Dietetic Rotations and Clinical Experiences

Clinical Dietetics (21 Weeks)

The clinical dietetics rotations are designed to develop skills in assessing, planning, implementing and evaluating nutritional care for hospitalized patients. In addition, the Interns participate in team rounds, conferences, group classes and case studies. Strong emphasis is placed on learning the pathophysiology of disease states in relation to nutritional therapy.

Rehabilitation (2 Weeks)
The intern will be introduced to the clinical nutrition management of hospitalized patients and will start to develop the clinical skills needed to work in dietetics. The brain injury rehabilitation unit provides experience in the continuum of care as patients’ transition from acute care to rehabilitation. The Intern will participate as part of the multidisciplinary team providing appropriate nutritional care including, nutrition supplementation, mechanically modified and therapeutic diets, enteral nutrition and nutrition related discharge planning and coordination.

General Medicine (4 Weeks)
The Intern will initially be oriented to the clinical area then acquire the nutritional skills needed in caring for patients with acute and chronic medical problems. Nutritional care plans are developed and communicated to the medical team via team rounds and documentation in the patient's electronic medical record using the Nutrition Care Process. The Intern also develops a basic knowledge of enteral and parenteral nutrition, as well as indications for use.

Cardiology (2 Weeks)
The Interns will become knowledgeable about cardiac diseases, medications, and potential drug/nutrient interactions. Interns will also develop a general knowledge of cardiac diagnostic and therapeutic procedures. Thorough cardiac nutrition education counseling will be conducted.

Surgery (2 Weeks)
The Intern rotates on two surgical units and will become familiar with major surgical techniques and their nutritional implications. The intern expands his/her knowledge of enteral and parenteral nutrition during this rotation.

Critical Care I NCCU (1 Week)
This rotation will take place on the NeuroCritical Care Unit. This rotation is designed to introduce the intern to the critically ill population and comprehensive nutritional intervention. This rotation will expand the use of enteral and parenteral nutrition.

Critical Care II MICU (2 Weeks)
During these two weeks in the Surgical Intensive Care Unit, the emphasis is placed on mastering nutrition support skills in high-risk patients. The intern will review and interpret current research regarding the application and implementation of parenteral and enteral nutrition. Interns will have the opportunity to develop and monitor the effectiveness of individualized parenteral and/or enteral therapy.

Critical Care III BICU/TICU/SICU (3 Weeks)
The Burn Intensive Care Unit is one of its kind in the Cleveland area and offers the interns exposure to care of both acute and critical burn patients. The unit operates by a team approach, affording the interns the opportunity to work with the residents, nurses and therapists. Interns will also work with critically ill patients in our Level 1 Trauma Center and surgical intensive care unit to further develop their experience and skills in nutrition support.

Pediatrics (3 Weeks)
Interns will begin this rotation with the NICU dietitian, focusing on normal infant nutrition. For the next two weeks, they will manage the nutrition care for hospitalized infants, children, and adolescents on the pediatric floors. Critically ill pediatric patients are also assessed in the Pediatric Intensive Care Unit. Interns will also participate in counseling pediatric patients and families in the outpatient pediatric specialty clinics.

Oncology (2 Weeks)
The Intern will manage the nutrition care for hospitalized patients with acute and chronic issues related to cancer. The Intern will continue to develop and work with enteral and parenteral nutrition during this rotation.

Food Service Management (4 Weeks)

The food production management rotations are designed to expand knowledge and provide opportunities to apply principles of management in a food service operation.

The intern is introduced to production units in food service, becoming familiar with employee job descriptions, activity guidelines, and food service equipment. The intern will learn the room service delivery system. The Intern is exposed to ordering and receiving systems, production forecasting, materials management, personnel management, employee in-service programming, customer service issues, and cafeteria operations. The Intern will assume responsibility for the food service area by performing staff functions in supervisory positions. The Intern is exposed to CBORD, Materials Management System and cost accounting procedures. The intern will become familiar with The Joint Commission and state inspection standards. The Intern will complete a major project as assigned during this rotation to meet competency standards.

Community Dietetics (10 Weeks)

The community nutrition rotations are designed to provide exposure to the roles of dietitians involved in various community programs.

Outpatient Nutrition Clinic (2 Weeks)
While in this rotation, interns will counsel adult patients on various therapeutic diets and participate in specialty clinics such as family practice, bariatrics, HIV, renal, geriatric, cardiac and diabetes. Interns may also have the opportunity to provide nutrition and health fair programs to the community.

Ambulatory Network Nutrition (2 Weeks)
Interns will work in MetroHealth’s satellite health centers, providing nutrition counseling to patients in a range of life stages. An emphasis is placed on application of nutrition principles for prevention or management of chronic diseases and prevention of pediatric obesity.

Women, Infants and Children's Program (WIC) (2 Weeks)
During this experience, the Dietetic Intern is given the opportunity to become familiar with the WIC organization and learn the eligibility requirements and referral procedures for WIC patients. The Intern will also observe the role of the Registered Dietitian in selecting and counseling patients. Counseling will include prenatal, postpartum, and pediatric education on both an individual and group basis.

Research (2 Weeks)
This rotation involves working with the Research Bionutrition Manager with the Clinical & Translational Science Collaborative. Exposure includes working on current studies or preparing for new studies. Interns will participate in data collection and analysis. The Intern will be exposed to equipment used in the research setting such as BodPod, DEXA, Bioelectrical Impedance, blood glucose monitoring, skin folds and circumference or other anthropometrics (as available).

Renal (2 Weeks)
Interns will participate in the nutritional assessment, intervention, and education of patients requiring hemodialysis or peritoneal dialysis. The Intern will work with dietitians through an outside affiliation. Interns will learn how to evaluate and make recommendations regarding the individualized mineral and electrolyte needs of the renal patient. Participation in multidisciplinary team meetings is encouraged.

Elective Experiences (4 Weeks)

The Intern will be able to choose from the following rotations to complete a total of 4 weeks of clinical experience that is a particular interest to them.

Obstetrics (1-2 Weeks)
This rotation involves exposure to an outpatient clinic within MetroHealth Medical Center dealing strictly with pregnant women. Many educational experiences are presented in this rotation: Application of literature, assessment of patients via chart review and patient interview, and nutrition counseling. Some assessment of inpatient high-risk OB patients will be included, as opportunities allow.

Diabetes (1-2 Weeks)
Working with our certified diabetes educators, interns will focus on diabetes patients and teach outpatient diabetes self-management classes for the outpatient clinic.

Neonatal Intensive Care Unit (2 Weeks)
The NICU is a 35-bed nursery that provides intensive care to newborns born with medical or surgical complications. Many of their problems place a nutritional risk resulting in complicated nutritional management. In addition to completing nutritional assessments and care plans and working with the NICU health care team, the intern will be exposed to the regional concept of high risk OB/neonatal care though the Ohio Department of Health’s educational outreach program, CPRN. Interns in this rotation may have the opportunity to observe a high-risk delivery or surgery.

Outpatient Pediatrics (2 weeks)
Interns will work with the Pediatrics dietitians in the outpatient Pediatrics Clinic and the Aamoth Family Wellness Center. This rotation will focus on the Nutrition Exercise and Wellness program to treat pediatric obesity. Interns may also spend time assessing and counseling patients with other conditions, such as chronic constipation, dysphagia, failure to thrive, and food allergies.

Staff Experience (2 Weeks)

Staff Relief (2 Weeks)
The Intern is provided with a two-week opportunity to perform autonomously as a clinical staff dietitian in an assigned area of choice. The intern is expected to use time-management and problem-solving skills developed during previous clinical rotations.