1 medium apple

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TOTAL CARBS FOR THE DAY: __________________

Interventions/Recommendations:

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Case study #2: Practice using the Nutrition Care Process, write an ADIME note using NCPT standardized terminology, the interventions you’d recommend and set sample goals.

Ms. KG, 51 year old Caucasian female, BMI 17, presents to clinic and reports she would like to gain weight, but her appetite is poor. She is consuming 1 meal per day, usually fast food at lunch. Beverages include drinking 1-2 pots of coffee and 20 oz Mt. Dew. She complains of poor energy levels and interrupted sleep patterns. Medical problems include PTSD, Insomnia, Hypertension, Chronic Low Back Pain, Tobacco Abuse.

Vitals: Height: 67” Current Weight: 108 lbs Previous Weight 6 months ago: 120 lbs

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Case study #3: Motivational Interviewing Scenarios For the following dialogue, identify 1) the stage of change the patient is in and 2) how the provider could improve their motivational interviewing skills. Think about what the appropriate response to each stage of change is and how the provider might guide the patient toward the next stage.

Scenario #1: Mr. Love is a 60 year-old diabetic with a recent BMI of 25 and HgbA1c of 9.8%, increased by 2% since last blood draw 6 months ago. Mr. L was referred by endocrinology for education on carbohydrate counting. His medications list shows he is receiving blood glucose strips to self-monitor his fasting blood glucose three times per week, and he is prescribed metformin (1000mg every 12 hours) and glipizide (10mg once in AM).

Dietitian (RD): Good morning! What brings you in to see a dietitian today?

Mr. L: I don’t know, I had an appointment so I came.

RD: Oh, okay. Have you seen a dietitian before?

Mr. L: Yes, a long time ago when they diagnosed me with diabetes

RD: Ah, yes I saw that you have diabetes. I believe the nurse practitioner you work with in the diabetes clinic entered the consult for nutrition.

Mr. L: Oh. Yeah, she said my sugars are too high. I know I’m supposed to cut out all the white stuff but there’s no way I can do that.

RD: Are you checking your blood sugar at home?

Mr. L: No, not really. I hate needles. They check it when I come to the diabetes clinic.

RD: Well, maybe we can learn about what you can do with your diet to help get those blood sugars down.

Mr. L: I’ve heard it all before, but it’s pretty impossible with my schedule. I work 12-hour shifts and have a rotating schedule, so sometimes I work 7am-7pm andsometimes I work 7pm-7am. I just eat when I can.

RD: Has your doctor ever talked to you about carbohydrate counting? It’s really simple once you get the hang of it! We have diabetes classes here at the VA, too, which teach you all about how to manage your blood sugars.

Mr. L: I don’t have time for classes. I know the sugars are bad. I don’t drink soda or eat any candy. I only have 2 meals per day, so there’s no way I’m eating too much. I don’t

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even have time to go to the gym anymore. The tingling in my feet is awful, I don’t even feel like going on my days off.

RD: What do your meals usually look like?

Mr. L: I get McDonald’s on my way to work – usually I have 2 of the egg biscuit sandwiches, 2 hash browns and a large coffee. I know coffee is bad but I need the energy for work. Then at work, I grab one of those Monster energy drinks. I’m pretty busy and don’t have time to eat again until I get home. Usually I’m too tired to cook and just have a big bowl of cereal. I like raisin bran and I don’t use whole milk anymore. I use 2%.

RD: Thanks for sharing that! That helps me understand your typical day and what you’re doing now in terms of your nutrition. Let’s talk about foods that have carbohydrates

*RD gives education on identifying carbohydrate foods, measuring carbohydrates andadvises patient on how many to eat per meal*

Mr. L: I just don’t know when I’d have the time to do all that. I know the diabetes nurse said my sugars are high, but I feel fine. I think I’ll just start going for walks on my days off. I’ve heard exercise helps too.

RD: You’re absolutely right- exercise can help manage diabetes as well. Be sure to start slow and increase your exercise slowly to meet 150 minutes per week! When do you think you can come to the diabetes class?

Mr. L: I don’t have time for that, but thank you for meeting with me today. I just don’t have the time to think about all this right now.

