Cassidy Pont
A healthier America awaits...
Dietetic Internship
This page highlights my work throughout my dietetic internship, which I am completing through the University of Michigan School of Public Health. Scroll below to learn about my rotations!
My first rotation was at the Washtenaw County Women, Infants, and Children (WIC) office. I learned a great deal about the organization of WIC, it's civil rights policies, and the certification process. Observing families coming through the office was eye-opening, and each appointment was unique; I observed high-risk appointments, certifications, and infant/child evaluations. Applying evidence-based, systematic reviews and scientific literature allowed me to research questions that arose in client appointments. Throughout this 2-week rotations, I created a myriad of nutrition education handouts, that dietitians requested, as well as where I saw gaps in client appointments; see the gallery below this paragraph of sample pieces I created. Using the SMOG readability Formula assured the reading level for all nutrition communication pieces were between a 4th to 8th grade level. I was also involved in community outreach by accompanying my preceptor to St. Joe's Hospital where we met with a social worker from an OB/GYN office, as well as going to Once Upon a Wish and contacting local businesses to help support WIC's Annual Breastfeeding Awareness Ice Cream Social during the month of Breastfeeding Awareness (August). Effect size:50-60 client appointments per day.
Next I started in-patient clinical work at Henry Ford Village, which is a skilled nursing facility. I hit the ground running with this 2-week rotation and had hands-on experience from the start. I worked as a valued member of the multi-disciplinary team attending daily staff meetings, care conferences, referred and worked with speech language pathologists, occupational therapy, and learned about state surveys. After a few days I was performing the clinical assessments and performing TPN calculations. Throughout my rotation I worked on a special project regarding depression and nutrition, which can be found below, since depression is ever-present in long-term care and skilled nursing facilities. I also completed an in-depth case study, which can also be found below. In this fast-paced environment, I was able to successfully prioritize clinical assignments, remained flexible in the day, and proactively problem-solve. With my preceptor's guidance, I charted with MDS and Vision, and observed her organization, excellent records and positive attitude! Effect size:89 beds in Health and Rehabilitation Center, plus independent and assisted living residents
Soon I found myself at the University of Michigan on the Liver/GI unit in-patient rotation. During this 3-week rotation I quickly acclimated to the medical team on the GI/Liver unit. Every morning I attended rounds with all medical professionals on the interdisciplinary “team”, including senior doctors, interns/residents, medical students, and dietitians/dietetic interns. I acted as a valued member of the clinical team, collaborating with patients while performing clinical interviews, mutually agreeing upon goals, communicating with other team members about such patients while being considerate of the patient’s past medical/social history, as well as their cultural practices. I efficiently charted on “my” patients and was able to see patients on my own after my preceptor saw my bedside manner one time. In speaking with patients, I used the SGA and NCP format, as well as reviewing physical signs of malnutrition, which then reflected into documentation. I was also able to summarize daily journal articles in a succinct manner, and used evidence-based literature to support the patient education and patient nutrition suggestions. My rotation culminated in a case-study where I wrote a 17 page paper and a 15 minute power point presentation on a patient with the main diagnosis of acute, severe pancreatitis. Effect size: 12-16 patients per day
I rounded out my in-patient clinical experience at the UM Hospital with the NICU and PCTU. I was in the NICU for four days where I was mentored on how to calculate TPN orders for premies and chart for this population. I attended daily rounds with the NICU dietitian and practiced writing notes for such patients. There are 52 beds total for the NICU and every day during the daily floor meeting with all health professionals within the unit, beds were always full; each dietitian had approximately 26 patients per day with the majority of them being on TPN. My last day in the ICU was with the PCTU: pediatric cardiothoracic intensive care unit, which is a 30 bed unit. I learned about ECMO, CRRT, and the nutritional needs and metabolic requirements for such patients; these patients were mostly infants, but could range to adulthood.
