Fall Practicum Overall Reflection

Jenna Godfrey
Nearing the finale of my first semester as a Sage dietetic intern, I can reflect on the
invaluable experiences gained through my three rotations. I have learned so much in just a few
months and feel a heightened sense of confidence as a future RD. Shadowing, observing, and
picking my preceptors brains have really enhanced my understanding of the various fields in
dietetics. Being empowered to perform tasks, projects, screenings, and assessments
independently has unquestionably strengthened my skills and ability to directly apply my
knowledge of nutrition. I have had nothing but positive experiences throughout this semesters
practicum, although I could do without the wound care rounds during long term care
Food Service Management
During this rotation I was able to gain invaluable experience and knowledge in the field
of school foodservice. This first few weeks of this rotation was spent mostly observing, studying,
touring and meeting the staff in the various kitchens within the district. After these few weeks, I
spent more time performing hands-on activities and working independently. I studied the details
of the School Breakfast Program and National School Lunch Program, both of which largely
govern the districts food service department and wellness policies.
I learned so much through the School Breakfast and National School Lunch Programs,
including how to plan menus based on meeting the nutritional guidelines (calorie, saturated fat,
and sodium requirements), as well as selecting products that contain at least 51% whole grain.
This required my preceptor to explore different products available and make careful selections
based on student acceptability, perceived quality, and nutritional value. Along with this, I learned
about the reimbursement rates for the three categories including free, reduced and paid meals.
The reimbursement rates are higher for those meals classifying as free, making the Community
Eligibility Program and the Universal Free Breakfast in the Classroom program appealing and
ideal for a district this size with so many low-income students.
The implementation of Universal Free Breakfast in the Classroom was another feature of
this rotation that I was able to participate in. This also served as the topic of my process
improvement project. Throughout my rotation, I witnessed the incessant grumbling and
protesting of the kitchen managers. There was so much frustration with the new program. Not
only was I able to observe the issues facing my preceptor and her assistants, but I was also able
to observe the issues facing the kitchens through the data collection of my process improvement
project. This really provided me with an interesting perspective, being able to see both sides of
the implementation process from an objective standpoint. I was able to really see the flaws in
these processes and think critically on how to make things work more efficiently.
I was also able to participate in the BIDs & procurement processes. My preceptors
assistant trained me on the procedures which allowed me to provide them with some staff relief
to get these tasks completed. This was a very interesting process to be a part of. Because this
department has endured some significant turnover, the new school years BIDs were not entered
or modified in time; my preceptors two assistants were working tirelessly to get these done.
Once these were completed, they encountered even more issues. There were constant problems
with the products not arriving on time, or kitchens receiving the wrong products/in the wrong

amount. It seemed especially challenging for this department to handle all of these problems as
my preceptor and her two assistants were relatively new to the positions and still learning the
ropes.
Being trained to enter and modify BIDs also enabled me to learn the NutriKids software
system. This is something my preceptor thought was very important for me to become familiar
with, as she found that in her experience this would greatly help someone land a job in school
foodservice. I utilized this system constantly throughout my rotation for various activities. It was
particularly useful for my menu and theme meal project, as the bulk of my menu planning,
nutrient and cost analyses were completed using this resource.
Working in the kitchens contributed to a large portion of my activities during this rotation. I
frequented the various kitchens within the district to help out and provide staff relief with their
breakfast and lunch production. I was able to work various positions, including servers and prep.
I was also trained as a cashier to learn the POS part of the NutriKids system. I performed various
preparatory and production tasks including chopping vegetables, portioning items, packaging
breakfast meals, etc. These tasks gave me perspective on how the kitchens work and what is
required to produce quality school meals in an efficient manner. Working in the kitchens also
enabled me to collect data for my process improvement project on the implementation of
breakfast in the classroom. Additionally, I selected one kitchen to help produce my theme meal
on theme meal day as well as several days prior.
Shadowing a kitchen manager covered a good chunk of the suggested competency activities,
such as scheduling, forecasting procedures, how to generate a purchase order, etc. This day
overall was very interesting and provided me with further insight into the responsibilities of my
preceptor as the food service director. In addition to shadowing a kitchen manager for a day, I
was able to observe several hiring interviews with my preceptor. This was honestly one of the
most interesting features of this rotation. I had never been on the hiring side of an interview,
and being able to put myself in my preceptors point of view during these interviews was
incredibly enlightening. I realized how far a little enthusiasm can go in making a good first
impression.
Overall, the menu and theme meal project provided me with a learning experience on the
thorough production of a time-consuming recipe. I learned the processes of batch preparation and
cooking, as well as the details of meal service in a school lunch environment. Through this
experience, I was also able to perform management tasks involved in the production of my theme
meal including planning, overseeing the production and quality of the recipes, holding for
service, etc. Additionally, I was able to evaluate my theme meal based on recording the amount
of servings prepared and the amount of servings taken.
Both the menu/theme meal and process improvement projects further strengthened my skills
in foodservice management. As part of these projects, I studied and researched current standards
in school foodservice such as the nutritional guidelines of menu planning and the production of
breakfast in the classroom. The process improvement project provided me with the opportunity
to really investigate processes through a management perspective, one that I had not previously
been familiarized with.
Lastly, my preceptor entrusted me with the responsibility of hosting a smoothie taste testing
event at one of the elementary schools. This proved to be a project similar to my theme meal
project in that I was able to select a recipe, make adjustments to that recipe to yield a certain