A. Mr. L’s stage of change: __________________________B. How could the RD improve? What are some examples of motivational

interviewing tactics that could have been used to help Mr. L?

Revised June 2018

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TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP

ROTATION INFORMATION: Waco Outpatient Clinic, CTVHCS

NUTRITION CLINIC: Location: VA Waco: 4800 Memorial Dr

Dietitian’s office/Nutrition Clinic: Bld 4, RM 129-A

Phone 1-800-423-2111 Ext. 53212 or 254-297-3212

Duration: 40-80 hours

Goal: Gain skill in assessing nutrition education needs for outpatients and planning and

providing education to meet those needs. Enhance listening, interviewing, and

communication skills. Develop ability to translate technical nutrition information into

patient counseling and group teaching.

I. ROTATION PREPARATION

A. Contact precepting dietitian 2 weeks prior to start of rotation.

Amber.Everett@va.gov

B. Complete workbook assignments and submit on Day 1 (sources must be listed).

C. Prepare personal goals for rotation and submit on Day 1.

D. Read articles outlined in rotation packet.

E. Familiarize self with education materials in outpatient clinic and with MOVE!

and HPDP programs (www.move.va.gov and www.prevention.va.gov).

F. Complete other assignments as outlined by precepting dietitian.

II. ROUTINE DUTIES

A. Work hours are 8:00AM – 4:00PM (arrive by 7:50AM)

B. Provide patient diet instructions and nutrition counseling.

C. Participate and provide group nutrition education and education via telehealth.

D. Complete computer documentation.

III. ASSIGNMENTS

A. Quiz/Role play – Day 1 (or during down times).

B. Special project (examples include bulletin board, presentation, handout creation

or revision, National Nutrition Month or other health-related monthly observance

project) as specified by precepting dietitian.

IV. EVALUATION

A. Ability to effectively interview and counsel patient(s).

B. Ability to develop appropriate nutrition plan and goals for patient(s).

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C. Ability to document education in patient’s computer medical record.

D. Quality and timeliness of completed assignments.

E. Schedule and complete evaluation for last day of rotation.

F. Submit completed evaluation forms to Internship Director.

Texas A&M University Dietetic Internship

Rotation Information: Outpatient Nutrition Clinic – VA

OUTPATIENT ROTATION WORKBOOK

I. Disease Processes:

Complete all sections of the workbook prior to the start of the rotation. If you

have questions, complete the assignment as best you can. We will review on Day

1 and/or as clinic allows. Please keep the workbook organized and neat. You may

want to consider keeping in a binder with marked tabs for easy reference and

discussion.

II. Medications:

The following medications are commonly used to treat patients seen in the clinic.

Familiarize yourself with the drugs as well as any food-drug interactions or any

nutritionally significant side effects. No documentation required in this section

but recommended.

Atorvastatin Cholestyramine Coumadin

Gemfibrozil Lasix Lovastatin

Nicotinic Acid Phenytoin Simvastatin

Mirtazapine Venlafaxine Carbamazapine

Sertraline Risperadone Olanzapine

Fluoxetine Pantoprazole Omeprazole

Esomeprazole Ranitidine Prazosin

Gabapentin Hydrocholorthiazide Pravastatin

Risperidone Lisinopril

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Revised 2017

- Overweight/Obesity -

Resources: AND Nutrition Care Manual

CDC Obesity: Halting the epidemic by making health easier Obesity 2009 (PDF)

Obesity and overweight: Introduction. Division on Nutrition, Physical Activity, and Obesity

MOVE (Managing Overweight/Obesity for Veterans Everywhere) website: MOVE!

Journal Article: Shai, R.D., Ph.D., Iris: Weight Loss with a Low Carb, Mediterranean Diet

1. Define Obesity. Discuss etiology of overweight/obesity.

2. Define BMI. State the BMI ranges:

3. According the AND Nutrition Care Manual, what are the 5 categories of obesity-

related complications?

4. What labs would be good to review for an overweight/obese patient? What could

the labs indicated if elevated or depressed?

5. What is the best predictive equation to use to estimate RMR for overweight/obese

patients in outpatient setting?

