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Dietetic Internship Program

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VA St. Louis Health Care System

The VA St. Louis Dietetic Internship Program is a 42-1/2 week program that prepares entry-level dietitians to work in a variety of dietetic settings. Our program concentration is "Health Promotion and Disease Prevention" with a sub-concentration of "Recognizing and Reducing Health Disparities". The combined educational experiences of didactic classes and workshops along with hands-on rotations, focuses on promoting good health, developing medical nutrition therapy (MNT) skills for disease prevention and treatment, refining teaching and presentation skills, developing interpersonal relationships, and identifying resources to prepare interns to assist patients/clients in meeting the healthcare challenges of their social and physical environments. Learning about health disparities will help interns understand and identify appropriate areas for developing health promotion programs. It is our philosophy that critical thinking, problem solving, strong communication skills, resource management skills, organizational skills, leadership skills and cultural competence are necessary to serve in professional organizations and to practice as a dietitian in a vast array of work settings.  The curriculum encourages the development of: a disciplined mind, critical thinking, creative abilities, skills in human relations, communications, flexibility, professional behavior, and cultural competence. Please be aware that as a VA hospital the majority of our patients are adult males of all ages. While there are many female Veterans, the majority of exposure to women and children is in the community rotations. Potential applicants with a professional interest in clinical pediatrics or private family practice may find that this particular internship program is not an ideal "match". 

ORIENTATION: Orientation begins in early August and lasts 1.5 weeks. Interns receive an overview of the VA, its facilities, the Nutrition and Foodservice department, the internship, and its activities. An internship binder containing detailed information about all rotations and projects as well as program and facility information, is provided during orientation. The information is also available electronically once interns are set up in the VA computer system. A tour of both divisions and meetings with various health care team members are scheduled. Discussions are based on the philosophy of learning, the interns' role as a professional-in-training and location of resources available to interns. Initial classes on skills needed for patient care and rotation basics are also included. Lastly, interns are matched with a mentor and use the High Performance Development Model to set goals for professional development, which they work on throughout the internship program.

CURRICULUM
The curriculum is divided into four major areas: 
    AREA     DESCRIPTION

Area of Concentration

 

 

HEALTH PROMOTION AND DISEASE PREVENTION (HPDP). HPDP refers to environmental, educational, motivational, and clinical activities designed to encourage improvement in health behaviors and conditions of living that are conducive to improving the health and well-being of populations and individuals. Disease prevention refers to health-related interventions or services that aim to prevent or minimize future morbidity and mortality by delaying or averting the onset or severity of disease or detecting already existing disease at an early stage when it can be successfully treated. Learning how health promotion and disease prevention is provided across the life span and cultural spectrum helps interns recognize personal biases that may affect patient and client care and also emphasizes the importance of both communication and cultural competence skills. Interns will advance their knowledge of individual, population, and environmental factors that contribute to health inequities, will learn how to advocate for policies aimed at improving the health of the population as a whole, and will learn how to provide health coaching and self-management support. Through class discussion, rotation experiences and assignments, and a short research project, interns will improve knowledge, skills and attitudes in order to work effectively with Veterans as well as diverse patient and community populations.
Clinical (Inpatient/Outpatient) The clinical experience is divided into several rotations that provide interns with both broad-based and in-depth experiences utilizing MNT in care. The finale of your internship experience is when you assume responsibility for the duties of a VA dietitian in Staff Relief for the final four weeks of the program in the spring. [See Program Rotations below for details.] 

Administrative/Management

 

Interns are provided with a variety of food service systems, food production and  management experiences. A staff relief week working as a food service supervisor serves to confirm your comprehension of managerial skills.  [See Program Rotations below for details.] 