After in-patient at UM, I moved to outpatient in the UM Pediatric Metabolic clinic. During this 2 week rotation I was able to learn and experience various genetic, metabolic disorders such as propionic academia, ornithine transcarbamylase (OTC) deficiency, methylmalonic acidemia (MMA), phenylketonuria (PKU), etc., that require special diets and medical foods. I kept the medical team up to date on new treatments via recent research studies for various diseases and created educational pieces for both medical professionals and patients/patient families on how to best care for specific diseases. Coordinating with the interdisciplinary medical team was vital in caring for patients, and I actively participated in all discussions to problem solve for various social and emergency situations. The NCP and SGA were continuously used to evaluate and assessment patients, during patient interviews, and for charting. Below you can see some of the patient education materials I created, as well as a presentation I did to inform the medical team about a patient who has MMA and chronic kidney disease stage 3 to best slow the progression of his kidney function. You will also find educational handouts for both patients/patient families and medical professionals for a range of disease states.
My next community rotation was at Ypsilanti Meals on Wheels (YMOW). Not only did I assist in deliveries, but also saw where there were gaps in nutrition education and administrative protocols, and filled such gaps. I created educational handouts, such as eating and depression, and flyers for recruitment to a new CAPABLE model as well as winter safety that were distributed to all clients; I also identified clients for this program by sifting through all client files. Additionally I created a safety manual for the volunteers and interns. I also assisted in MOW presentations for other student groups. Below you can see some of the work I did while at this site.
Effect size: average 175 clients each day; 200 clients some days
As Regional Alliance for Healthy Schools (RAHS) is part of the University of Michigan Health system, I was able to facilitate one-on-one counseling with students in middle and high school working on an interdisciplinary team with NPs, SWs, MAs, and RDs for two weeks. Counseling on RAHS's 8 Healthy Goals was just one educational tool I used in counseling, as well as label reading, using a large can of soda for sugar-sweetened beverage reduction, Vegetarian protein sources, relaxation strategies, MyPlate/balanced meals, importance of fruits and vegetables, etc. In counseling, I was able to appropriately identify students who were food insecure and connect them, as well as provide them with food boxes to take home to their family's. I used the Nutrition Care Process for all documentation in writing nutrition notes. I also came up with different days to celebrate with food, such as National pumpkin Seed Day where I created a handout about the benefits of consuming pumpkin and its seeds. Mood and Movement is a collaborating group between the RDs and SWs and I applied scientific research to present the benefits of cardio drumming to incorporate into their sessions, as well as creating a handout on it for students. Comparing the nutritional information, as well as price, is something I did for RAHS in comparing fast food and grocery store items. I also attended meetings with the Directors of RAHS learning about how they track progress, grant funds, procedures, etc. Throughout the rotation I became acquainted with data collected at the schools for outcome measures and tracking purposes, such as number of visits to the dietitian, number of return visits, etc. Another project I worked on was coming with ideas of ways RAHS could celebrate National Nutrition month with their students, and information handouts for taste testing kiwi and sunflower seeds, which you can see below.
Effect size: upwards of 5-6 students per day
I then spent four week at Dexter Public Schools Food and Nutrition services for my food service rotation. I learned about the National School lunch program, reimbursement, procurement, food service processes, budgeting, as well as commodity food items, and reviewed productivity indicators. Attending assessment and quality improvement meetings were also included in this rotation, providing information on how to approach managers for various scenarios, such as cost improvement, product and inventory control, etc. I also created marketing, as well as an educational bulletin board posted within the various school cafeterias, and giving parents healthy tips for Thanksgiving. Allergy education was given to kitchen staff, identifying menu items for all eight allergens and carbohydrate counting were all included in my tasks. Perhaps my favorite thing about this rotation was performing taste tests with the Farm to School program at various schools; we introduced the kids to rainbow carrots, butternut squash, and apple chips where we also made them aware of locally grown produce served in the cafeteria. Being in the kitchen was no stranger to this rotation, as well as making new menu items, such as Shaker Salads. And it was fun to be able to teach children about the importance of breakfast by participating in healthy breakfast burrito cooking classes with middle schoolers.
