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UBC DIETETICS MAJORUBC DIETETICS MAJOR
Internship Manual
2012 -
2013
Food, Nutrition and HealthFaculty of Land and Food Systems
UBC Dietetics Major FNH 481/482 (Dietetic Internship)
Internship Manual 2012-13
TABLE OF CONTENTS
Contents 1 Page
1. General internship documents a) FNH 481/482 Overview 1b) Master Checklist (DC competency coverage) 3c) Internship Role Delineation Summary 15d) Evaluation documents (not module-specific)
- Evaluation Statements Based on DC Competencies 20- Intern Self Evaluation Form 22- Formal Oral Presentation Evaluation Form 25- Written Learning Plan (for coordinator use) 27- Internship Performance Issues Summary (for coordinator use) 29- Interim Evaluation Form (for coordinator use) 31- Final Evaluation Form (for coordinator use) 34
2. Modules and module-specific evaluation forms a) Orientation 36b) Clinical I
- Medical Condition and Lifespan Stages Tracking Form (for use with all clinical modules) 41
- Module Clinical I 48- Performance Evaluation Preceptor Component 58
c) Clinical II - Module Clinical II 63- Performance Evaluation Preceptor Component 76
d) Clinical III - Module Clinical III, (a) Advanced Practice 83- Performance Evaluation Preceptor Component, (a) Advanced
Practice 92- Module Clinical III, (b) Relief 98- Performance Evaluation Preceptor Component, (b) relief 104
e) Community - Module Community 109- Performance Evaluation Preceptor Component, Community 116
f) Education - Module Education 120- Education Module Activity Evaluation Form 122
1-2012 Table of Contents Sept 4 2012.doc
Contents 1 Page
- Formal Oral Presentation Evaluation Form 123g) Elective
- Module Elective 125- Performance Evaluation Preceptor Component 130- Elective Observational Experiences Form 134- Elective Ideas 135
h) Foodservice Administration - Module Foodservices 137- Foodservice Projects Checklist 149- Performance Evaluation Preceptor Component, Foodservices 151
i) Research - Module Overview 155- Role Delineation 156- Research Project Limits by Core Site 157- Most Desirable Project Type 158- Project Requirements and Resources 159- Project Activities and Timelines Checklist 163- Appendix 1.0 Intern Research Idea and Submission Form 169- Appendix 2.0 Guidance Notes for Research Ethics Board
Applications 171- Appendix 3.0 Literature Search Strategy Worksheet 176- Appendix 4.0 Research Proposal (RP) Template 177- Appendix 5.0 Research Key Activities & Dates Flow Chart 181- Appendix 6.0 Documented Completion of Module Requirements 182
3. Program policies relevant to interns a) 1.03 Student Accident Insurance 184b) 1.04 Personnel and Professional Standards 186c) 1.06 Intern Evaluation 188d) 1.08 Internship Performance Issues 191e) 1.09 Termination and Appeal 198f) 1.10 Facility Service Disruption 200g) 1.11 Completion of the Dietetics Program 201h) 1.12 Affiliation Agreements 202i) 1.15 Professional Behaviour 208j) 1.16 Academic Regulations and Requirements 210
1 Note that electronic versions of all documents in this manual are available on the internship website, accessible at http://dieteticsinternship.landfood.ubc.ca/dietetics_internship_docs/
1-2012 Table of Contents Sept 4 2012.doc
UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
OVERVIEW
The internship year is comprised of two courses, FNH 481 and FNH 482, scheduled from September to late June. This is a fast-paced year consisting of 39 weeks of full time (8 hours per day, 5 days per week) practice education placements in clinical and public health facilities in addition to homework outside of placement hours (e.g., review clinical topics, complete research and other projects, prepare professional presentations). The internship includes two weeks of vacation over the holiday season in late December/early January plus statutory holidays.
Modules:
The internship consists of nine modules:
MODULE DESCRIPTION/FOCUS 1. Orientation - 1 week orientation to core site facilities, policies and
operations - Workshops and educational activities are scheduled by the
core site 2. Clinical I
(basic concepts in nutritional care)
- 7 weeks with exposure to 2 – 3 different clinical areas - Development of core clinical skills while working with
patients/clients with a limited number of co-morbidities
3. Clinical II (complex nutritional care and counselling)
- 7 weeks with exposure to 2 – 3 different clinical areas, with one outpatient setting
- Development of counselling skills and exposure to more complex clinical cases (multiple co-morbidities)
4. Clinical III
- 3 – 4 weeks of advanced clinical practice - 3 – 4 weeks of clinical relief in an area experienced in
Clinical I or II 5. Food Service
Administration - 10 weeks of foodservice administration
6. Community - 4 weeks of exposure to and experience with the varied roles and practice settings of dietitians working in community health
7. Elective - 2 weeks
8. Research - 1 dedicated week plus one-half day per week throughout the internship year for practice-based group research project
FNH 481 and 482 Overview April 15 2012.doc Page 1 of 2 1
MODULE DESCRIPTION/FOCUS 9. Education - A non-placement module that provides opportunities for
interns to reflect upon their own education and contribute to the education of others
- Learning activities are planned by core placement sites and may include journaling; providing case study presentations, seminars or in-services; and organizing educational events
Components:
Each internship module has several components:
COMPONENT DESCRIPTION 1. Performance Objectives
and Learning Activities Checklist
- A module specific checklist
- Intern-completed record of learning activities carried out within a placement or module
- Intern-completed assessment re achievement of performance objectives (reviewed with preceptor on evaluation)
2. Performance Evaluation Preceptor Component
- A module-specific evaluation form used by preceptors to determine if an intern has successfully completed a placement/module
3. Performance Evaluation Intern Component
- An evaluation form used by interns to evaluate a placement/module
4. Study Questions - Study questions may be developed and assigned to interns by preceptors
5. Case Studies - Case studies may be developed and assigned by preceptors if real cases are not available during a placement/module
6. Medical Condition and Lifespan Stages Tracking Form
- Tracking form used by interns to track their exposure/involvement with certain diseases, conditions, and lifespan stages throughout their clinical and community placements
Internship Resources: Dietetic interns and preceptors have access to a login-based, program-specific internship resources website, developed in collaboration with the Faculty’s Learning Centre, UBC Library, students, interns, and the British Columbia dietetics community. The website includes learning modules and related learning materials, policies and procedures, RHA-specific and library resources, student placement schedules, and discussion forums for interns and preceptors to share experiences and resources.
FNH 481 and 482 Overview April 15 2012.doc Page 2 of 2 2
UBC Dietetics Major Link of Professional Practice Courses to Competencies for the Entry Level Dietitian
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FN
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FNH
381
FNH
480
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Professional Practice 1. Practices dietetics in accordance with the
ethics of the profession by:
a) demonstrating integrity in professional practice;
b) demonstrating empathy in professional practice;
c) maintaining objectivity; d) practices dietetics in accordance with
the ethics of the profession by maintaining confidentiality;
e) observing conflict of interest guidelines;
f) working in the best interest of the client;
g) identifying and acting appropriately in dealing with unethical or incompetent behaviour.
2. Promotes a high standard of professional practice by:
a) supporting colleagues in the pursuit of their professional development;
b) supporting the training and education of others;
*
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 1 of 12 April 2012
3
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
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Clin
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Clin
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c) supporting the advancement of dietetic practice, research and knowledge;
*
d) promoting a high standard of professional practice by disseminating nutrition knowledge and information.
* *
3. Commits to a high standard of professional competence through continuous learning and self-development by:
a) assessing personal and professional strengths and limitations;
b) identifying development needs in practising dietetics;
c) pursuing a plan for self-development; d) monitoring a plan for
self-development.
4. Manages time efficiently. 5. Practices effectively to achieve desired
outcomes.
6. Accepts accountability in performing responsibilities.
7. Practices within areas of competence. 8. Utilizes research that improves practice. 9. Applies a research approach to problem
solving by:
a) examining a problem; b) reviewing related literature/resources;
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 2 of 12 April 2012
4
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
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Food
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c) applying research findings to the problem;
d) evaluating the results of the solution. Assessment 1. Identifies confirms issues that have
dietetic implications.
2. Identifies/obtains relevant data including: a) needs assessment data; * * b) dietary intake data (e.g. 24 hour
recall, food frequency, and food record);
* *
c) health record data (e.g. anthropometric, biochemical, clinical, dietary, psychosocial);
* * *
d) team/stakeholder meetings data (formal and informal); *
e) physical nutritional assessment data (e.g. height, weight, anthropometrics); * *
f) operational parameters (e.g. physical layout, staffing levels, union contracts);
*
g) financial data (e.g. enteral feeding product cost, socioeconomic status of clients, monthly budget reports);
* * * * * *
h) quality management data (e.g. client satisfaction questionnaire, standards of practice audit);
* * * * *
i) marketing data; * *
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 3 of 12 April 2012
5
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
ity
Food
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j) factors affecting learning (e.g. literacy, language comprehension, readiness to learn);
* *
k) product data (e.g. product specifications); * * *
l) appropriate literature/resources (e.g. epidemiological, demographic, practical research);
*
m) legal and contractual information. * * * 3. Recognizes factors affecting an issue
(e.g. psychosocial, cultural, political, legal, ethical, religious, linguistic, environmental, social, economic, organizational, and biomedical factors).
4. Uses effective data collection techniques (e.g. interviews, surveys, literature reviews, focus groups).
5. Translates raw data into interpretable data (e.g. height/weight to BMI, foods to nutrients, financial data to budget variance).
6. Integrates and interprets: a) needs assessment data; * * b) dietary intake data (e.g. 24 hour recall,
food frequency, and food record); * *
c) health record data (e.g. anthropometric, biochemical, clinical, dietary, psychosocial);
* * *
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 4 of 12 April 2012
6
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
ity
Food
Se
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tive
Educ
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d) team/stakeholder meetings data (formal and informal); *
e) physical nutritional assessment data (e.g. height, weight, anthropometrics); * *
f) operational parameters (e.g. physical layout, staffing levels, union contracts);
*
g) financial data (e.g. enteral feeding product cost, socioeconomic status of clients, monthly budget reports);
* * * *
h) quality management data (e.g. client satisfaction questionnaire, standards of practice audit);
* * * * *
i) marketing data; * * j) factors affecting learning; * * k) product data (e.g. product
specifications); * * *
l) appropriate literature/resources (e.g. epidemiological, demographic, practical research);
*
m) legal and contractual information. * * * 7. Formulates conclusions based on the
interpretation and integration of data.
Planning 1. Establishes, with the client and
appropriate others, realistic goals consistent with the assessment, ethical considerations, legislation, and policies.
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 5 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
ity
Food
Se
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2. Determines, with the client and appropriate others, measurable objectives.
3. Prioritizes, with the client and appropriate others, the objectives.
4. Formulates, with the client and appropriate others, strategies to meet the objectives.
5. Develops, with client and appropriate others, plans of action for managing:
a) human resources (e.g. recruiting, orienting, training, supervising, evaluating, scheduling);
*
b) financial resources (e.g. inventory management); *
c) the quality of programs, products, and services; * *
d) communication; * e) education; * * f) community action; * * g) practice-based research; h) operations (e.g. schedules, policies
and procedures, emergency response, contractual agreements);
*
i) technology (e.g. computer utilization); *
j) facilities and equipment; *
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 6 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
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Food
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k) the safe provision of foods/nutrients (e.g. menu planning, production, distribution, choice of nutritional products);
*
l) the marketing of programs, products, and services. * *
6. Develops a specific plan of action with the client and appropriate others to meet the objectives for nutrition promotion and clinical nutrition by:
a) defining a framework; * b) identifying the appropriate approach
(e.g. program, advocacy, feeding route, dietary regimen);
*
c) determining content; * d) developing time lines; * e) identifying the responsibilities and
accountability of the client and appropriate others;
*
f) identifying, accessing, managing and/or creating resources required to implement the plan of action;
*
g) identifying collaborators and support services (e.g. self-help groups, community agencies, local businesses);
*
h) determining monitoring parameters; * * i) determining monitoring methods; * * j) determining decision point criteria; * *
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 7 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
ity
Food
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Res
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k) establishing outcome measures; * * l) addressing the implications of the plan
with the client and appropriate others; *
m) addressing constraints to implementing the plan; *
n) determining implementation strategies (e.g. media lobbying, counselling strategies);
*
o) establishing short and long-term plans; *
p) establishing evaluation procedures to measure the effectiveness of the plan; *
q) adjusting the plan of action as required. *
Implementation 1. Activates the plan by:
a) communicating the plan to the client and appropriate others;
b) confirming the responsibilities and accountability of the client and appropriate others;
2. Executes the plan by: a) managing the delivery of programs,
products, and services (e.g. delegating when appropriate);
b) using a variety of strategies to meet client needs;
c) creating an environment conducive to executing the plan;
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 8 of 12 April 2012
10
Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
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Food
Se
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es
Res
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tive
Educ
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d) utilizing/developing resources (e.g. education materials, practice-based research, discussion with colleagues);
e) managing human resources; f) managing within the established
budget;
g) utilizing practice-based research approaches;
h) applying pertinent legislation, standards, and contractual agreements.
3. Monitors the achievement of the plan's objectives according to:
a) client acceptance/satisfaction; * b) quality of products and services; * c) human resource utilization (e.g.
supervision, performance evaluation, workload measurement);
*
d) financial performance (e.g. cost effectiveness, budget variance); *
e) communications (e.g. feedback, response to the plan); *
f) operations (e.g. time plan, safety, and sanitation); *
g) facilities, equipment, and technology availability and utilization; * *
h) safe provision of foods/nutrients (e.g. intake assessment, product dating); *
i) behavior/attitude change; * * This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 9 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
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II
Clin
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III
Com
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Food
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j) other monitoring parameters as identified (e.g. laboratory results, cafeteria revenue).
* *
4. Modifies the plan, as indicated through the monitoring process or as a result of unexpected circumstances.
Evaluation 1. Evaluates the achievement of the planned
objectives with respect to:
a) outcomes * b) effectiveness * c) efficiency * d) client satisfaction. *
2. Evaluates the process with respect to: a) effectiveness b) efficiency c) client satisfaction d) impact (e.g. financial, community,
psychosocial and nutritional benefit).
3. Evaluates the outcomes with respect to: a) goals b) effectiveness c) efficiency d) client satisfaction e) impact (e.g. financial, community,
psychosocial and nutritional benefit).
4. Determines the need for further evaluation.
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 10 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
ity
Food
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5. Determines the need for future action. Communication 1. Collaborates with clients, colleagues,
agencies, etc. during all phases of practice (i.e. assessment, planning, implementation, and evaluation).
2. Uses appropriate communication channels (e.g. formal, informal, focus groups, community actions).
3. Uses a variety of opportunities for teaching.
4. Applies principles of education (e.g. adult education, learning challenged).
5. Recognizes and responds to non-verbal communication (e.g. resistance to change, lack of understanding).
6. Uses appropriate terminology for the client, team members, and appropriate others.
7. Communicates using appropriate technology (e.g. television, slides, computers).
8. Communicates effectively considering the client's profile (e.g. positioning marketing strategies).
9. Actively participates with individuals and groups.
10. Provides information at the appropriate comprehension level.
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 11 of 12 April 2012
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Pre-internship Professional
Practice Courses Dietetic Internship Modules (FNH 481, 482)
Competencies for the Entry Level Dietitian
FNH
380
FNH
381
FNH
480
Orie
ntat
ion
Clin
ical
I
Clin
ical
II
Clin
ical
III
Com
mun
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Food
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11. Seeks, recognizes, and responds appropriately to feedback.
12. Demonstrates effective oral and written communication skills.
13. Effectively demonstrates the following communication skills when appropriate:
a) advocacy * b) negotiation * c) lobbying * d) interviewing * * e) teaching * f) counselling * g) facilitation. * *
14. Documents at each stage of the process: a) according to policy, established
timelines, and legal requirements;
b) in an appropriate format (e.g. concise and organized style).
* This competency area may be addressed for some interns (depends on the nature of the placement/learning activities) Page 12 of 12 April 2012
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UBC Dietetics Major Internship Role Delineation Summary
Responsibility Core
Council UBC Dietetics
Program Leader or Dietetics
Education Coordinator
Core Site Internship
Coordinator or Designate
Preceptor Intern
1. University-level program administration: a) Oversee student selection process. • b) Plan and coordinate campus-based
professional practice courses. •
c) Represent Dietetics on committees and initiatives involving UBC health and human service training programs and the BC Regional Health Authorities.
•
d) Address resource and operational issues with faculty senior administration.
•
e) Program policies: - Provide input to ensure policies
meet DC standards, align with UBC policies, and address program needs.
• •
- Seek faculty input on policies as necessary. •
- Approve policies. • - Maintain and disseminate policy
and procedure documents. •
- Abide by intern policies. • f) Complete tasks related to successful
completion of dietetic internship (enter grades, process confirmation
•
UBC internship role delineation summary Apr 15 2012.doc Page 1 of 5 15
Responsibility Core Council
UBC Dietetics Program Leader or Dietetics
Education Coordinator
Core Site Internship
Coordinator or Designate
Preceptor Intern
letters, etc.). g) Assist any student who fails or
withdraws from internship to select an alternate major so graduation requirements can be met.
•
2. DC linkages: a) Represent internship program at DC
Educators’ meetings. • •
b) Coordinate accreditation correspondence. •
c) Correspond with DC re internship program-related issues. •
3. Program planning: a) Conceptualize program philosophy,
plan and structure. •
b) Oversee design, maintenance, and dissemination of program documents. •
4. Program learning resources: a) Maintain internship website. • b) Provide input re suitable resources
for sharing province-wide via the website.
• • • • •
c) Gather, develop and maintain placement-specific learning resources.
•
5. Intern evaluation: a) Conceptualize evaluation strategy. • b) Oversee design and dissemination of
forms. •
UBC internship role delineation summary Apr 15 2012.doc Page 2 of 5 16
Responsibility Core Council
UBC Dietetics Program Leader or Dietetics
Education Coordinator
Core Site Internship
Coordinator or Designate
Preceptor Intern
c) Evaluate interns within each placement. • •
d) Review all intern evaluations as completed and identify any arising performance trends.
•
e) Develop action plans to address chronic performance issues that may interfere with successful program completion.
• •
f) Conduct mid-point and final evaluation.
•
g) Prepare Completion of Dietetics Program Form; send to regulatory college.
•
6. Program evaluation: a) Conceptualize evaluation strategy. • b) Oversee design and administration of
preceptor and intern evaluation surveys.
•
c) Provide feedback about the program. • • • d) Review evaluation results and
develop action plan to address issues.
•
e) Oversee implementation of program quality improvement action plan. •
f) Participate on committees to address program quality improvement initiatives.
• • •
UBC internship role delineation summary Apr 15 2012.doc Page 3 of 5 17
Responsibility Core Council
UBC Dietetics Program Leader or Dietetics
Education Coordinator
Core Site Internship
Coordinator or Designate
Preceptor Intern
7. Internship operations: a) Match students to core internship
sites. •
b) Provide orientation to internship expectations, forms and policies (within pre-internship professional practice course).
•
c) Coordinate orientation activities at core site. •
d) Prepare core site internship schedules. •
e) Plan placement-specific schedule and learning activities to achieve the requirements of the internship modules.
•
f) Provide information for setting up affiliation agreements for non-health authority placements.
• •
g) Arrange affiliation agreements for non-health authority placements. •
h) Coordinate intern activities during weekly education/project time. •
i) Provide high level oversight to internship research. • •
j) Develop action plans to address intern-specific issues arising that may affect timeliness or success of program completion (e.g. extended illness).
• •
UBC internship role delineation summary Apr 15 2012.doc Page 4 of 5 18
Responsibility Core Council
UBC Dietetics Program Leader or Dietetics
Education Coordinator
Core Site Internship
Coordinator or Designate
Preceptor Intern
8. Program communications: a) Prepare and disseminate Core
Council meeting documents. •
b) Correspond with interns regarding core site internship operational issues.
•
c) Correspond with interns regarding university-related issues. •
d) Correspond with preceptors. • • 9. Preceptor education:
a) Conceptualize education strategy. • b) Plan educational events delivered at
the Core Site level. •
c) Plan educational activities intended for all preceptors (e.g., province-wide workshop).
•
UBC internship role delineation summary Apr 15 2012.doc Page 5 of 5 19
UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
EVALUATION STATEMENTS BASED ON DC COMPETENCIES
Outlined below is a summary of the Competencies for the Entry Level Dietitian (Dietitians of Canada 1996) that all interns are required to achieve during their internship year. The statements under each competency area may be useful to preceptors during the evaluation process when determining an intern’s strengths and areas that may need further development. The full text of the competencies is available on the UBC internship website. Competency Areas Entry Level Competencies Assessment The intern:
- identifies and confirms issues that have dietetic implications - identifies and obtains relevant data - recognizes factors affecting an issue - uses effective data collection techniques and/or tools - translates raw data into interpretable data - integrates and interprets data appropriately - formulates conclusions based on the interpretation and integration of
raw data Planning The intern:
- establishes, with the client and appropriate others, realistic goals consistent with the assessment, ethical considerations, legislation and policies
- determines, with the client and appropriate others, measurable objectives
- prioritizes, with the client and appropriate others, the objectives - formulates, with the client and appropriate others, strategies to meet
the objectives - develops, with the client and appropriate others, strategies to meet
the objectives - develops, with the client and appropriate others, appropriate plans of
action Implementation The intern:
- activates the plan by communicating the plan and by confirming the responsibilities and accountability of the client and appropriate others
- executes the plan appropriately - monitors the achievement of the plan’s objectives - modifies the plan as needed
Evaluation The intern: - evaluates the achievement of the planned objectives - evaluates the process used to achieve the objectives - evaluates the outcomes - determines the need for further evaluation - determines the need for further action
Professional Practice The intern: - practices dietetics in accordance with the ethics of the profession - promotes a high standard of professional practice - commits to a high standard of professional competence through
continuous learning and self-development - manages time efficiently - practices effectively to achieve desired outcomes
Evaluation Statements based on Competencies April 15 2012.doc Page 1 of 2 20
Competency Areas Entry Level Competencies - accepts accountability in performing responsibilities - practices within area of competence - utilizes research to improve practice - applies a research approach to problem solving
Communication The intern: - collaborates with clients, colleagues, agencies etc. during all phases
of practice - uses appropriate communication channels - uses a variety of opportunities for teaching - applies principles of education - recognizes and responds to nonverbal communication - uses appropriate terminology for the client, team members, and
appropriate others - communicates using appropriate technology - communicates effectively considering the client’s profile - actively participates with individuals and groups - provides information at the appropriate comprehension level - seeks, recognizes, and responds appropriately to feedback - demonstrates effective oral and written communication skills - effectively demonstrates a variety of communication skills (e.g.,
advocacy, negotiation, lobbying, interviewing, teaching, counselling, facilitation)
- documents at each stage of the process in accordance with policy, established time lines, and legal requirements and in an appropriate format
Notes: The client:
1. may be an individual, family, group, agency, employer, employee, organization, community, etc. 2. is a potential or actual recipient of the intern’s expertise 3. is unique, diverse in needs, culture, demands, motivations, resources, religion, and definition of
wellness 4. is an active partner in the process.
The environment:
1. includes a variety of practice settings and relationships 2. encompasses physical, social, political, economic, and cultural factors 3. is influenced by legislation, regulatory and professional bodies, the public, employment
philosophies and practices, research, and technology 4. is ever changing and dynamic.
Evaluation Statements based on Competencies April 15 2012.doc Page 2 of 2 21
UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP) EVALUATION FORM INTERN COMPONENT
Evaluation Form Intern Component April 15 2012.doc Page 1 of 3
INTERN’S NAME: PLACEMENT NUMBER: OF MODULE MODULE DATES: LENGTH OF PLACEMENT: PLACEMENT LOCATION: PRECEPTOR(S): Intern Instructions: A few days prior to a scheduled evaluation meeting: a) submit your completed Performance Objectives and Learning Activities Checklist to your preceptor
for review; and b) complete this form. A. Strengths and areas for development related to competency areas: ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
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PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
B. Feedback for preceptor (things that worked well, suggested changes for future interns): -
C. Additional comments (if applicable): -
D. Complete Intern Goal Setting Sheet on the final page of this document. Obtain preceptor
input, modifying goals as necessary. Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions for interns: 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Preceptor Component c) Performance Evaluation Intern Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the completed Performance Objectives and Learning Activities Checklist should also be submitted to the Internship Coordinator within 5 working days after completion of the placement.