6. What are 3 main components of successful weight loss? (HINT: nutrition

intervention section of AND NCM)

7. What would be a safe rate of weight loss?

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- Motivational Interviewing -

Resources:

PayneC Motivational Interviewing (PDF) Stages of Change in Clinical Nutrition Practice (PDF)

1. Describe Motivational Interviewing (MI).

2. VA expressed the main principles of MI in an acronym “RULE”. Describe the

main principles of MI and how they are applied to counseling.

3. What is Change Talk. How important is Change Talk in predicting a client’s

outcome of the counseling therapy?

4. What are some strategies for helping patients advance through the stages of

change?

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- Diabetes -

Resources: ADA Diabetes Nutrition Therapy Pocket Guide: ADA 2015 Guidelines Nutrition Therapy

ADA Diabetes Standards of Medical Care Pocket Guide: ADA 2015 Guidelines Medical Care

CDC 2104 National Factsheet Diabetes: 2014 Diabetes Factsheet

AND Nutrition Care Manual

ADA Nutrition Recommendations and Interventions for Diabetes (PDF)

AND RD Pocket Guide

ADA All About Carb Counting (PDF)

1. State and describe the classifications of DM.

1) Type 1 DM

2) Type 2 DM

3) Gestational DM

2. The most powerful risk factor in the pathogenesis of Type 2 DM is __ .

3. What are the criteria for the diagnosis of DM?

4. What is the HgbA1C?

5. What are the glycemic goals for nondiabetic and diabetic patients:

Biochemical Index Nondiabetic Diabetic Add’l Action Suggested

Fasting/Pre-prandial

Glucose

Bedtime Glucose

HbA1C (%)

6. For patients with impaired glucose tolerance (IGT), impaired fasting glucose

(IFG), or a HgbA1C of 5.1-6.4%, what is recommended to prevent or delay

Type 2 DM?

7. Describe the benefits of consuming a consistent carbohydrate diet for a patient

with DM. How many carbohydrates per meal should the individual consume?

What is considered 1 serving of Carbohydrates?

8. State the (4) updated goals of MNT for adults with diabetes.

9. Hepatic glucose output decreases after nutrient ingestion. How?

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10. State the symptoms of hypoglycemia. At what blood glucose level does a patient

clinically experience a hypoglycemic event?

11. What should an individual carry to treat potential insulin reactions? What is the

“Rule of 15?”

12. Why should chocolate and ice cream be avoided when treating a hypoglycemic

episode?

13. State advantages of SMBG.

14. What benefits can exercise provide to patients with DM?

15. Describe 5 of the most common complications of DM in the US.

Define:

1. Dawn Phenomenon:

2. Somogyi effect:

3. Basal Insulin:

4. Bolus Insulin:

5. Diabetic Ketoacidosis:

6. Insulin Resistance:

Lab Values. Fill in the Normal ranges and effects of DM:

Test Normal What effect does diabetes have

on this lab value? (raises or

lowers – choose one)

Blood Glucose – Fasting

Random BG

HbA1c

Urine sugar

Urine Acetone

Cholesterol – Total

LDL

HDL

Triglycerides

Na

Cl

K

P

CO2

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Revised 2017

Medications: State the mode of action for each class of OHA. Include target organ.

Oral Hypoglycemic Agent Brand Name Dosage Range Duration (hrs)

Secretagogoes:

- Sulfonylureas - Second Generation

Insulin Sensitizers:

- Biguanides

DPP-4 Inhibitor:

Insulin:

Fill in the Table

Insulin Preparations Onset (hrs) Peak (hrs) Duration (hrs)

Rapid-Acting

1. Lispro (Humalog)

2. Aspart (Novolog)

Short-Acting

1. Regular (Humulin R, Novolin R)

Intermediate-Acting

1. NPH

2. (Humulin N, Novolin N)

Long-Acting

1. Glargine (Lantus)

2. Detemir (Levemir)

Mixed Insulin

1. Humulin 50/50

2. Humulin 70/30

3. Novolin 70/30

4. Humalog Mix 75/25

5. Novolog Mix 70/30

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Revised 2017

Case study #1:

Mr. PJ, 48 year old African American male, BMI 33, presents to clinic and reports the

following “typical” PO intake. He reports he has a limited budget for groceries so he

typically eats fast food. He does not exercise at this time. He takes 1000 mg of Metformin

BID and 5mg of Glipizide BID; however he often takes Metformin and Glipizide after he

eats.