Effect size: over 8 sites including public schools (k-12), senior centers, and young adult services; schools can serve 300-500 students per day
To further my community experiences I was able to spend time with Silverspoon's Maternal Infant Health Program (MIHP). This 1-week rotation provided experience at Michigan’s largest, evidence-based home visiting program that services eligible Medicaid pregnant women and infants. I was able to work on an interdisciplinary team of registered dietitians, licensed social workers, registered nurses, lactation consultants, and infant mental health specialists to provide services in the home to reduce infant and maternal morbidity and mortality. Initiating initial screenings, prenatal and parenting educations, as well as connecting those in need to community resources are some of the tasks I completed. Additionally I created appropriate grade-level educational materials (see below) regarding hypertension and pregnancy, consuming fish while pregnant, and nutrition while breastfeeding, which are now used by MIHP staff.
Effect size: counties served include Wayne, Oakland, Macomb, Washtenaw
For four weeks I was back in an outpatient clinic setting at University of Michigan's Cardiovascular Center at Domino's Farms called, Preventive Cardiology. I was able to be exposed to a variety of different aspects of the center including Cardiac Rehab and Metabolic Fitness programs. Food frequency questionnaires were used for both programs to monitor progress, direct care and improve program development. Throughout my time here I performed much research to apply evidence-based advice. The research included: a literature review on dairy fat biomarkers which I presented to the nutrition staff meeting, a case study on hyperapolipoproteinemia and hypercholesterolemia with statin intolerance and POTS which I also presented to nutrition staff, low carbohydrate diet and metabolic health, cerebral palsy and gut health, soy/coffee/cruciferous vegetable and Hashimotos and Synthroid medication, and selenium deficiency and appropriate use of Brazil nuts. Appropriate guidelines such as AHA/ACC guidelines, NLA lifestyle, DASH, NIH, ADA, and Obesity were used during all patient interactions and documentation. After observing various dietitians in the clinic I was then able to perform appointment sessions from start to finish with patients with a variety of nutrition related diseases, including: elevated LDL-C, high triglycerides, mixed lipid disorders, hyperapobetalipoproteinemia, POTS, hypertension, obesity/overweight/underweight, diabetes, eating disorders, renal failure, status post bariatric surgery, and GI concerns. I effectively used education materials when teaching about the DASH and/or Mediterranean diet, proper fueling before and after exercise, ways to decrease saturated fat and increase unsaturated fats, interpreting lab results and what to do with those numbers, and much more. Referring to other health professionals was imperative to patient's health; referrals included for psychology, social work, endocrinologist, and smoking cessation program. I was able to work with patients to problem solve various situations and come up with an action plan together. Some behavior techniques I used were empowerment, motivational interviewing, positive affirmations, etc. These mutually agreed upon goals were tailored to each individual's diagnosis, personal goals, cultural practices, and blood work values. After appointments I used the Nutrition Care Process and the Subjective Global assessment to appropriate document nutrition notes, as those processes were also used during patient interactions. MiChart was used for all patient preparation, documentation, and analyzing labs. I was also able to help in the development, preparation, execution and marketing of the new cooking class for Cardiac patients. Performing a mini-teach about healthy carbohydrates and readiness to change was also something I completed with cardiac patients in cardiac rehab. I participated in a quarterly staff meeting discussing quality improvement of staff, administration and patient involvement, as well as improving quality assurance with hand washing. During my time here there was a mock Joint Commission survey and therefore reviewed those guidelines, as well. I also observed the exercise physiologists in Cardiac Rehab and a stress echo, and watched a presentation by a sleep specialist in Metabolic Fitness classes. I also discussed billing, insurance coverage, and billing codes with my preceptor and other RD's in the clinic.
Effect size: up to 8 patients per day, plus patients in the Cardiac Rehab and Metabolic Fitness classes/program
I finished my dietetic internship by completing my elective rotation at Gerber/Nestle Nutrition. I was able to work in all aspects of the Medical Affairs, Scientific, and Regulatory Unit (MSRU), and contribute to analyzing competitor data, research, and brainstorming for innovation aligning with company and business objectives. In working with the scientific unit I was able to translate scientific information to other health care professionals and consumers. I was also able to write communication pieces for consumers regarding specific ingredient benefits and certification meanings for the regulatory team. Although I cannot share the projects I worked on, you can see my evaluation sheet below.