DIETETIC INTERN S GUIDELINES & COMPETENCY PACKAGE

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Indian Dietetic Association

DIETETIC INTERN’S

GUIDELINES &

COMPETENCY PACKAGE

NAME

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DATE

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From:

To:

INSTITUTION

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GUIDELINES

1. OBJECTIVES: a) To understand the functioning of the Dietary Department. b) To gain knowledge and practical experience in the nutritional management of various disorders. c) To gain experience in all aspects of food service management. d) To develop expertise in various types of communication and soft skills. e) To understand application of a research approach to solving problems. 2. ROTATIONS: CLINICAL DIETETICS Clinical 1 3 weeks Clinical 2 2 weeks Clinical 3 3 weeks Clinical 4 3 weeks Clinical 5 2 weeks Clinical 6 2 weeks Clinical 7 3 weeks FOOD SERVICE

Patient food service + Production + Cafeteria 4 weeks OTHERS

Community nutrition 1 week Research project 2 week General management 1week

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TOTAL 26 weeks 3. PROJECTS: In each rotation, the dietitian may give the intern small specific projects – eg, labelling the storage racks in the store rooms, reviewing a patient education leaflet and updating the information, getting patient or cafeteria feedback, or assisting at a catering event. These should be listed for each rotation with a short description. (See Appendix for format) 4. RESEARCH PROJECT: A research project on a clinical nutrition topic with 30 – 100 subjects should be completed by the Intern. A list of topics may be suggested by the Course Director and other dietitians, unless the intern has a specific interest. The review of literature and data collection will have to be carried out concurrent with other rotations. The data analysis and presentation can be done during the week allotted for Research. or Pan India Standardisation Project under the www.idaindia.com under the head Registration Board, Project for the R. D. Board (http://www.idaindia.com/Files/STANDARDIZATION%20OF%20COOKED%20FOODS.doc) 5. NUMBER & CATEGORIES OF PATIENTS FOR NUTRITION CARE DURING CLINICAL ROTATIONS (See Appendix for format to be used for each patient. To be filed and submitted to Internship Coordinator.) CLINICAL DIETETICS ROTATIONS; 50 CASES

1 Clinical 1 (Medicine)

3 weeks 10 (Infectious (Malaria, Dengue, TB)/ Hypertension/ CVA/ Stroke/ Anemia/ COPD/ILD/ Renal calculi/ obesity/ HIV 2 Clinical 2

(Critically ill)

2 weeks 5 (EN feeds, 1 Diabetic RT (fragmented) (DKA)+1Renal 1 Hepatic enceph,1ARDS on venti, pancreatitis (continuous drip feed)1TPN or NJ)

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3 Clinical 3 (Superspeciality)

3 weeks 10 (4 Gastro (cirrhosis, hepatitis, IBD), 3Onco ( ENT + Hematology),2 Nephro+1Neuro/ Neuromuscular (AIDP/ GBS/ CIDP)/ Pre eclampsia of pregnancy/ PIH/

Skin Pamphigus vulgaris/Steven Johnson syndrome 4 Clinical 4

(Surgery)

3 weeks 5(1 onco, 1Trauma, 1major abdomen/whipples,1Stoma,1IBS (small bowl resection) or 1 with 35%Burns /renal transplant)/ Chylous ascites/ Head Injury on GT feeds

5 Clinical 5 (Paeds)

2 weeks 5(3Genral+2Surgical) (1PEM,1Nephrotic syndrome,1Wilsons disease/padder willy syndrome/CLD) (1TOF/MVR&1Ileostomy infant)

6 Clinical 6 (Cardiac)

2 weeks 5 (3 General+2 Surgical) (1IWMI, 1HF with CCF/ RHD/1LVF with EF 15%) (1CABG, 1VSD)

7 Clinical 7 Endocrine & diabetes

3 weeks 10(2 Type 1 + 1 GDM + 1 Type2 with pregnancy+1Diabetic foot+1Renal DI DIabetic+2uncontroled DM on 4doses of insulin &1on basal bolus &1on OHA(secretagogue+Bigunides or Alfa glucosidase inhibitor)