Internship Co-ordinator’s Signature: _______________________________Date: _______________
Evaluation Form Intern Component April 15 2012.doc Page 2 of 3
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INTERN GOAL SETTING SHEET (to be shared with the preceptor for your next placement) DATE: INTERN’S NAME: CURRENT PLACEMENT: PLACEMENT NUMBER: OF MODULE DATES: PLACEMENT LOCATION: PRECEPTOR: NEXT PLACEMENT: PLACEMENT NUMBER: OF MODULE DATES: PLACEMENT LOCATION: PRECEPTOR: Comment on the progress you have made in attaining the three key goals for the current placement: Outline three key goals for your next placement/module. In brackets, indicate the competency area(s) each goal pertains to (i.e., assessment, planning, implementation, evaluation, professional practice, communication) Additions/modifications to goals for next placement/module based on discussion with preceptor for current placement (can be hand written if necessary)
Evaluation Form Intern Component April 15 2012.doc Page 3 of 3
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP) FORMAL ORAL PRESENTATION EVALUATION FORM
Formal Oral Presentation Evaluation Form April 15 2012.doc Page 1 of 2
This form is for use by the site internship coordinator (or designate) to summarize feedback to an intern following each of his/her formal presentations. Other session attendees and the presenting intern may also be asked to complete these forms and submit them to the internship coordinator (or designate) for use in planning the evaluation meeting. Following the evaluation meeting with the intern, the intern should be given a copy of this form for his/her personal records. The internship coordinator should retain the original form for the intern’s file.
Date: _______________
Intern: ________________________________________
Presentation: ________________________________________________________
ASPECT CRITERIA YES NO COMMENTS
Topic is pertinent to dietetic practice
Selection of information is appropriate for audience
Amount of information is appropriate for audience
Evidence-based approach is used
Speaker is comfortable and familiar with topic
Content
Speaker is able to adequately address audience questions
Key presentation elements are included (introduction, main body, summary and conclusions)
Material is presented in logical sequence
Organization
AV aids used enhance the presentation
Pace of delivery is appropriate – not too fast or too slow
Speaker Style
Voice projection is appropriate
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Formal Oral Presentation Evaluation Form April 15 2012.doc Page 2 of 2
ASPECT CRITERIA YES NO COMMENTS
Body language is appropriate
Speaker is able to engage and involve audience
Overall Summary: Strengths: Areas for Improvement: Recommendations: Intern Comments on Evaluation:
Evaluator: _____________________________________________
Date: _________________________________________________
Following the evaluation meeting, give a copy of this form to the intern and retain the original for the intern’s file in the site internship coordinator’s office.
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UBC Dietetics Major FNH 481/482 Dietetic Internship
WRITTEN LEARNING PLAN
PURPOSE: For use by internship coordinators to establish a learning plan to assist interns to achieve entry level competencies. A Written Learning Plan should be developed when an intern has not successfully completed a placement or module. Plan should be developed in collaboration with interns and relevant preceptors. DATE: INTERN: CORE SITE: MODULE: SUMMARY OF ISSUES AND ACTION PLAN: Issue Competency Area
(Assessment, Planning, Implementation, Evaluation, Professional Practice, or Communication)
Action Plan By When
1.
2.
3.
4.
(Insert additional rows as needed)
Written Learning Plan April 15 2012.doc Page 1 of 2 27
PLACEMENT PLAN TO FACILITATE LEARNING (double click to select)
Adjust current placement(s) within a module Describe:
Arrange additional placement(s) Describe: APPROACH TO REVIEWING PROGRESS TOWARDS GOALS (double click to select all that apply):
Mid-placement evaluation (conducted by preceptor) End of placement evaluation (conducted by preceptor) Followup meeting with coordinator (provide details) Other (describe)
SIGNATURES: Signatures below indicate that this document has been reviewed and discussed, and the intern is committed to the plan. INTERN SITE COORDINATOR
Written Learning Plan April 15 2012.doc Page 2 of 2 28
UBC Dietetics Major FNH 481/482 Dietetic Internship
INTERN PERFORMANCE ISSUES SUMMARY
PURPOSE: For use by internship coordinators to summarize serious performance issues, outline required actions, and communicate potential consequences in the event that performance issues are not addressed within the allotted timeframe. DATE: INTERN: CORE SITE: MODULE: SUMMARY OF ISSUES AND ACTION PLAN: Issue Competency Area
(Assessment, Planning, Implementation, Evaluation, Professional Practice, or Communication)
Action Plan By When
1.
2.
3.
4.
(Insert additional rows as needed)
Intern Performance Issues Summary April 15 2012.doc Page 1 of 2 29
PLACEMENT PLAN TO FACILITATE LEARNING (double click to select each that applies):
Adjust current placement(s) Describe:
Arrange additional placement(s) Describe:
Other Describe: APPROACH TO REVIEWING PROGRESS TOWARDS GOALS (double click to select each that applies):
Mid-placement evaluation (conducted by preceptor) End of placement evaluation (conducted by preceptor) Followup meeting with coordinator (provide details) Other (describe)
SUMMARY: Serious performance issues have been identified. Without immediate evidence of improvement, successful completion of the program could be jeopardized. INTERN COMMENTS: SIGNATURES: Signatures below indicate that this document has been reviewed and discussed. INTERN SITE COORDINATOR UBC DIETETIC EDUCATION COORDINATOR
Intern Performance Issues Summary April 15 2012.doc Page 2 of 2 30
UBC Dietetics Major FNH 481/482 (Dietetic Internship) INTERIM INTERN EVALUATION FORM
Interim Evaluation Form April 15 2012.doc Page 1 of 3
INTERN: ____________________________________ DATE: _______________________ Core Site Internship Coordinator (CSIC) Instructions: 1. The CSIC must carry out an interim evaluation with each intern at the midpoint of the internship year
(approximately mid-January) or more frequently if required. 2. Arrange a meeting to discuss the intern’s performance to date. 3. In preparation for the meeting, review the Performance Objectives and Learning Activities Checklists
and evaluation forms from all modules completed to date, noting trends and gaps in performance objective achievement.
4. Complete this form, identifying key strengths, areas for development, and goal setting for the remaining months of internship, if needed.
5. At the meeting, discuss intern strengths identified, issues of concern, and goal setting for the remaining months of the internship, if required.
6. Sign off completed forms and provide intern with a signed copy of this form. 1. Modules Completed or in Progress:
Module Completed In Progress Orientation Clinical I Clinical II Clinical III a Advanced Practice Clinical III b Clinical Relief Food Service Community Elective(s)
2. Education Module Activities Completed: - 3. Other Significant Accomplishments: - 4. Summary of Performance in Achieving Competencies (strengths, areas for development) Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
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Interim Evaluation Form April 15 2012.doc Page 2 of 3
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
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Interim Evaluation Form April 15 2012.doc Page 3 of 3
5. Overall Summary:
There are no major issues that could result in unsafe practice and professional conduct is satisfactory.
There are issues of concern. Goal setting and follow-up plans are needed.
Summary of Issues of Concern, e.g., performance objectives not achieved; issues related to unsafe practice, concerns related to knowledge or skill, personal conduct (be specific) − Goals for Addressing Concerns − Follow-up Plans −
6. General Comments 7. Intern Comments Intern's Signature: _______________________________________ Date: ___________ CSIC Signature: __________________________________________Date: ___________ The above signatures indicate that the Intern and CSIC have reviewed and discussed this form.
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UBC Dietetics Major FNH 481/482 (Dietetic Internship)
FINAL INTERN EVALUATION FORM
Final evaluation form April 15 2012.doc Page 1 of 2
INTERN: ____________________________________ DATE: _______________________ Core Site Internship Coordinator Instructions: 1. The CSIC must carry out a final evaluation with each intern at the end of the internship year. 2. Schedule a final evaluation meeting with the intern for the final week of internship placements. 3. In preparation for the meeting, review all evaluation documents in the intern’s file and complete this
form. 4. At the meeting, review and discuss this form. 5. Sign off completed forms and provide the intern and the UBC Dietetic Education Coordinator with
signed copies of this form. Evaluation Summary 1. Summary of Performance in Achieving Competencies (strengths, areas for development)
Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
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Final evaluation form April 15 2012.doc Page 2 of 2
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
2. General Comments
3. Intern Comments Intern's Signature: _______________________________________ Date: ___________ CSIC Signature: _________________________________________ Date: ___________ The above signatures indicate that the Intern and CSIC have reviewed and discussed this form.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: ORIENTATION
Module Orientation April 24 2012.doc Page 1 of 5
INTERN’S NAME: ______________________________________ DATES: _________________ Module Overview: This is a one-week module that provides dietetic interns with an orientation to their core placement site/affiliate sites. The module is designed to be adaptable to a variety of internship settings. The preceptor for this module is the Internship Coordinator or a designate. Module Competencies: Competencies1 (those addressed in this Module are bolded) Assessment 1, 2a,b,c,d,e,f,g2,h2,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h2,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. 2. Complete the form in ink. 3. As required learning activities are completed, check them off. Use the Notes section to clarify how
learning activities have been completed. Note that the learning activities listed are only suggestions and your preceptor may modify the learning activities as needed.
4. Typically, interns are not evaluated at the end of the Orientation Module; however, it is essential to complete all orientation activities in preparation for placements. In the event you have missed any key activities on the list, contact the internship coordinator.
5. At the completion of the module, hand in this form to your Internship Coordinator and keep a copy for your records.
Preceptor Instructions: 1. Adjust the orientation week schedule as needed to meet program needs (e.g., delaying the
orientation week until interns are at the primary site; breaking up the week into smaller segments). 2. Develop a schedule for achieving all learning activities. When preparing the schedule, keep in mind
that the focus of this module is to assist interns in becoming oriented with the policies, guidelines and systems in place at the core site in order that they may participate effectively in future modules.
3. The learning activities outlined in the module are suggestions. You may wish to add additional ones. Notes:
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In Orientation, interns focus on becoming familiar with the core placement site, in order to be able to participate effectively in other program learning modules.
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to: 1. Demonstrate familiarity with
the core site.
− Review site-specific resource
materials as assigned − Attend hospital orientation − Tour clinical and foodservice
areas (or participate in scavenger hunt to become oriented to key places and things)
− Attend intern welcome event − Become oriented with library
2. Demonstrate familiarity with the internship program operations at the core site.
− Review internship program/scheduling, including modules and elective options
− Determine date for decision regarding elective options
− Discuss goals and program expectations
− Discuss expectations for professionalism
− Introduce to Nutrition and Food Services, including staff
− Review site-specific applications of UBC Internship Program Policies and Procedures
− Review site-specific guidelines including the role of the dietitian, standards of practice, practice guidelines, nutrition care manuals and nutrition education materials
− Review institutional policies (i.e., ethics, patient rights and responsibilities, confidentiality, immunizations)
Module Orientation April 24 2012.doc Page 2 of 5
37
PERFORMANCE OBJECTIVES EDone ( )
NOTES R QUIRED LEARNING ACTIVITIES
− Review intern expectations and dress code
− Review guidelines for feedback and evaluations
− Review of Education Module requirements
3. Demonstrate familiarity with the core site computer and communication systems.
− Attend orientation to site computer systems
− Introduction to internal communication systems: paging, email, internet, intranet
4. Demonstrate familiarity with foodservice systems and operations.
− Orientation to and overview of food production system and rotations
− Overview of patient menu systems
− Overview of diet office communications and review of tray service systems
5. Demonstrate readiness for internship research.
− Connect with Internship Coordinator and designated research preceptor to begin to plan research project
− Discuss and determine how scheduling will be achieved for the half day per week for interns to have free time to work on research and other projects
− Attend site library services orientation
− Investigate services available at health authority research office and procedures for local study approval
6. Participate in any additional training and/or educational learning sessions as may be
Examples: − Attend training session on
personal learning styles and
Module Orientation April 24 2012.doc Page 3 of 5
38
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
assigned by the core site. teaching techniques to use for different learning styles
− Attend “surviving internship” session by past interns
− Attend social gathering with RD’s − Attend educational offerings put
on by the site’s educational department
− Attend other sessions as assigned
7. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking
and problem solving skills c) effective time
management d) ability to manage work
independently e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective interpersonal skills
To be demonstrated throughout the placement, as learning activities are carried out.
Module Orientation April 24 2012.doc Page 4 of 5
39
P RE REQUIRED LEARNING ACTIVITIES Done ( )
NOTES FORMANCE OBJECTIVES
l) ability to communicate appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
Module Orientation April 24 2012.doc Page 5 of 5
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 1 of 7
Purpose and Overview: The Medical Condition and Lifespan Stages Tracking Form helps to ensure that interns obtain a wide range of clinical exposures during the internship year. It serves as a guide, rather than a list that must be explicitly followed. The intern should aim to achieve a good balance between applied and observed experiences. Intern Instructions: 1. Carry this form with you throughout your clinical and community placements. It is your responsibility
to ensure that you gain an array of clinical/lifespan exposures during internship. 2. As you are exposed to a disease/condition or lifespan stage, make note of the date on this form and
the name of your supervising preceptor. Add details to describe the exposure, particularly in regards to your level of involvement. Levels of involvement may include:
• Observed • Assessed • Counselled • Followed (as part of caseload)
3. Monitor your exposures/level of involvement throughout your clinical and community placements and alert your preceptors and/or internship coordinator about gaps that you are having difficulty addressing. Options for addressing these gaps may include case studies, self-directed reading, a discussion with preceptors, and/or a dietitian-led education session.
4. In addition to sharing this form with each preceptor, this form should be brought to the interim and final evaluation meetings with your internship coordinator.
Preceptor Instructions: 1. At the start of each clinical or community placement, review and discuss the Medical Condition and
Lifespan Stages Tracking Form with the intern to gain an understanding of the intern’s experience, allowing for appropriate placement activities to be scheduled.
2. In the event that an intern is unable to have exposure to or be involved with a patient/client with a disease or condition typically seen in your clinical area, assign a case study, self-directed reading, and/or have a discussion with the intern.
Notes:
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 2 of 7
Medical Condition Exposure
Date of Initial Exposure
Preceptor’s Name
Description of Involvement
Alcoholism
Anemia (macrocytic, microcytic)
Arthritis
Brain Injury
Burns
Cancer
Cardiac Surgery
Celiac Disease
Cerebral Vascular Accident
Congestive Heart Failure
Chronic Obstructive Pulmonary Disease
Constipation
Cystic Fibrosis
Decubitus Ulcers
Dementia/Alzheimer’s
Diabetes, Type 1
Diabetes, Type 2
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 3 of 7
Medical Condition Exposure
Date of Initial Exposure
Preceptor’s Name
Description of Involvement
Diabetes, Gestational
Diarrhea
Disordered Eating
Diverticular Disease
Dysphagia
Esophagectomy
Failure to Thrive, infant
Failure to Thrive, adult
Fistula
Food Allergy
Food Intolerance
Gastric Surgery
Human Immunodeficiency Virus
Hyperemesis
Hyperlipidemia
Hypertension
Inflammatory Bowel Disease
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 4 of 7
Medical Condition Exposure
Date of Initial Exposure
Preceptor’s Name
Description of Involvement
Ileostomy / Colostomy
Irritable Bowel Syndrome
Jaw Surgery/Wired Jaw
Liver Disease (cirrhosis, hepatitis)
Malnutrition
Mental Health Issues, e.g., schizophrenia, bi-polar disease, borderline personality
Multiple Organ Failure
Nausea/Vomiting
Neurodegenerative Disease, e.g., amytrophic lateral sclerosis, Parkinson’s disease, multiple sclerosis
Organ Transplant
Osteoporosis
Pancreatitis (acute, chronic)
Refeeding Syndrome
Renal Failure, acute
Renal Failure, chronic
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 5 of 7
Medical Condition Exposure
Date of Initial Exposure
Preceptor’s Name
Description of Involvement
Renal Dialysis
Respiratory Failure
Sepsis
Short Bowel Syndrome
Tracheotomy and oral feeding
Trauma
Tube Feeding, continuous
Tube Feeding, intermittent
Tube Feeding transitions – intermittent
Tube Feeding transitions – nocturnal
Tube Feeding transition to oral
Tube Feeding, home teaching
Total Parenteral Nutrition
Total Parenteral Nutrition transition (to oral or EN)
Total Parenteral Nutrition transition (peripheral to central)
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 6 of 7
Medical Condition Exposure
Date of Initial Exposure
Preceptor’s Name
Description of Involvement
Wound Management
Lifespan Stages Exposure Date of Initial
Exposure Preceptor’s
Name Description of Involvement
Infant
Toddler
Child
Youth
Adult
Pregnancy
Elderly
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MEDICAL CONDITION AND LIFESPAN STAGES TRACKING FORM
Medical Condition Tracking Form April 15 2012.doc Page 7 of 7
Confirmation of internship coordinator review (Interim): The signature below confirms that, as part of the intern’s interim evaluation, this form has been reviewed and plans for addressing any significant gaps have been discussed. Internship Coordinator’s Name (Please Print) ____________________________________________ Internship Coordinator’s Signature: _________________________________________ Date:________________ Confirmation of internship coordinator review (Final): The signature below confirms that, as part of the intern’s final evaluation, this form has been reviewed and sufficient exposure to medical conditions and lifespan stages has been completed. Internship Coordinator’s Name (Please Print) ____________________________________________ Internship Coordinator’s Signature: _________________________________________ Date:________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: CLINICAL I
Module Clinical I April 24 2012.doc Page 1 of 10
INTERN’S NAME: ______________________________________ DATES: ______________________ Clinical Modules Overview: This 21-week experience consists of three 7-week modules as described below. NOTE: These are general guidelines only. Interns who are capable of progressing more quickly (greater workload, higher level of independence) than outlined in a module can be encouraged to do so.
Clinical I (Introductory Exposure to Clinical Care) Clinical I, consisting of 2 – 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a limited number of nutritional co-morbidities. Clinical I placements are in clinical settings where rapid-pace decision-making is less likely to be required. From weeks 1 to 4, an intern is expected to provide clinical care under direct guidance from, or in collaboration with, the preceptor. Progressing through weeks 5 to 7, the intern is expected to independently collect data, and create assessments and care plans, reviewing with the preceptor prior to implementation. Clinical II (Clinical Care for In and Outpatients) Clinical II, consisting of 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a greater number of co-morbidities and/or situations where more rapid decision-making is required. As part of the Clinical II experience, interns gain some experience in counselling, with at least one of the 3 placements being in an outpatient setting. Following an initial orientation to each new placement setting, the intern is expected to independently collect data, and create assessments and care plans (reviewing as necessary with preceptor prior to implementation). For patients with complex care issues, the intern may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical III (Complex Clinical Care and Relief) Clinical III, consisting of 3 placements, is designed to assist interns to gain further exposure to complex clinical care and to carry out clinical relief.
Clinical IIIa (Advanced Practice) This sub-module provides interns with additional exposure to complex clinical care in more specialized clinical settings. Assigned workload and level of independence varies by placement setting. Interns are encouraged to practice independently where possible; however, in highly specialized areas they may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical IIIb (Relief) This sub-module provides interns with the opportunity to apply past experience to the independent management of a patient caseload in a clinical area experienced during earlier placements (checking with preceptor for appropriate scope of practice and level of independence). In this final clinical module, the pace of work and decision-making is similar to that of a practicing dietitian. Interns are expected to have a high level of independence, in that only a final check and documentation signoff is required from the preceptor.
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Upon successful completion of the clinical modules, interns are expected to be able to achieve entry level clinical practice proficiency, defined as follows: - When presented with routine situations, the intern performs relevant practice competencies in a
manner consistent with generally accepted standards in the profession, with minimal supervision or direction, and within a reasonable timeframe. The intern anticipates what outcomes to expect in a given situation, and responds appropriately.
- The intern recognizes unusual, difficult to resolve and complex situations which may be beyond their
capacity. The intern takes appropriate and ethical steps to address these situations, which may include seeking consultation, supervision or mentorship, reviewing research literature, or a referral.
Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this Module are bolded) Assessment 1, 2a,b,c,d,e,f,g2,h2,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h2,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. 2. Complete the form in ink. You may want to use different coloured pens for each placement within the
module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
Module Clinical I April 24 2012.doc Page 2 of 10
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Module Clinical I
April 24 2012.doc Page 3 of 10
Preceptor Instructions: 1. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a
specific placement location. 2. Note that, unless otherwise stated, the learning activities listed are required to be completed in each
placement within the module. 3. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns
to achieve entry level practice skills. 4. Focus on clinical practice fundamentals and avoid providing too much information or assigning an
excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
5. Review the checklist and the Medical Condition and Lifestyle Stages Tracking Form with the intern weekly during the placement to track progress and to plan activities for the following week.
6. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
7. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
50
Performance Objectives and Learning Activities Checklist Module: Clinical I
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to: 1. Organize work to achieve the
requirements of the placement
- Print off Module forms - The week prior to the placement,
contact the preceptor to obtain pre-placement work assignments (e.g., readings, terminology, course work review, study questions)
- Working with preceptor, develop and implement a plan to ensure that required learning activities are achieved
- Arrange meetings with preceptor at least weekly to discuss progress and revise plans as needed to reflect issues arising
2. Reflect upon past performance and set personal goals
- Develop personal learning goals for each placement
- Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement (N/A if this is the first placement in the internship; in this instance verbally share goals)
- Review Medical Condition and Lifespan Stages Tracking Form with preceptor to share areas of coverage to date (N/A if this is the first placement in the internship)
3. Demonstrate familiarity with Clinical I environments (e.g. resources, tools, routines)
- Tour clinical areas - Read assigned materials relevant
to practice area, e.g., articles, policies and procedures,
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Performance Objectives and Learning Activities Checklist Module: Clinical I
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
regulations - Review medical terminology
4. Demonstrate familiarity with the clinical dietitian role in Clinical I settings
- Job shadow preceptor for assigned time period
- Arrange discussion(s) with preceptor re their approach to practice
- Discuss with preceptor, relationship of clinical nutrition to foodservices
- Actively participate in discussions with preceptor, asking appropriate questions as issues arise
5. Demonstrate familiarity with interprofessional roles in Clinical I areas
− Attend and, if needed, participate in pertinent meetings (e.g. ward rounds, care conferences, family meetings)
− By the end of Clinical I, meet with at least four professionals to observe and discuss their roles (e.g. occupational therapist, physical therapist, recreational therapist, nurse, pharmacist, social worker, speech language pathologist, physician)
6. Demonstrate relevant knowledge of diseases, conditions, and nutrition support interventions commonly seen in Clinical I areas, e.g., a) cardiovascular disease b) constipation c) diabetes d) dysphagia
− Review course notes, texts and assigned readings related to Clinical I diseases and conditions
− Undertake a self-directed learning process as unfamiliar issues are encountered (e.g. diseases, drugs, terms)
− Review and discuss study questions as assigned by preceptor
− If appropriate patients/residents
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Performance Objectives and Learning Activities Checklist Module: Clinical I
P R
Module Clinical I April 24 2012.doc Page 6 of 10
E JECTIVES Done ( )
NOTES FORMANCE OB REQUIRED LEARNING ACTIVITIES
e) malnutrition f) osteoporosis g) wounds h) tube feedings i) cognitive impairment
are not available, complete case studies as assigned by preceptor
− Work on completing Medical Condition and Lifespan Stages Tracking Form (form for documenting exposure to diseases and conditions throughout clinical modules)
7. Screen populations of Clinical I patients or residents, in order to identify high priority cases with appropriate supervision, e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently screening and prioritizing, reviewing results with preceptor
− For each assigned area, review nutritional risk indicators and priorities for nutritional intervention
− Screen patients/residents for nutritional risk using available screening tools
− For each assigned area: - visit patients/residents at
meal-time - identify patients/residents
potentially requiring nutrition intervention
8. Demonstrate familiarity with diet modifications used in Clinical I areas
− Review diet office procedures and menu systems, including − diet types and textures relevant
to the placement − process for ordering diets − available supplements − menu substitution procedures
− When visiting patients/residents during meal times for each assigned area, take note of diet types in use
9. Complete nutritional assessments and develop nutritional care plans for Clinical I patients or residents with appropriate supervision,
− Observe preceptor gathering and interpreting pertinent information from various sources (e.g., the patient/resident, the medical record, and verbal communication
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Performance Objectives and Learning Activities Checklist Module: Clinical I
P RE Done ( )
NOTES RFO MANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES
e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently (care plans should be reviewed with preceptor prior to implementation)
with physicians, nursing staff, allied health staff)
− Review medical records to identify and interpret information necessary to develop a care plan under preceptor supervision
− Observe preceptor conducting a nutrition assessment interview with patient or significant other and developing a nutrition care plan
− Conduct nutrition assessment interviews with preceptor observation/ supervision and develop care plans for preceptor feedback
− By the end of Clinical I, conduct a calorie count for at least one assigned patient/resident
− By the end of Clinical I, under preceptor supervision, complete at least one tube feeding assessment
− Under preceptor supervision, complete a minimum of three to five nutritional assessments per week
− Complete homework as assigned and discuss with preceptor
− If applicable to area, observe a patient/resident swallowing assessment
10. Implement care plans, including: - diet modifications - health care team
communication (verbally
Diet Modifications − Using area-specific procedures,
communicate diet changes for assigned patient/residents to appropriate others (food services,
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Performance Objectives and Learning Activities Checklist Module: Clinical I
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
and in writing) - patient/resident/family
education as needed, with appropriate supervision, e.g.
a) weeks 1 to 4: with direct guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently (care plans should be reviewed with preceptor prior to implementation)
team members, family, etc.) − Assess need for and choose
appropriate nutrition and assess need for vitamin/mineral supplements for assigned patients/residents
Healthcare Team Communication − Document your complete nutrition
assessments and care plans for each assigned patient/resident, seeking preceptor feedback prior to placing in health record
− Identify and communicate with team members necessary for implementation and monitoring of a nutritional care plan
− Establish follow-up plans Documentation in the Health Record
− according to policies and established timelines
− using appropriate abbreviations and medical terminology
Patient/Resident/Family/Staff Education − By the end of Clinical I, observe
preceptor providing at least four nutrition education sessions
− Provide nutrition education for at least one assigned patient/resident, including: − Establish nutrition goals with
patient/resident/family − Select appropriate education
resources and tools − Lead nutrition education
session
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Performance Objectives and Learning Activities Checklist Module: Clinical I
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
11. Evaluate a nutritional care plan and modify as necessary with appropriate supervision, e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently (care plans should be reviewed with preceptor prior to implementation)
− Conduct follow-up visits and health record reviews to assess achievement of nutrition goals
− With preceptor, discuss effectiveness of intervention
− Assess patient/resident satisfaction with nutritional care
12. Progress towards managing a small patient caseload of Clinical I patients or residents, e.g. − weeks 2 to 3: 3 patients − weeks 4 to 5: 6 patients − weeks 6 to 7: 10 patients with appropriate supervision, e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently (care plans should be reviewed with preceptor prior to implementation)
Note: Caseload expectations may be adjusted in pediatrics.