amount of servings, conduct a cost analysis of producing the recipe, as well as actually produce
the recipe. In addition to these tasks, I developed an educational poster board on the topic of the
event (carrots- the vegetable of the month). This was somewhat challenging as I had to create
educational content focusing on the nutritional characteristics of carrots that could appeal to a K8 audience. I did not have much guidance on this project, but I think that helped me really jump
into a leadership role. Overall, this project was really enjoyable and allowed me to interact
directly with the students.
Diabetes Outpatient
Despite this being a short two-week rotation, I had such a detailed experience. I was exposed
to a wide variety of patients and was able to enhance my understanding of nutrition counseling,
particularly in the CDE focus. Almost all topics on the diabetes pre-rotation assignment were
discussed during this rotation. Every bit of diabetes-related information that I gained from this
rotation was also repeatedly reinforced during the individual patient sessions and diabetes
education classes. I learned about diabetes medications including which were most common
(metformin, Lantus, Humalog), non-insulin injectables (GLP-1), when certain medications start
working, how insulin should be adjusted at mealtime based on the amount of carbs consumed, as
well as some new medications such as inhalable insulin. I observed individual counseling
sessions with type 2, type 1, and gestational diabetes patients. I was also able to review patient
charts to look at past medical history, dietary patterns, and how the nutrition counseling sessions
have influenced the patient over time. I was able to observe how my preceptor structures her
counseling sessions and what specific strategies she has for nutrition and diabetes education. I
was also able to learn the differences between initial nutrition visits and follow-up visits. For
instance, my preceptor spends more time on diet education, comparing current and past lab
values and discussing their implications, as well as reviewing and discussing the implications of
blood glucose testing logs during follow-up visits. It was very interesting to observe my
preceptor investigating the underlying reasons with the patient for why certain blood glucose
level patterns are occurring, or why high levels occur. Luckily, I was also able to observe one
inpatient consultation during this rotation. This was certainly an interesting experience, as it was
my first real glimpse into an inpatient environment. It was also interesting to see the differences
in how my preceptor counsels inpatient versus outpatient consultations.
Long Term Care
This was my most organized and hands-on rotation during this practicum. I had a specific
task to complete almost every single day during this rotation that all served to cover my
suggested competency activities. My preceptor devoted so much time into helping me learn. I
was exposed to a variety of cases, both in the long term and short term units, as well as other
disciplines (speech pathology and occupational therapy). I completed four nutrition assessments
including two initial and two quarterly. Along with these assessments, I completed MDS
assessments as well as created and adjusted care plans to reflect the residents current status. My
first nutrition assessment was reviewed with my preceptor who gave me specific ideas on how to
improve. I was able to incorporate these suggestions into my next assessments, which was wellreceived by my preceptor. Additionally, as part of these nutrition assessments, I conducted
interviews with each resident to gather information necessary to complete the assessment.
Overall, I feel that these nutrition assessment tasks were extremely helpful in strengthening my
clinical skills and knowledge.

During this rotation, I also spent time reviewing policies and procedures of the nutrition
department, observing and participating in meal rounds, reviewing resident charts, and doing
research on current practice guidelines in long term care. I completed four meal tray audit reports
on high-risk residents. Using those same high-risk residents, I conducted a food intake study
using the recorded data on average meal intake percentages (reported by the nursing staff in
categories) and calculated their caloric/protein/fluid needs based on relevant conditions.
I think having had outpatient and long term care prior to my clinical rotation is really
going to help me succeed next semester as I feel very confident in my understanding and
experience of clinical dietetics. Overall, my long term care rotation provided me with the most
clinical exposure and learning experiences.