1. Please evaluate the following dietary recall for total carbohydrates consumed

without assistance from reference materials (give it your best guess!).

MEAL 1

Food Carbohydrates (g)

8 oz. 2% milk

1 Sausage, Egg, and Cheese Biscuit

1 hash brown

MEAL 2

Food Carbohydrates (g) Foot long BLT

Sour Cream and Onion Chips

Large Sweet Tea

2 chocolate chip cookies

MEAL 3

Food Carbohydrates (g)

1 Fried Bologna Sandwich

1 medium apple

TOTAL CARBS:

2. If you were providing nutrition education to Mr. PJ, what are some

recommendations you would make to help him control his carbohydrate intake?

Would you address the timing of his medication? Explain.

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Revised 2017

- Cirrhosis -

Resources:

AND Nutrition Care Manual

1. A) Describe cirrhosis.

B) What are complications of cirrhosis that can arise and impact nutrition status?

C) How can these complications be managed with nutrition?

2. What are goals of nutrition intervention for patients with cirrhosis?

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Revised 2017

- Irritable Bowel Disease and Irritable Bowel Syndrome -

Resources:

AND Nutrition Care Manual

1. What is inflammatory bowel disease?

2. What is irritable bowel syndrome (also known as spastic colitis)?

3. What are symptoms of IBS?

4. What are major differences between IBS and IBD? What symptoms do the two

conditions have in common?

5. According the AND Nutrition care manual, what are the ROME III and ACG

definitions of IBS?

6. How can IBS be managed with nutrition therapy?

7. What part of the gastrointestinal tract does ulcerative colitis affect? What are

symptoms of UC?

8. What part of the GI tract does Crohn’s affect? What are symptoms of Crohn’s?

9. What are some complications of Crohn’s disease?

10. What are some potential nutritional deficiencies that can occur with IBD?

11. What is the nutrition prescription/recommendations when someone is having an

exacerbation of IBD (e.g. “flare-up”)?

12. What is the nutrition prescription/recommendations during remission of IBD

flare (e.g. normal intake)?

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Revised 2017

- Cardiovascular -

Resources:

AND Nutrition Care Manual

AND Position: Dietary Fatty Acids for Healthy Adults (PDF)

AND Position: Health Implications of Dietary Fiber (PDF)

American Heart Association: Don't Let Salt Sneak Up on You

American Heart Association Journal Article: Salt Sensitivity in Humans

1. Describe to following:

A) Dyslipidemia/Hyperlipidemia (HLD) -.

B) Sodium Sensitivity –

C) Metabolic Syndrome –

2. What are the risk factors for CVD?

3. List the lab values indicative of dyslipidemia:

4. Outline the following for each of the lab values you listed in #3:

State what the lab values indicate

State the normal ranges of the lab values

5. Describe the following fats and identify food sources of each group:

a. Monounsaturated Fatty Acids (MUFAs)–

b. Polyunsaturated Fatty Acids (PUFAs)–

c. Saturated Fatty Acids (SFAs)–

6. Why are fats essential to our diet?

7. What are the benefits of consuming Omega-3s?

8. Describe the Mediterranean Dietary Pattern?

9. Describe a high fiber diet for men and women. How does consuming a high

fiber diet help to prevent CVD? What are ways to increase dietary fiber

consumption?

10. Identify target BP target ranges for individuals <60 yo and >60 yo with / without

chronic disease(s).

Labs Normal Ranges Indications:

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Revised 2017

11. For pts that are salt sensitive, what is the recommended daily sodium intake?

Why are salt substitutes not typically safe to consume?