− Provide nutritional care for assigned patients/residents
13. Demonstrate appropriate professional conduct, including:
To be demonstrated throughout the placement as learning activities are carried out
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Performance Objectives and Learning Activities Checklist Module: Clinical I
P RE REQUIRED LEARNING ACTIVITIES Done ( )
NOTES FORMANCE OBJECTIVES
a) an appropriate level of professional confidence
b) effective critical thinking and problem solving skills
c) effective time management
d) ability to manage work independently
e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective interpersonal skills
l) ability to communicate appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
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57
UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE CLINICAL I
Evaluation Form Preceptor Component Clinical I April 24 2012.doc Page 1 of 5
INTERN’S NAME: PLACEMENT NUMBER: DATES: LENGTH OF PLACEMENT: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with Clinical I environments (e.g. resources, tools, routines)
4. Demonstrates familiarity with the clinical dietitian role in Clinical I settings
5. Demonstrates familiarity with interprofessional roles in Clinical I areas
6. Demonstrates familiarity with diseases, conditions and nutrition support interventions commonly seen in Clinical I areas, e.g., a) cardiovascular disease b) constipation c) diabetes d) dysphagia e) malnutrition f) osteoporosis g) wounds h) tube feedings i) cognitive impairment
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
7. With appropriate supervision, e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently screening and prioritizing, reviewing results with preceptor
screens populations of Clinical I patients or residents to identify high priority cases
8. Demonstrates familiarity with diet modifications used in Clinical I areas
9. With appropriate supervision, e.g. a) weeks 1 to 4: with direct
guidance from or in collaboration with preceptor
b) weeks 5 to 7: independently (care plans should be reviewed with preceptor prior to implementation)
completes nutritional assessments and develops nutritional care plans for Clinical I patients or residents
10. With appropriate supervision (as above), implements care plans, including: a) Diet modifications b) Health care team communication
(verbally and in writing) c) Patient/resident/family education
as needed
11. With appropriate supervision (as above), evaluates a nutritional care plan and modifies as necessary
12. With appropriate supervision (as above), manages a small patient caseload of Clinical I patients or residents, e.g., a) weeks 2 to 3: 3 patients b) weeks 4 to 5: 6 patients c) weeks 6 to 7: 10 patients Note: Caseload expectations may be adjusted in pediatrics.
13. Demonstrates appropriate professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative
Evaluation Form Preceptor Component Clinical I April 24 2012.doc Page 2 of 5
59
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
h) Uses a collaborative approach i) Shows effective interpersonal
skills j) Communicates appropriately,
both verbally and in writing k) Assesses strengths and
weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
Evaluation Form Preceptor Component Clinical I April 24 2012.doc Page 3 of 5
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IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics-based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice; and, professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1, 2 and 3 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and/or behaviours of concern below and contact internship coordinator immediately. -
Evaluation Form Preceptor Component Clinical I April 24 2012.doc Page 4 of 5
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D. Additional comments (if applicable): Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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62
UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: CLINICAL II
Module Clinical II April 24 2012.doc Page 1 of 13
INTERN’S NAME: ______________________________________ DATES: _________________ Clinical Modules Overview: This 21-week experience consists of three 7-week modules as described below. NOTE: These are general guidelines only. Interns who are capable of progressing more quickly (greater workload, higher level of independence) than outlined in a module can be encouraged to do so.
Clinical I (Introductory Exposure to Clinical Care) Clinical I, consisting of 2 – 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a limited number of nutritional co-morbidities. Clinical I placements are in clinical settings where rapid-pace decision-making is less likely to be required. From weeks 1 to 4, an intern is expected to provide clinical care under direct guidance from, or in collaboration with, the preceptor. Progressing through weeks 5 to 7, the intern is expected to independently collect data, and create assessments and care plans, reviewing with the preceptor prior to implementation. Clinical II (Clinical Care for In and Outpatients) Clinical II, consisting of 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a greater number of co-morbidities and/or situations where more rapid decision-making is required. As part of the Clinical II experience, interns gain some experience in counselling, with at least one of the 3 placements being in an outpatient setting. Following an initial orientation to each new placement setting, the intern is expected to independently collect data, and create assessments and care plans (reviewing as necessary with preceptor prior to implementation). For patients with complex care issues, the intern may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical III (Complex Clinical Care and Relief) Clinical III, consisting of 3 placements, is designed to assist interns to gain further exposure to complex clinical care and to carry out clinical relief.
Clinical IIIa (Advanced Practice) This sub-module provides interns with additional exposure to complex clinical care in more specialized clinical settings. Assigned workload and level of independence varies by placement setting. Interns are encouraged to practice independently where possible; however, in highly specialized areas they may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical IIIb (Relief) This sub-module provides interns with the opportunity to apply past experience to the independent management of a patient caseload in a clinical area experienced during earlier placements (checking with preceptor for appropriate scope of practice and level of independence). In this final clinical module, the pace of work and decision-making is similar to that of a practicing dietitian. Interns are expected to have a high level of independence, in that only a final check and documentation signoff is required from the preceptor.
63
Upon successful completion of the clinical modules, interns are expected to be able to achieve entry level clinical practice proficiency, defined as follows: - When presented with routine situations, the intern performs relevant practice competencies in a
manner consistent with generally accepted standards in the profession, with minimal supervision or direction, and within a reasonable timeframe. The intern anticipates what outcomes to expect in a given situation, and responds appropriately.
- The intern recognizes unusual, difficult to resolve and complex situations which may be beyond their
capacity. The intern takes appropriate and ethical steps to address these situations, which may include seeking consultation, supervision or mentorship, reviewing research literature, or a referral.
Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c,d,e,f,g,h,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. 2. Complete the form in ink. You may want to use different coloured pens for each placement within the
module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
Module Clinical II April 24 2012.doc Page 2 of 13
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Module Clinical II
April 24 2012.doc Page 3 of 13
Preceptor Instructions: 1. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a
specific placement location. 2. Note that, unless otherwise stated, the learning activities listed are required to be completed in each
placement within the module. 3. Because this module provides experiences in both in and outpatient settings, preceptors must modify
the list of required learning activities based on the setting. For example: if a position has no outpatient component, the outpatient related learning activities will not be relevant.
4. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns to achieve entry level practice skills.
5. Focus on clinical practice fundamentals and avoid providing too much information or assigning an excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
6. Review the checklist and the Medical Condition and Lifestyle Stages Tracking Form with the intern weekly during the placement to track progress and to plan activities for the following week.
7. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
8. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
65
Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to:
1. Organize work to achieve the requirements of the placement
− Print off Module forms − The week prior to the placement,
contact the preceptor to obtain pre-placement work assignments (e.g. readings, terminology, course work review, study questions)
− Working with preceptor, develop and implement a plan to ensure that required learning activities are achieved
− Arrange meetings with preceptor at least weekly to discuss progress and revise plans as needed to reflect issues arising
2. Reflect upon past performance and set personal goals
− Develop personal learning goals for each placement
− Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement
− Review Medical Condition and Lifespan Stages Tracking Form with preceptor to share areas of coverage to date
3. Demonstrate familiarity with Clinical II environments (e.g. resources, tools, routines).
− Tour clinical areas − Read assigned materials relevant
to practice area, e.g. articles, policies and procedures, regulations
− Review relevant medical terminology
− Review referral processes − Review documentation guidelines
Module Clinical II April 24 2012.doc Page 4 of 13
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
− Review teaching tools used − Discuss services available in the
community with preceptor 4. Demonstrate familiarity with
the dietitian role in Clinical II settings
− Job shadow preceptor for assigned time period
− Arrange discussion(s) with preceptor re their approach to practice
− Actively participate in discussions with RD, asking appropriate questions as issues arise
5. Demonstrate familiarity with interprofessional roles in Clinical II settings
− Attend pertinent meetings (e.g. ward rounds, care conferences, family meetings)
− By the end of Clinical II, meet health professionals in Clinical II settings to observe and discuss their roles (e.g. occupational therapist, physical therapist, recreational therapist, nurse, pharmacist, social worker, speech language pathologist, physician) with a focus on health professionals whose roles you are not yet familiar with
6. Demonstrate knowledge of diseases, conditions, and nutritional interventions commonly seen in Clinical II areas, e.g. a) allergies b) cancer c) cardiovascular disease d) diabetes e) disordered eating f) GI disorders
− Review course notes, texts and assigned readings related to common diseases and conditions seen in Clinical II areas
− Undertake a self-directed learning process as unfamiliar issues are encountered (e.g. diseases, drugs, terms)
− Review and discuss study questions and case studies as assigned by preceptor
− If appropriate patients/clients are
Module Clinical II April 24 2012.doc Page 5 of 13
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Performance Objectives and Learning Activities Checklist Module: Clinical II
P RE JECTIVES Done ( )
NOTES FORMANCE OB REQUIRED LEARNING ACTIVITIES
g) liver disease h) malnutrition i) mental health issues j) nutrition support (enteral
and parenteral) k) obesity l) renal disease m) surgery
not available, complete case studies as assigned by preceptor
− Work on completing Medical Condition and Lifestyle Stages Tracking Form (form for documenting exposure to diseases and conditions throughout clinical modules)
7. Demonstrate knowledge of nutrition through the lifecycle e.g. a) childhood nutrition b) infant nutrition c) pre- and post natal
nutrition d) nutrition for seniors
− Review course notes, texts and assigned readings related to nutrition through the lifecycle
− Undertake a self-directed learning process as unfamiliar issues are encountered
− Review and discuss study questions and case studies as assigned by preceptor
− If appropriate patients/clients are not available, complete case studies as assigned by preceptor
− Work on completing Medical Condition and Lifestyle Stages Tracking Form
8. Screen populations of Clinical II patients or residents, with appropriate supervision, e.g. a) for patients with 1–2 co-
morbidities: independently screening and prioritizing, reviewing results with preceptor
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with
− For each assigned area, review nutritional risk indicators and priorities for nutritional intervention
− Screen patients for nutritional risk using available screening tools
− For each assigned area: - visit patients at meal-time - identify patients potentially
requiring nutrition intervention
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
preceptor in order to identify high priority cases
9. Demonstrate familiarity with diet modifications used in Clinical II inpatient areas
− Review diet office procedures and menu systems, including − diet types and textures relevant
to the placement − process for ordering diets − available supplements − menu substitution procedures
− When visiting patients during meal times for each assigned area, take note of diet types in use
10. Complete nutritional assessments and develop nutritional care plans for Clinical II inpatients with appropriate supervision, e.g. a) for patients with 1 – 2 co-
morbidities: independently collecting data, creating assessments and care plans, reviewing same with preceptor prior to implementation
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
− Observe preceptor gathering and interpreting pertinent information from various sources (e.g. the patient, the medical record, verbal communication with physicians, nursing staff, allied health staff)
− Review medical records to identify and interpret information necessary to develop a care plan under preceptor supervision
− Observe preceptor conducting a nutrition assessment interview with patient or significant other and developing a nutrition care plan
− Conduct nutrition assessment interviews of a patient with multiple co-morbidities with preceptor observation/ supervision and develop a care plan for preceptor feedback
− Under preceptor supervision, complete a minimum of five to ten nutritional assessments per week
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
− By the end of Clinical II, complete at least two tube feeding assessments and at least one parenteral nutrition assessment
− Complete homework as assigned and discuss with preceptor
11. Implement care plans for Clinical II inpatients, including:
- diet modifications - health care team
communication (verbally and in writing)
- patient/family education as needed
with appropriate supervision, e.g. a) for patients with 1–2 co-
morbidities: independently collecting data, creating assessments and care plans (reviewing with preceptor prior to implementation)
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
Diet Modifications − Using area-specific procedures,
communicate diet changes for assigned patient to appropriate others (food services, team members, family, etc.)
− Assess need for and choose appropriate nutrition and assess need for vitamin/mineral supplements for assigned patients
Healthcare Team Communication − Document your complete nutrition
assessments and care plans for each assigned patient, seeking preceptor feedback prior to placing in health record
− Identify and communicate with necessary team members on the implementation and monitoring of a nutritional care plan
− Establish follow-up plans Documentation in the Health Record − according to policies and
established timelines − using appropriate abbreviations
and medical terminology Patient/Family/Staff Education − By the end of Clinical II, observe
preceptor providing at least four individual or group education sessions
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
− Provide nutrition education for at least one assigned patient/family, including: − Establishing nutrition goals with
patient/family − Selecting appropriate
education resources and tools − Leading nutrition education
session 12. Carry out the nutritional care
process with patients/clients in an outpatient setting, including: a) nutritional assessment b) goal setting c) counselling d) follow-up plans e) documentation
− Observe preceptor carrying out the process, including: − Review of patient/client referral
documents and other data (e.g. lab values, medications, nutritional risk factors, social history)
− Patient/client assessment interview including diet history or food record review
− Goal setting − Counselling − Follow-up plans − Documentation
− Carry out the process for a minimum of two patients/clients with preceptor observation
− Carry out the process independently, debriefing with preceptor afterwards, for a minimum of two patients/clients
− Conduct follow-up visits with assigned patients/clients
13. Evaluate a nutritional care plan for inpatients and modify as necessary with appropriate supervision, e.g.
− For assigned patients, conduct follow-up visits and health record reviews to assess achievement of nutrition goals
− With preceptor, discuss
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Performance Objectives and Learning Activities Checklist Module: Clinical II
P RE O Done ( )
NOTES F RMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES
a) for patients with 1–2 co-morbidities: independently collecting data, creating assessments and care plans (reviewing these with preceptor prior to implementation)
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
effectiveness of intervention − Assess patient satisfaction with
nutritional care
14. Implement and evaluate care plans for outpatients including: a) health care team
communication (verbally and in writing)
b) realistic time lines for interventions and plans for follow-up
c) evaluate the effectiveness of the nutrition care plan and modify the plan as appropriate
Healthcare Team Communication − Document nutrition care plans for
each assigned patient/client, seeking preceptor feedback prior to placing in health record or sending report to referring physician (complete documentation according to policies and established timelines and using appropriate abbreviations and medical terminology)
− As needed, communicate verbally to appropriate professionals (e.g., physician, social worker) about the care plan
Follow-up and Evaluation − Establish follow-up plans − Review the achievement of
outcome measures for follow-up patients/clients and discuss with preceptor
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
15. Progress towards managing a small patient caseload of Clinical II inpatients, e.g.,
- weeks 2 and 3: 3 to 5 patients
- weeks 4 and 5: 6 to 10 patients
with appropriate supervision, e.g. a) for patients with 1–2 co-
morbidities: independently collecting data, creating assessments and care plans (reviewing these with preceptor prior to implementation
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
Note: Caseload expectations may be adjusted in pediatrics.
− Provide nutritional care for assigned patients.
16. Address patient/client issues or questions on topics such as: a) complementary nutritional
therapies b) diet/medication
interactions c) general nutrition d) vitamin, mineral or herbal
supplements e) weight issues
− Discuss with preceptor approaches to nutrition counselling for these issues
− As opportunities arise, observe preceptor providing counselling on these topics
− As opportunities arise, provide counselling on these topics
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
17. Evaluate an outpatient nutritional care plan and modify as necessary
− For assigned patients/clients, conduct follow-up visits and health record reviews to assess achievement of nutrition goals
− Discuss effectiveness of intervention with preceptor
− Assess patient/client satisfaction with nutritional care
18. Plan, provide, and evaluate a group education session for patients/clients of an ambulatory care clinic
− Observe preceptor providing a minimum of one group education session.
− Plan and provide at least one group education session, seeking feedback from preceptor and relevant others regarding performance
19. Develop a patient/client resource
− Under the direction of the preceptor, develop at least one written resource
20. Progress towards effective patient/client counselling approaches, e.g., a) Establish rapport b) Listen effectively c) Uses a client-focused
approach d) Show empathy e) Make an effort to
understand client concerns, goals and motivation
f) Manage time and session flow
g) Prioritize issues h) Assess patient/client
understanding
− Set goals for aspects of counselling you would like to improve
− Seek feedback from preceptor after each patient/client session
− Record observations re effective and less effective techniques used by preceptor
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Performance Objectives and Learning Activities Checklist Module: Clinical II
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
21. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking
and problem solving skills c) effective time
management d) ability to manage work
independently e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective interpersonal skills
l) ability to communicate appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
To be demonstrated throughout the placement, as learning activities are carried out.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE CLINICAL II
Evaluation Form Preceptor Component Clinical II April 24, 2012.doc Page 1 of 7
INTERN’S NAME: PLACEMENT NUMBER: DATES: LENGTH OF PLACEMENT: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with Clinical II environments (e.g. resources, tools, routines)
4. Demonstrates familiarity with the clinical dietitian role in Clinical II settings
5. Demonstrates familiarity with interprofessional roles in Clinical II settings
6. Demonstrates knowledge about diseases, conditions and nutritional interventions commonly seen in Clinical II areas, e.g., a) allergies b) cancer c) cardiovascular disease d) diabetes e) disordered eating f) GI disorders g) liver disease h) malnutrition i) mental health issues j) nutrition support (enteral and
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
parenteral) k) obesity l) renal disease m) surgery
7. Demonstrates knowledge about nutrition through the lifecycle, e.g. a) childhood nutrition b) infant nutrition c) pre- and post-natal nutrition d) nutrition for seniors
8. Screens populations of Clinical II patients with appropriate supervision, e.g. a) for patients with 1 – 2 co-
morbidities: independently screening and prioritizing, reviewing results with preceptor
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
in order to identify high priority cases
9. Demonstrates familiarity with diet modifications used in Clinical II inpatient areas
10. Completes nutritional assessments and develop nutrition care plans for Clinical II inpatients with appropriate supervision, e.g. a) for patients with 1 – 2 co-
morbidities: independently collecting data, creating assessments and care plans (reviewing with preceptor prior to implementation)
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
11. Implements care plans for Clinical II inpatients with appropriate supervision, e.g. a) for patients with 1 – 2 co-
morbidities: independently
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
b) for patients with more than 2 co-morbidities or complex care issues: with direct guidance from or in collaboration with preceptor
including:
- diet modifications - health care team
communication (verbally and in writing)
- patient/family education as needed
12. Evaluates a nutritional care plan for inpatients and modifies as necessary with appropriate supervision (as above)
13. Manages a small patient caseload of Clinical II inpatients with appropriate supervision (as above), e.g. a) weeks 2 and 3: 3 to 5
patients b) weeks 4 and 5: 6 to 10
patients Note: Caseload expectations may be adjusted in pediatrics.
14. Carries out the nutritional care process with patients/clients in an outpatient setting, including a) nutritional assessment b) goal setting c) counselling d) follow-up plans e) documentation
15. Implements and evaluates care plans for outpatients, including: a) health care team
communication (verbally and in writing)
b) realistic time lines for interventions and plans for follow-up
c) evaluation of the effectiveness of the nutrition care plan with modifications
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
to the plan as appropriate 16. Addresses patient/client issues
or questions on topics such as: a) complementary nutritional
therapies b) diet/medication interactions c) general nutrition d) vitamin, mineral or herbal
supplements e) weight issues
17. Evaluates an outpatient nutritional care plan and modifies as necessary
18. Plans, provides, and evaluates a group education session for patients/clients in an ambulatory care clinic
19. Develops a patient/client resource
19. Progresses towards effective patient/client counselling approaches, e.g. a) Establishes rapport b) Listens effectively c) Uses a client-focused
approach d) Shows empathy e) Makes an effort to
understand client concerns, goals and motivations
f) Manages time and session flow
g) Prioritizes issues
20. Demonstrates appropriate professional conduct, including: a) Manages time effectively b) Manages work
independently c) Shows initiative d) Shows flexibility and
adaptability e) Practices according to the
ethics of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
h) Uses a collaborative approach
i) Shows effective interpersonal skills
j) Communicates appropriately, both verbally and in writing
k) Assesses strengths and weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
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EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1, 2, 3 and 4 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. - D. Additional comments (if applicable):
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Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
Evaluation Form Preceptor Component Clinical II April 24, 2012.doc Page 7 of 7
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: CLINICAL III (a) Advanced Practice
Module Clinical III a Advanced Practice April 24 2012.doc Page 1 of 9
INTERN’S NAME: ______________________________________ DATES: _________________ Clinical Modules Overview: This 21-week experience consists of three 7-week modules as described below. NOTE: These are general guidelines only. Interns who are capable of progressing more quickly (greater workload, higher level of independence) than outlined in a module can be encouraged to do so.
Clinical I (Introductory Exposure to Clinical Care) Clinical I, consisting of 2 – 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a limited number of nutritional co-morbidities. Clinical I placements are in clinical settings where rapid-pace decision-making is less likely to be required. From weeks 1 to 4, an intern is expected to provide clinical care under direct guidance from, or in collaboration with, the preceptor. Progressing through weeks 5 to 7, the intern is expected to independently collect data, and create assessments and care plans, reviewing with the preceptor prior to implementation. Clinical II (Clinical Care for In and Outpatients) Clinical II, consisting of 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a greater number of co-morbidities and/or situations where more rapid decision-making is required. As part of the Clinical II experience, interns gain some experience in counselling, with at least one of the 3 placements being in an outpatient setting. Following an initial orientation to each new placement setting, the intern is expected to independently collect data, and create assessments and care plans (reviewing as necessary with preceptor prior to implementation). For patients with complex care issues, the intern may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical III (Complex Clinical Care and Relief) Clinical III, consisting of 3 placements, is designed to assist interns to gain further exposure to complex clinical care and to carry out clinical relief.
Clinical IIIa (Advanced Practice) This sub-module provides interns with additional exposure to complex clinical care in more specialized clinical settings. Assigned workload and level of independence varies by placement setting. Interns are encouraged to practice independently where possible; however, in highly specialized areas they may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical IIIb (Relief) This sub-module provides interns with the opportunity to apply past experience to the independent management of a patient caseload in a clinical area experienced during earlier placements (checking with preceptor for appropriate scope of practice and level of independence). In this final clinical module, the pace of work and decision-making is similar to that of a practicing dietitian. Interns are expected to have a high level of independence, in that only a final check and documentation signoff is required from the preceptor.
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Upon successful completion of the clinical modules, interns are expected to be able to achieve entry level clinical practice proficiency, defined as follows: - When presented with routine situations, the intern performs relevant practice competencies in a
manner consistent with generally accepted standards in the profession, with minimal supervision or direction, and within a reasonable timeframe. The intern anticipates what outcomes to expect in a given situation, and responds appropriately.
- The intern recognizes unusual, difficult to resolve and complex situations which may be beyond their
capacity. The intern takes appropriate and ethical steps to address these situations, which may include seeking consultation, supervision or mentorship, reviewing research literature, or a referral.
In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c,d,e,f,g,h,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. If you are doing relief, use Clinical Module III (b).
2. Complete the form in ink. You may want to use different coloured pens for each placement within the module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
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Module Clinical II
I a Advanced Practice April 24 2012.doc Page 3 of 9
Preceptor Instructions: 1. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a
specific placement location. 2. Note that, unless otherwise stated, the learning activities listed are required to be completed in each
placement within the module. 3. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns
to achieve entry level practice skills. 4. Focus on clinical practice fundamentals and avoid providing too much information or assigning an
excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
5. Review the checklist and the Medical Condition and Lifespan Stages Tracking Form with the intern weekly during the placement to track progress and to plan activities for the following week.
6. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
7. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to: 1. Organize work to achieve the
requirements of the placement
− Print off module forms − The week prior to the placement,
contact the preceptor to obtain pre-placement work assignments (e.g., readings, terminology, course work review, study questions)
− Working with preceptor, develop and implement a plan to ensure that required learning activities are achieved
− Arrange meetings with preceptor at least weekly to discuss progress and revise plans as needed to reflect issues arising
2. Reflect upon past performance and set personal goals
− Develop personal learning goals for each placement
− Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement
− Review Medical Condition and Lifespan Stages Tracking Form with preceptor to share areas of coverage to date
3. Demonstrate familiarity with Clinical III environments (e.g. resources, tools, routines)
− Tour clinical areas − Read assigned materials relevant
to practice area, e.g., articles, policies and procedures, regulations
− Review medical terminology
4. Demonstrate familiarity with the clinical dietitian role in
− Job shadow preceptor for assigned time period
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
PERFORMANCE OBJECTIVES EDone ( )
NOTES R QUIRED LEARNING ACTIVITIES
Clinical III settings − Arrange discussion(s) with preceptor re their approach to practice
− Actively participate in discussions with preceptor, asking appropriate questions as issues arise
5. Demonstrate familiarity with interprofessional roles in Clinical III areas
− Attend and, if needed, participate in pertinent meetings (e.g. ward rounds, care conferences, family meetings)
− By the end of Clinical III, meet with health professionals in Clinical III areas to observe and discuss their roles (e.g. occupational therapist, physical therapist, recreational therapist, nurse, pharmacist, social worker, speech language pathologist, physician) with a focus on health professionals whose roles you are not yet familiar with
6. Demonstrate relevant knowledge of diseases, conditions, and nutrition support interventions commonly seen in Clinical III areas, e.g., a) burns b) critical care c) ICU d) nutrition support e) organ transplant f) renal unit
− Review course notes, texts and assigned readings related to patients in Clinical III areas
− Undertake a self-directed learning process as unfamiliar issues are encountered (e.g., diseases, drugs, terms)
− Review and discuss study questions as assigned by preceptor
− If appropriate patients are not available, complete case studies as assigned by preceptor
− Work on completing Medical Condition and Lifespan Stages Tracking Form (form for
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
documenting exposure to diseases and conditions throughout clinical modules)
7. Screen populations of Clinical III patients, in order to identify high priority cases, checking with preceptor for scope of practice and appropriate level of independence
− Review diet types, diet textures and process for ordering diets
− For each assigned area, review nutritional risk indicators and priorities for nutritional intervention
− Screen patients for nutritional risk using available screening tools
− For each assigned area: - If relevant, visit patients at
meal-time − identify patients potentially
requiring nutrition intervention
8. Demonstrate familiarity with diet modifications used in Clinical III areas
− Review diet office procedures and menu systems, including − diet types and textures relevant
to the placement − process for ordering diets − available supplements − menu substitution procedures
− When visiting patients during meal times for each assigned area, take note of diet types in use
9. Complete nutritional assessments and develop nutritional care plans for Clinical III patients, checking with preceptor for scope of practice and appropriate level of independence
− Observe preceptor gathering and interpreting pertinent information from various sources (e.g. the medical record, verbal communication with physicians, nursing staff, allied health staff)
− Review medical records to identify and interpret information necessary to develop a care plan under preceptor supervision
− Observe preceptor conducting a nutrition assessment interview
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
with patient or significant other and developing a nutrition care plan
− Conduct nutrition assessment interviews with preceptor observation/ supervision and develop care plans for preceptor feedback
− Under preceptor supervision, complete a minimum of three to five nutritional assessments per week
− Complete homework as assigned and discuss with preceptor
10. Implement care plans, including: - Diet modifications - Health care team
communication (verbally and in writing)
- Patient/ family education as needed, with appropriate supervision (checking with preceptor for scope of practice and appropriate level of independence)
Diet Modifications − Using area-specific procedures,
communicate diet changes for assigned patient to appropriate others (food services, team members, family, etc.)
− Choose appropriate nutrition support for assigned patients
Healthcare Team Communication − Document your complete nutrition
assessments and care plans for each assigned patient, seeking preceptor feedback prior to placing in health record
− Identify and communicate with team members necessary to implementation and monitoring of a nutritional care plan
− Establish follow-up plans Documentation in the Health Record − according to policies and
established timelines − using appropriate abbreviations
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
PERFORMANCE OBJECTIVES ACTIVITIES Done ( )
NOTES REQUIRED LEARNING
and medical terminology Patient/Resident/Family/Staff Education − By the end of Clinical III, observe
preceptor providing at least one education session
− Provide nutrition education for at least one assigned patient or family, including: − Establishing nutrition goals with
patient/family − Selecting appropriate
education resources and tools − Leading nutrition education
session − Establishing follow-up plans
11. Evaluate a nutritional care plan and modify as necessary, checking with preceptor for scope of practice and appropriate level of independence
− For assigned patients, conduct follow-up visits and health record reviews to assess achievement of nutrition goals
− With preceptor, discuss effectiveness of intervention
− Assess patient satisfaction with nutritional care
12. Progress towards managing a small patient caseload of Clinical III patients, e.g., 4 to 8 patients by the end of a placement, checking with preceptor for scope of practice and appropriate level of independence
− Provide nutritional care for assigned patients.
13. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence
To be demonstrated throughout the placement, as learning activities are carried out.
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Performance Objectives and Learning Activities Checklist Module: Clinical III (a)
P RE REQUIRED LEARNING ACTIVITIES Done ( )
NOTES FORMANCE OBJECTIVES
b) effective critical thinking and problem solving skills
c) effective time management
d) ability to manage work independently
e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective interpersonal skills
l) ability to communicate appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE CLINICAL III (a) Advanced Practice
Evaluation Form Preceptor Component Clinical III (a) April 24 2012.doc Page 1 of 6
INTERN’S NAME: PLACEMENT NUMBER: DATES: LENGTH OF PLACEMENT: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with Clinical III environments (e.g. resources, tools, routines)
4. Demonstrates familiarity with the clinical dietitian role in Clinical III settings
5. Demonstrates familiarity with interprofessional roles in Clinical III areas
6. Demonstrates familiarity with diseases, conditions and nutrition support interventions commonly seen in Clinical III areas, e.g., a) burns b) critical care c) ICU d) nutrition support e) organ transplant f) renal unit
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
7. Screens populations of Clinical III patients in order to identify high priority cases, checking with preceptor for scope of practice and appropriate level of independence
8. Demonstrates familiarity with diet modifications used in Clinical III areas
9. Completes nutritional assessments and develops nutritional care plans for Clinical III patients, checking with preceptor for scope of practice and appropriate level of independence
10. Implements care plans, including: a) Diet modifications b) Health care team communication
(verbally and in writing) c) Patient/family education as
needed Checking with preceptor for scope of practice and appropriate level of supervision
11. Evaluates a nutritional care plan and modifies it as necessary, checking with preceptor for scope of practice and appropriate level of supervision
12. Manages a small patient caseload of Clinical III patients (e.g., 4 to 8 patients, depending on area) checking with preceptor for scope of practice and appropriate level of independence
13. Demonstrates appropriate professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
h) Uses a collaborative approach i) Shows effective interpersonal
skills
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
j) Communicates appropriately, both verbally and in writing
k) Assesses strengths and weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
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B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics-based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
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COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1 and 2 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. - D. Additional comments (if applicable): Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
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2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: CLINICAL III (b) Clinical Relief
Module Clinical III b Clinical Relief April 24 2012.doc Page 1 of 6
INTERN’S NAME: ______________________________________ DATES: _________________ Clinical Modules Overview: This 21-week experience consists of three 7-week modules as described below. NOTE: These are general guidelines only. Interns who are capable of progressing more quickly (greater workload, higher level of independence) than outlined in a module can be encouraged to do so.
Clinical I (Introductory Exposure to Clinical Care) Clinical I, consisting of 2 – 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a limited number of nutritional co-morbidities. Clinical I placements are in clinical settings where rapid-pace decision-making is less likely to be required. From weeks 1 to 4, an intern is expected to provide clinical care under direct guidance from, or in collaboration with, the preceptor. Progressing through weeks 5 to 7, the intern is expected to independently collect data, and create assessments and care plans, reviewing with the preceptor prior to implementation. Clinical II (Clinical Care for In and Outpatients) Clinical II, consisting of 3 placements, is designed to assist interns to gain experience providing nutritional care for patients/clients while focusing on a greater number of co-morbidities and/or situations where more rapid decision-making is required. As part of the Clinical II experience, interns gain some experience in counselling, with at least one of the 3 placements being in an outpatient setting. Following an initial orientation to each new placement setting, the intern is expected to independently collect data, and create assessments and care plans (reviewing as necessary with preceptor prior to implementation). For patients with complex care issues, the intern may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical III (Complex Clinical Care and Relief) Clinical III, consisting of 3 placements, is designed to assist interns to gain further exposure to complex clinical care and to carry out clinical relief.
Clinical IIIa (Advanced Practice) This sub-module provides interns with additional exposure to complex clinical care in more specialized clinical settings. Assigned workload and level of independence varies by placement setting. Interns are encouraged to practice independently where possible; however, in highly specialized areas they may need to receive direct guidance from, or work in close collaboration with, the preceptor. Clinical IIIb (Relief) This sub-module provides interns with the opportunity to apply past experience to the independent management of a patient caseload in a clinical area experienced during earlier placements (checking with preceptor for appropriate scope of practice and level of independence). In this final clinical module, the pace of work and decision-making is similar to that of a practicing dietitian. Interns are expected to have a high level of independence, in that only a final check and documentation signoff is required from the preceptor.
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Upon successful completion of the clinical modules, interns are expected to be able to achieve entry level clinical practice proficiency, defined as follows: - When presented with routine situations, the intern performs relevant practice competencies in a
manner consistent with generally accepted standards in the profession, with minimal supervision or direction, and within a reasonable timeframe. The intern anticipates what outcomes to expect in a given situation, and responds appropriately.
- The intern recognizes unusual, difficult to resolve and complex situations which may be beyond their
capacity. The intern takes appropriate and ethical steps to address these situations, which may include seeking consultation, supervision or mentorship, reviewing research literature, or a referral.
Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c,d,e,f,g,h,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. If you are doing advanced practice, use Clinical Module III (a).
2. Complete the form in ink. You may want to use different coloured pens for each placement within the module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
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Module Clinical II
I b Clinical Relief April 24 2012.doc Page 3 of 6
Preceptor Instructions: 1. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a
specific placement location. 2. Note that, unless otherwise stated, the learning activities listed are required to be completed in each
placement within the module. 3. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns
to achieve entry level practice skills. 4. Focus on clinical practice fundamentals and avoid providing too much information or assigning an
excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
5. Review the checklist and the Medical Condition and Lifespan Stages Tracking Form with the intern weekly during the placement to track progress and to plan activities for the following week.
6. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
7. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
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Performance Objectives and Learning Activities Checklist Module: Clinical III (b)
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
1. Organize work to achieve the requirements of the placement
- Print off module forms - The week prior to the placement, contact
the preceptor to obtain pre-placement work assignments (e.g. readings, terminology, course work review, study questions)
− Working with preceptor, develop and implement a plan to ensure that required learning activities are achieved
− Arrange daily meetings with preceptor to discuss progress and revise plans as needed to reflect issues arising
2. Organize work to reflect upon past performance and set personal goals
- Develop personal learning goals for each placement
- Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement
- Review Medical Condition and Lifespan Stages Tracking Form with preceptor to share areas of coverage to date
3. Demonstrate familiarity with clinical environment (e.g. resources, tools, routines)
− Review assigned materials relevant to practice area, e.g. articles, policies and procedures, regulations
− Review medical terminology − Review diet writing guidelines for the
area, if applicable
4. Demonstrate familiarity with interprofessional roles in the assigned clinical area
− Attend and participate in pertinent meetings (e.g. ward rounds, care conferences, family meetings)
− Meet with various professionals as required
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Performance Objectives and Learning Activities Checklist Module: Clinical III (b)
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
5. Demonstrate knowledge of nutritional management of patients/residents in the assigned area
− Review course notes, texts and assigned readings related to patients/residents in the assigned clinical area
− Undertake a self-directed learning process as unfamiliar issues are encountered (e.g. diseases, drugs, terms)
− Work on completing Medical Condition and Lifespan Stages Tracking Form
6. If applicable to the assigned area, screen populations of patients or residents, in order to identify high priority cases, practicing independently with the ability to review and consult with preceptor
− For each assigned area, review nutritional risk indicators and priorities for nutritional intervention
− Screen patients for nutritional risk using available screening tools
− For each assigned area: − visit patients at meal-time
− identify patients potentially requiring nutrition intervention
7. If applicable to the assigned area, demonstrate familiarity with diet modifications used
− Review diet office procedures and menu systems, including − diet types and textures relevant to the
placement − process for ordering diets − available supplements − menu substitution procedures
− When visiting patients/residents during meal times for each assigned area, take note of diet types in use
8. Manage a caseload of patients or residents in the assigned area (e.g. starting with 50% and working towards a full caseload, as determined by area), practicing independently with the ability to review and consult with preceptor
− Working with preceptor, determine appropriate caseload progression for area
− Provide nutritional care for assigned patients/residents
− Meet daily with preceptor to discuss care provided and have documentation approved
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Performance Objectives and Learning Activities Checklist Module: Clinical III (b)
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
9. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking and
problem solving skills c) effective time management d) ability to manage work
independently e) initiative f) flexibility and adaptability g) ability to practice according to
the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach k) shows effective interpersonal
skills l) ability to communicate
appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
To be demonstrated throughout the placement, as learning activities are carried out.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE CLINICAL III (b) Clinical Relief
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INTERN’S NAME: PLACEMENT NUMBER: DATES: LENGTH OF PLACEMENT: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with clinical environment (e.g. resources, tools, routines)
4. Demonstrates familiarity with interprofessional roles in the assigned clinical area
5. Demonstrates knowledge of the nutritional management of patients/residents in the assigned area
6. If applicable to the assigned area, screens populations of patients or residents, practicing independently with the ability to review and consult with preceptor
7. If applicable to the assigned area, demonstrates familiarity with diet modifications used
8. Manages a caseload of patients or residents in the assigned area (e.g. starting with 50% and working towards a full caseload, as determined by area)
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
9. Performs relief functions in a manner consistent with generally accepted standards in the profession, with minimal supervision or direction, and within a reasonable timeframe. The intern anticipates what outcomes to expect in a given situation, and responds appropriately.
10. Recognizes unusual, difficult to resolve and complex situations which may be beyond his/her capacity. Takes appropriate and ethical steps to address these situations, which may include seeking consultation, supervision or mentorship, reviewing research literature, or a referral.
11. Demonstrates appropriate professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
h) Uses a collaborative approach i) Shows effective interpersonal
skills j) Communicates appropriately,
both verbally and in writing k) Assesses strengths and
weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
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B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
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PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1 and 2 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. - D. Additional comments (if applicable):
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Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: COMMUNITY NUTRITION
Module Community April 24 2012.doc Page 1 of 7
INTERN’S NAME: ______________________________________ DATES: _________________ Community Nutrition Module Overview: This 4-week module is designed to assist interns in gaining exposure and experience in community health and nutrition. The module is designed to be adaptable to a variety of settings, both urban and rural. The majority of time is spent participating in the various roles of the community nutritionist and carrying out applied projects. Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c2,d,e,f,g2,h2,i,j,k,l,m2, 3, 4, 5, 6a,b,c2,d,e,f,g2,h2,i,j,k,l,m2, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j2, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. 2. Complete the form in ink. You may want to use different coloured pens for each placement within the
module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
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Preceptor Instructions: 1. This module may be structured as one 4-week placement or two 2-week placements. 2. For each placement within this module, each intern is assigned a preceptor or a pair of preceptors,
when this is a more workable arrangement. Although the intern may spend time with other nutritionists during the module, the preceptor(s) will coordinate the overall experience, including: − providing the intern with an overview of the placement (e.g. how it will be organized, key resource
materials to review, procedures to be aware of, etc.) − assisting the intern in finalizing a personal module schedule − assisting with issues arising during the module − coordinating the intern evaluation.
2. Prior to the placement, in collaboration with other community preceptors, as appropriate, plan an area-specific schedule for addressing the learning activities at a specific placement location.
3. Note that, unless otherwise stated, the learning activities listed are required to be completed by the end of the module.
4. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns to achieve entry level practice skills.
5. Focus on community practice fundamentals and avoid providing too much information or assigning an excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
6. Review the checklist and the Medical Condition and Lifespan Stages Tracking Form (if applicable) with the intern weekly during the placement to track progress and to plan activities for the following week.
7. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
8. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
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Performance Objectives & Learning Activities Checklist Module: Community Nutrition
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to: 1. Organizes work to achieve
the requirements of the placement
- Print off module forms - One month prior to the
placement, contact the preceptor to discuss plans for the placement and to obtain pre-placement work assignments (e.g. readings, terminology, course work review, study questions)
- Working with preceptor, develop and implement a plan to ensure that required learning activities are achieved
- Arrange meetings with preceptor at least weekly to discuss progress and revise plans as needed to reflect issues arising
2. Reflects upon past performance and set personal goals
- Develop personal learning goals for each placement
- Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement (N/A if this is the first placement in the internship; in this instance, verbally share goals)
− Review Medical Condition and Lifespan Stages Tracking Form with preceptor to share areas of coverage to date (if applicable)
3. Demonstrates familiarity with key concepts, roles, activities, and tools in community
− Read assigned materials relevant to practice area, e.g. articles, policies and procedures,
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Performance Objectives & Learning Activities Checklist Module: Community Nutrition
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
nutrition settings regulations, practice guidelines, policy statements, legislation, education materials, etc.
− Review and discuss study questions as assigned by preceptor
− Discuss approaches with preceptor to assessing clients and groups in varied community settings
− Discuss scope of practice with preceptor
4. Assumes assigned aspects of community nutrition roles in the placement setting
− Discuss with preceptor local community programs and services that preceptor is or could be involved in
− Observe and, where possible, participate in a variety of the preceptor’s roles, actively participating in at least four, e.g. - advocacy - assessment of food and nutrition services at community care facilities (licensing, quality assurance)
- chronic disease management - community development - education of other health professionals and care providers
- health services for community living
- home care - individual and group client consultation
- nursing support services - participation in interdisciplinary planning and project groups
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Performance Objectives & Learning Activities Checklist Module: Community Nutrition
PERFORMANCE OBJECTIVES EDone ( )
NOTES R QUIRED LEARNING ACTIVITIES
- program planning, implementation, and evaluation
- research - other:
5. Participates in community nutrition programs
− Observe and participate in community programs targeted at various stages of the lifecycle and a variety of client groups, actively participating in at least four programs, e.g. - adult - community kitchen - food assistance - home meal delivery - infant feeding - prenatal/postnatal - school programs - senior - supermarket tour - wellness programs - other, as assigned
− Carry out other activities as assigned
6. Contributes to community projects
− Discuss potential projects with preceptor
− Contribute to planning, implementation, and evaluation phases, as feasible, of at least one project requiring verbal skills, e.g. - chair a meeting - client education session - grocery store tour - media interview - presentation to professionals or clients - other, as assigned
− Contribute to the planning,
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Performance Objectives & Learning Activities Checklist Module: Community Nutrition
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
implementation, and evaluation phases, as feasible, of at least one project involving information gathering, writing skills, and evaluation, as appropriate, e.g. - article - briefing note - education material - news release - planning or funding proposal - other, as assigned
7. Demonstrates appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking
and problem solving skills c) effective time
management d) ability to manage work
independently e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective
To be demonstrated throughout the placement, as learning activities are carried out.
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Performance Objectives & Learning Activities Checklist Module: Community Nutrition
PERFORMANCE OBJE TC IVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
interpersonal skills l) ability to communicate
appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE COMMUNITY
Module Community April 24 2012.doc Page 1 of 4
INTERN’S NAME: DATES: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with key concepts, roles, activities, and tools in community nutrition settings
4. Assumes assigned aspects of the preceptor’s role in the placement setting
5. Participates in community nutrition programs
6. Contributes to community projects 7. Demonstrates appropriate
professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
h) Uses a collaborative approach
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
i) Shows effective interpersonal skills
j) Communicates appropriately, both verbally and in writing
k) Assesses strengths and weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
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EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics-based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1, 2 and 3 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. -
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D. Additional comments (if applicable): Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
MODULE: EDUCATION
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Module Overview: The Education Module is a non-placement module that provides opportunities for interns to reflect upon their own education and contribute to the education of others. Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c,d,e,f,g2,h2,i,j,k2,l,m, 3, 4, 5, 6a,b,c,d,e,f,g2,h2,i,j,k2,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h2,i2,j2,k2,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g2,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Performance Objectives: By participating in this module, interns will be able to: 1. Assess audience learning needs and preferences. 2. Plan, prepare, deliver and evaluate educational events, sessions and tools. 3. Reflect upon personal performance in educational planning and delivery and establish goals for
improvement. 4. Contribute to the learning of others. 5. Enhance personal presentation skills.
Internship Coordinator Guidelines: 1. Plan three education-related activities for all interns to participate in during the internship year.
Activities should be based on considerations such as: - feasibility for the core site to coordinate - availability of mentors with appropriate skills - value of the activities as a learning experience for interns - value of the activities in contributing to education of others (e.g. dietitians, fellow interns, or
patients) - intern preferences.
2. Activity options include (but are not limited to):
- reflective journaling about the internship experience (with group debriefing) - clinical case study presentation - development and delivery of an educational session for interns and dietitians (e.g. major seminar,
grand rounds, in-service) - development of an educational resource - participation in an educational program, e.g. Food Sense program at VGH
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- coordination of site nutrition month activities. 3. Activities may involve interns working individually or in groups.
4. Scheduling considerations:
- Attempt to schedule activities throughout the year rather than in a single focused time period. - When scheduling activities, consider intern placement location and workload related to other
modules. - Time may be allocated in the weekly unscheduled half day for activities related to this module.
5. Each year, seek intern feedback about the activities (contribution to their learning needs, workload,
etc.) and revise plans accordingly. Core Site Coordinators are also encouraged to share experiences with each other about Education Module activities and approaches that do and do not work well.
Evaluation Guidelines: Due to the variable nature of the learning activities in this module, typical internship module evaluation forms are not used. Some Education Module learning activities do not lend themselves to formal evaluation (e.g. journaling), while others do (e.g. delivery of a formal presentation). Sites may use their own judgment about evaluation approaches for this module. As with all modules, regular informal feedback to interns is encouraged. Two evaluation forms are available for use as appropriate: − Education Module Activity Evaluation Form − Formal Evaluation of Oral Presentation Form.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
EDUCATION MODULE
EDUCATION MODULE ACTIVITY EVALUATION FORM
Education Module Activity Evaluation Form April 15 2012.doc Page 1 of 1
This form may be used by the site internship coordinator or designate to summarize discussion with an intern about his/her performance in an Education Module activity. Date: ______________ Intern: ________________________________________ Activity: ________________________________________________________ Summary of Performance (based on discussion between intern and evaluator): Strengths: − Improvements needed: − Recommendations: − Intern Comments: − Evaluator Comments: − Evaluator: _________________________________ Intern: ________________________________ Signatures (indicating that an evaluation meeting has taken place) Date: ________________________
Following the evaluation meeting, give a copy of this form to the intern and retain the original for the intern’s file in the site internship coordinator’s office.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
EDUCATION MODULE
FORMAL ORAL PRESENTATION EVALUATION FORM
Formal Oral Presentation Evaluation Form April 15 2012.doc Page 1 of 2
This form is for use by the site internship coordinator (or designate) to summarize feedback to an intern following each of their formal presentations. Other session attendees and the intern presenting may also be asked to complete these forms and submit to the internship coordinator (or designate) for use in planning the evaluation meeting. Following the evaluation meeting with the intern, the intern should be given a copy of this form for his/her personal records. The internship coordinator should retain the original form for the intern’s file.
Date: _______________
Intern: ________________________________________
Presentation: ________________________________________________________
ASPECT CRITERIA YES NO COMMENTS
Topic is pertinent to dietetic practice
Selection of information is appropriate for audience
Amount of information is appropriate for audience
Evidence-based approach is used
Speaker is comfortable and familiar with topic
Content
Speaker is able to adequately address audience questions
Key presentation elements are included (introduction, main body, summary and conclusions)
Material is presented in logical sequence
Organization
AV aids used enhance the presentation
Pace of delivery is appropriate – not too fast or too slow
Speaker Style
Voice projection is appropriate
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Formal Oral Presentation Evaluation Form April 15 2012.doc Page 2 of 2
ASPECT CRITERIA YES NO COMMENTS
Body language is appropriate
Speaker is able to engage and involve audience
Overall Summary: Strengths: Areas for Improvement: Recommendations: Intern Comments on Evaluation:
Evaluator: _____________________________________________
Date: _________________________________________________
Following the evaluation meeting, give a copy of this form to the intern and retain the original for the intern’s file in the site internship coordinator’s office.
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITIES CHECKLIST MODULE: ELECTIVE
Module Elective April 24 2012.doc Page 1 of 5
INTERN’S NAME: ______________________________________ DATES: _________________ Module Overview: Each intern has two weeks of elective placements during the internship year, to be selected based on personal interest and placement availability. Electives may pertain to any area of dietetic practice. Interns are responsible for investigating elective options to fit with their internship schedule. The program and sites share elective ideas with interns, but interns are free to choose other options as well. To maximize their exposure to different areas, interns typically arrange two separate elective weeks. Elective time may be spent in traditional placements or alternate experiences that contribute to competency attainment (such as attendance at professional conferences or brief observational experiences at multiple locations). Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a2,b2,c2,d2,e2,f2,g2,h2,i2,j2,k2,l2,m2, 3, 4, 5, 6a2,b2,c2,d2,e2,f2,g2,h2,i2,j2 ,k2,l2,m2,7 Planning 1,2,3,4,5a2,b2,c2,d2,e2,f2,g,h2,i2,j2,k2,l2,6a2,b2,c2,d2,e2,f2,g2,h2,i2,j2,k2,l2,m2,n2,o2,p2,q2 Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a2,b2,c2,d2,e2,f2,g2,h2,i2,j2, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b2,c2,d2, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a2,b2,c2,d2,e2,f2,g2, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not need
to use separate checklists for each individual placement within this module. 2. Complete the form in ink. You may want to use different coloured pens for each placement within the
module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms.