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USING THE COMPETENCY PACKAGE

1. The competency package serves as a communications tool; it provides feedback for the intern as well as information for dietitians in their areas with respect to the trainee’s learning experiences while on their rotation. 2. The ‘competencies’ or skills have to be developed, demonstrated and assessed as the intern goes through the specified rotations in clinical dietetics, food service and other rotations. 3. All competencies have to be completed and opportunities for completing each one have to be found by the intern. For example, all clinical competencies can be completed during clinical rotations. While the competency for ‘Standardizing a Recipe’ may be done during the kitchen rotation, ‘Media’ competency such as making a presentation on TV or writing an article for the newspaper or a magazine will have to be done side‐by‐side with any rotation. 4. Formats for clinical nutrition care and project reports can be found in the Appendix. GUIDELINES FOR THE DIETITIAN 1. Please initial each performance objective when it is completed. If an objective is only partially completed, document the trainee’s progress to date under “Progress Notes”. 2. When all performance objectives for a competency have been completed, sign off the competency by putting your initials and the date under “Competency Achieved”. GUIDELINES FOR THE DIETETIC INTERN 1. Review package with the dietitian on first day of each area. 2. Request a verbal evaluation close to the mid‐point of rotation. 3. Use this package to complete a self‐assessment prior to the final evaluation. Nirmala Jesudason and Salome Benjamin. (2014)

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DIETETIC INTERN’S COMPETENCY PACKAGE

CLINICAL DIETETICS A.1. Clinical Nutrition and Dietetics COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 1a) Participate in routine nutrition screening Conduct nutrition screening as per policy to identify patients requiring special nutritional care 1b) Monitor patient’s food intake and acceptance Monitor patients’ care via daily visiting to: ‐ Assess acceptance of diet ‐ Provide smaller or larger portions such that food wastage is minimized ‐ Suggest adjustments to meet patient’s needs ‐ Initial and ongoing patient screening ‐ Meal reports from Nursing 1c)Write menus, including adjusting standard diets and following calculated patterns Adjust standard diets for patients, based on notes, special diet orders, interview with patient or discussion with physician 1d) Effectively communicate with Department staff, health care team members and patients ‐ Answer patient’s questions regarding menu so that patients are satisfied ‐ Communicate menu specials with Food Production ‐ Information obtained during rounds

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 1f) Apply knowledge of medical terminology ‐ Read patient file/ chart and indicate understanding ‐ Medical Dictionary 1g) Apply knowledge of medications ‐ Relay rationale for key medications ‐ Identify medications with nutritional significance ‐ Food medication interactions information 1h) Apply knowledge of basic laboratory data ‐ Identify nutritional significance of abnormal laboratory data ‐ Request laboratory tests that indicate nutritional status ‐ State normal range values ‐ Lab Reports ‐ Text books 1I) Reading the patient medical files ‐ Read and interpret patient medical file for understanding reason for admission, goals of treatment and rationale for care ‐ Patient medical files 1j) Take and analyze diet History ‐ Retrieve all information needed, using patient’s file, diet history and interviews. ‐ Food composition data 1k) Identify psychological, social and cultural factors affecting nutritional management ‐ Evaluate the effect of above factors on the nutritional management of the patient ‐ Health Care Team ‐ Patient’s file ‐ Rounds 1l) Complete nutritional Assessments ‐ Collect data from history, physical findings, anthropometrics ‐ Calculate nutrient requirements ‐ Interpret data ‐ Design nutrition support based on findings ‐ Nutrition support notes ‐ Diet manuals