Community

 

Planned community experiences, along with several opportunities to participate in community wellness and culinary programs, are provided. [See Program Rotations below for details.]
 PROGRAM ROTATIONS:
Interns have rotations at both divisions of the VA St. Louis Health Care System as well as affiliate sites in the St. Louis community. All clinical inpatient, outpatient and community rotations are 1-1 with the preceptor, allowing for personalized learning, and are therefore, unique. Except for the community rotations, all patient interaction is with adults. An approximate breakdown (subject to change) of the rotations is as follows:
 
    ROTATION     DESCRIPTION     DURATION
Clinical Inpatient and Group Teaching Clinical rotation areas emphasize MNT and include MEDICINE & ONCOLOGY, CARDIOLOGY, COMMUNITY LIVING CENTER/HOSPICE, SPINAL CORD INJURY,  PSYCHIATRY/SUBSTANCE ABUSE CARE and NUTRITION SUPPORT. All VA chart notes are written following the Nutrition Care Process/ADIME format using a computerized template. Interns will write and present a case study on a patient of their choice during their clinical rotations. Interns also have an opportunity to observe a variety of GI-related surgical and other nutrition-related procedures, if interested.  Interns collaborate with other health care professionals participating in medical and wound rounds and presenting their patients during interdisciplinary team (IDT) meetings. These interactions help interns learn to work within a multidisciplinary approach to healthcare and disease management. Several rotations offer interns opportunities to teach group classes on healthy eating, meal planning and weight management. All clinical rotations are two weeks in length, except for nutrition support, which is three weeks. Each rotation consists of 1:1 time with the preceptor. Interns progress from general dietetics to the more complex specialty and nutrition support rotations during the internship. 13 weeks

Administrative/ Management

 

The ADMINISTRATIVE rotation provides interns with a variety of managerial experiences, including food production, food service, procurement, and dining service using VA's advanced food prep and VCS's commercial food service systems. Interns complete the rotation in teams of two where they plan and supervise the production of a themed meal, develop marketing plans, complete nutrition analysis of menus, complete an administrative project, teach in-service classes to food service workers, create a labor schedule, gather and analyze statistical data, and write quarterly managerial reports on patient satisfaction and food waste. Interns complete a week of staff relief coverage as a food service supervisor to demonstrate their newly developed management skills. 9 weeks
Outpatient and home visits with 1-1 Counseling Most individual patient nutrition  education experiences take place in the 3-week NUTRITION  OUTPATIENT CLINIC and in the residence for the 2-week HOME-BASED PRIMARY CARE (HBPC) teams.  Interns learn to use a unified health communication approach for providing one-on-one counseling to Veterans with nutritionally related health problems such as obesity, diabetes, hypertension, cancer, hyperlipidemia and renal disease. Interns continue to work with other health care professionals and participate in interdisciplinary team (IDT) meetings.  5 weeks
Community Rotations with either OPERATION FOOD SEARCH or the ST. LOUIS AREA FOOD BANK (4 weeks) and WIC (2 weeks) allow interns to learn about local, state, and federal programs for low income populations. Interns learn about issues facing those with limited access to health care as well as food insecurity and challenges faced by the homeless. Interns become familiar with social determinants of health and observe firsthand how one's physical environment affects food choices. Interns participate in a food stamp challenge, complete a Community Health Assessment/Audit, and teach nutrition and cooking classes to a variety of population groups of all ages in the St. Louis community. In addition to planned community rotation experiences, interns have opportunities to volunteer at events for Veterans and at ST. LUKE'S COMMUNITY OUTREACH, participating in community health and wellness projects and assisting at local health fairs and outreach educational events. 6 weeks

Health Promotion and Disease Prevention

Our HEALTH PROMOTION DISEASE PREVENTION (HPDP) rotation, which includes the nationally acclaimed MOVE! Weight Management Program, provides exposure to public health messaging and programming both inside and outside of nutrition. Interns complete the rotation in teams of two and learn how to provide appropriate clinical preventive services, health education, self-management support and health coaching. They also receive Telehealth training, which is the latest in classroom education technology,  teach "Cooking Matters" classes to Veterans, and participate in our Whole Health program. 3 weeks
Staff Relief After all clinical and outpatient rotations are completed in the spring, interns finalize their training by managing the full clinical load of an inpatient, HPDP, or outpatient dietitian at the St. Louis VA. The STAFF RELIEF experience is a confidence-builder that is designed for the dietetic intern to demonstrate their knowledge, skills and ability to work as an entry-level dietitian upon graduation. 4 weeks
 THROUGHOUT THE PROGRAM:   
Projects