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e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the evaluation session. Keep a copy for your records.
f) When you have finished all placements within this module, hand in this form to your Internship Coordinator and keep a copy for your records.
6. In the event that your elective experience involves one or more short term observational activities, record these placements on the Elective Observational Experiences form and have the person overseeing your experience sign the form to confirm that it took place.
Preceptor Instructions: 1. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a
specific placement location. 2. If you are hosting an intern for a short term observational placement and do not have enough
experience with the intern to provide an evaluation, the intern will record their experience on the Elective Observational Experiences form and ask you to sign the form to confirm the experience has taken place.
3. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns in achieving entry-level practice skills.
4. Focus on clinical practice fundamentals and avoid providing too much information or assigning an excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
5. Review the checklist and the Medical Condition and Lifespan Stages Tracking Form with the intern weekly during the placement to track progress and to plan activities for the following week.
6. All interns require preceptor supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
7. According to the College of Dietitians of British Columbia, all health record documentation completed by an intern must be co-signed manually or electronically by a preceptor.
Notes:
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Performance Objectives and Learning Activities Checklist Module: Elective
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to:
1. Organize work to achieve the requirements of the placement
− Print off Module forms − For a non-placement experience:
prepare a brief document to share with internship coordinator to outline how the planned experience will contribute to competency attainment
− For a placement-based experience: − In advance of the placement,
contact the preceptor to discuss potential placement learning activities and to determine if any pre-placement work needs to be completed (e.g. readings, terminology, course work review, study questions).
− Working with preceptor, develop and implement a plan to ensure that all planned learning activities are achieved and revise the plan as needed to reflect issues arising
2. Reflect upon past performance and set personal goals
- Develop personal learning goals for each placement
- Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement
- Review Medical Condition and Lifespan Stages Tracking Form
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Performance Objectives and Learning Activities Checklist Module: Elective
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
with preceptor to share areas of coverage to date (if applicable)
3. Demonstrate familiarity with the placement environment (e.g. resources, tools, routines)
− If applicable to experience, tour preceptor work areas
− Read assigned materials relevant to experience, e.g. articles, policies and procedures, regulations, terminology list
4. Demonstrate familiarity with the dietitian role in the elective placement setting
− If applicable to experience, job shadow preceptor
− If applicable to experience, arrange discussion(s) with preceptor re personal approach to practice
− If applicable to experience, actively participate in discussions to gain understanding of the practice area or setting
5. Demonstrate familiarity with interprofessional roles in the elective placement setting
− Attend and participate in pertinent meetings
− Meet with relevant professionals
6. Assume assigned aspects of the preceptor’s role in the placement setting
− Complete projects if assigned − Take on operational roles if
applicable to the experience (e.g. direct patient care, teaching, administrative roles)
7. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking
and problem solving skills c) effective time
management d) ability to manage work
To be demonstrated throughout the placement, as learning activities are carried out
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Performance Objectives and Learning Activities Checklist Module: Elective
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
independently e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective interpersonal skills
l) ability to communicate appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE ELECTIVE
Evaluation Form Preceptor Component Elective Module April 24 2012.doc Page 1 of 4
INTERN’S NAME: DATES: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with the placement environment (e.g. resources, tools, routines)
4. Demonstrates familiarity with the dietitian role in the elective placement setting
5. Demonstrates familiarity with interprofessional roles in the elective placement setting
6. If applicable, assumes assigned aspects of the preceptor’s role in the placement setting
7. Demonstrates appropriate professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
g) Uses appropriate workplace conduct
h) Uses a collaborative approach i) Shows effective interpersonal
skills j) Communicates appropriately,
both verbally and in writing k) Assesses strengths and
weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
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EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1 and 2 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. - D. Additional comments (if applicable):
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Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
ELECTIVE MODULE
ELECTIVE OBSERVATIONAL EXPERIENCES FORM
This form is for use by interns during the Elective Module to document short term observational placements where it is not feasible for preceptors to evaluate intern performance. Each experience recorded on this form should be signed by the person overseeing the experience to confirm that it took place.
Dates of Elective Module: ___________________
Intern: ________________________________________
PRECEPTOR DATE(S) EXPERIENCE DESCRIPTION
NAME AND POSITION TITLE SIGNATURE
Insert rows as needed.
Intern’s Signature: _____________________________________________
Date: _________________________________________________
Intern Instructions: Provide the original to the site internship coordinator within 5 business days following the end of the experience. Retain a copy for your records.
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FNH 481/482 Dietetic Internship Elective Ideas The elective module offers two weeks of placements for interns to explore their own interests related to the dietetics profession. This list is compiled from site offerings and intern feedback from the annual year end survey. Most interns opt to spend their elective time in clinical settings. Private practice and community are other options of interest. Experiences marked with *** were rated particularly highly by past interns.
Administration Food service or clinical administration
Clinical Burns and trauma (VGH)
Diabetes (gestational at BGH or RCH)
Heart Health (Healthy Heart Program at SPH; Heart Health program/outpatient counselling at BGH; in- and outpatient cardiology at RCH)
HIV/AIDS (SPH; Oak Tree Clinic at BC Women’s)
ICU (VGH, VIHA)
*** Mental Health (SPH)
Oncology (BC Cancer Agency)
***Pediatrics (BC Children’s; Neonatal ICU at SMH, RCH, VIHA)
*** Eating Disorders (SPH; Tri-Cities Mental Health Centre; Kelowna and Vernon)
Rehabilitation (GF Strong)
Renal (Kelowna Hospital; RCH; community units)
Residential care (various)
Swallowing assessment and management (Peter Lam; SAM program Eagle Ridge Hospital)
Community Aboriginal health (VIHA)
BC Dairy Foundation
Community nutritionist (Revelstoke)
Health Link BC
*** Home care
International nutrition
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Sports nutrition
Pregnancy outreach (Healthiest Babies Possible)
Government Government of Canada (Department of Defence; nutrition policy)
Ministry of Health in Victoria
Industry Nutritional product sales (Novartis; Abbott)
Choices Market
Save on Foods
Private Practice Allergy nutrition (Dr. Janice Joneja)
Healthy eating, sports nutrition, weight management (e.g. Asia Peters)
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE OBJECTIVES & LEARNING ACTIVITES CHECKLIST MODULE: FOOD SERVICES
Module Food Services April 24 2012.doc Page 1 of 12
INTERN’S NAME: ______________________________________ DATES: _________________ Food Services Module Overview: This 10-week module provides interns with experience in food services. The module is designed to be adaptable to a variety of settings, both urban and rural. The module consists of a minimum of two placements. Management roles in foodservices are often beyond entry level. The internship helps to prepare graduates for roles such as management positions in small settings (e.g., position in care facility involving both clinical and foodservices) or positions in a larger/more complex setting where there are good support structures in place. Students who enter the internship with extensive experience and skills related to foodservices may be able to function at a higher level. Module Competencies: In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this module are bolded) Assessment 1, 2a,b,c,d,e,f,g2,h,i,j,k,l,m, 3, 4, 5, 6a,b,c,d,e,f,g,h,i,j,k,l,m, 7 Planning 1, 2, 3, 4, 5a,b,c,d,e,f,g,h,i,j,k,l, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b, 2a,b,c,d,e,f,g,h, 3a,b,c,d,e,f,g,h,i,j, 4 Evaluation 1a,b,c,d, 2a,b,c,d, 3a,b,c,d,e, 4, 5 Professional Practice 1a,b,c,d,e,f,g, 2a,b,c,d, 3a,b,c,d, 4, 5, 6, 7, 8, 9a,b,c,d Communication 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13a,b,c,d,e,f,g, 14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings Intern Instructions: 1. Use this checklist to track your progress in meeting the requirements of this module. You do not
need to use separate checklists for each individual placement within this module. 2. Complete the form in ink. You may want to use different coloured pens for each placement within the
module to help distinguish growth and development as you transition between preceptors/placements.
3. As required learning activities are completed, check them off. Use the Notes section to clarify how learning activities have been completed.
4. Review this checklist with your preceptor weekly during each placement in order to track your progress and to plan activities for the following week.
5. To prepare for your evaluation, a few days prior to the end of your placement: a) Review your checklist for completeness. b) Pass the completed checklist to your preceptor. Your preceptor may opt to have a discussion
with you when you submit it. c) Prior to your evaluation meeting, complete the Performance Evaluation – Intern Component form. d) Once your evaluation meeting with your preceptor has taken place, this checklist will be returned
to you along with the signed evaluation forms. e) Hand in signed evaluation forms to your Internship Coordinator within five (5) days of the
evaluation session. Keep a copy for your records. f) When you have finished all placements within this module, hand in this form to your Internship
Coordinator and keep a copy for your records.
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Preceptor Instructions: 1. For each placement within this module, each intern is assigned a preceptor or a pair of preceptors,
when this is a more workable arrangement. Although the intern may spend time with other dietitians or food service managers and staff during the module, the preceptor(s) will coordinate the overall experience, including: − providing the intern with an overview of the placement (e.g., how it will be organized, key
resource materials to review, procedures to be aware of, etc.) − assisting the intern in finalizing a personal module schedule − assisting with issues arising during the module − coordinating the intern evaluation.
2. Prior to the placement, plan an area-specific schedule for addressing the learning activities at a specific placement location.
3. Note that, unless otherwise stated, the learning activities listed are required to be completed by the end of the module.
4. When planning an intern’s activities, keep in mind that the focus of these modules is to assist interns to achieve entry level practice skills.
5. Focus on food service administration fundamentals and avoid providing too much information or assigning an excessive workload. Homework assignments can be given, but must be designed to be completed before the next placement.
6. Review the checklist with the intern weekly during the placement to track progress and to plan activities for the following week.
7. All interns require RD supervision. During earlier placements within the clinical modules, this supervision typically needs to be more direct. As interns become more proficient, they can move towards independent work with general supervision only.
Notes:
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
Upon completing this module, you must be able to: 1. Organize work to achieve the
requirements of the placement
- Print off module forms - The week prior to the placement,
contact the preceptor to obtain pre-placement work assignments (e.g. readings, terminology, course work review, study questions)
- Review module to identify relevant past learning and experiences (academic, employment, volunteer) to share with preceptor
- Working with preceptor (with consideration to past learning and experience relevant to the module), develop and implement a plan to ensure that required learning activities are achieved and determine project assignment topics
- Arrange meetings with preceptor at least weekly to discuss learning activities, progress and revise plans as needed to reflect issues arising
2. Reflect upon past performance and set personal goals
- Develop personal learning goals for each placement
- Review and discuss with preceptor the Goal Setting Sheet from the final page of the Intern Self Evaluation Form from the last placement (N/A if this is the first placement in the internship; in this instance, verbally share goals)
3. Demonstrate familiarity with food service environments (e.g. resources, tools, routines) in at least two settings, e.g.
− Tour food service areas and review floor plans
− Become oriented with the computer systems used by the facility
− Know how and where to access
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
-acute care -residential care -production facility -retail
resource materials for the placement area, including facility, department and area manuals
− Review notes, regulations, texts and assigned readings
− Read assigned resource materials relevant to practice area, e.g. articles, policies and procedures, regulations, safety standards, collective agreements
− Complete study questions if assigned and discuss with preceptor
− Review schedules, audits and evaluation procedures for placement area
4. Demonstrate familiarity with the dietitian’s role in food service settings
- Job shadow preceptor(s) for assigned time period
- Arrange discussion(s) with preceptor(s) re: their role, approach to practice, and links/liaison with clinical nutrition services
- Discuss with preceptor the role and implications of privatized foodservices within the health care system
- If applicable, observe, discuss and become familiar with contract management
- Actively participate in discussions with preceptor, asking appropriate questions as issues arise
5. Demonstrate familiarity with interrelated roles of staff in food service areas
− Attend and participate in pertinent meetings (e.g. menu planning, production, event planning, human resource related)
− Review job descriptions of various staff in the food service areas
− In each new placement setting, spend one to two days job shadowing staff and
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
discussing their roles with them (e.g. staff supervision, diet office operations, trayline, dishroom, delivery/pickup of meals and nourishments, scheduling, payroll, ordering/purchasing, receiving, production, tally)
− Review roles of, and, when feasible, meet with and/or directly observe, managers in departments carrying out the following functions: housekeeping, maintenance, material management/purchasing, human resources, payroll, infection control). Discuss these roles with preceptor.
6. Carry out supervisory and management functions related to menu planning
- Review master menu, menu marking guidelines, recipe and ingredient references
- Compare selective and non-selective menus and identify appropriate uses and limitations
- Investigate and discuss with preceptor steps taken to ensure menu meets nutritional needs of patients and residents
- Conduct recipe and menu nutrient analyses and costing, where available
- Plan menu(s) for a target population, including diet restrictions
- Other, as assigned
7. Carry out supervisory and management functions related to food production
- Tour production facilities to observe production systems in use
- Review and discuss with preceptor, the advantages and disadvantages of the following production systems: conventional, cook chill, cook freeze, and prepared food
- Review and discuss with preceptor,
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
tools for maintaining each production system observed (e.g. production schedules, recipe books)
- Review and discuss with preceptor, critical control points for each production system observed
- Conduct weekly/monthly inventory - Place food orders according to area
procedures - Oversee receival of food orders - Describe the processes involved in
projecting needs for menu items and, if applicable, recipe explosion, including the role of standard serving sizes
- Calculate projected vs. actual yield, number of servings and costing for a recipe
- Describe steps in food/supply distribution processes including transportation, where appropriate
- Other, as assigned 8. Carry out supervisory and
management functions related to patient services
- Observe and perform basic diet office operations
- Identify mechanisms for ordering and delivery of diets, nourishments and tubefeedings
- Identify options for supplying water to patients, including advantages and disadvantages
- Identify mechanisms for communicating allergies
- Identify and discuss with preceptor, key features of computer systems used to support patient service functions, including the interface with hospital admission discharge transfer systems
- Track a diet order from point of entry (at a nursing unit) to the diet office, the
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES S Done ( )
NOTES REQUIRED LEARNING CTA IVITIE
kitchen and delivery; discuss observations with preceptor
- Collect/correct menus, if applicable - Review menus and evaluate adequacy
of menu selections and make recommendations to correct deficiencies
- Review and discuss with preceptor the features of the following meal tray assembly and delivery systems: centralized, decentralized, individual, bulk, cold plating, hot plating; discuss implications for workflow, staffing, equipment, space, menu, and client satisfaction
- Observe trayline, including organization of stations, mechanisms for controlling portions and temperatures, and methods of assuring that correct items are provided
- Supervise tray line/tray delivery - Monitor nourishments and floor stock
assembly and delivery process - Participate in meal rounds with dietitian - Other, as assigned
9. Carry out supervisory and management functions related to quality assurance, safety, and sanitation
- Identify quality assurance and food safety program activities for placement area
- Review HACCP principles - Identify the critical control points of a
specific food item from receiving, through production (if applicable) to point of leaving the kitchen
- Identify quality assurance audits routinely conducted
- Conduct time/temperature audits and develop action plans
- Conduct at least 4 meal tray audits, examining taste, appearance, texture,
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
temperature, and adherence to recipe; make recommendations as appropriate
- Perform nourishment audit(s) and develop action plans
- Conduct waste audit(s) and develop action plans
- Review tools for and results of customer satisfaction audits, administering audits if feasible
- Perform other audits as assigned - Review WHIMIS principles and site
documentation; discuss their importance with preceptor
- Review chemicals used in sanitation and their applications in the food service operation
- Identify approaches and barriers to recycling
- Review mechanisms for ensuring safe use of equipment
- Review procedures for incident reporting and complete a mock incident report for a workplace accident
- Other, as assigned
10. Carry out supervisory and management functions related to human resources
- Review collective agreement(s) in use - Review and discuss with preceptor the
following codes/acts: Employee Standards Act, BC Human Rights Code, Labour Relations Code of BC, Freedom of Information and Protection of Privacy Act (FOIPPA)
- Review and discuss with preceptor the role of the Health Employers Association of BC (HEABC)
- Identify mechanisms for filling a vacancy according to collective agreement(s) in use
- Define and discuss with preceptor:
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES Done ( )
NOTES REQUIRED LEARNING ACTIVITIES
benchmark, job description, work routine - Identify and discuss with preceptor,
procedures for addressing employee grievances
- Define and discuss with preceptor uses of the following third party interventions: trouble shooter, expeditor, arbitrator
- Review and discuss with preceptor graduated return to work and early intervention programs
- Identify and discuss with preceptor human rights considerations for employee recruitment
- Discuss with preceptor attendance management programs in use
- Review and discuss with preceptor, mechanisms for progressive discipline
- Based on assessment of learner educational needs, conduct an inservice for employees and evaluate its effectiveness
- Revise or write a job description according to facility format
- Write work routine for a staff position - Participate in scheduling of staff - Participate in timekeeping/paybook
preparation - Perform physical safety audits and make
appropriate corrections - Participate in interview and selection
process for new employees, including preparation of interview guide and questions for referees
- Discuss job performance/performance appraisals with preceptor
- Other, as assigned
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
11. Carry out supervisory and management functions related to financial management
- Discuss the budgeting process with preceptor
- Review computerized financial information systems
- Participate in budget planning - Define full time equivalent (FTE) and
compute FTE for an employee working 4 hours per day 5 days per week
- Define and discuss with preceptor the role of cost centres and expense object codes
- Discuss with preceptor types of and the role of meal day costs
- Identify the difference between minor and capital equipment
- Identify the role of and examples of the financial accountability report and key performance indicators
- Review the tendering process for food, supplies and enteral products (if applicable)
- Research, justify and make a recommendation for the purchase of a piece of equipment, comparing at least two vendors’ products
- Supervise the financial management of a cash operation (if applicable)
- Other, as assigned
12. Carry out supervisory functions related to disaster or emergency planning
- Discuss with preceptor key elements for disaster or emergency planning
- Review the manager’s role in disaster planning
13. Assume assigned aspects of the preceptor’s role in the placement setting
- Working with preceptor, determine appropriate opportunities to take on functions of the manager
- Assume assigned functions, address problems and provide appropriate
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES NING ACTIVITIES Done ( )
NOTES REQUIRED LEAR
solutions - Other, as assigned
14. Contribute to food services projects
- Discuss potential projects with preceptor - Plan, implement, and evaluate at least
one food service project in each of the following topic areas: -quality improvement -marketing/food-related event using the Food Services Project Checklist as a guide
15. Demonstrate appropriate professional conduct, including: a) an appropriate level of
professional confidence b) effective critical thinking
and problem solving skills c) effective time
management d) ability to manage work
independently e) initiative f) flexibility and adaptability g) ability to practice
according to the ethics of the profession with honesty, integrity and respect
h) maintains a professional appearance
i) practices appropriate workplace conduct
j) utilizes a collaborative approach
k) shows effective
To be demonstrated throughout the module, as learning activities are carried out
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Performance Objectives and Learning Activities Checklist Module: Food Services
PERFORMANCE OBJECTIVES REQUIRED LEARNING ACTIVITIES Done ( )
NOTES
interpersonal skills l) ability to communicate
appropriately, both verbally and in writing
m) ability to assess strengths and weaknesses and take appropriate action
n) ability to seek, recognize, and respond to feedback
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
FOOD SERVICES PROJECTS CHECKLIST MODULE: FOOD SERVICES
This Food Services Project Checklist is to be used to complete Performance Objective 14 of the Performance Objectives and Learning Activities Checklist for the Food Services Module. Note: Pair/group projects may be used, but an effort should be made to ensure that each intern has clearly delineated and substantive individual responsibilities.
Projects Date Completed Comments
Quality Improvement
- identify a problem that needs to be corrected, e.g.
system related problem - patient satisfaction issue
- create a project plan, including role delineation
- discuss issue with preceptor
- conduct a analysis of the problem/issue by
collecting data
analyzing data
- present recommendations to management staff
- decide on a course of action and implement recommendations
- follow-up on recommendations (if implemented during placement)
- provide written report on project
Marketing/Food Related Event
- discuss assigned project with preceptor
- create project plan, including role delineation
- conduct a needs assessment using surveys, interviews, purchasing patterns, etc.
- based on results of needs assessment, plan and develop a marketing event for a target audience
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Projects Date Completed Comments
- relate the plan to the organization and department goals and objectives
- develop marketing strategy
- develop some materials to market the event e.g. signs in cafeteria, informational piece on the facility website
- develop menu
- conduct taste test of recipes developed for event prior to implementation, including a variety of employees in the process
- present the plan to the management team for approval
- carry out staff training as appropriate
- coordinate and carry out approved marketing event
- evaluate response/effectiveness
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP)
PERFORMANCE EVALUATION
PRECEPTOR COMPONENT MODULE FOOD SERVICES
Evaluation Form Preceptor Component Food Services April 24 2012.doc Page 1 of 4
INTERN’S NAME: DATES: PLACEMENT LOCATION: PRECEPTOR(S): This form is available as an electronic form and should be used to complete this evaluation. Prior to completing this evaluation, review the intern-completed Performance Objectives and Learning Activities Checklist. A. Achievement of Module Performance Indicators (Note: Assess intern based on
expectations for stage of internship training. If “Not Met” is checked, please provide clarifying details under “Comments/Suggestions”.)
Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
1. Organizes work to achieve the requirements of the placement
2. Reflects upon past performance and set personal goals
3. Demonstrates familiarity with food service environments (e.g. resources, tools, routines) in at least two settings, e.g. acute care, residential care, production facility, retail)
4. Demonstrates familiarity with the dietitian’s role in food service settings
5. Demonstrates familiarity with interrelated roles of staff in food service areas
6. Assumes assigned supervisory and management functions related to menu planning
7. Assumes assigned supervisory and management functions related to food production
8. Assumes assigned supervisory and management functions related to patient services
9. Assumes assigned supervisory and management functions related to food safety and quality assurance
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Assessment (For Stage of Internship) Indicator
Met Not Met
Comments/Suggestions
10. Assumes assigned supervisory and management functions related to human resources
11. Assumes assigned supervisory and management functions related to financial management
12. Assumes supervisory functions related to disaster or emergency planning
13. Assumes assigned aspects of the preceptor’s role in the placement setting
14. Contributes to food services projects 15. Demonstrates appropriate
professional conduct, including: a) Manages time effectively b) Manages work independently c) Shows initiative d) Shows flexibility and adaptability e) Practices according to the ethics
of the profession with honesty, integrity and respect
f) Maintains a professional appearance
g) Uses appropriate workplace conduct
h) Uses a collaborative approach i) Shows effective interpersonal
skills j) Communicates appropriately,
both verbally and in writing k) Assesses strengths and
weaknesses and takes appropriate action
l) Seeks, recognizes, and responds to feedback
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B. Strengths and areas for development related to competency areas: Comment on key strengths and key areas for development. Use the Evaluation Statements based on DC Competencies document available on the UBC Internship website as a guide for comments. Other comments may be added as appropriate. ASSESSMENT (The ability to identify all relevant data and recognize the factors pertaining to the problem at hand. This competency also includes the ability to use effective data collection techniques or tools; the ability to translate raw data into interpretable data and to formulate a conclusion based on the interpretation and integration of data.) Strengths Areas for Development - -
PLANNING (The ability to establish goals, measurable objectives, and formulate and develop a course of action.) Strengths Areas for Development - -
IMPLEMENTATION (The ability to activate and execute the plan, to monitor the achievement of the plan’s objectives, and to modify the plan if necessary.) Strengths Areas for Development - -
EVALUATION (The process of determining the achievement of goals and objectives and the need for further evaluation.) Strengths Areas for Development -
-
PROFESSIONAL PRACTICE (The application of dietetics-based knowledge, ethics, and the principles of personal development to all professional activities. The behaviour in this area of competence enhances both the profession of dietetics and the role of the individual dietitian.) Strengths Areas for Development -
-
COMMUNICATION (The application of theories of communication and counselling. This includes verbal, written and listening skills.) Strengths Areas for Development -
-
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C. Assessment of successful completion of placement:
An intern has met the requirements of a placement when: - the required learning activities for the placement (outlined on the Performance Objectives and
Learning Activities Checklist) have been completed; - no major issues exist that could result in unsafe practice and professional conduct is appropriate; - substantial progress has been made toward achieving the stated Performance Indicators or, if this is
the final placement within the module, all Performance Indicators (outlined on pages 1, 2 and 3 of this form) have been met.
In your opinion, has the intern successfully completed this placement? Yes No If no, outline specific knowledge, skills, and or behaviours of concern below and contact internship coordinator immediately. - D. Additional comments (if applicable): Intern's Signature: _______________________________________ Date: ___________ Preceptor’s Signature: ____________________________________Date: ___________ The above signatures indicate that the Intern and Preceptor have reviewed and discussed this form. Distribution instructions 1) Provide the intern with the following finalized documents:
a) Performance Objectives and Learning Activities Checklist b) Performance Evaluation Intern Component c) Performance Evaluation Preceptor Component (this form).
