VA St. Louis Health Care System - Dietetic Internship Program
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Dietetic Internship Program


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VA St. Louis Health Care System

Program Curriculum and Rotations

Area of Concentration: Health Promotion to Chronic Disease Management 
Our concentration seeks to provide the intern with a full range of opportunities to work with the general public and Veteran patients regarding their personal nutritional health care needs. Health promotion 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. Learning how health promotion is provided across the life span and cultural spectrum helps interns recognize personal biases that may affect patient and client care and emphasizes the importance of both communication and cultural competence skills. 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. Chronic disease management involves the use of medical nutrition therapy (MNT) to address an existing disease and develop an appropriate plan of care. 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, and will learn how to provide health coaching and self-management support. Through class discussion, rotation experiences and project assignments, interns will improve knowledge, skills, and attitudes to work effectively with Veterans as well as diverse patient and community populations.

Curriculum and Rotations
The supervised practice portion of the internship program is 42.5 weeks long, which includes 1.5 weeks in Orientation and 1 week vacation in December. The remaining 40 weeks are spent in didactic classes and a variety of rotations. The curriculum is divided into four major areas listed below. Most Mondays are for mandatory didactic classes (8 hours) with the remainder of the week in rotations for specific supervised practice (32 hours).  Interns have rotations at both the John Cochran Medical Center and the Jefferson Barracks complex divisions of the VA St. Louis Health Care System as well as community outpatient clinics and affiliate sites in the St. Louis community. A personal vehicle will be necessary. All clinical inpatient, outpatient and community rotations are 1-to-1 with the preceptor, allowing for personalized learning. Except for the community rotations, all patient interaction at the VA is with adults of all ages.   

Depending on the assigned rotation, interns will be required to report to the worksite as early as 6:00 am and may be scheduled to stay as late as 8:30 pm, though not on the same day. Interns are required to work the same schedule as their preceptor. Interns do not work from home. In addition to rotation experiences, the various projects and assignments will require at least 10 hours weekly of evening and/or weekend personal time outside of the internship program to successfully complete them.

Orientation – 1 week  
During Orientation, which begins in August, interns receive an overview of the VA, its facilities, the Clinical Nutrition and Nutrition and Food Service departments, the internship, and its activities. An internship binder containing detailed information about all rotations and projects as well as program policies 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 of their choice and use the High Performance Development Model (HPDM) to set goals for professional development, which they work on throughout the internship program.

Health Promotion and Disease Prevention (HPDP) – 2 weeks 
The HPDP rotation focus is on interns learning to provide clinical preventive services, related health education, self-management support, and health coaching for Veterans. Opportunities include:
- teaching classes for the nationally acclaimed MOVE! Weight Management Program
- exposure to public health messaging and programming activities both inside and outside of nutrition
- receive Telehealth and VA Video Connect training
- participate in our Whole Health program, which encourages Veterans to take charge of their life and health by working with their health care team to build positive habits for life. It’s all about “what matters to you”, not “what is the matter with you”.

Medical Nutrition Therapy (MNT) Clinical (Inpatient/Outpatient) – 20 weeks 
The clinical experience is divided into several rotations that provide interns with both broad-based and in-depth experiences utilizing MNT in care. 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. Interns learn to use a unified health communication approach for providing one-on-one counseling to Veterans with nutrition-related health problems such as obesity, diabetes, hypertension, cancer, hyperlipidemia and renal disease. 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. The outpatient rotation allows interns to provide 1-1 counseling focusing on motivation interviewing skills. The HBPC rotation allows the intern to work with the Veteran in their home environment. Each rotation consists of 1:1 time with the preceptor. Patient care may be provided in person or virtually, depending on the patient and the rotation. Interns progress from general dietetics to the more complex specialty and nutrition support rotations during the internship. The following general breakdown is subject to change. 

- Cardiology – 2 weeks
- Geriatrics/Hospice Care – 2 weeks
- Home-Based Primary Care (HBPC) – 2 weeks
- Medicine - 2 weeks
- Nutrition Outpatient Counseling – 3 weeks
- Nutrition Support & Surgery – 3 weeks
- Oncology – 1 week
- Psychiatry/substance abuse care – 2 weeks
- Renal – 1 week
- Spinal Cord Injury – 2 weeks 

Administrative/Management – 9 weeks 
The Administrative/Management rotation provides interns with a variety of managerial experiences, including food procurement and production, and food dining service using VA's advanced food prep and the Veteran Canteen Service’s (VCS) commercial food service operation. 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 a waste QI project, teach in-service classes to food service workers, create a labor schedule, conduct charting audits, and gather and analyze statistical data to use for writing a quarterly report on patient satisfaction. The rotation capstone is when interns complete a confidence-building week of staff relief coverage as a food service supervisor to demonstrate their newly developed management skills.

Community – 5 weeks 
Community rotations 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, participate in community health and wellness projects and to assist at local health fairs and outreach educational events.
- Family Care Center (WIC) – 2 weeks
- Operation Food Search or St. Louis Area Food Bank – 3 weeks
- Volunteer opportunities at community outreach programs and food banks (as available)

Staff Relief – 4 weeks 
The Staff Relief experience is the ultimate 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. During this finale of your internship experience you will assume full responsibility for the duties of a dietitian in an area of your choice (inpatient, HPDP, or outpatient) at the VA for the final four weeks of the program in the spring.

Paid Vacation – 1 week (in December)

Didactic Class Days 
Weekly didactic class days are designed to prepare interns for their various rotations and projects and allow time for project work.  In addition, guest speakers present on a variety of clinical and nutrition topics and interns present their various projects throughout the year. A field trip is also planned to an agri-biotechnology research center, as available.  A springtime mini-Advocacy Workshop is conducted where interns prepare for attending Legislative Day in Jefferson City, the Missouri state capitol. Special class  topics and workshops (subject to change) to round out the educational experiences include:  nutrition-focused physical exams, whole health, nutrition support, health promotion, sports nutrition, eating disorders, public school policy, pediatric nutrition workshop, motivational interviewing, goal setting and coaching, professional ethics, wound care, state surveyor overview, women's health issues, and how to be a mentor/preceptor.  Job preparation begins in the spring with Career Day and a performance-based interviewing workshop.

Program Projects 
A variety of 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 national NFS Express Newsletter, and create monthly nutrition newsletters for the medical center following 508 Compliant guidelines.  They also develop their first PDP (Professional Development Portfolio) earning a minimum of 15 CEUs. Interns learn about advocacy by volunteering for a minimum of 12 hours at local community service organizations, working with our homeless Veterans program, doing committee work at the local dietetic association, and develop their own health promotion proposal. They also have an individual booth at the Wellness Health Fair during National Nutrition Month presenting on a subject matter of their choice. Lastly, interns write and present a case study on a patient of their choice during their clinical rotations.