12. Define the following “low salt” market terms:

1) Sodium-free:

2) Very low sodium:

3) Low-sodium:

4) Reduced (or less) sodium:

5) Light (for sodium-reduced products):

6) Light in sodium:

13. Describe insulin resistance. How does insulin resistance and dyslipidemia put

patients at risk for CVD? How can the dietitian screen for insulin resistance and

prevent CVD and DM? (Hint: Do some of your own research to answer this

question)

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Revised 2017

- Renal -

Resources: Renal Calculations Page 1 & 2 (PDF)

RD Pocket Guide

AND Nutrition Care Manual

NIDDK Health Information Diet and Lifestyle Changes

1. List and discuss 5 functions of the kidneys.

2. Outline the following for each of the lab values you listed in #2:

State what the lab values indicate

State the normal ranges of the lab values

State acceptable ranges of the lab values for renal patients

Labs Normal Ranges Renal Ranges If Elevated: If Low:

EGFR

Creat

BUN

K+

PO4

Na+

Alb

Ca2+

PTH

Transferrin

Ser. Ferritin

Hgb

Hct

Bld glu

HgB A1C

3. Describe the importance of adequate calorie intake in renal patients.

4. Describe the reason behind limiting protein intake in earlier stages of CKD vs.

ESRD.

5. What is the recommended dietary protein intake in stable non-dialysis CKD

patients with eGFR <45 mL/min?

6. Describe the relationship between diabetes and chronic kidney disease.

7. Give 3 examples of snacks appropriate for patients with renal disease and

diabetes.

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- Identifying Malnutrition -

Resources: AND Nutrition Care Manual

AND RD Pocket Guide

Screening Tool for Malnutrition (PDF)

Nutrition-Focused Physical Exam Chart (PDF)

1. Define Malnutrition.

2. What are the 2 areas of focus when conducting a nutrition-focused physical

exam?

3. What are some common physical indicators of malnutrition? Explain.

4. MNT can help underweight patients gain weight by consuming more calories.

List at least 6 ways patients can increase their caloric intake.

5. Nutrition Supplements are often used to support adequate intake until the patient

can maintain his/her weight with foods alone. Identify the calorie, protein,

carbohydrate, fat, fluid, fiber, potassium, sodium, and phosphorus content of the

following oral nutritional supplements. (can put in chart form) Describe which

patients would be appropriate for each supplement:

1) Ensure Powder

2) Ensure Plus

3) Ensure Clear

4) Boost Plus

5) Boost Glucose Control

5) Nepro

6) Suplena

7) Beneprotein

6. What are the guidelines for significant weight loss in 1 week, 1 month, 3

months, 6 months, and 1 year?

7. Mr. P.F. is 5’ 8” and weighs 110 lbs today. He usually weights 145 lbs. At his

last visit 1 month ago, he weight 116 lbs. Calculate IBW, % IBW, % UBW, and

% Weight Change? Is his weight loss significant?

43

TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION

Texas A&M AgriLife Extension Service Texas A&M University System

I. EXTENSION Location: Texas A&M AgriLife Extension Service Texas A&M University, Cater-Mattil Room 115

Duration: 120 hours

Goal 1: Become aware of the land grant history; Extension mission and goals; Food and Nutrition Unit programs such as SNAP-ED, EFNEP, and FP; and program development process.

Goal 2: Understand and experience the Extension program development process through traditional and non-traditional formats; merge approaches to face-to-face, online, and social media applications for nutrition and health programming.

II. ROTATION PREPARATION (Complete prior to starting rotation)

A. Contact preceptor two weeks prior to rotation to make necessary arrangements: (979)845-0861 or email adhammond@tamu.edu .

B. Read The Health Status of Texas sections related to demographics and diet/physicalactivity related diseases.

C. Be familiar with demographic and health data related to the following counties:Brazos, Grimes, Burleson and Washington.

D. Prepare a personal goal and objectives for this Extension rotation to discuss withpreceptor(s).

III. ROUTINE DUTIESA. Plan, design, implement, measure and interpret nutrition education through traditionaland non-traditional formats including face-to-face, online, and social mediaapplications.B. Adhere to documentation, confidentiality, and quality assurance requirements, and

perform special projects as assigned by preceptor(s).

IV. PLANNED ASSIGNMENTS

A. Plan Nutrition Extension Outreach. Conduct needs assessment; identify keymessages and behavior goals for targeted audience grounded in evidence-basedresearch on assigned topic area.

B. Design Nutrition Education Materials . Develop educational resources based onoutcomes from planned nutrition Extension outreach.

C. Implement Extension Programs. Observe and deliver county Extension education.D. Measure/Evaluate Effectiveness. Review and prepare evaluation instruments. Obtain

client and peer feedback.E. Interpret Results. Provide an interpretation event on rotation outcomes and learnings

to Food and Nutrition Extension Unit members and others.

