Failure to Thrive and General Surgery

​Starting my dietetic internship (DI) in a clinical rotation at a children’s hospital may not be your typical internship experience, it was definitely not what I expected. I began in an outpatient clinic working with kids who have been diagnosed as failure to thrive (FTT). First off, I knew absolutely nothing about this area of dietetics, which comes to be a common theme throughout my internship. We hardly covered pediatrics in undergrad and when we did, we learned what healthy kids need, not how you get a child to grow through adverse life circumstances or when they simply won’t eat. 

Despite feeling like I knew nothing about nutrition, I learned a lot about child nutrition in those first two weeks. My preceptor was very good about explaining the variety of formula’s they use in the clinic and showing me how to calculate the nutrients they provide. Additionally, she let me jump right in and begin taking diet histories, as that’s a consistency throughout all dietetics practices. During this time, I got my first taste of charting, I was terrible. I thought charting would be the one thing I could do because I always did well with writing notes in my undergrad. However, charting with medical software is not like writing an ADIME note for a case study. I did get lucky here though, the system used at my rotation was set up in an ADIME format for the most part, whereas some of the other interns in my program used a different set up. The hardest thing for me to grasp was how to be evaluative of the assessment data to explain why the interventions are necessary. They also don’t you the IDNT codes, which I was used to using for the diagnosis, interventions, and monitoring and evaluation. They did use IDNT diagnosis, just not the codes, and they seemed to just know what to use which was stressful as a beginner. Don’t worry though, this comes with time and practice, there is no need to stress, just learn from your experiences and move on.

I did have a unique experience during these first two weeks because my preceptor is one of the RD’s who does blended diets for kids on tube feeds. She showed me the software they use and what the nutrient goals are then let me work with the ingredients to discover the cause and effect relationship, specific foods have on the nutrient contents. This experience really opened my eyes to blended diets, they aren’t something we hear much about in class and when we do it’s mainly related to the food safety risks. 
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Transitioning into my third week at the hospital, I began inpatient care. My preceptor for this week is on the general surgery service, burn service, and just picked up plastic surgery this week. Because her services are so broad I took in a lot of information and she gave me the autonomy to call the resident physicians to give our nutrition recommendations as well as working with food service to make sure the patients had the food they needed for their specific diets. 

I was slow with charting this week and still struggling with being evaluative. My preceptor was patient but very particular when it came to charting and I was feeling like I would never get it. However, because she was particular about the charting and making sure it was by the books, it made me better and my charting really improved this week. 

Overall, these first three weeks were a full on learning experience and I really enjoyed the preceptors I had. The lessons I learned during this time were: never think you know everything, ask questions, and appreciate those who are tough on you because they are doing you a favor.  I hope you keep my experiences in mind as you begin your internships, take it in stride, you’ll make it through it.