April is National Preceptor Month: A Chance to Honor Our Virginia Preceptors!

April is National Preceptor Month, which is the perfect opportunity to honor and thank Virginia RDNs and others who precept our interns!  Thank you all for training and mentoring them to become the next registered dietitian nutritionists who will help us fulfill our vision to optimize the health of Virginians through food and nutrition expertise.

Today, we hear from Diana Gulotta, a dietetic intern at the University of Virginia Health System.  She says:

Here are  2 preceptors that have had made this internship amazing:

12715571_1201699356525958_852573829153607260_n1. Chef Otis Sims: Otis is always willing to go above and beyond when it comes to helping out with intern projects and events. For example, at our student cooking demo, Otis packaged all the leftovers and cleaned the whole kitchen while we were eating the meal we had prepared. His only responsibility was to help with the actual cooking, but he did so much more. Another example is when we needed samples to give out during National Nutrition Month. On the morning that we were supposed to be passing out samples, the menu had been changed from what it was originally supposed to be. When we reminded all the chefs that we needed the vegan chili that was originally supposed to be on the menu for that day, Otis immediately stepped up to whip up the chili and put it in a serving dish that would keep warm while we were handing out samples. Overall, Otis is my go-to guy in the kitchen because he is always ready to help with a smile on his face!

248717_1210317295664164_4335472641147996259_n2. Angie Hasemann: Day in and day out, Angie is there to do whatever it takes to make every intern’s experience great. She often sends out kind emails thanking us for our efforts (for example, she sent an email to say how proud she was of everyone that presented posters at the VAND annual meeting) and never fails to make us feel like our work as interns is important. I know I can go to Angie with any problem, question, or concern I have and she will be there with a solution or just to lend an ear. She is one of the most hard-working, caring, driven, and compassionate people I know.

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It Takes Two: Top Tips for Interns and Preceptors

DSC07393It’s the time of year when dietetic interns prepare to transition from students to professionals. As I reflect back on the past eight months, I can’t believe how much things have changed. At the beginning of the program, I timidly met with preceptors to learn the basics of nutrition assessment and charting, unsure how to interact with other dietitians, professionals, and patients. As time went by, I became more confident in my skills, only to be thrown into another unfamiliar area. Although more confident now than when I started, I still wonder how I will ever feel fully ready to fly. What I do know, however, is that when I make the leap, I will be okay. This is in part because of the hard work I have put into this internship, but also in part thanks to the many amazing preceptors I have come to know. Whether intern, preceptor, or a dietitian who doesn’t regularly work with students, I think we can all use a reminder of ways to help create successful nutrition professionals.

Let’s start with interns. Here are my top 6 tips for getting the most out of your internship:

  1. Ask questions, but be willing to do some of your own research.
    The internship is a time of learning, so don’t be scared to ask if you are confused. However, if you are curious about something you could easily look up, it shows initiative to do your own research. For example, if you have already researched the physiology of bone mineral disease in kidney patients but you are still confused, don’t be shy in asking your preceptor to explain it. On the other hand, if you can’t remember which vitamin supplements are recommended for bariatric patients, try looking this up on your own because it is easily accessible on the Internet. Even better, you could say, “I want to learn more about bariatric vitamin and mineral supplementation. Do you know any good resources for finding this information?”
  2. Take advantage of the wealth of knowledge your program directors and preceptors have.
    The internship is also a unique time where you’re surrounded by people whose job it is to help you achieve your full potential. Seek their advice and get to know them; you never know when one of them will inspire you. Ask about how they landed in the area in which they now work or talk to them about what they wish they had done differently (if anything).
  3. Focus on what is most useful to you from the readings and assignments.
    It’s easy to get caught up in completing assignments and readings just for the sake of finishing them. However, you will learn and remember more if you focus on the things that help you better understand the subject at hand (and not what you think your preceptor wants you to know). On assignments, it may be useful to make your own note sheet separate from what you will turn in so you can add information related to the questions that will be helpful in practice.
  4. Instead of looking at assignments, projects, volunteer opportunities, etc. as work, look at them as opportunities to build your resume and increase your knowledge.
    Again, it’s easy to get caught up in the cycle of completing assignment after assignment, but try to think about how each opportunity will impact your future. For example, while my capstone research project was difficult and time-consuming, I can now say I presented my research at the VAND annual meeting and can demonstrate to future employers that I have valuable research skills.
  5. Be willing to volunteer.
    I know, you’re busy. But volunteering will give you a chance to put what you’re learning into practice in a non-traditional setting. Volunteering is also a great resume booster and way to meet other students and professionals.
  6. Find something you enjoy outside the internship.
    When you just can’t look at another piece of internship-related work, it’s nice to have something else to do. Many interns have joined workout or yoga classes, made friends at church, discovered new areas to hike, or taken up new hobbies. Whatever it is you enjoy doing outside nutrition, DO IT!