V. EVALUATION

Revised July 2018 44

A. Prepare and present an interpretation presentation reviewing your experiences,learnings and applications.

B. Schedule and complete evaluation for last day of rotation and submit completedevaluation forms to Internship Director.

Revised July 2018 45

Texas A&M University-Dietetic Internship Rotation Information

Student Health Services Rotation Information

I. Location: Texas A&M Student Health ServicesA.P. Beutel Health Center 1264 TAMU College Station, TX 77843

Duration: 40-80 hours

Goal 1: Increase knowledge and skills to provide nutrition education and counseling to college-age students with a wide variety of nutrition-related conditions.

Goal 2: Develop creative ways to interact with college-age students and prepare effective nutrition-based programs.

II. Rotation Preparationa. Contact preceptor one week prior to rotation to make necessary arrangements:

979-458-8327.b. Review Academy of Nutrition and Dietetics eating disorder practice and position

papers.c. Prepare a written list of personal goals and objectives for the rotation to discuss

with preceptor on day one.

III. Routine Dutiesa. Participate in nutrition counseling sessions with patients regarding various topics

including: eating disorders, weight management, abnormal blood lipids, diabetesmanagement, and others.

b. Participate in nutrition education events on and off campus, as assigned.c. Adhere to documentation, confidentiality and quality assurance requirements, and

perform special projects as assigned by preceptor.

IV. Planned Assignmentsa. Observe Registered Dietitian and become familiar with college health model.b. Conduct dietary recalls with patient during nutrition education sessions.c. Learn the basics of EMR charting and complete documentation on patient charts.d. Observe interdisciplinary approach to treatment of eating disorders.e. Organize, prepare and lead a grocery store tour at the local HEB.f. Observe Bod Pod device as a way to measure body composition and provide

feedback for protocol.g. Create handouts and materials to be used during nutrition counseling sessions.h. Develop an educational model (article, nutrition power point presentation) or

other resource, using appropriate format as assigned.

Revised August 2018

46

i. Participate in conferences/meetings as appropriate.

V. Evaluationa. Complete assignments as given by preceptor.b. Schedule and complete evaluation for last day of rotation.c. Submit completed evaluation forms to Internship Director.

Revised August 2018

47

TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP ROTATION INFORMATION

CHEF Culinary Nutrition and Community Nutrition Learning Experiences for Interning Dietetic Students

Location: CHEF: Culinary Health Education for Families 250 East Grayson Street, Suite C San Antonio, TX 78215

Duration: 120-300 hours

GOALS: 1) To experience comprehensive learning opportunities in community

nutrition with the Culinary Health and Education for Familiesprogram , CHEF, in San Antonio community partners and TheChildren’s Hospital of San Antonio.

2) Improve professional communication and writing skills associatedwith CHEF projects and partners including the Children’s hospital,marketing team, and various community partners in the San Antonioarea; The Boys and Girls Club, YMCA, and Witte Museum.

I. ROTATION PREPARATIONa. Contact preceptor two weeks prior to rotation to make necessary

arrangements: 210-314-1840b. Inquire about materials needed before commencement of rotation

II. ROTATION DUTIES/ASSIGNMENTSa. Develop marketing skills in the area of community nutrition by working

with the marketing team to develop key community messages, content forthe website, newsletters, and community outreach programs.

b. Participate in quality control activities for the teaching kitchens,community programs, and medical conferences.

c. Apply scientific based guidelines and scientific literature in nutrition forteaching / assisting with community nutrition classes and programs thatemphasize a family and child approach to culinary nutrition learning.

d. Develop an understanding of the Goldsbury Foundations executiveorganization and funding behind CHEF.

III. ROTATION EVALUATIONa. Design, implement, and evaluate a service learning project as assigned by

the CHEF team preceptors.b. Assist and support research / data collection for CHEF designed

community nutrition surveys and studies in San Antonio.

Revised July 2018 48

Texas A&M University Dietetic Internship Information Cooper Clinic Rotation Information

I. Location: Cooper Clinic 12200 Preston Rd Dallas, TX 75230

Duration: 2 weeks (80 hours), 8 a.m. – 4:30 p.m.