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 1n) Assess and plan enteral Feedings 1o) Assess and plan parenteral nutrition regimes ‐ Calculate nutritional requirements ‐ Understand rationale for feeding route ‐ Select appropriate feedings ‐ Determine feeding regime ‐ Calculate nutritional requirements ‐ Understand rationale for feeding route ‐ Select appropriate products. ‐ Design parenteral regime ‐ Nutrition support Information ‐ ‐ Nutrition support information A.2.Communication 2a) Document subjective data, objective data, assessment and plan for a patient consult ‐ Complete standardized file forms ‐ Demonstrate correct use of SOAP Format ‐ Patient care ‐ SOAP format outline 2b) Follow up plan and revise when necessary; record in patient file ‐ Document follow up in patient’s file which reflects patient’s personal and clinical response to nutritional care and makes recommendations to improve response ‐ Patient care 2c) Demonstrate effective interviewing skills ‐ Interview patient and / or family to obtain the information necessary for effective patient care ‐ Patient care 2d) Communicate plan for nutritional care to patient and / or family and food services personnel ‐ Explain nutritional care to patient / family ‐ Communicate plan to food service personnel for follow‐up ‐ Patient care

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 2e) Respond to nonverbal communication ‐ Identify and respond appropriately to nonverbal communication. ‐ Make adjustments in response to the physical environment ‐ Patient care ‐ Text books 2f) Communicate at a level appropriate to the patient, family and Food Services’ Personnel ‐ Evaluate level of understanding ‐ Adjust communication to meet person’s needs ‐ Demonstrate tact and empathy ‐ Patient care 2g) Work with other health professionals to promote a team approach ‐ Participate in patient care rounds ‐ Contribute to overall patient care ‐ Communicate nutritional care to relevant health care team members ‐ Patient rounds ‐ Interactions with other professionals 2h) Effectively communicate to non‐professionals in writing ‐ Write nutrition information for patients/general public that is free of errors, clear, concise, aimed at a suitable literacy level and well‐presented ‐ Patient education pamphlets ‐ News articles 2I) Demonstrate effective writing and organizational skills in documentation ‐ Written messages are clear ‐ Written book includes background, action taken, conclusions and recommendations ‐ Memos ‐ letters ‐ minutes ‐ reports 2j) Use a research approach to problem solving ‐ Successfully complete a research Project ‐ Advisors ‐ Text books 2k) Effectively communicate to peers verbally and in writing ‐ Make a formal presentation of research project

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 2l) Communicate information within the Department ‐ Communicate information clearly, concisely, appropriately and in a timely manner 2m) Use appropriate communication system for relaying information between departments ‐ Identify those who need to be informed of actions, decisions or events ‐ Communicate information clearly, concisely and in a timely manner 2n) Demonstrate effective meeting skills including planning, conducting ‐ Develop meeting agenda ‐ Record minutes ‐ Conduct meetings ‐ Participate in meetings ‐ Serve as Chair, Secretary for Dietitians’ meetings 2o) Demonstrate effective skills to present information to the media ‐ Prepare information for media that is concise and easily understood ‐ Material is presented or published that supports the goals of the profession ‐ Radio ‐ Television ‐ Newsletter ‐ Newspaper ‐ Letter to Editor ‐

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A.3.Education COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 3a) Counsel individual Patients ‐ Use a variety of appropriate techniques and tools in presentation ‐ Encourage learner participation and feedback ‐ Evaluate learning ‐ Patient Care 3b) Present established group sessions ‐ Use a variety of appropriate techniques and tools in presentation ‐ Encourage learner participation and feedback ‐ Evaluate learning ‐ Group classes ( patients) ‐ Group classes ( non‐patient) 3c) Design and present group sessions ‐ Assess needs and design program to meet needs of participants ‐ Use a variety of appropriate techniques and tools in presentation ‐ Encourage learner participation and feedback ‐ Evaluate learning ‐ Group Classes ( patients) ‐ Group classes ( Non‐patient) ‐ Outside talks 3d) Organize and conduct in‐ service training ‐ Assess development and training needs of staff ‐ Organize and conduct in‐service training using principles of adult education ‐ Obtain feedback from participants ‐ Evaluate learning ‐ Sanitation text book ‐ Food service texts ‐ Other texts