Now for the preceptors. Here are my top 6 tips for being an effective teacher:

  1. Get to know the interns.
    Most of our waking hours are spent focusing on the internship, so it’s nice for someone to make the effort to get to know us as human beings. Doing this will make us more comfortable working with you, which will make us more likely to ask questions and challenge ourselves in rotation.
  2. Think about the experiences your intern has and/or has not had.
    Either by sitting down with your intern at the beginning of the week or by looking at the intern schedule, it’s helpful to know which rotations your intern has gone through. Acknowledging the intern’s experiences will let them know you understand for what they may or may not be ready.
  3. Introduce your intern to the people you work with.
    Consider the fact that interns have to work on new floors/in new buildings with people they don’t know regularly. Add that to the fact that they are likely still a little unsure of what they are doing, and it can be scary to start a new rotation. Introducing the intern to your co-workers helps make them feel like part of the team and will make them more likely to get involved with interdisciplinary care.
  4. Try not to focus on the format/style of the note, and instead focus on the content.
    Do your best to remove your own style bias from the equation. While it is helpful to get some pointers on proper wording and formatting of notes in the first few months, most interns have found their own style after a few months. Remember that everyone has their own way of writing notes (as do you!), and pointing non-content-related details of notes may take away from important discussions about note content.
  5. Find a balance between challenging your intern and leaving them feeling overwhelmed and/or stranded.
    One of my preceptors told me on my first day of rotation that I would be leading a counseling session later that afternoon. This was about my third week of rotation, so I was terrified. However, this preceptor gave me adequate time to prepare for the session and ensured that she would jump in if I had questions. Although it was scary, she made sure I wasn’t overwhelmed and was very encouraging. Sometimes we need a little push, but make sure you offer proper support instead of leaving us feeling stranded.
  6. Make time for a one-on-one meeting at the end of the rotation.
    Although getting feedback can be intimidating, it is also extremely useful. You might point something out that your intern had never thought of. When providing feedback about your intern’s performance, try the sandwich method: highlight something the intern did well, provide any constructive criticism, and close by providing another meaningful piece of positive feedback. Here is an example: “I was really impressed by how you took the initiative during rounds to advocate for the role of nutrition in our patient’s care. That showed a lot of confidence! For your next rotation, I might work on your understanding of lab values and ways in which dietitians can intervene. However, it was great when you were able to recommend that vitamin D supplement for Mr. Smith! Keep up the great work.”

As we all know, whether intern or preceptor, the dietetic internship experience is both challenging and rewarding. Interns are asked to work 40 hours each week learning clinical nutrition skills and attending class, while working tirelessly outside rotation on assignments. Preceptors, likewise, hold full-time jobs with full patient loads, while being required to take time out of their busy days to act as teachers and mentors. However, it is because of everyone’s hard work that dietetics is one of the fastest growing fields in America. So I guess it’s true what they say: sometimes the richest things in life are also the most challenging.

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Diana Gulotta is a Dietetic Intern at the University of Virginia Health System in Charlottesville, VA. A Wisconsin native (Go Pack Go!), Diana graduated with Highest Distinction from the University of Wisconsin-Madison in 2015 with a degree in Dietetics. In her free time, Diana enjoys singing, hiking, cooking, and reading.  She is pictured here with her internship class and Internship Directors.