II. Rotation Preparation:A. Email preceptor two weeks prior to rotation. Review schedule provided. Elana

Paddock, RDN, LD, CDE, elanapaddock@cooper-clinic.comB. Review Cooper website to become familiar with the facility:

www.cooperaerobics.com

III. ROTATION ACTIVITIES AND DUTIES:A. Meet with each RDN in their specialty areas.B. Participate in a campus tour and orientation.C. Observe patient consults with each RDN. Discuss/review patients observed with

the RDN if possible prior to and following consult.D. Complete Cooper Clinic’s Nutrition for Life forms for 3 patients during

observation. Review patient 3-day food records.E. Familiarize self with Nutrition Department education materials.F. Observe resting metabolic rate testing (RMR). Interpret RMR results, energy

equations and recommendations with the RDN.G. Observe data entry of 3-day food record(s) with the RDN.H. Meet with other entities at Cooper Aerobics (Cooper Fitness Center, Cooper

Complete Vitamins, and Marketing Department).I. Prepare for and complete a mock patient consult (with an assigned RDN).

Incorporate evidence-based nutrition information, use appropriate educationmaterials, and formulate a written customized plan with the patient.

IV. ROTATION ASSIGNMENTS (to be determined at time of rotation and mayinclude several or all of the following):A. Evaluate emerging research and write a summary paper of findings to present to

RDNs in staff meeting.B. Write a nutrition-related article and/or blog for the Cooper website.C. Develop and/or revise education materials assigned by RDNs.D. Review and provide copies of all completed assignments to preceptor.

Revised July 2018

49

V. EVALUATION:A. Complete evaluation on the last day of the rotation and discuss experiences,

learnings and applications with preceptor.

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Revised 2017

Texas A&M University Dietetic InternshipRotation: Excellence in Health

Community/Consultation & Business Practice

I. Rotation Information

Dietitians

Lisa Hoelscher, MS,RD,LD

Lisa.hoelscher@yahoo.com

5033 Rosenthal Parkway

Lorena, TX 76655-4016

ph/fax 254-881-7341

cell 254-715-1938

Susan Fogleman, RD,LD,CDE

254-899-0449

Ronda Hanley, RD,LD

254-396-0868

Location/Logistics

Rotation experiences will be completed at various healthcare sites in the central

Texas area. A tentative schedule will be provided prior to the rotation. Travel

capabilities within the Temple/Waco area will be necessary.

*** Contact must be made with Lisa Hoelscher 7-10 days prior to beginning the rotation.

(Email is ok!!)

II. Rotation Preparation (must completed by end of rotation)

A. Review The Entrepreneurial Nutritionist by Kathy King Helm; carefully read the

following sections:

2: Business Ventures in Dietetics

3: Building a Strong Foundation

4: Starting Your Business Venture

Chapter 30 - Media Savvy

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Revised 2017

B. Create a business plan; include a business name/logo and a brochure to market

you and your services. Use computer graphics or sketching and printing.

Note: For B, use these instructions if Entrepreneurial Nutr. is not available:

Business Plan:

Create a summary of the nutrition-related business idea of your choice. In the

summary, include goal/purpose of the business, proposed costs to start-up and

operate, plans for financing, location/office space, equipment needs, expected

revenue, organizational structure and staffing plans, prospective clients,

marketing strategies and as many other details as you can imagine.

Name/Logo:

Create a business name and logo for your company; use computer graphics or

sketch your idea and sample business card.

Marketing Brochure:

Develop a brochure that you could use to advertise your business (a bifold or

trifold usually works best). Use desk-top publishing or hand-write/sketch it.

C. Develop a two page nutrition newsletter for seniors and a one page lesson plan

(very simplified -- see sample enclosed); target seniors living at home receiving

meals-on-wheels; check topic with Lisa prior to beginning; provide in

black/white copy or on disc w/program compatible w/Microsoft Word.