2) The intern is responsible for submitting signed originals of the Performance Evaluation Intern Component and the Performance Evaluation Preceptor Component forms to the Internship Coordinator within 5 working days after completion of the placement.
3) If this is the last placement within the module, the intern should submit the completed Performance Objectives and Learning Activities Checklist to the Internship Coordinator within 5 working days after completion of the placement.
--------------------------------------------------------------------------------------------------------------------------------------------- FOR COMPLETION BY INTERNSHIP COORDINATOR FOLLOWING REVIEW OF EVALUATION:
No major concerns identified, no actions required.
Concerns identified. Description of followup actions taken: Internship Coordinator’s Signature: ____________________________ Date: __________________
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UBC DIETETICS MAJOR FNH 481/482 (DIETETIC INTERNSHIP) MODULE: RESEARCH
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INTERN NAME: ________________________________ DATE: _______________ MODULE OVERVIEW The purpose of the Research Module is to provide interns with a basic foundation and introductory experience in practice-based dietetic research. Interns (working in groups) complete a small research project over the course of the internship year. Guiding Principles: • The research experience should be a mutually beneficial process for the intern and
preceptors. • The project scope should be small enough to fit within the limitations of the internship
timeline. • The student research experience should be positive. Interns can work on research projects as part of the weekly unscheduled half day allocated to meetings, research, and education activities. As well, each intern has one scheduled research week. In addition to these scheduled times, it is typically necessary to work on internship research outside of internship hours. COMPETENCIES In accordance with the accreditation requirements of Dietitians of Canada, the competencies addressed by this Module are outlined below. It is the responsibility of all interns and preceptors to familiarize themselves with these competencies. Competencies1 (those addressed in this Module are highlighted) Assessment 1,2a2,b2,c2,d,e2,f,g2,h2,i2,j,k2,l,m,3,4,5,6a2,b2,c2,d,e2,f,g2,h2,i2,j,k2,l,m,7 Planning 1,2,3,4,5a,b,c2,d,e2,f2,g,h,i,j,k,l2, 6a,b,c,d,e,f,g,h,i,j,k,l,m,n,o,p,q Implementation 1a,b,2a,b,c,d,e,f,g,h,3a,b,c,d,e,f,g,h,i,j,4 Evaluation 1a2,b2,c2,d2,2a,b,c,d,3a,b,c,d,e,4,5 Professional Practice
1a,b,c,d,e,f,g, 2a,b,c,d2,3a,b,c,d,4,5,6,7,8,9a,b,c,d
Communication 1,2,3,4,5,6,7,8,9,10,11,12,13a,b,c,d,e,f,g2,14a,b 1 Competencies for the Entry Level Dietitian (Dietitians of Canada 1996), available on internship website 2 Addressed in some placement settings
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FORMAT AND EVALUATION The Research Module is structured differently than other modules, as it is project-based and collaborative. The Project Activities and Timelines Checklist serves as a guide to ensure the required learning activities are achieved by each research team. The Research Module does not require a final evaluation by the research preceptor, due to the focus on continuous feedback as the research process unfolds. To pass the module, intern research teams must have their preceptor sign off the completed the Project Activities and Timelines Checklist to verify project role delineation and completion of all required learning activities. ROLE DELINEATION INTERN
Collaborate with research team (fellow interns, research preceptors and Principal Investigator (PI) to carry out all aspects of the research process).
Ensure equitable distribution of workload. Ensure you are familiar with the deadlines and key components of the research process (e.g. as appropriate: RISe and local ethics applications, data collection procedures/tools and inter/intra-rater variability testing).
Connect with research preceptors to have them review, provide feedback and approve all research documents and presentations for external release.
Complete the Project Activities and Timelines Checklist and obtain signoff from preceptor at the end of project.
RESEARCH PRECEPTOR
Select a research project(s) and confirm it meets the project criteria (refer to: Most Desirable Project Type).
Complete the Intern Research Idea Submission Form and submit to the Core Internship Coordinator by the last Friday in April prior to the start of the internship year for confirmation of project support.
Review key components in the research process (e.g. RISe and local ethics applications, data collection procedures/tools and inter/intra rater variability testing).
Act as facilitator and resource through all phases of the research process. Monitor projects regularly to assess progress, provide advice and support so that deadlines are met (e.g. research question, research proposal (RP), data collection tools, study approval, study report and presentations).
Review, provide feedback and approve all research documents/presentations for external release (e.g. RP and associated documents, abstract, presentation, final report).
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Upon project completion, sign off the completed the Project Activities and Timelines Checklist for the research team, to verify role delineation and completion of required learning activities.
Report any significant intern performance issues to the Core Site Internship Coordinator or Designate.
CORE SITE INTERNSHIP COORDINATOR (CSIC) OR DESIGNATE
Confirm research preceptor proposed project meets the project criteria (refer to: Most Desirable Project Type.
Submit the Appendix 1 - Intern Research Idea Submission Form (Appendix 1) to the Dietetics Education Coordinator (DEC) by email by the last Friday in April for approval.
Coordinate process for preceptor and project identification. Refer research teams to support resources as needed (e.g., Master’s prepared RD, research department, UBC dietetics program personnel).
Maintain awareness of research projects in process. Assist with any site-based issues that cannot be resolved at the preceptor level. Address any intern performance issues arising. Must be a co-investigator on all projects in order to take on the responsibility of data storage and destruction following project completion.
May also serve as the PI for intern research projects (site specific, refer to Appendix – 1.0 Guidance Notes for UBC RISe Applications).
INTERNSHIP RESEARCH ADVISORY COMMITTEE (RAC)
Review and provide feedback on proposed research projects as delegated by the DEC.
Establish Research Module requirements. Plan annual Internship Research Symposium.
DIETETIC EDUCATION COORDINATOR
Delegate proposed research project ideas to RAC members for their review The DEC may serve as the PI for intern research projects (site specific, refer to Appendix – 2 Guidance Notes for UBC RISe Applications)
Provide high level oversight to all projects, serving as a resource to research teams as needed.
Chair RAC. Inform interns of Morgan Medal deadline and encourage them to apply.
RESEARCH PROJECT LIMITS BY CORE SITE The RAC, DEC and CSIC have limited capacity to review and advise dietetic intern research projects. As such, a maximum number can be submitted: Internship Core Sites with <5 students: 1 project can be submitted
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Internship Core sites with ≥ 5 students: 2 projects can be submitted PROJECT CONFIRMATION DEADLINE: In order to ensure sufficient time to review the appropriateness of all projects, the CSICs must submit project ideas to the DEC by email by the last Friday in April.
MOST DESIRABLE PROJECT TYPE (The following project types have been found to provide
the most positive experience for both the student and preceptor.) CHOOSE ONE OF THE FOLLOWING:
A retrospective chart review (e.g. describe the characteristics of a group; randomly sample a non-vulnerable population and describe RD involvement)
A quantitative analysis of adherence to a practice standard A survey using an existing validated tool and easily accessible population
(i.e. group of dietitians) A quantitative analysis of secondary anonymized or de-identified data
Sample final research project proposals: retrospective chart review review of a current practice standard survey using a validated tool in an accessible population
PROJECTS THAT MAY BE ACCEPTABLE
UNDER CERTAIN CIRCUMSTANCES CONDITION UNDER WHICH PROJECT MAY BE CONSIDERED APPROPRIATE
Small project (e.g. focus group, pilot project or small intake audit of one ward) Qualitative studies (e.g. interviews, thematic analysis) Survey design Prospective study (without hypothesis testing) & short time line
Preceptor has experience in this type of research
PROJECTS THAT ARE NOT APPROPRIATE
REASON PROJECT NOT APPROPRIATE
Hypothesis testing Ethics application time consuming/complicated
Requires full board review Surveys of large scope (e.g. national surveys), diverse population or difficult to access
Identifying, targeting and accessing audience time consuming
Projects requiring full ethics review (e.g. hypothesis testing or intervention studies)
Ethics application time consuming and complicated
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PROJECT REQUIREMENTS & RESOURCES Research Process Component
Requirement/Guidelines
Resources/comments
Ethical Review Limited to minimal risk or expedited reviews (e.g. low risk studies)
Dietetic Intern Research Guidance Notes Appendix – 2 Guidance Notes for UBC RISe Applications
UBC RISe guidance notes: http://www.rise.ubc.ca/content/ubc-research-ethics-guidance-notes
Local (e.g. Health Authority) guidance notes: o Vancouver Coastal Health Research Institute (VCHRI):
http://www.vchri.ca/s/FormsLogos.asp o Interior Health:
http://www.interiorhealth.ca/AboutUs/ResearchandEthics/Pages/REB.aspx
o Fraser Health Research Ethics Board (REB): http://research.fraserhealth.ca/media/20120113_FHGN_Initial_Application_for_Ethical%20Review(1).pdf
o Northern Health Research Review Committee: http://www.northernhealth.ca/YourHealth/ResearchandEvaluation/ResearchEthicsNHResearchReviewCommittee.aspx
o Providence Health REB: http://www.providencehealthcare.org/research/forms-guidance-notes.html
o Provincial Health Services Authority − UBC/Children’s and Women’s Health Centre of BC:
http://www.cfri.ca/reb/templates.asp − UBC/BC Cancer Agency REB:
http://www.bccancer.bc.ca/RES/REB/NewAppl.htm o Vancouver Island Health REB:
http://www.viha.ca/rnd/research_ethics/forms_page.htm
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PROJECT REQUIREMENTS & RESOURCES Research Process Component
Requirement/Guidelines
Resources/comments
Study Population & Sampling
Should be a homogeneous population (e.g. attendees of a cystic fibrosis clinic; RDs in one health authority). Heterogeneous groups are discouraged due to the need for a larger sample size Population sample should be local and easily accessible Sample size must be justified and explained (e.g. random or convenience sample to accommodate time constraints) and attainable within 2-3 days
Cheney CL, Boushey CJ. Estimating sample size. In: Monsen ER, ed. Research: Successful Approaches. Chicago, IL: American Dietetic Association; 2003:389-398
Data Collection Data collection should not last more than 2-3 days Team should be confident data can be collected in the given time period
Data collection must be documented Time should be built into the project to create and test data collection tools
Excel Data Validation – Introduction: http://www.contextures.com/xlDataVal01.html Best practice example for retrospective chart review to minimize descriptive study limitations: Gearing, RE, et al., J Can Acad Child Adolesc Psychiatry, 2006;15(3):126-34
There must be a standardized approach to data collection by all data collectors Inter and intra variability testing of
Reliability testing: Gleason PM, et al. JADA 2010;110(3):409-19 http://www.socialresearchmethods.net/kb/reltypes.php
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PROJECT REQUIREMENTS & RESOURCES Research Process Component
Requirement/Guidelines
Resources/comments
researchers must be conducted Data Analysis
Descriptive statistics are expected for all projects (e.g. mean, median, mode, proportions, frequency, standard deviation, variance, sum, count, range, sum, count, min/max, etc) Advanced analysis (e.g. basic correlational, comparative analysis or thematic analysis) is appropriate only if there are available resource people Achievable in 2-3 days. If not, re-evaluate project scope & feasibility
A beginner’s guide for descriptive stats http://www.bio.davidson.edu/courses/Bio111/Bio111LabMan/Lab%207.html
http://www.socialresearchmethods.net/kb/statdesc.php Using Excel to calculate descriptive statistics:
http://www.princeton.edu/~otorres/Excel/ (Excel 2003) http://www.ehow.com/how_6789812_do-statistics-ms-excel-2007.html (Excel 2007)
For visual learners: http://www.youtube.com/watch?v=5UXw-LlML-g
Study Completion Documentation & Results Dissemination
Required: Final paper which follows the format required for submission of an “Original Research” piece to the Canadian Journal of Dietetic Practice and Research (3000 word limit). Includes: abstract, introduction, methods, results and discussion Research abstract for Canadian Foundation for Dietetic Research meeting held in conjunction with the Dietitians of Canada annual
Canadian Journal of Dietetic Practice and Research http://dcjournal.metapress.com/images/guide_for_authors.pdf Canadian Foundation for Dietetic Research abstract guidelines: (http://www.cfdr.ca/sharing/conference.aspx#intern). Interns only expected to complete the first draft of the final paper (including one round of edits, which incorporates feedback from research preceptors). If aiming for publication, a final version is beyond the scope of internship research module and therefore becomes the responsibility of the research preceptor to prepare for submission.
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PROJECT REQUIREMENTS & RESOURCES Research Process Component
Requirement/Guidelines
Resources/comments
conference Study close out and data storage within RISe and local health authority REB as stated in approved RISe and local REB submissions. Also refer to UBC Dietetic Intern Guidelines for Storing and Destroying Data after Completion of Study.
Optional: Draft paper for publication (final version for publication is beyond the scope of the research module). Submission to Dietitians of Canada “Practice” publication: http://www.dietitians.ca/Knowledge-Center/Publications/Practice.aspx (DC membership required for submission. If not a member, ask CSIC to facilitate access.)
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PROJECT ACTIVITIES AND TIMELINES CHECKLIST Date: ____________________ Intern Research Team Members: ________________________________________
___________________________________________________________________ Preceptor(s): ________________________________________________________ Instructions: 1. The project leader to complete this checklist to document project role delineation and track the team’s progress in
meeting the requirements of this module. 2. By the end of the internship year (i.e. June 15th):
a) Review the checklist for completeness. b) Pass the completed checklist to preceptor for review and signoff. c) Submit signed document to CSIC or designate.
REQUIRED LEARNING ACTIVITIES Who By NOTES/RESOURCES
1. Establish intern research team: a. Delineate intern(s) roles (e.g.
project lead, literature search, methodology, ethics, etc.)
b. Determine individual and shared roles (e.g. lead for: project, methods, literature review, ethics etc.) in the project considering team member strengths and skills (refer to your self-assessment
CSIC/ preceptors
Interns/
preceptor
Early Sept
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REQUIRE ES Who By NOTES/RESOURCES D LEARNING ACTIVITIfrom FNH 480)
2. Begin to establish research question(s) or statement of purpose for the chosen project
Interns/ preceptors
Early Sept
3. Identify available support resources for the project (e.g. health authority research office, libraries, internship site print resources, and research resource people to call upon as needed)
Interns Sept
4. Complete APPENDIX – 3 Literature Search Strategy Worksheet. Review with a librarian (UBC or health authority) and conduct the literature review
Interns Sept - Oct
Literature review tutorial: http://www.lib.ncsu.edu/tutorials/lit-review/
5. Begin to complete APPENDIX – 4 Research Proposal (RP) Template
Interns/Preceptors
Sept Refer to Project Requirements & Resources
6. Become familiar with local project approval requirements. Inform RISe PI of required dates for any review and signature activities. Review APPENDIX – 5 Research Key Activities & Dates Flow Chart
Interns Sept - Oct
Refer to Appendix – 2 Guidance Notes for UBC RISe Applications
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EQ S Who By NOTES/RESOURCES R UIRED LEARNING ACTIVITIE 7. Create a project time-line and
establish a communication schedule with preceptor to ensure that all required activities are approved and completed in a timely manner
Interns Sept
8. Identify intern contact person for all correspondence (including RISe and local ethics).
Interns End Oct.
9. Submit APPENDIX – 4 Research Proposal (RP) Template to the DEC for review
Intern contact person
1st Fri. in Nov.
APPENDIX – 5 Research Key Activities & Dates Flow Chart Sample RP#1 Sample RP#2 Sample RP #3
10. Share DEC feedback re the Research Proposal with the team
DEC Mid. Nov.
11. If necessary, meet as a team with preceptor to address issues with Internship Research Proposal. Complete edits to RP based on DEC feedback for RISe and local ethics submission
RAC & Research
Team rep(s)
Week 3 Nov.
12. Prepare RISe submission and required attachments; submit for DEC review
Interns 1st Fri. Dec.
Appendix – 2 Guidance Notes for UBC RISe Applications Sample RISe #1 Sample RISe #2 Sample RISe #3
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Q Who By NOTES/RESOURCES RE UIRED LEARNING ACTIVITIES 13. Notify intern research team
contact person of any required RISe edits
DEC Early in week 2 of
Dec.
14. Complete edits to RISe application based on DEC feedback. Inform DEC when it is ready for submission
Research Team
2nd Fri. Dec.
Refer to Appendix – 2 Guidance Notes for UBC RISe Applications
15. Submit RISe application. DEC 2nd Fri. Dec.
16. Complete approval submission forms according to requirements by local ethics approval body. Have preceptor review; obtain required signatures and submit
Interns Local deadlines
apply
17. Address any RISe provisos Interns January 18. Inform local ethics approval body
of any significant project changes required as a result of the RISe provisos
Primary Intern
Research Contact
19. Address any local ethics approval body requirements. Inform RISe of any significant project changes required
Primary Intern
Research Contact
January
20. Obtain study approval (“Certificate of Approval”) from RISe and local ethics board and forward to preceptor and CSIC
Primary Intern
Research Contact
January (approx.)
21. Pilot test data collection procedures and tools
Interns When approval
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ES Who By NOTES/RESOURCES REQUIRED LEARNING ACTIVITIreceived
22. Conduct research Interns Feb/ March
23. Analyze results Interns April 24. Prepare an intern research
abstract for Canadian Foundation for Dietetic Research using guidelines provided on the Dietitians of Canada website: (http://www.cfdr.ca/sharing/conference.aspx#intern). Submit abstract by deadline and forward to DEC
Interns April 15
25. Submit final project abstract and slides for the UBC Dietetic research symposium prepared according to requirements to DEC
Interns May 31 Refer to Intern Research Symposium Presentation Guidelines
26. Produce a final research report according to the Project Requirements & Resources. Submit to preceptor, CSIC, and DEC
Interns Last Friday in
May
27. Modify report as needed based on all feedback
Interns June 15
28. Present project findings at province-wide internship research symposium. If feasible,
Interns June (date TBA)
Refer to Project Requirements & Resources
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Who By NOTES/RESOURCES REQUIRED LEARNING ACTIVITIESdisseminate findings in other ways, e.g., Article for Practice, local presentations
29. Close out research project within RISe and local approval agency REB. Complete procedures for storing and destroying data according to RISe and local REB guidelines. Refer to UBC Dietetic Intern Guidelines for Storing and Destroying Data after Completion of Study.
Interns June
30. Submit APPENDIX – 6.0 - Documented Completion of Module Requirements to the CSIC by June 15th
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APPENDIX 1 Intern Research Idea Submission Form
Purpose:
1. Provide a tool for research preceptors to use to describe their project idea
2. Guide project selection
3. Confirm project idea meets module requirements
Instructions: 1. Project idea generator - Complete (type directly in the form) and submit to the Core Site
Internship Coordinator (CSIC) for review and support
2. CSIC – submit to Dietetics Education Coordinator or designate by email by: last Friday in April
Submittor’s Name: _____________________________________________________________________
Core Internship Site: FH VCH NH NH PH VIHA PHSA
IH (Okanagan) IH (Kamloops)
Proposed Project: 1. Population (if applicable): _________________________________________________________
2. Project objective(s): ______________________________________________________________
3. Project Type (please choose one):
A retrospective chart review
A quantitative analysis of adherence to a practice standard
A survey using an existing validated tool and easily accessible population
A quantitative analysis of secondary anonymized or de-identified data
Other (please refer to page 2 and specify project type & preceptor
qualifications/experience):
______________________________________________________________________________
4. Describe how data collection can be completed in ≤3 days: _______________________________
5. Describe why population or the data is easily accessible1: ________________________________
6. Time has been allocated for testing of all tools and procedures: Yes
7. Eligibility criteria for “expedited ethical review” (page 2) met: Yes
8. Survey is validated: Yes Not applicable
1 e.g. population has been accessed in the past or is readily available
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Additional details: (optional) Please include any additional information that might help the research advisory committee have a clear
understanding of your proposed project. Information may include, but is not limited to, the following:
project rationale, an outline of the study design or methodology, comments about the project feasibility
(e.g. timing and data collection, preceptor experience), sample size, statistics, infrastructure supporting
the project type, etc
PROJECTS THAT MAY BE ACCEPTABLE
UNDER CERTAIN CIRCUMSTANCES
CONDITION UNDER WHICH PROJECT
MAY BE CONSIDERED APPROPRIATE
Small project (e.g. focus group, pilot project or small intake audit of one ward)
Qualitative studies (e.g. interviews, thematic analysis)
Survey design Prospective study (without hypothesis testing) &
short time line
Preceptor has experience in this type of research
PROJECTS THAT ARE NOT APPROPRIATE
REASON PROJECT NOT APPROPRIATE
Hypothesis testing Ethics application time consuming/complicated
Requires full board review Surveys of large scope (e.g. national surveys),
diverse population or difficult to access Identifying, targeting and accessing audience
time consuming Projects requiring full ethics review (e.g.
hypothesis testing or intervention studies) Ethics application time consuming and
complicated
RESOURCES TO CONFIRM PROJECT ELIGIBLE FOR “MINIMAL RISK” OR EXPEDITED REVIEW
Dietetic Intern Research Guidance Notes (Appendix – 1.0 Guidance Notes for UBC RISe Applications)
UBC RISe guidance notes: http://www.rise.ubc.ca/content/ubc-research-ethics-guidance-notes Local (e.g. Health Authority) guidance notes:
o Vancouver Coastal Health Research Institute (VCHRI): http://www.vchri.ca/s/FormsLogos.asp o Interior Health: http://www.interiorhealth.ca/AboutUs/ResearchandEthics/Pages/REB.aspx o Fraser Health Research Ethics Board (REB):
http://research.fraserhealth.ca/media/20120113_FHGN_Initial_Application_for_Ethical%20Review(1).pdf
o Northern Health Research Review Committee: http://www.northernhealth.ca/YourHealth/ResearchandEvaluation/ResearchEthicsNHResearchReviewCommittee.aspx
o Providence Health REB: http://www.providencehealthcare.org/research/forms-guidance-notes.html
o Provincial Health Services Authority − UBC/Children’s and Women’s Health Centre of BC: http://www.cfri.ca/reb/templates.asp − UBC/BC Cancer Agency REB: http://www.bccancer.bc.ca/RES/REB/NewAppl.htm
o Vancouver Island Health REB: http://www.viha.ca/rnd/research_ethics/forms_page.htm
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APPENDIX – 2 Guidance Notes for UBC RISe Applications
1. Which projects require submission to a research ethics board (REB)?
All dietetic intern research projects require submission to an REB including quality improvement and quality assurance projects.
2. Do I need to submit to both RISe and a health authority (HA)/Health Services Association (HSA) ethics application? Can a project have one Principal Investigator (PI) for the UBC RISe submission and a different PI for the HA/HSA (REB) submission?
It depends on the HA/HSA. Refer to chart below. (Link to UBC RISe Forms & Guidance notes: http://www.rise.ubc.ca/content/ubc-research-ethics-guidance-notes)
Who should be PI Forms &/or Guidance Notes
SITE
Where to submit ethics application(s)
Local REB UBC RISe
FH UBC RISe AND FH REB
FH employee UBC DEC http://research.fraserhealth.ca/approvals_%26_ethics/forms-and-guidance-notes/
IH UBC RISe AND IH REB
UBC DEC UBC DEC
http://www.interiorhealth.ca/AboutUs/ResearchandEthics/Pages/REB.aspx
NH UBC RISe AND NH REB
NH employee as the NH contact for the NH application, but use the UBC DEC as the PI when asked for the local ethics PI in the UBC RISe system
UBC DEC http://www.northernhealth.ca/YourHealth/ResearchandEvaluation/ResearchEthicsNHResearchReviewCommittee.aspx
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Who should be PI Forms &/or Guidance
Notes
SITE Where to submit ethics application(s)
Local REB UBC RISe
PHC PHC REB in the UBC RISe system
Submission not required
PHC employee OR UBC DEC
http://www.providencehealthcare.org/research/forms-guidance-notes.html
PHSA Children’s and Women’s REB OR BC Cancer Agency REB in the UBC RISe system
Submission not required
BC Children’s and Women’s OR BC Cancer Agency employee
http://www.cfri.ca/reb/default.asp http://www.bccancer.bc.ca/RES/REB/NewAppl.htm
VCH UBC RISe AND VCH Research Institute REB
Needs to be a person that is both a UBC faculty (i.e. Clinical Instructor) & a VCH employee
http://www.vchri.ca/s/FormsLogos.asp
VIHA UBC RISe AND VIHA HREB
VIHA employee as the VIHA contact for the VIHA application.Use the UBC DEC as the local ethics PI for the UBC RISe system
UBC DEC http://www.viha.ca/rnd/research_ethics/forms_page.htm
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3. Technical Considerations: • N/A - Use throughout the application rather than leaving sections blank or
using “no”. • Spelling - Have a second or third person check the document for
grammatical errors (e.g. “Principal” is commonly misspelled as “principle”).
4. Guidance Notes with answer:
RISe Section Number
Guidance Notes FAQ with answer
1.8 What should be used for the project nickname? The first part of the name can be to your choosing, but the name must end with your health authority initials and the year of submission in brackets. For example a project called “Craving Change” submission for Interior Health for 2012-2013 would be: “Craving Change (IH2012-2013)”.