 

 

As April is National Preceptor Month, stay tuned to the blog this week as interns in Virginia highlight those preceptors who have had a great impact on their learning this year!

Myth Busters: The Stress and Nutrition Edition

shutterstock_90278629Whether from friends, family members, or patients, we’ve all heard it before: “It’s so frustrating that I keep gaining weight, but I’ve just been so stressed out lately!” Upon hearing this, do you ever wonder if simply being stressed can actually lead to weight gain? Have you ever questioned if there is actually such a thing as stress-inducing foods?

Before answering these questions, it is important to understand that stress is not just an emotion; it is a physiologic reaction to anything that overwhelms or threatens the body’s ability to maintain homeostasis. There are various types of stressors, ranging from physical (i.e. surgery) to chemical (i.e. reduced oxygen supply) to social (i.e. personal conflicts or major life changes), and not all of these stressors are created equal. While some occur repeatedly, leading to chronic stress, others elicit an acute stress response.

The acute stress response is also known as the Sympathetic Adrenal Medullary (SAM) System, or “fight-or-flight” response. Its main end products are epinephrine and norepinephrine, which, in addition to increasing heart and respiratory rates, decrease appetite. The theory is that once upon a time, when encountering dangerous situations, the body could not afford to expend energy digesting food because it needed to divert all of its energy to “fighting or fleeing.”

However, when people talk about being stressed out, they are likely not referring to things that would activate the acute stress response. Instead, daily stressors activate the chronic stress response, also known as the Hypothalamic-Pituitary-Adrenal (HPA) Axis. The end product of this system is cortisol, which is the hormone most people think of when they hear the word “stress.” Not only does cortisol stimulate appetite, but it also leads to preference of hyperpalatable foods. Moreover, cortisol inhibits insulin release and blocks the migration of GLUT4 glucose receptors to cells’ surfaces. Thus, when cortisol is released, our appetite increases while insulin release decreases, meaning the glucose we consume cannot properly enter our cells. Therefore, despite adequate energy intake, our cells think we are starving, which further stimulates appetite and perpetuates the issue.

But what about the reverse relationship? Can consuming certain foods make us more stressed? In general, it’s not that simple. Most foods that are touted as stress-inducing demons have not actually been studied by reputable researchers, and those that have been studied haven’t produced enough solid evidence to warrant us warning our patients about them. Here are a few of the foods that have been studied recently and the results of these studies:

  • Caffeine: Research shows that caffeine can keep cortisol levels from falling, but this does not prove a causal relationship between caffeine and stress.
  • Alcohol: About 3 well-defined studies have come to the same conclusion: Heavy drinking does lead to increased cortisol output. Again, this does not prove a causal relationship.
  • Sugar: Evidence is very weak that consuming sugary foods actually causes stress.

So what are the takeaway points from all of this when it comes to intelligently discussing stress and nutrition with our patients?
Chronic stress can in fact lead to increased appetite, but we must recognize that mental health is not our area of expertise as dietitians. Encourage patients to seek out help from a psychologist or psychiatrist as necessary. It may be appropriate to explain that working to control one’s stress may aid in the weight loss process.

  1. Encourage patients to pay attention to hunger and satiety cues. Explain the concept of emotional eating and teach them to pay attention to whether they are eating because they are hungry or because they are stressed or bored.
  2. Research has not yet shown us that there are foods that cause stress. Continue to teach patients about consuming a balanced diet full of fruits, vegetables, and whole grains.

And most importantly… The relationship between stress and weight gain is correlational, not causal! There are many other factors affecting weight gain and loss. Emphasize to patients that in the face of stress, there are still other things they can be doing to work towards weight loss. They are not helpless.

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Diana Gulotta is a Dietetic Intern at the University of Virginia Health System in Charlottesville, VA. A Wisconsin native (Go Pack Go!), Diana graduated with Highest Distinction from the University of Wisconsin-Madison in 2015 with a degree in Dietetics. In her free time, Diana enjoys singing, hiking, cooking, and reading.