III. Routine DutiesA. Teach classes

- inservices for dietary staff; will use same topic for several facilities; may choose

sanitation/safety, meal service or nutrition topics; 30-45 minutes; include handout,

visual aides and quiz; check topic with Lisa before beginning

- dietary manager program; will teach a segment of the class; may be

sanitation/safety or nutrition; Lisa will give you topic/ideas

B. Conduct chart reviews and nutritional assessments; document in medical

record/care plan, etc

C. Participate in care plan meetings

D. Conduct sanitation inspections/reviews; evaluate meal service

E. Participate in conferences/meetings as appropriate

IV. Submit completed assignments by morning of last day of rotation.

Evaluation (use short-form) will be completed on last day of rotation.

52

TEXAS A&M UNIVERSITY DIETETIC INTERNSHIP EXTENSION ROTATION INFORMATION

City of San Antonio Metropolitan Health District Chronic Disease Prevention Section- Community Nutrition

I. EXTENSION Location: 111 Soledad, Suite 1000San Antonio, Texas 78205

Duration: 120 hours

Goal 1: Become aware of the Chronic Disease Prevention Section strategies and programs. Understand the two community nutrition programs, ¡Viva Health! and ¡Por Vida!, and be able to identify how they help prevent the development of chronic diseases in the community.

Goal 2: Engage in community nutrition outreach events or projects that include face-to-face, online, and social media applications that encourages a better understanding of the cultural diversity in San Antonio. Engage with other Metro Health programs and community organizations to understand how cross-sector partnerships improve the health of the community.

II. ROTATION PREPARATION (Complete prior to starting rotation)

A. Contact preceptor 8 weeks prior to rotation to make necessary arrangements: HaleyAmick (210) 207-5263 or email haley.amick@sanantonio.gov and Arisa Larios-(210) 207-5261 or email arisa.larios@sanantonio.gov

B. Complete and submit the Metro Health Intern Application form, Internship Release& Indemnification form, and Volunteer Criminal Background Check form topreceptor 8 weeks prior to rotation.

C. Parking—there are fees to park downtown. Please contact your preceptor prior torotation for parking suggestions.

D. Supplies & Attire—please plan to bring your personal laptop. Let your preceptorknow if you do not have a personal laptop so that other arrangements can be made.Attire is business casual.

E. Visit http://www.sanantonio.gov/Health/HealthyLiving/HealthyEating,www.porvidasa.com,https://www.sanantonio.gov/Health/HealthyLiving/VivaHealth, andhttp://www.sanantonio.gov/Health/HealthyLiving/HealthyNeighborhoods to learnabout the nutrition/chronic disease prevention programs we are currently workingon.

F. Be familiar with demographic and health data related to Bexar countyG. Prepare a personal goal and objectives for this rotation to discuss with

preceptor(s).

III. ROUTINE DUTIES1. Provide community-based nutrition services (nutrition classes, community

outreach displays, attend coalition meetings, develop educational materials,etc.).

2. Participate in nutrition interventions that target public health issues amongdiverse populations.

3. Observe other Metro Health programs that implement Viva Health materials

Revised August 2018 53

and messaging, such as Healthy Neighborhoods, Healthy Start, Dental, WIC/Baby Café, etc.

4. Engage with Metro Health community partners to understand howcross-sector partnerships improve the health of the community.

5. Complete assignments pertaining to public health nutrition.6. With preceptor input and approval, develop a project that will enhance or

add to existing programs or services at the site.

IV. PLANNED ASSIGNMENTS

A. Plan to attend Community Outreach Events . Be able to identify key messages andbehavior goals for targeted audience and select appropriate educational material forevent.

B. Design Nutrition Education Materials . Develop educational material/curriculumbased on outcomes from planned outreach events. Develop Viva Health educationalmaterial for Metro Health programs including Dental, WIC, Baby Café, Health Startand Healthy Neighborhoods program.

C. Implement Nutrition/Chronic Disease Programs. Observe and/or present nutritionprogram’s education or core messages within the department or at communityengagements. Write a Viva Health press release and social media posts to engage thecommunity via social media outlets.

D. Measure/Evaluate Effectiveness. Review and/or prepare evaluation instruments fornew curriculum. Ensure pre/post evaluation tools are effectively being used by othercity departments.

V. EVALUATION

A. Prepare and present an interpretation presentation reviewing your experiences,learnings and applications with ¡Viva Health! or ¡Por Vida! programs.

B. Schedule and complete evaluation for last day of rotation and submit completedevaluation forms to Internship Director.

Revised August 2018 54