2.1 What should be the study start dates? The first Monday In February. The study can begin as soon as it is approved regardless of this stated start date.
4.1 Which UBC REB should be applied to? The UBC Clinical REB should be applied to when projects involve the review of clinical medical records, questionnaires or interviews. The UBC Behavioural REB should be applied to when projects involve the potential invasion of privacy such as: questionnaires, interviews, focus groups, observation, secondary use of data, deception, testing, video and audio taping.
4.4B Who has reviewed this project? Should state: “This research proposal was peer reviewed by the Dietetic Internship Research Advisory Committee, which includes dietitian representatives from UBC Faculty and the BC Health Authorities.”
5.4 Method of recruitment? Researchers cannot contact participants directly without the prior approval of the release of their personal contact information (see 5.4.4 in RISe Behavioural Guidance Notes). However, in accordance with Third Party Recruitment guidelines (see 5.4.4 in RISe Behavioural Guidance Notes), a third party can do so on your behalf.
5.5 How should the coding of subject de-identified data be summarized? Suggested wording: “To maintain confidentiality, subjects will be assigned a non-identifying study code. The study code will not be derived from personal identifiers such as a birth date or social insurance number.”
5.6 Obtaining access to information If applying for access to information, state that you have applied or are in the process of applying for permission to access, collect….etc. Not that you will apply.
5.7 Summary of procedures Avoid the use of specific data collection dates. It is unnecessary and may limit
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you. If validated survey being used, state that it was previously validated and include a copy in the documentation section. If a survey is being validated, then indicate so and provide a draft in the documentation section. Address pilot testing of the survey and indicate any issues arising during the pilot. The final version will need to be submitted to RISe.
6.6A Waiver of requirement for consent You can ask for a waiver of subject informed consent under the following conditions:
• UBC Behavioural REB (BREB): Waiver of consent for the secondary use of identifiable information can be requested if it meets criteria outlined in by the BREB, found here on pg 29 under section 7.3.7: http://www.ors.ubc.ca/sites/research.ubc.ca/files/uploads/documents/Ethics/BREB/Revised%20BREB%20guidance%20notes.pdf (7.3.7)
• For both Behavioural and Clinical REBs: o The research involves no more than minimal risk to subjects o The waiver or alteration is unlikely to adversely affect the rights
and welfare of the subjects o The research could not be practicably carried out without the
waiver or alteration o Whenever possible and appropriate, the subjects will be
provided with additional pertinent information after participation o The waivered or altered consent does not involve a therapeutic
intervention 7.1C Other jurisdiction
Should add the health authority you are conducting the research in. 7.1E Has a request for ethics been submitted
Should state “yes”. 7.4 Who will actually conduct the study and what are their qualifications?
Should state: “Undergraduate UBC dietetic students completing their internship at [indicate the health authority] from September [indicate year] to June [indicate year]. The UBC Dietetics Program Leader and Dietetics Education Coordinator oversee the UBC Dietetics Program and have extensive experience with internship research.”
8.2 Access to data and confidentiality Do not include the name of the UBC Dietetics Internship coordinator since that person won’t have had the confidentiality training required by local REB.
8.3 How to protect the identity of research subject’s data? If using a non-anonymous questionnaire, indicate that only the subject study code will be used on the questionnaire and that data analysis files will also only use subject study code numbers.
8.5A Data storage Should state: “Data will be stored in a password protected file on a secure [insert health authority name here] network and/or that all hard copy information will be stored in a locked cabinet in an office that only the [insert co-investigator or PI]
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has access to.” 8.5B Data confidentiality and security safeguards
If storing data electronically, indicate that files will not include subject names but rather just subject study code numbers. Indicate that files will be password-protected on a network computer.
8.6 Data handling after study completed This section must be completed. Must indicate how long the data will be stored (refer to guidance notes), where it will be stored, plans for future use of the data. If there are no future plans for using the data, must also state that. State how the data will be destroyed (e.g. data files will be deleted or hard copy data will be shredded after x years). Check local requirements. UBC requires 5 years of data storage, but other health authorities are longer.
9.1A Protocol documentation Must attach the research proposal with a version date in the footer.
9.2 Consent forms Suggest state: “Attached cover letter prepared according to REB guidelines”. Insert the cover letter into this section. Ensure that all required logos (e.g. UBC, Health Authority) are included. Document version date must be in the footer.
9.7 Letter of initial contact Must have a version date in the footer and must have all relevant logos in the header (i.e. UBC logo, health authority logo).
9.8A Other documents All documents require a version date inserted either into the footer or the title and file name.
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APPENDIX – 3
Literature Search Strategy Worksheet
The Project Activities and Timelines Checklist includes the requirement of creating a literature search strategy, reviewing it with a librarian (UBC or health authority) and then conducting the literature review. Systematically searching the topic being investigated is a key step in the research process. Each research group should use this worksheet to organize and document their search approach.
1. Your research topic - In point form, describe the key aspects of your topic:
2. List each aspect of your topic (i.e. your concepts) and corresponding key words &
Medical Subject Headings (MeSH). Use these words as search terms in your chosen databases (below). When possible, use Medical Subject Headings (http://www.nlm.nih.gov/mesh/filelist.html) to improve the relevance of your search results.
Your concept Keywords MeSH
3. Search restriction(s)/inclusion(s) criteria (if applicable). Consider applying these to your chosen databases (below) to increase the specificity of your search strategy. □ Gender □ Age □ Language □ Publication dates □ Other
4. Choose the appropriate databases for your topic:
□ Medline □ CINAHL □ EMBASE □ PEN (Practice Based Evidence in Nutrition) □ Cochrane Database of Systematic Reviews □ ACP Journal Club □ Other (specify sources(s) used):__________________________________________________
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APPENDIX – 4 Research Proposal (RP) Template
Overview: The purpose of the RP is to create a project summary to attach to the RISe application. Instructions: 1. Complete one RP (next page) per study team. 2. Complete form electronically. Use “N/A” for any items that do not apply. 3. Use complete sentences and paragraphs where requested (use point form in other
sections). 4. DO NOT alter margins or font size. 5. Prepare references using a bibliography management program
(e.g. Refworks: http://guides.library.ubc.ca/refworks). 6. Prior to submitting form, have preceptor(s) review and endorse. 7. Assign file name as follows: “RP.InternshipCoreSite.Last name of contact
intern.Intern year” (e.g. RP.FH.Smith.2012). 8. Email the completed form (next page) to the DEC by the 1st Friday in November. 9. Once the RP is ready for submission, delete this page prior to attaching to the RISe
application.
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Submitting Intern Last Name: ___________________________ Year: _______________ Internship Core Site: __________________________________ Specify project type (refer to Project Requirements & Resources):_____________________ Specify which RISe review board applying to: _____________________________________
REQUIRED INFORMATION
ENTER DETAILS BELOW
Current Date Project Title
Internship Core Site(s)
Double click to select: Fraser Health Vancouver Coastal Health IH Okanagan Northern Health Provincial Health Services Authority Providence Health IH Kamloops Vancouver Island Health
Authority Research Preceptor(s)
Name Telephone Email
Principal Investigator for RISe
Principal Investigator for local ethics
Other Research Preceptors
Co-Investigator(s) Name Telephone Email Primary Intern Research Contact
Other Intern(s) (names only)
Study Team Members
Others, if applicable
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Summary of relevant literature & significance to dietetic practice2
Summary to include: • Available
research supporting proposed method & topic
• Relevance to dietetic practice
• 400 word limit
Summary (100 word limit) in lay language of what and why
Purpose 1-2 project objectives
Research method (including data collection). Indicate plans for testing data collection procedures/tools (consider accuracy and completeness). Indicate plans for inter and intra/rater-variability testing.
Summary of Study & Recruitment
Statistical or other analysis
Variables: List outcome variable(s) being measured: __________ _________________________________________ ________________________________________ Statistics: List descriptive statistics (e.g. mean, mode, median, standard deviation, proportions, frequency) to be reported: ___________________________________ ________________________________________
2 Use complete sentences and paragraphs in this section.
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________________________________________ List advanced analysis planned (only applicable if local resources are available):
Correlational analysis (specify):________________
Comparative analysis (specify):________________
Thematic analysis (include description): _________ _________________________________________ _________________________________________
Inclusion Criteria Exclusion Criteria Method of Recruitment (if applicable)
Sample size and rationale (e.g. # of subjects/charts, etc.)
REFERENCE LIST (Maximum 1 page)
1.
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APPENDIX – 5 Research Key Activities & Dates Flow Chart
Submit RP to DEC for feedback 1st Friday in Nov
Revise RP & re-submit to DEC if requested
1st Fri in Dec Complete RISe application
for DEC review Complete local ethics application
for preceptor review
Local ethics board
deadlines apply
Finalize & submit to
local ethics for approval Address issues identified by DEC; inform DEC when ready for submission
2nd Fri in Dec
Address any local provisos Address any UBC provisos
January Post approval certificate on RISe Forward approval certificate
to local ethics board & CSIC
Feb-Mar Conduct research
Mar-Apr Analyze results
Apr 15Submit abstract DC & DEC
KEY: RP = research proposal DEC = UBC dietetics education coordinator RAC = UBC dietetics research advisory council DC = Dietitians of Canada CSIC = Core site internship coordinator
Last Fri in May Submit final research report to preceptor, CSIC & DEC
Submit abstract & slides for UBC dietetic intern research symposium May 30th
May/Jun
Jun 15
Document & disseminate findings
Close-out project with UBC & local ethics; complete Appendix 6 & submit to CSIC 181
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APPENDIX – 6.0 - Documented Completion of Module Requirements
The role delineation is accurate to my knowledge and the research team has carried out all required learning activities. Any significant intern performance concerns have been reported to the CSIC. Preceptor’s Signature:__________________________ Date: _________________ Name: _____________________________________ Preceptor’s Signature:__________________________ Date: _________________ Name: _____________________________________ Distribution instructions: The intern research team is responsible for submitting the signed original of this form to the CSIC by June 15th. _______________________________________________________________________
FOR COMPLETION BY CSIC FOLLOWING REVIEW: Internship Coordinator Signature: _____________________________ Internship Coordinator Name: _____________________________ Date: __________________
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UBC DIETETIC INTERN RESEARCH SYMPOSIUM STUDENT PRESENTATION GUIDELINES
Event Schedule: Symposium is typically scheduled on an afternoon in the second week of June. Interns will be informed when the schedule is finalized.
Speaker: Please select one member of your team to present.
Questions from the audience can be handled by that person or anyone else on your team.
Location: Students in the Lower Mainland are expected to present at
the live symposium site. Students at other sites will deliver their presentations via teleconference.
Schedule: Presentations are scheduled according to a standard schedule template. For the benefit of attendees, presentations are organized by topic themes. The final schedule will be distributed the week before the symposium.
Abstract: No more than 300 words including title and author details
(the abstract submitted in April for national DC conference, prepared using these guidelines http://www.cfdr.ca/conference.html#intern should be the starting place; please update as needed to reflect full findings)
Duration: 8 minutes Slide content: Six slides as follows:
• Title–team members, research preceptor(s), site • Introduction – topic and its relevance to practice • Study objectives • Methods – brief description • Results – brief description • Limitations of study • Conclusions/implications for practice
Deadlines: Send slides & abstract to Tamar Kafka
([email protected]) by the last business day in May.
Symposium student presentation guidelines April 15 2012.doc 183
1.03 Student accident insurance Dec 6 11.doc Page 1 of 1
Policy No.:
1.03
Current Version: December 2011 Original Version: July 2006
The University of British Columbia UBC Dietetics Major
Approved by: UBC Dietetic Education Core Council
Title: Student Accident Insurance
Policy 1. For the internship year, students in the Dietetics Major are required to carry Student
Accident Insurance in addition to BC Medical Plan coverage or its equivalent from another province.
2. Student Accident Insurance is arranged via the UBC Treasury. This insurance plan is for UBC students performing course work in environments where the risk of injury is greater than in a classroom (e.g., laboratories, practice education settings). The plan applies only during the time that the student is actually doing course work (i.e., not 24 hours per day). Course work conducted outside of Canada and flights with non-scheduled (chartered) airlines are not covered as part of this plan.
3. Students are responsible for the insurance premiums.
4. Internship placements cannot commence until student accident insurance is in place.
Procedure Action Who When
1. Inform year 4 students of Student Accident Insurance requirement, referring them to the UBC Treasury web site for policy coverage http://www.treasury.ubc.ca/wp-content/uploads/2010/10/student_accident_insurance.pdf and general information http://www.treasury.ubc.ca/wp-content/uploads/2010/10/general_insurance_memo_appendix3.pdf
Dietetics Program Leader (DPL)
May of internship year
2. Collect Student Accident Insurance premiums ($7) from students.
FNH front desk assistant
May of internship year
3. Submit list of students’ names, student numbers, faculty, and internship dates, along with a journal voucher (with a completed debit line) to the Risk and Insurance Analyst in UBC Treasury on the students’ behalf.
FNH administrative assistant or designate
Summer prior to internship year
4. Retain records and correspondence related to Student Accident Insurance coverage for the current internship year.
FNH front desk assistant
Sept-June
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1.04 Personnel and Professional Standards Nov 21 11.doc Page 1 of 3
Policy No.:
1.04
Most Recent Revision: November 21, 2011 Original Approval Date: July 2006
The University of British Columbia
UBC Dietetics Major FNH 481/482 (Dietetic
Internship) Approved by: UBC Dietetic Education Core Council
Title: Personnel and Professional Standards
Policy Dietetic interns are expected to adhere to the personnel and professional practice policies in place at their core and affiliate internship sites. Core Site Internship Coordinators (CSIC) provide this information during internship orientation. General guidelines are provided below. General Guidelines Accommodation Interns are responsible for securing their own housing accommodation for all placements. Attendance Regular attendance is a professional obligation. In the event of illness or other unexpected absence, interns must follow site absence reporting procedures. Typically, this involves informing both current preceptor and the site internship coordinator (or designate). If a substantial portion of a placement is missed, the site internship coordinator (in collaboration with the UBC Dietetic Education Coordinator, if required) will determine a plan to make up for the lost time (e.g. internship extension, adjustment of future placements, elimination of an elective). Codes of Ethics Interns are to review and abide by codes of ethics (institutional and profession-specific) in effect at placement sites. Links: College of Dietitians of British Columbia http://www.collegeofdietitiansbc.org/documents/Principles-CodeofEthics-Nov5-05.pdf; Dietitians of Canada http://www.dietitians.ca/career/i2.htm. Consent for Care Interns are required to introduce themselves as students to patients/clients and obtain verbal consent prior to providing care, in accordance with site-specific policies. General guidance on consent for care is available at this link http://www.hspcanada.net/docs/peg/4_1_consent_involve_care.pdf. Dress Code Interns are expected to follow the dress code of the core and affiliate sites. Professional appearance (e.g., good grooming, avoidance of excessive makeup, jewellery, adornments, and piercings) and professional attire (e.g., no exercise or beach attire, blue jeans, or revealing clothing) are expected at all times. For safety reasons, footwear worn in patient care and food service areas must be closed-toed and closed-heeled with moderate heel height. Food service
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1.04 Personnel and Professional Standards Nov 21 11.doc Page 2 of 3
areas typically have additional attire requirements, including hair covering, no nail polish, and possibly laboratory coats. Health Insurance Interns must have British Columbia medical coverage (or equivalent) and UBC-arranged student accident insurance (see Policy 1.3) in place throughout the internship year. Hours of Work Work hours are scheduled to meet the requirements of the core site and affiliate sites (typically full-time hours, Monday to Friday). Shift times may vary with area of placement (early, late, or weekend shifts may be required at times). Interns are expected to remain on-site during designated working hours, unless they have approval from the preceptor or core site coordinator for alternate work location arrangements. Identification Tags Site-approved photo identification tags must be worn at all times. Immunization Requirements In accordance with deadlines and procedures established by the Dietetics Program, all students are expected to submit documentation to demonstrate that health authority immunization requirements have been met. Internship Scheduling Internship scheduling is subject to core site operational requirements. Interns are required to accept site scheduling decisions. Parking Parking at many hospital sites is limited and interns are responsible for any parking costs incurred. Secured areas for bicycle storage are typically available. Details can be obtained from Core Site Internship Coordinators Perfumes/Fragrances In keeping with health authority policies, interns are to avoid wearing perfumes or other fragranced products. Professional Behaviour All students in the Dietetics Major must abide by Policy 1.15 (Professional Behaviour) at all times. Interns are expected to be polite and respectful, punctual, and reliable. The following behaviours must be avoided at internship placement sites: eating or drinking in presence of patients or clients, gum chewing, and listening to music devices. As a general principle, cell phone calling or text-messaging at placement sites is to be avoided. Some sites may approve use of cell phones (with audible ring turned off) in select circumstances (e.g., to ensure safety during remote travel). Requests for Leave Requests should only be made when absolutely necessary (e.g., medical specialist appointment, compassionate leave, personal illness). Every effort should be made to schedule personal appointments outside of working hours.
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1.04 Personnel and Professional Standards Nov 21 11.doc Page 3 of 3
Statutory Holidays One day off will be given for each statutory holiday (or designated alternate date, should the holiday fall on a weekend). Respiratory protection UBC does not provide respiratory mask fit testing for interns due to low requirements for respiratory protection in dietetic practice. Respiratory mask fit testing may be required for some clinical placements. Any intern who becomes aware of such a requirement for a specific placement, should contact the site internship coordinator so that onsite fit testing or an alternate placement setting can be arranged. Transportation Interns are responsible for their own transportation. Some placements may require use of a vehicle. Vehicle Ride Along Health authority vehicles: Interns are expected to follow health authority policies (including completion of any required forms). Personal vehicles belonging to preceptors or fellow interns: When choosing to ride in someone else’s vehicle, interns are advised to check with the driver to ensure that appropriate rate class of insurance and third party liability coverage are in place. Winter Break A two week winter break is scheduled for all interns in late December/early January (dates determined by the Dietetics Program). There are no additional scheduled breaks in the internship year.
187
1.06 Intern Evaluation July 14 09.doc Page 1 of 3
Policy No.:
1.06
Current Version: July 2009 Original Version: July 2006
The University of British Columbia UBC Dietetics Major
FNH 481/482 (Dietetic Internship) Approved by: UBC Dietetic Education Core Council
Title: Intern Evaluation
Policy 1. Dietetic interns take an active role in evaluation activities, reflecting on their own
performance, as well as setting, and as appropriate, sharing personal goals.
2. Dietetic intern evaluation within each placements or module is conducted by preceptors and is based on assessment of intern achievement of performance objectives and learning activities (which have been developed to address Entry Level Competencies).
3. Formal evaluation of overall dietetic intern progress in the program is conducted by the core site internship coordinator (CSIC) and is based on assessment of intern achievement of performance objectives and learning activities, as well as assessment of their overall progress toward achieving the Entry Level Competencies. This evaluation takes place at the midpoint and end of the internship (or more frequently if needed).
4. Any intern performance issues arising are identified, communicated and addressed promptly.
5. A dietetic intern may access his/her file upon request.
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1.06 Intern Evaluation July 14 09.doc Page 2 of 3
Procedures I. Placement/Module Evaluation Action Who When 1. Participate in formative evaluation discussions
(no forms to complete). Intern Preceptor
Daily during placement
2. Complete Performance Objectives and Learning Activities Checklist.
Intern Daily during placement
3. Provide completed Performance Objectives and Learning Activities Checklist to preceptor for use in preparing final evaluation.
Intern Prior to end of placement (e.g., mid-point of final week)
4. Complete Intern Component of Evaluation form. Intern Prior to final evaluation meeting
5. Refer any significant performance issues identified during the placement/module to the CSIC.
Preceptor As arising
6. Complete Preceptor Component of Evaluation form.
Preceptor Prior to final evaluation meeting
7. Participate in final evaluation meeting. Discuss and sign off evaluation forms.
Intern Preceptor
End of placement
8. Make copy of forms for preceptor and for personal records. Send originals to Site Internship Coordinator.
Intern Within 5 business days of final evaluation
9. Manage in-coming intern evaluation documents: a) Read and sign off evaluation forms. b) Place in intern files.
CSIC As received
10. Follow up on performance issues identified. If an intern does not pass a module, refer to policy 1.8 for procedures.
CSIC As identified
II. Interim (Internship Midpoint Evaluation) Action Who When 1. As part of routine updates, advise interns that
midpoint evaluation meetings are upcoming. CSIC In advance of
meetings 2. Prepare for meeting:
a) Review all Performance Objectives and Learning Activities Checklists and evaluation forms to date.
b) Identify performance trends and issues. c) Complete Interim Intern Evaluation Form.
Intern CSIC CSIC CSIC
Prior to evaluation meeting
3. Meet to discuss performance, make action plans if required, date and sign off Interim Intern Evaluation Form.
Intern CSIC
By February 15
4. Provide intern with a copy of the Interim Evaluation Form. Retain original for the intern’s file.
CSIC Following evaluation meeting
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1.06 Intern Evaluation July 14 09.doc Page 3 of 3
III. FNH 481 Completion
Action Who When 1. Complete Successful Completion of FNH 481
form. Email to DEC. CSIC Mid April
IV. Final (End of Program) Evaluation
Action Who When 1. As part of routine updates, advise interns that
final evaluation meetings are upcoming. CSIC Prior to meetings
2. Meet to discuss performance and sign off Final Intern Evaluation Form.
Intern CSIC
Final week of internship placements
3. Provide intern and UBC Dietetic Education Coordinator with copy of Final Intern Evaluation Form.
CSIC
Following final evaluation meeting
4. Complete communication requirements associated with program completion (see Policy 1.11 Completion of the Dietetics Program)
CSIC Early June (or when program end date is known)
190
1.08 Internship Performance Issues March 15 10.doc Page 1 of 3
Policy No.:
1.08
Current version: March 2010 Original version: August 2006
The University of British Columbia Dietetics Major
Approved by: UBC Dietetic Education Core Council
Title: Internship Performance Issues
Policy Throughout the internship year, progressive feedback approaches are used to keep interns informed of their progress and to assist them to achieve established goals (see Policy 1.6 Intern Evaluation). When performance issues arise, coordinators make every effort to assess contributing factors, modify placements as needed, and assist with goal setting. While the program is committed to assisting interns to achieve entry level competence during the internship year, operational constraints limit the extent to which internship placements can be extended. Unless there are extenuating circumstances, a maximum of 4 weeks of internship extension can be granted. When performance issues are due to personal or health reasons, an intern may opt or be required to withdraw from the internship year. Such an intern may be able to continue in the Dietetics Major and re-enrol in the internship in a subsequent year if the issues leading to withdrawal can be resolved. In the event of non-resolvable performance issues, an intern will not be permitted to continue with the internship and will be required to graduate from an alternate major. Procedure Action Who When A. Performance issues related to personal or health reasons
1. Inform Core Site Internship Coordinator (CSIC) of any personal or health issues with potential impact on internship completion and provide medical documentation if significant absences are required.
Intern As issues arise
2. Maintain communication with interns about personal or health issues that may interfere with successful internship completion.
CSIC Throughout internship year
3. Adjust internship schedule for limited duration absences.
CSIC As needed
4. In the event of potential requirement for an extended Intern CSIC
As needed
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1.08 Internship Performance Issues March 15 10.doc Page 2 of 3
Action Who When absence, meet to discuss issues and determine approach. Dietetic
Education Coordinator (DEC)
5. In the event internship course completion by the maximum extension dates set by UBC is not feasible, provide medical documentation and withdraw from the internship.
Intern As situation arises
6. Re-admit to a subsequent internship year upon receipt of medical documentation to confirm the intern is fit to return.
DEC As needed
B. Other performance issues
1. Use Evaluation Procedures (Policy 1.06) to monitor and document intern performance.
Preceptors CSIC
Throughout internship year
2. Keep CSIC informed of any significant performance issues arising.
Preceptors Throughout internship year
3. As required, provide feedback and adjust learning activities and preceptor supports to assist intern to pass the module.
CSIC As required
4. In the event an intern is expected to not pass a placement:
a) Alert the CSIC.
b) Prior to the evaluation meeting between preceptor and intern, review evaluation form prepared by the preceptor to ensure that issues are clearly documented and the box indicating that requirements of the placement have not been met has been checked.
Preceptor
CSIC
As required
5. If an intern does not pass a placement or module, assist the intern to address the performance challenges, as follows:
a) Establish a Written Learning Plan using the standard template. Include measurable objectives and timeframe (typical timeframe: 2 weeks).
b) Adjust current placements or arrange additional placement(s) to facilitate learning.
c) Note:
(i) Additional placements must not take time away from placements in other core modules. Options for scheduling additional placements include reallocating elective weeks or extending internship.
(ii) Internship extension should not be offered unless there are good indications that the intern will achieve entry level competence.
d) Meet with intern to present and discuss the Written Learning Plan. Ask the intern to sign the plan to verify
CSIC (in consultation preceptors and DEC)
As required
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1.08 Internship Performance Issues March 15 10.doc Page 3 of 3
Action Who When that it has been reviewed and discussed and the intern is committed to the plan. Provide the intern with a copy, retaining the original in the intern’s file.
