DIETETIC INTERN S GUIDELINES & COMPETENCY PACKAGE

Transcription

1 Indian Dietetic Association DIETETIC INTERN S GUIDELINES & COMPETENCY PACKAGE NAME : DATE : From: To: INSTITUTION :

2 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 No provision of leave or vacation it is 6mth continuous internship or 3+3 MTh with break not more than 15 days between internship.

3 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 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 under the head Registration Board, Project for the R. D. Board ( 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) 2 Clinical 2 (Critically ill) 3 weeks 10 (Infectious (Malaria, Dengue, TB)/ Hypertension/ CVA/ Stroke/ Anemia/ COPD/ILD/ Renal calculi/ obesity/ HIV 2 weeks 5 (EN feeds, 1 Diabetic RT (fragmented) (DKA)+1Renal 1 Hepatic enceph,1ards on venti, pancreatitis (continuous drip feed)1tpn or NJ)

4 3 Clinical 3 (Superspeciality) 4 Clinical 4 (Surgery) 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 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) 6 Clinical 6 (Cardiac) 7 Clinical 7 Endocrine & diabetes 2 weeks 5(3Genral+2Surgical) (1PEM,1Nephrotic syndrome,1wilsons disease/padder willy syndrome/cld) (1TOF/MVR&1Ileostomy infant) 2 weeks 5 (3 General+2 Surgical) (1IWMI, 1HF with CCF/ RHD/1LVF with EF 15%) (1CABG, 1VSD) 3 weeks 10(2 Type 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)

5 CONTENTS CLINICAL DIETETICS A. 1. Clinical nutrition & dietetics 2. Communication 3. Education 4. Management skills in clinical dietetics FOOD SERVICE B. 1. Menu system 2. Personnel management 3. Food supply, procurement and control 4. Food production 5. Food service distribution 6. Financial management

6 MANAGEMENT SKILLS C. 1. Universal management tools 2. Management of the Department APPENDIX List of projects Nutrition Assessment and Care

7 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)

8 DIETETIC INTERN S COMPETENCY PACKAGE CLINICAL DIETETICS A.1. Clinical Nutrition and Dietetics COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED 1a) Participate in routine Conduct nutrition screening as per policy to nutrition screening identify patients requiring special nutritional care 1b) Monitor patient s food intake and acceptance 1c)Write menus, including adjusting standard diets and following calculated patterns 1d) Effectively communicate with Department staff, health care team members and patients 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 Adjust standard diets for patients, based on notes, special diet orders, interview with patient or discussion with physician Answer patient s questions regarding menu so that patients are satisfied Communicate menu specials with Food Production Initial and ongoing patient screening Meal reports from Nursing Information obtained during rounds (Date& Initials)

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

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

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

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

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

14 A.4.Management Skills in Clinical Dietetics COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED 4a) Keep workload Collect accurate workload measurement Internship measurement data of data manual dietitians Summary form 4b) Is familiar with standards and procedures for auditing nutritional care 4c) Is familiar with applications of computers in patient care Review a completed audit and discuss the findings Internship manual 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 4f) Demonstrate knowledge of quality management in clinical nutrition Discuss with the manager Job description Duty lists Review QM program Participate in clinical audit data analysis and corrective action Nutrition products specifications (Date& Initials)

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

16 COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED 2d) Recommend and Recognize appropriate and inappropriate Attendance document action related work performance reports to employee discipline Recommend action plan (Date& Initials) 2e) Supervise Food Production 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 issued as they arise Meet deadlines Communicate changes that have an operational impact Apply knowledge of diets to menu planning and management of area 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 Job descriptions Job routines Time schedules

17 COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED Demonstrate understanding of job Job descriptions 2g) Supervise cafeteria descriptions and routines Job routines Services Work with time schedules so that staffing Time schedules needs are met at each position Deal with issues as they arise Meet deadlines Communicate changes that have an operational impact (Date& Initials) 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

18 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 3c) Issue according to Process an order through the storeroom Procedures 3d) Demonstrate a working Understand how forecast amounts are knowledge of forecasting determined (Date& Initials) B.4 Food Production 4a) Apply established control to maintain food and operational standards 4b) Apply knowledge of sensory and quality standards in evaluation of a recipe or product Do cleaning checks Do temperature checks Check for approved portion sizes Participate in tasting rounds 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 Sanitation standards Taste test forms

19 4c) Develop a standardized recipe from data Take a recipe and develop it to meet service demands Standardized recipe information B.5. Food Service Distribution COMPETENCY 5a) Apply marketing / merchandising techniques 5b) Assist in processing a catering or special event PERFORMANCE JOB ACTIVITIES ( Initial when each is completed) Develop merchandising ideas Implement approved ideas Use merchandising for providing customer information and enhancing revenue Developing action plan Implementing action plan Communicating with persons involved with event. Modifying action plan in case of problems Draw conclusions from financial data SUGGESTED ACTIVITIES AND Graphics Programs Text books Sample project action plan Catering experience for familiarity with procedures B.6 Financial Management

20 6a) Demonstrate knowledge of meaning of financial indicators in food industry 6b) Apply principles to cash handling controls C.1. Universal Management Tools Define indicators Raw food cost % Labour cost % Patient meal days Profit Calculate above indicators Monitor operation of cash registers Demonstrate familiarity with cash handling procedures Read and comprehend cash tape data MANAGEMENT SKILLS COMPETENCY PERFORMANCE JOB ACTIVITIES OTHER SUGGESTED 1a) Demonstrate a working Apply quality assurance theory: knowledge of the quality Conduct audit using standardized management process for procedures and document results the Department Analyze audit results and draw valid conclusions Communicate results to management and area involved. Develop recommendations for action and action plan for implementation (Date& Initials) C.2. Management of the Department

21 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

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

23 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:

24 RD COMPETENCY COMPLETION CERTIFICATE Name: Institute: RD Trainer; Internship Dates: From To: 1. ROTATIONS: Clinical 1 Clinical 2 Clinical 3 Clinical 4 Clinical 5 Clinical 6 Clinical 7 Food Service Patient food service Food production Others Community nutrition General management Research Length of Rotation Dates - From To 3 weeks 2 weeks 3 weeks 3 weeks 2 weeks 2 weeks 3weeks 2 weeks 2 weeks 1 week 1 week 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 CHIEF RD DIETITIAN;SIGN & STAMP; RD N0

25 3. RESEARCH PROJECT Title: No. of Subjects: Length of Study: Findings: 4. OTHER PROJECTS: Project Area / Rotation Comments s 5. EVALUATION: Signature of Supervisor Date