The total length of clinical rotations is approximately 21 weeks. Rotations are completed at Geisinger Medical Center, Geisinger Wyoming Valley Medical Center and Geisinger Community Medical Center.
This introductory rotation provides theory and practice in nutritional care for patients with cancer. Interns work with members of the bone marrow transplant team, and spend time in the radiation oncology and hematology/oncology clinics to observe patients undergoing therapy.
Interns help provide medical nutrition therapy for patients who are insulin-dependent, non-insulin dependent and have gestational diabetes. Interns also observe the diabetes nurse specialist as she provides care and teaches patients disease management techniques. Interns will also experience a new Geisinger initiative, Fresh Food Farmacy, which serves clients in the community who have diabetes and food insecurity.
Interns develop skills in educating patients with hyperlipidemias, and in nutrition assessment and care of patients with a variety of cardiac diseases or who have undergone open heart surgery. They also observe various cardiac diagnostic procedures and rehabilitation activities for patients with cardiac disease.
Interns participate as team members providing care to patients undergoing hemodialysis, peritoneal dialysis or kidney transplantation. They also have the opportunity to work with children with renal disease in the pediatric renal clinic. This rotation provides practical experience in both hospital-based and free-standing dialysis units.
Interns will become familiar with gastroenterology (GI) disorders and surgical procedures and their nutritional implications. They will have opportunities to go on rounds with enterostomal and wound nurse specialists, and observe procedures, such as an endoscopy. Interns will also gain experience working with trauma patients in this rotation. Additionally, part of this rotation includes working with patients going through bariatric surgery.
The key experiences of this rotation are providing nutritional care for pediatric patients with failure to thrive disorders, chronic conditions such as diabetes, obesity, cystic fibrosis, and those born with cardiac disease or defects. Interns gain competence in selecting infant formulas, tube feedings and parenteral nutrition. They also have opportunities to work with the multidisciplinary feeding team and provide outpatient counseling for children and their families. Interns in the pediatric concentration will have more in-depth, pediatric-supervised practice rotations including in the pediatric intensive care and neonatal intensive care units.
Critical care/nutrition support
In the adult intensive care unit (ICU), interns gain competence in formulating and monitoring nutritional therapy for critically ill patients, many of whom require mechanical ventilation. Interns also gain experience with tube feeding and parenteral nutrition selection, volume and rate prescription, tolerance assessment and feeding adjustment. Interns participate in multidisciplinary ICU team rounds. This rotation also includes working with the nutrition support team to provide care for patients on total parenteral nutrition (TPN).
Ambulatory nutrition services
On the Danville and Wilkes-Barre campuses,as well as outlying medical clinics, interns have the opportunity to develop nutrition counseling and behavior modification skills in the following areas: obesity, pregnancy, diabetes and hyperlipidemia. Interns will also work with a multidisciplinary team in a high risk obesity clinic. Patients in this clinic may be managed with medications or choose to have bariatric surgery.
To gain staff experience, each intern completes a rotation as the clinical dietitian on assigned hospital-based inpatient units.
Clinical nutrition management
Each intern will spend a week with a clinical nutrition manager to learn the role of administering department policies and procedures, monitoring budgets, and managing clinical staff and to complete and present a major management project.
- General pediatrics -Interns will be exposed to a diverse pediatric population (under 18 years old) admitted to the general pediatric floors to become familiar with multiple disease states including pediatric cancer, malnutrition, gastrointestinal disorders, respiratory issues, developmental delays and diabetes. Interns will participate in interdisciplinary rounds and assist in developing nutrition care plans including diet education, enteral nutrition and parenteral nutrition.
- Neonatal intensive care unit -Interns will experience nutrition support in Geisinger Medical Center’s 41 bed, level 3 NICU. Interns work with the dietitian to participate in multidisciplinary rounds to provide nutrition care to patients in this unit and gain experience working with complications of prematurity including necrotizing enterocolitis, short gut, gastroschisis, congenital cardiac anomalies, osteopenia of prematurity and neonatal abstinence syndrome.
- Pediatric intensive care unit - Interns gain competence with nutrition support in our level 1 pediatric intensive care unit by assessing the nutrition needs of medically complex or seriously injured pediatric patients, actively participating in interdisciplinary rounds and assisting in ordering enteral and parenteral nutrition.
- Pediatric outpatient clinics- Interns develop nutrition expertise in the outpatient setting by working with patients with a variety of medical conditions. Interns participate in interdisciplinary clinics including feeding team clinic, cystic fibrosis clinic and renal clinic, and are exposed to patients with a variety of nutritional needs including malnutrition, prematurity, food allergies, eosinophilic esophagitis, GI disorders, obesity, diabetes, special dietary requirements, home tube feeding and home parenteral nutrition.
Pediatric dietetic interns will also spend some time in adult-focused clinical rotations to achieve a comprehensive experience with all aspects of clinical nutrition.
Pediatric dietetic interns are also offered several learning opportunities including our “Lunch and Learn” program in which staff members present updates or case studies on pediatric nutrition topics.
Interns rotate through the Department of Foodservices at the Danville campus or the Wilkes-Barre campus to meet many of the competencies related to management
These services are provided: Inpatient meals and snacks, outpatient meal service in designated areas, visitor feeding, employee feeding, contract feeding for Geisinger Encompass Health Rehabilitation Hospital, catering and vending contract administration. The total length of food service rotations is approximately 11 weeks.
Interns produce recipes for assigned food products, set up and present a taste panel, and critique the results. Using a computer-generated program, they expand recipes and complete nutrient analyses. They assist with coordinating the production, service, and clean-up of a catered event, and complete a catering cost analysis report. Interns also forecast production needs, observe and help production personnel, and assist with the preparation of employee work schedules.
Interns participate in purchasing food and supplies and managing inventory. They write specifications, evaluate contracts, attend food shows, if scheduled, coordinate a product evaluation session, and meet with sales representatives.
Patient food service
Interns participate in all facets of patient-directed food service including analyzing and revising menus for modified diets, managing tray delivery to patients and proper sanitation techniques, inservicing employees on a variety of education topics, and conducting performance improvement activities, such as conducting tray audits. Interns also have opportunities to participate in employee interviews for hiring new food service workers.
Retail food service
Interns learn about the various retail food service operations at Geisinger, their customer composition, equipment and menu offerings. Interns will advertise new menu items, create menu boards, develop employee work assignments, cost recipes, set prices and manage cash operations.
Interns collaborate with Geisinger's wellness manager and team to plan a variety of activities and programs for work-site wellness for employees.
Systems and operations food service management/staff experience
Interns learn how food service interfaces with other medical center services. Interns participate in leadership development, problem solving, quality improvement, proposal writing, budget development, employee education and management meetings. After completing all food service rotations, they will function as managers to lead staff meeting, conduct patient rounds and participate in human resource activities.
The total length of community rotations is approximately four weeks.
Interns will observe and assist care givers in the following community facilities:
- Tapestry of Health which includes Women, Infants and Children (WIC)
- Long-term acute care hospital
- Community hospital/rehabilitation medicine
- Supermarket dietetics
Interns will develop consumer writing skills by creating a review article of a popular nutrition book for the Nutrition News and Views newsletter. To enhance public speaking skills, interns are involved in presenting nutrition lectures and programs in the community and during National Nutrition Month health promotions. Interns will also select a professional or community organization to serve on a committee and participate in established planning meetings and projects.