6. Brief the next preceptor on the Written Learning Plan and requirements for the placement.
CSIC
7. At the end of the next placement, complete evaluation form to indicate whether the intern has met the requirements of the placement and the Written Learning Plan.
Preceptor
8. If the requirements of the placement have not been met and the Written Learning Plan has not been achieved, meet with the intern to discuss and to determine next steps. Inform the intern that issues and recommendations will be summarized in writing.
CSIC (in consultation with DEC)
As required
9. Using the Intern Performances Issues Summary template, document the issues, action plan, and consequences in the event the intern is unable to achieve the plan.
CSIC (in consultation with DEC)
10. Provide Intern Performances Issues Summary to intern to review and sign. In the event the intern refuses to sign, indicate this on the letter. Provide the intern with a copy of the signed document, retaining the original in the intern’s file.
CSIC (in consultation with DEC)
11. In the event that all remedial plans fail:
a) Arrange a meeting to communicate the decision to the intern.
b) If appropriate (and feasible, according to course drop dates set by UBC), counsel the intern to withdraw from the internship course and switch to an alternate major. or
c) In the event the intern is unable or unwilling to withdraw, advise the intern that he/she will not pass the internship course(s), internship placements will be discontinued, and he/she will be terminated from the Dietetics Major.
d) In the event of a termination, advise the intern of his/her appeal rights (see Policy 1.09).
DEC (in consultation with CSIC)
As needed
12. Summarize final decisions in a letter and request that intern sign. Provide the intern with a copy of the signed letter, retaining the original in the intern’s file. In the event the intern refuses to or is unavailable to sign, indicate this on the letter. Should the intern not be available to receive the letter in person, send a registered letter to the intern’s last known address.
DEC (in consultation with CSIC)
As situations arise
193
1.08 Intern Performance Issues Summary March 27 09.doc Page 1 of 2
UBC Dietetics Major FNH 481/482 Dietetic Internship
INTERN PERFORMANCE ISSUES SUMMARY
PURPOSE: For use by internship coordinators to summarize serious performance issues, outline required actions, and communicate potential consequences in the event performance issues are not addressed in the allotted timeframe. DATE: INTERN: CORE SITE: MODULE: SUMMARY OF ISSUES AND ACTION PLAN: Issue Competency Area
(Assessment, Planning, Implementation, Evaluation, Professional Practice, or Communication)
Action Plan By When
1. 2. 3. 4. (Insert additional rows as needed)
PLACEMENT PLAN TO FACILITATE LEARNING: (double click to select each that applies)
Adjust current placement(s) Describe:
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1.08 Intern Performance Issues Summary March 27 09.doc Page 2 of 2
Arrange additional placement(s) Describe:
Other Describe: APPROACH TO REVIEWING PROGRESS TOWARDS GOALS (double click to select each that applies):
Mid-placement evaluation (conducted by preceptor) End of placement evaluation (conducted by preceptor) Followup meeting with coordinator (provide details) Other (describe)
SUMMARY: Serious performance issues have been identified. Without immediate evidence of improvement, successful completion of the program could be jeopardized. INTERN COMMENTS: SIGNATURES: Signatures below indicate that this document has been reviewed and discussed. INTERN SITE COORDINATOR UBC DIETETIC EDUCATION COORDINATOR
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1.08 Written Learning Plan March 27 09.doc Page 1 of 2
UBC Dietetics Major FNH 481/482 Dietetic Internship
WRITTEN LEARNING PLAN
PURPOSE: For use by internship coordinators to establish a learning plan to assist interns to achieve entry level competencies. A Written Learning Plan should be developed when an intern has not successfully completed a placement or module. Plan should be developed in collaboration with interns and relevant preceptors. DATE: INTERN: CORE SITE: MODULE: SUMMARY OF ISSUES AND ACTION PLAN: Issue Competency Area
(Assessment, Planning, Implementation, Evaluation, Professional Practice, or Communication)
Action Plan By When
1. 2. 3. 4. (Insert additional rows as needed)
PLACEMENT PLAN TO FACILITATE LEARNING (double click to select)
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1.08 Written Learning Plan March 27 09.doc Page 2 of 2
Adjust current placement(s) within a module Describe:
Arrange additional placement(s) Describe: APPROACH TO REVIEWING PROGRESS TOWARDS GOALS (double click to select all that apply):
Mid-placement evaluation (conducted by preceptor) End of placement evaluation (conducted by preceptor) Followup meeting with coordinator (provide details) Other (describe)
SIGNATURES: Signatures below indicate that this document has been reviewed and discussed, and the intern is committed to the plan. INTERN SITE COORDINATOR
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1.09 Termination and Appeal Dec 6 11.doc Page 1 of 2
Policy No.:
1.09
Current Version: December 2011 Original Version: August 2006
The University of British Columbia Dietetics Major
Approved by: UBC Dietetic Education Core Council and LFS Student Services
Title: Termination and Appeal
Policy This policy is guided by UBC Academic Regulations. Program Termination: Dietetics is a regulated health profession. The program reserves the right to terminate students who do not meet professional expectations. Students may be terminated from the Dietetics Major for academic reasons (poor academic performance, professional or internship course failure) or for breaches of Policy 1.05 (Professional Behaviour). Appeal: Students who are terminated from the Dietetics Major have the right to appeal according to the University of British Columbia’s Academic Appeal Procedures. In the case of program termination related to professional expectations not being met, as the Faculty’s Academic Appeals Committee represents a diverse faculty and is unlikely to have dietetics expertise, an ad hoc Advisory Committee of impartial dietetics profession members familiar with dietetics education is formed to investigate the circumstances surrounding the termination and make a recommendation to the Appeals Committee. Procedure Action Who When 1. At the time of termination, inform terminated student
in writing of Academic Appeals Procedures. Dietetic Program Leader (DPL) with LFS Assistant Dean Students
As required
2. Provide Faculty with written notice of intention to appeal, using established UBC procedures.
Terminated student
By established deadline
3. In the event of termination for academic reasons, utilize standard LFS appeals procedures.
LFS Assistant Dean Students
As required
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1.09 Termination and Appeal Dec 6 11.doc Page 2 of 2
Action Who When
4. In the event of termination for professional reasons, form ad hoc Advisory Committee (AC) to review case details and advise the Faculty Academic Appeals Committee.
Committee to include 2-3 Registered Dietitians with student education experience (e.g., coordinator or preceptor), no previous relationship with the student.
DPL with LFS Assistant Dean Students
As required
5. Review documentation and if requested conduct interviews with individuals involved in the decision to terminate the student.
AC By established deadline
6. Prepare written report to summarize findings for Faculty Appeals Committee.
AC By established deadline
7. Identify AC representative to make a brief presentation at Faculty Academic Appeals Committee meeting.
AC By established deadline
8. If Faculty Appeals Committee does not include Dietetics faculty member, invite a Dietetics faculty member to participate in the meeting when the appeals case will be discussed.
LFS Assistant Dean Students
Prior to meeting
9. Meet to discuss the appeals case and make decision. Faculty Appeals Committee AC representative
On scheduled date
10. Inform student of decision. LFS Assistant Dean Students
Following meeting
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1.10 Facility Service Disruption March 27 09.doc Page 1 of 1
Policy No.:
1.10
Current Version: March 27, 2009 Original Version: August 2006
The University of British Columbia UBC Dietetics Major
FNH 481/482 (Dietetic Internship) Approved by: UBC Dietetic Education Core Council
Title: Facility Service Disruption
Policy 1. Internship placements are for the purpose of student learning and professional
development. If there are disruptions to placement site operations such that internship learning activities cannot continue (e.g., strike or job action by employees at the host institution, communicable disease outbreak, natural disaster), it will be necessary to alter or suspend internship placements until the disruption is over.
2. Interns are not permitted to work in a setting where a labour disruption is in effect. It is inappropriate to ask interns to do the work of bargaining unit employees during a labour dispute.
3. Core site internship coordinators, working in collaboration with the UBC Dietetic Education Coordinator, are to make every effort to adjust intern schedules and learning activities to minimize the impact of site operations disruption on internship learning and program duration. However, program extension may be required.
4. In the event of the need for program extension, interns are not required to pay additional tuition.
200
1.11 Completion of the Dietetics Program Jan 18 12.doc
Policy No.:
1.11
Current Version: January 2012 Original Revision: July 2006
The University of British Columbia UBC Dietetics Major
FNH 481/482 (Dietetic Internship) Approved by: UBC Dietetic Education Core Council
Title: Completion of the Dietetics Program
Policy 1. To successfully complete the program, students must successfully complete both academic
and internship components of the Dietetics Major.
2. The UBC Dietetics Program Leader (DPL) has ultimate responsibility for determining if a student has met program requirements.
Procedure Action
Who
When
1. Prepare Final Evaluation for each intern and meet with intern to discuss.
Core Site Internship Coordinator (CSIC)
June
2. Complete a Completion of FNH 482 Form (see attached) to communicate program completion information for the interns. Email to DEC.
CSIC
Early June (or as appropriate)
3. Organize a site intern recognition event.
CSIC June
4. Process final internship grades (pass/fail) at UBC. DPL Late June
5. Email list of students successfully completing program to Dietitians of Canada.
DPL Late June
6. Email documentation to regulatory colleges: a) Letter to confirm program requirements have been met
(signed by DPL) b) Copy of Degree Navigator Checklist to demonstrate
academic course completion. c) Successful Completion of Dietetic Internship form (signed
by DPL)
DPL Early June (or as appropriate)
7. Apply to UBC for November graduation. Students August
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1.12 Affliation Agreements Jan 18 12.doc Page 1 of 4
Policy No.:
1.12
Current version: January 2012 Original version: August 2007
The University of British Columbia UBC Dietetics Major
FNH 481/482 (Dietetic Internship) Approved by: UBC Dietetic Education Core Council
Title: Affiliation Agreements for Non-Health Authority Placements
Policy 1. This policy is guided by The Student Placement Package Instructions developed by The
Office of the University Council. Should there be a discrepancy between this policy and procedures and those of the University Council, the University Council documents take precedence.
2. Legal affiliation agreements are required for all student placements except those consisting of short-term observational experiences.
3. All student placements within British Columbia Health Authorities are covered by a master affiliation agreement with UBC.
4. For non-health authority placements, affiliation agreements must be established.
5. The UBC Dietetic Education Coordinator (DEC) is responsible for ensuring that affiliation agreements are established.
6. No student placement may begin until all required documents have been signed off.
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Procedures Action Who When 1. When a non-health authority placement is
scheduled, check the list of existing agreements (Dietetic Internship Website) to determine if an agreement for that site will be in effect during the dates of the placement (many agreements are set up to be in effect for two years).
Core Site Internship Coordinator (CSIC) (if non-elective placement) Intern (if elective placement)
At the time of scheduling
2. If a necessary agreement does not exist, complete an Information Needed to set up a Dietetics Affiliation Agreement form (see attached; Word version available in Policy and Procedure section of Internship Website) and send to UBC Dietetic Education Coordinator (DEC).
CSIC After checking Dietetic Internship Website and at least 3 months before the placement start date.
3. Use information obtained from site to complete required forms to set up an agreement. Send to the designated contact at the Office of the University Counsel for review.
DEC or designate
ASAP
4. Send out finalized forms for signatures. DEC or designate
After any final changes approved by Office of the University Counsel
5. Inform sites of any issues arising related to affiliation agreements.
DEC or designate
As issues arise
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UBC Dietetics Major Affiliation Agreements
Information Needed to Set Up Dietetics Affiliation Agreement
Information Required Details Proper legal name of facility or organization (registered name in the Province hosting placement – if host is conducting business but does not have a registered business name put N/A)
Private practitioners without a registered legal name: indicate the name practitioner is doing business under
Doing business as
Placement host description Put an X beside the listed item that best describes the placement host: Health care facility Organization Private practice Other (please describe):
For organizations only, describe key function of the organization (e.g., retail grocery store chain, telephone nutrition counselling service, food service contract company)
Name and contact information of contact dietitian at placement facility or organization
Facility or organization address (placement location)
Mailing address (if different than placement address above)
Is this agreement for a one-time placement? If yes, indicate start and end dates if known
Might UBC dietetics students be placed at this site on a regular basis? (if yes, a 2 year agreement will be set up to cover future placements)
Name of authorized legal signatory for the facility/organization (person who normally signs affiliation agreements on behalf of the organization)
Position title of authorized legal signatory for the facility/organization
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Information Required Details Pre-placement requirements: All students are required to meet the following requirements prior to placements. Please list any additional requirements of the facility/organization/practice. Criminal Records Check: All students are required to have a current criminal records check. Insurance: All students are required to have current BC medical coverage in addition to student accident insurance purchased through UBC (they are not eligible for WorkSafe coverage as they are not employees). Immunization: All students are required to have up to date immunizations per health authority guidelines (tetanus/diphtheria; poliomyelitis, measles, mumps & rubella; hepatitis B; varicella (Chicken Pox); tuberculin; influenza).
Other rules, policies student to be aware of (e.g., confidentiality agreement)
Please send this information to [email protected] or [email protected] who will arrange preparation of a legal affiliation agreement for review and signing.
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1.12 Information Needed to Set up Dietetics Affiliation Agreement Dec 16 11.doc Page 1 of 2
UBC Dietetics Major Affiliation Agreements
Information Needed to Set Up Agreement
Information Required Provide Details Below Placement “facility” Notes: - Although the UBC student agreement uses
the term “Facility”, this could be a hosting organization, company or private practice
Name of hosting facility, organization, company, or private practitioner:
Dietitian contact for the agreement (if applicable)
Name: Email Address:
“Facility” description Put an X beside the listed item that best describes the placement host: Health care facility Organization Private practice Food service contract company Other (please describe):
“Facility’s” location
Mailing address of placement site (with postal code):
Legal name of the Operator responsible for the “facility” Notes: - Registered legal name of the operator of
the “facility” (or organization, company) in the Province or jurisdiction hosting placement.
- To avoid delay in getting the agreement finalized, please ensure that a registered legal name is provided.
- Private practitioners who do not have a registered business name may use one of the following options:
o personal legal name o personal legal name followed by
the unregistered company name they are using (e.g., Jane Smith, doing business as Eat an Apple Nutrition).
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1.12 Information Needed to Set up Dietetics Affiliation Agreement Dec 16 11.doc Page 2 of 2
Information Required Provide Details Below Operator’s contact information Note: The contact person here is the person who will receive correspondence about the agreement, arrange for authorized legal signatures, and return signed agreement to UBC.
Name of contact person for the agreement: Email address of contact person: Phone number of contact person: Fax number of contact person: Mailing address with postal code:
Type of placement agreement Note: - Choose ongoing if there is a high likelihood
that additional dietetics students will be placed at this location in the future.
- Setting up an ongoing agreement does not obligate a facility/organization to take students; sites make this decision on a per request basis.
- For ongoing agreements, UBC’s preference is to set up a 5 year term to limit the need to renew agreements. This term can be modified at the request of the hosting organization.
Put an X beside the agreement type: One time Ongoing Any requests related to term of ongoing agreement:
Dates of next student placement (if known)
Pre-‐placement requirements All dietetics students are required to meet the following requirements: - Criminal Records Check per BC Criminal
Records Review Act requirements - Insurance: BC medical coverage plus
student accident insurance purchased through UBC (note: students are not eligible for WorkSafe coverage as they are not employees)
- Immunization schedule per health authority requirements
- Review and abide by any regulations, rules, policies and procedures provided by the placement site
If there are any additional requirements, list them below:
Please send this information to [email protected] who will arrange preparation of a legal affiliation agreement for review and signing.
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1.15 Professional Behaviour Dec 6 11.doc Page 1 of 2
Policy No.: 1.15
Current Version: Dec 6, 2011 Original Version: November 2009
The University of British Columbia
Dietetics Major Approved by: Dietetic Education Core Council in consultation with LFS Student Services
Title: Professional Behaviour
Background As outlined in the Policies and Regulations section of the UBC Academic Calendar, all UBC students are required to observe policies and guidelines established by the University and Faculty. This includes a requirement to behave in a collegial manner and contribute to a learning environment that is professional, respectful, and free of discrimination and harassment.
In addition to following conduct policies and guidelines established by UBC and the Faculty, students in the Dietetics Major are also required to observe conduct policies established by health authorities or other placement agencies when participating in internship or professional practice course placements.
Dietetics is a professional program. Accordingly, the Faculty of Land and Food Systems must ensure that all students in the program demonstrate the competencies required for registration with a provincial dietetic regulatory college. These competencies include expectations for professional behaviour.
The document, Required Skills and Abilities for Students in the UBC Dietetics Major (available in the admissions section of the LFS Dietetics website), includes expectations related to behavioural and interpersonal conduct. This document provides examples of the professional practice skills and abilities that are required for all dietetic program applicants and current students as well as how they are applied throughout the Dietetics program.
Policy Upon entering the Dietetics Major, all students are expected to review and abide by the requirements of Policy 1.15. Professional behaviour is expected by students at all times in both campus and professional practice placement settings.
Professional behaviour is assessed during professional practice and internship courses. Behaviour in other courses and general interactions while in the program may also be considered.
Breaches of professional behaviour expectations are taken very seriously. Regardless of a student’s academic standing, the Faculty reserves the right to require students who do not behave professionally to withdraw from the Dietetics Major.
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1.15 Professional Behaviour Dec 6 11.doc Page 2 of 2
Procedures Action Who When
1. Utilize established feedback mechanisms to assist students to address inappropriate behaviour.
Course instructors, Core Site Internship Coordinators (CSIC), Dietetics Program Leader (DPL), and/or Dietetic Education Coordinator (DEC)
As situations arise
2. Refer serious and/or chronic student behavioural issues to Student Services and/or the Dietetics Program Leader (DPL).
CSIC, LFS Student Services, students, others as required
As situations arise
3. Work in collaboration with LFS Student Services and/or internship site(s) to determine an appropriate course of action. Refer to UBC, LFS, and internship policies as required.
DPL/DEC As situations arise
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The University of British Columbia
Dietetics Major
Policy No.: 1.16
Current Version: DRAFT November 21, 2011 Original Version: DRAFT August 2010
Approval: UBC Dietetic Education Core Council
Title: Academic Regulations and Requirements
Background All students of UBC are bound by the following declaration http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,285,0,0: "I hereby accept and submit myself to the statutes, rules and regulations, and ordinances (including bylaws, codes, and policies) of The University of British Columbia, and of the faculty or faculties in which I am registered, and to any amendments thereto which may be made while I am a student of the University, and I promise to observe the same." Students in the Dietetics Major are subject to UBC policies and regulations. Due to the professional nature of the program, there are also program-specific requirements. The first section of this document outlines UBC regulations and requirements applicable to all students. The second section describes program-specific requirements for the Dietetics Major. Summary of UBC Academic Regulations and Requirements Academic Accommodation for Students with Disabilities Academic accommodation is provided to students with disabilities in accordance with the Human Rights Code (BC) and the Canadian Charter of Rights and Freedom. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,34,0,0 Academic Assessment Details regarding examination procedures, examination hardship, results, deferred or supplemental examinations, and viewing marked work are outlined in the UBC Calendar. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,41,0,0 Academic Concession Students may request academic concession in circumstances that adversely affect their attendance or performance in a course or program. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,48,0,0 Academic Freedom All members of the University have the right to “freedom, within the law, to pursue what seems to them as fruitful avenues of inquiry, to teach and to learn unhindered by external or non-academic constraints, and to engage in full and unrestricted consideration of any opinion.” http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,33,86,0
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Academic Honesty and Standards UBC students are expected to behave as honest and responsible members of an academic community. Failure to follow the policies on academic honesty may result in disciplinary action. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,286,0,0 Academic Performance Evaluation In the Faculty of LFS, academic performance is evaluated at the end of the winter session. Based on this evaluation, a student will either be promoted to the next year or placed on academic probation. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,237,0,0 Attendance Regular attendance is expected of students in all their classes. Students who are absent because of extenuating circumstances should notify their instructor in advance. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,36,0,0 Change of Registration Details regarding course registration and withdrawal are outlined in the UBC Calendar. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,45,0,0 Grading Practices Percentage and letter grade guidelines are listed in the UBC Calendar. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,42,0,0 Graduation Following completion of internship courses in June of program year 5, students must apply for graduation via the Student Services Centre. The application deadline for November congregation is August 31. Application for graduation is necessary, regardless of whether or not a student intends to participate in the ceremonies. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,44,0,0 Retention of Student Records Academic records are kept indefinitely. Materials supporting applications for admission, correspondence, and transcripts from other institutions and similar material may be destroyed five years after a student’s last registration. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,51,0,0 Review of Assigned Standing Students who would like to appeal a course grade must submit an application form to Enrolment Services. Applicants must clearly state why he or she deserves a higher course grade. The student must also submit an application fee, which will only be refunded if the mark is raised. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,49,0,0 Student Conduct and Discipline Academic misconduct includes cheating, plagiarism, submitting the same assignment more than once, impersonating a candidate at an examination and submitting false information or documents. Non-academic misconduct includes disrupting instructional activities, damaging, removing or making unauthorized use of university property and assaulting individuals. Acts of academic or non-academic misconduct are subject to disciplinary measures. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,54,0,0
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Teaching Evaluation Instructors of campus-based courses are annually evaluated by procedures which include provision for assessment by students. In the Faculty of Land and Food Systems (LFS), students are given the opportunity to complete online evaluations at the end of each course. http://www.calendar.ubc.ca/vancouver/index.cfm?tree=3,35,0,0 Summary of Requirements Specific to the Dietetics Major Academic Accommodation for Students with Disabilities The skills and abilities required by students in the Dietetics Major are outlined in the document, Required Skills and Abilities for Students in the UBC Dietetics Major (available in the admissions section of the LFS Dietetics website). Any prospective or current student who has concerns about whether or not they have the required skills and abilities for admission to or progression through the Dietetics Major program can contact the UBC Access and Diversity office (604-822-5844 or http://www.students.ubc.ca/access/drc.cfm). In accordance with UBC policy, when appropriate, an effort will be made to negotiate reasonable accommodation of student needs, such that they can meet the required skills and abilities. Academic Leave The Dietetics Major generally has fixed scheduling, due to the integrated internship component. Only in extenuating circumstances may a student take leave of absence. Such circumstances may include: illness, family issues (e.g., family relationship breakdown, death of a close relative), hardship (e.g., sudden loss of employment, victim of crime), and conflicting obligations (e.g., representing the University, province or country in a competition or performance). As situations arise, students discuss with the DPL/DEC to provide any required documentation. Academic Exchange Due to the fixed scheduling of the internship year, it is typically not possible for students in the Dietetics Major to go on academic exchange. If a student enters the program ahead on upper level coursework and can arrange an exchange without impacting completion of pre-internship courses it may be possible. Any student in this position should consult with the Dietetics Practice Leader (DPL)/Dietetics Education Coordinator (DEC) before applying to do an exchange. Academic Standing To remain in good standing, once admitted to the Dietetics Major, students must pass all courses, continue to perform at or above the minimum academic average for entry into the program (70%), and achieve a minimum level of academic performance (68%) in each upper level Food Nutrition and Health (FNH) course. Students are required to report any emerging academic struggles to the DPL/DEC so remediation plans can be established. LFS Student Services will complete an annual review of academic performance to ensure students enrolled in the Dietetics Major remain in good standing. The program reserves the right to remove a student from the program who does not meet minimum academic standards. Advance Placement for Internship Occasionally there are unexpected internship vacancies, allowing students who are ahead on coursework to complete their internship in year 4. The number of such opportunities is typically limited. When advance placement internship opportunities do arise, first priority is given to those students requiring the fewest credits to complete program requirements and with the least need
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to be forced into courses. Approved students must complete both May professional practice courses simultaneously. Course Exemption Students who have taken upper level courses at another institution may submit course information to the DPL/DEC to request an exemption. Course Sequencing Courses in the program have been organized to facilitate learning. Students must take courses in the required order. Professional practice courses are scheduled in May following each of program years 3 (FNH 381) and 4 (FNH 480). Students will only be permitted to take both courses simultaneously when there is a program-related rationale (for example, availability of an advance placement internship position). Requests for personal reasons will not be considered. Dietetics as a Second Degree Students completing dietetics as a second degree must meet all dietetics major course requirements. They must obtain 60 credits that were not used towards the previous degree. Internship Eligibility Internship positions are limited. Each student entering the program has an internship reserved for her or him in Year 5. To be eligible to enter the internship, all pre-internship courses must be completed successfully. Unless there are extenuating circumstances, internship scheduling will not be altered for a student who has not met pre-internship course completion requirements. The program reserves the right to remove such a student from the program. Internship Scheduling Scheduling within internship courses is subject to core site operational requirements. Students are required to accept site scheduling decisions. Professional Behaviour Refer to Policy 1.15. Requirements to Receive a Degree Program requirements are listed in the Dietetics Major entry in the UBC Calendar. To receive a degree in Dietetics, students must successfully complete all campus based required courses and internship courses. Space in Courses Students are guaranteed enrolment in required program courses. However, for electives, enrolment is limited and there is no guarantee that space will be available for these courses. Studying at Another Institution Although pre-program courses may be taken at other institutions, once a student is registered in the Dietetics Major, core program courses must be taken at UBC. With special permission of the DPL/DEC and Faculty, a student may be able to take an elective course at another institution.
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