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A.4.Management Skills in Clinical Dietetics COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 4a) Keep workload measurement data of dietitians ‐ Collect accurate workload measurement data ‐ Summary form ‐ Internship manual 4b) Is familiar with standards and procedures for auditing nutritional care ‐ Review a completed audit and discuss the findings ‐ Internship manual 4c) Is familiar with applications of computers in patient care ‐ Locate patient information ‐ Training with IT presonnel ‐ Find and recordinformati on 4d) Manage time effectively ‐ Establish time limits and set priorities ‐ Perform responsibilities in a timely manner ‐ 4e) Understand basics of clinical nutrition services management ‐ Discuss with the manager ‐ Job description ‐ Duty lists 4f) Demonstrate knowledge of quality management in clinical nutrition ‐ Review QM program ‐ Participate in clinical audit – data analysis and corrective action ‐ Nutrition products specifications

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FOOD SERVICE B.1 The Menu System COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 1a) Demonstrate a working knowledge of the master menu ‐ Interpret the patient master menu ‐ Master menu 1b) Apply knowledge of production in working with the menu and available resources ‐ Prepare daily production summary sheets to assign all tasks. ‐ Approve menu changes considering principles of menu planning , nutrient guidelines, cost control and available resources ‐ Time schedules ‐ Job descriptions ‐ Master menu ‐ Cafeteria menu 1c) Apply principles of Food & Nutrition Policy to menu planning ‐ Plan menus such that Food & Nutrition policy goals are met ‐ Nutrition policy ‐ Menus B.2 Personnel Management 2a) Participate in the interviewing and selection of applicants ‐ Determine selection criteria ‐ Review interview questions and rating form ‐ Screen applications and resumes ‐ Participate in selection interview ‐ Rate and rank applicants ‐ Interview score guides ‐ Text books 2b) Document personnel information for payroll ‐ Demonstrate a working knowledge of the payroll process ‐ Weekly time keeping reports

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 2d) Recommend and document action related to employee discipline ‐ Recognize appropriate and inappropriate work performance ‐ Recommend action plan ‐ Attendance reports 2e) Supervise Food Production ‐ Demonstrate understanding of job descriptions and routines ‐ Work with time schedules so that staffing needs are met at each position ‐ Deal with issued as they arise ‐ Meet deadlines ‐ Communicate changes that have an operational impact ‐ Apply knowledge of diets to menu planning and management of area ‐ Job descriptions ‐ Job routines ‐ Time schedules 2f) Supervise Patient Food Services ‐ Demonstrate understanding of job descriptions and routines ‐ Work with time schedules so that staffing needs are met at each position ‐ Deal with issues as they arise ‐ Meet deadlines ‐ Communicate changes that have an operational impact ‐ Job descriptions ‐ Job routines ‐ Time schedules

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COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 2g) Supervise cafeteria Services ‐ Demonstrate understanding of job descriptions and routines ‐ Work with time schedules so that staffing needs are met at each position ‐ Deal with issues as they arise ‐ Meet deadlines ‐ Communicate changes that have an operational impact ‐ Job descriptions ‐ Job routines ‐ Time schedules B.3 Food Supply, Procurement and Control Demonstrate a working knowledge of procurement including: 3a) Purchasing according to established standards ‐ Familiar with dealing with suppliers to ensure correct product specification ‐ Familiar with inventory requirements and changes to meet special needs ‐ Review pricing agreements and specifications for food and other supplies

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3b) Receive and store according to food and supply specifications ‐ Identify products which do/ do not meet the specifications ‐ Correctly receive a shipment from a supplier, i.e. checks invoices, fills out requisition ‐ Familiar with freezer and dry goods inventories ‐ Familiar with health regulations for food storage ‐ Review specifications ‐ Sanitation book COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 3c) Issue according to Procedures ‐ Process an order through the storeroom ‐ 3d) Demonstrate a working knowledge of forecasting ‐ Understand how forecast amounts are determined ‐ B.4 Food Production 4a) Apply established control to maintain food and operational standards ‐ Do cleaning checks ‐ Do temperature checks ‐ Check for approved portion sizes ‐ Participate in tasting rounds ‐ Sanitation standards 4b) Apply knowledge of sensory and quality standards in evaluation of a recipe or product ‐ Scheduling of taste test ‐ Solicitation of panel participants ‐ Presentation of test recipe product ‐ Assess a product for sensory quality ‐ Collect and analyze data ‐ Make meaningful , fair, accurate conclusions ‐ Taste test forms