Projects are designed to provide interns with a well-rounded experience by completing assignments that registered dietitians also complete as professionals. Throughout the program interns develop their creative writing and presentation skills, practice public speaking, and begin professional networking.  Interns prepare a journal club presentation, write an article suitable for publication in our nationwide NFS Express Newsletter, develop a low literacy handout and create monthly nutrition newsletters for the medical center.  They also complete a medical center project of their choice and develop their first PDP (Professional Development Portfolio) earning 15 CEUs. Interns learn about advocacy by volunteering at local community service organizations, working with our homeless Veterans program, developing and preparing a meal (as a team) for the local Food Outreach Center, developing their own health promotion proposal, and doing committee work at the local dietetic association. They also work in teams to complete a short research project, have an individual booth at the employee wellness health fair during National Nutrition Month and update the employee wellness website. 

Didactic Class Days Weekly didactic class days are designed to prepare interns for their various rotations and projects and allow time for team project work.  In addition, guest speakers present on a variety of clinical and nutrition topics and interns present their various projects throughout the year. Field trips are also planned to a local urban farm, when available, and an agri-biotechnology research center.  A springtime mini-Public Policy Workshop (PPW) is conducted where interns  prepare for attending Legislative Day in Jefferson City, the Missouri state capitol. Special class  topics and workshops to round out the educational experiences include:  nutrition-focused physical exams, whole health/functional medicine, nutrition support, introduction to research, supervisor basic training, health promotion, sports nutrition, eating disorders, public school policy, pediatric nutrition workshop, motivational interviewing, goal setting and coaching, customer service skills, developing low literacy education materials,  professional ethics, wound care, state surveyor overview, women's health issues, and how to become a mentor/preceptor.  Job preparation begins in the spring with Career Day and a performance-based interviewing workshop.

 Internship Graduation Requirements

Interns must do the following to graduate from the Program:

  • Successfully complete all supervised practice rotations (for a minimum of 1200 hours) as determined by the preceptors and the Dietetic Internship Director
  • Attend all class lectures, workshops and seminars
  • Complete all projects with a rating of "Competent" and pass an MNT exam with minimum score of 70%
  • Complete staff relief with an overall rating of "Competent" (at entry level)

Dietetic internship graduates will receive a verification statement of successful program completion from the internship director and will be eligible to take the Registration Examination for dietitians. Once the RD credential is obtained, state licensure may be applied for, if applicable in the state of residence.

SCHEDULE AND HOLIDAYS:
The internship program is FULL TIME, with interns spending eight (8) hours per week in the classroom and 32 hours per week in a supervised practice setting. Each intern schedule for the program is unique in order to allow for 1:1 rotations with preceptors. Class days are reserved for didactic lessons, guest lecturers, field trips, planning sessions for individual and group projects, and intern presentations. ADDITIONAL PERSONAL TIME ABOVE THE SCHEDULED HOURS IS NECESSARY for rotation preparation and assignments, professional meetings, projects, and other related activities. Having another job outside of the internship program  may interfere with successful completion of the program.

Interns earn paid leave (vacation) during the program. Some vacation days are automatically scheduled during winter holidays and in the spring. Interns may select 2.5 days off in the spring with approval from the internship director. Details will be provided during Orientation. SPECIAL LEAVE REQUESTS MUST BE DISCUSSED WITH THE INTERNSHIP DIRECTOR IN JUNE, BEFORE ENTERING THE PROGRAM IN AUGUST, IN ORDER TO BE CONSIDERED. Up to nine paid holidays are also included in the program. Infrequent evenings may be part of the intern schedule and weekends offer volunteer opportunities for specialized learning experiences. There is no compensation paid for "overtime" and interns do not work holidays or weekends. 

 

ACCREDITATION:
The program is currently granted continued accreditation by the Accreditation Council for Education in Nutrition and Dietetics (ACEND) for the Academy of Nutrition and Dietetics. http://www.eatright.org/ACEND/ 

Accreditation Council for Education in Nutrition and Dietetics

120 South Riverside Plaza, Suite 2000

Chicago, IL   60606-6995

PH: 312-899-0040 ext. 5400

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