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from data 4c) Develop a standardized recipe ‐ Take a recipe and develop it to meet service demands ‐ Standardized recipe information B.5. Food Service Distribution COMPETENCY PERFORMANCE JOB ACTIVITIES ( Initial when each is completed) SUGGESTED ACTIVITIES AND RESOURCES COMPETENCY ACHIEVED 5a) Apply marketing / merchandising techniques ‐ Develop merchandising ideas ‐ Implement approved ideas ‐ Use merchandising for providing customer information and enhancing revenue ‐ Graphics Programs ‐ Text books 5b) Assist in processing a catering or special event ‐ Developing action plan ‐ Implementing action plan ‐ Communicating with persons involved with event. ‐ Modifying action plan in case of problems ‐ Draw conclusions from financial data ‐ Sample project action plan ‐ Catering experience for familiarity with procedures B.6 Financial Management

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6a) Demonstrate knowledge of meaning of financial indicators in food industry Define indicators ‐ Raw food cost % ‐ Labour cost % ‐ Patient meal days ‐ Profit Calculate above indicators 6b) Apply principles to cash handling controls ‐ Monitor operation of cash registers ‐ Demonstrate familiarity with cash handling procedures ‐ Read and comprehend cash tape data MANAGEMENT SKILLS C.1. Universal Management Tools COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED RESOURCES COMPETENCY ACHIEVED (Date& Initials) 1a) Demonstrate a working knowledge of the quality management process for the Department Apply quality assurance theory: ‐ Conduct audit using standardized procedures and document results ‐ Analyze audit results and draw valid conclusions ‐ Communicate results to management and area involved. ‐ Develop recommendations for action and action plan for implementation C.2. Management of the Department

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2a) Demonstrate ability to recognize role, skills and responsibilities of senior management in operation of Department and of institution I Recognize issues of concern to health care managers:Utilization, productivity, resource limitations, quality management, revenue development, change management II Learn role of Department head:Assurance of service quality, resources and Departmentpromotion III Identify required skills of Department head:Leadership skills, process for development, consensus‐seeking and promotion of Department philosophies. Learn processes involved in financial management ‐ Goals & objectives ‐ SWOT analysis ‐ QM ‐ Equipment plan ‐ HR plan ‐ Meetings ‐ Monthly/ quarterly reports ‐ Budget ‐ Statistical and financial reports and indicators

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APPENDIX LIST OF PROJECTS (Submit at end of each rotation) NAME : ROTATION : DATE :

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NUTRITION ASSESSMENT AND CARE Name : Patient ID No : Address : Contact No : Gender : Age : Date of birth : A. SubjectiveInformation Social history : Family medical history: Diet history: B. Objective Information

Weight : Height: BMI: WHR:

Diagnosis: Previous medical history: Laboratory values: C. Assessment : Present intake: Requirements: Others: D. Plan Education: Materials given: Follow‐up:

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RD COMPETENCY COMPLETION CERTIFICATE

Name: Institute: RD Trainer;

Internship Dates: From To:

1. ROTATIONS:

Length of Rotation Dates - From To

Clinical 1 3 weeks Clinical 2 2 weeks Clinical 3 3 weeks Clinical 4 3 weeks Clinical 5 2 weeks Clinical 6 2 weeks Clinical 7 3weeks Food Service

Patient food service 2 weeks

Food production 2 weeks

Others

Community nutrition 1 week

General management 1 week

Research 2 weeks

2. FULL CLINICAL CASES. (Inclusive of OPD & IPD)

Speciality Target No. Completed

Diabetes and endocrinology 10 Cardiovascular disease 5 Renal disease GI Diseases Critical care 5 Pediatrics 5 Super-speciality 10 Any other Surgery 5 Gen Med 10 Total 50

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3. RESEARCH PROJECT Title:

No. of Subjects: Length of Study:

Findings:

4. OTHER PROJECTS:

Project Area / Rotation Comments

5. EVALUATION: s Signature of Supervisor Date

DIETETIC INTERN S GUIDELINES & COMPETENCY PACKAGE

Indian Dietetic Association