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Program Directors and Professors
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These resources help
you teach counseling skills to future nutrition
Professionals...
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February, 2010
March, 2010
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2010
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2010
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2011
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2011
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2011
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2012
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2012
February, 2010
In this
issue:
Inspiration
from the field:
Melanie Brede, MS, RD, CSSD, is a preceptor who works at
the University of Virginia’s Student Health Center.
She has this strategy for interns who want to practice
counseling with patients in an outpatient setting when
their skill level is not yet adequate. First, she
assigns Counseling Tips to the interns to read. Then
they observe one of her sessions and use the Counseling Session
Feedback Form to pick out the skills they see
demonstrated. If Melanie is seeing a client who would
feel uncomfortable with an intern in the room, she
lets the interns use the Feedback Form with a previously
recorded session.
Interns get frustrated when we don’t let them counsel real clients. When they do work with clients, they understandably focus on the content of what they need to cover because this is fairly new to them. Their process tends to get off track, and we cringe. This interim step of focused observation gives them experience with attending to the process when it’s easy to get distracted by the content. It may be useful to set up the observation session by promising to discuss the nutrition issues afterward, but emphasizing that you want them to focus this time on tallying open and closed questions or by noticing the client’s “change talk.”
You could choose the Tips or you could let the interns choose a few (thereby demonstrating choice). You and the interns could design the observation exercise based on the Tips chosen. For example, an intern may be fascinated with self-disclosure and what to do when clients ask personal questions. You would assign Tips #1, Self -Disclosure, and #18, How to Handle Personal Questions. Then during the session, the intern can be assigned to jot down any self-disclosure on your part and/or note times she would have been tempted to add something about herself if she were the counselor. Afterward, discuss the pros and cons of each example of disclosure.
Share your
strategies! Got something that is working well? Send
me an e-mail.
In a coming issue, I’d love to see:
• Ideas on coordination to further learning of
counseling skills. Do you have experience coordinating
between a DPD program and a DI program in the same
institution? What ways have you found within a DI
program to coordinate efforts from one placement to
another?
• Formats or checklists that you use to show students
how a session can smoothly incorporate both
client-centered counseling and the Nutrition Care
Process. I’ve been sent one and would love to share
several.
• Methods for feedback to students/interns on their
counseling process. Anyone using the standardized
patient process described in these articles?
o Henry, B.W, Duellman, M.C, Smith, T.J. Nutrition-based
standardized patient sessions increased counseling
awareness and confidence among dietetic interns. Top
Clin Nutr. 2009;24:25-34.
o Henry, B.W, Smith, T.J. Evaluation of the FOCUS
(Feedback on Counseling Using Simulation) instrument for
assessment of client-centered nutrition counseling
behaviors. J Nutr Educ Behav. 2020; 42:57-62.
Q:
I have your Toolbox of materials and am teaching
counseling skills to undergraduates for the first time.
Can you direct me to basic exercises for first-time mock
counseling?
A: I
would start with the Mirroring Exercise since the
process of reflecting is so critical to all counseling.
Some students are natural mirrors, and reflecting will
come easily since they already do it in their social
conversations. For them, you are highlighting a natural
process they can employ strategically with clients.
Other students do not yet mirror out loud in their
social interactions, and the skill will be difficult and
take practice. All students will benefit from your
suggestion to practice it with friends and bring their
experiences to the next class.
The Unpacking Exercise gives students a chance to practice focusing on what is important to the client without the distraction of nutrition content. I have often seen even experienced nutrition counselors get off track quickly when instructed to unpack what is important to their mock client when the topic is nutrition or health. Instructing the “client” to talk about something that matters to him (unrelated to health or food) makes it more likely that the counselor will not get off track and give advice too soon. The counselor can focus on exploring the topic in detail, practicing open-ended questions and reflecting.
The Elicit/Provide/Elicit Exercise works well, too. Students may be excited about providing nutrition advice. Introducing this process for embedding the advice in a client-centered frame early in their training will serve them well later.
Free
Webinar:
Looking
for content on eating disorders for your students
or interns?
Here is a
link to a 75-minute
webinar you are free to share. It was recorded in
January, 2010 for the ARAMARK Dietetic Internship
Program. I serve as a volunteer for A
Chance to Heal, an advocacy and education non-profit
in Philadelphia and conduct several lectures per year
for future health professionals to ensure they will
respond appropriately when they encounter an eating
disorder. I share this to further this mission.
Resources
from others:
Run into articles, textbooks, videos, websites or other
resources that help you do a better job? Let me know and
I’ll post them here.
Here’s one of my favorite articles: Miller, W.M, Rose,
G.S, Toward a theory of motivational interviewing.
American Psychologist. 2009; 64:6, 527-537.
It reviews the latest research on the effectiveness of
Motivational Interviewing. I particularly appreciate
that it includes research on training for MI. It’s
probably most appropriate for graduate courses, though
I’d love to hear feedback from others who have
assigned it.
March, 2010
In this issue:
Fascinating conversations on the spring
conference call!
Topics included:
- How to include body image in curriculum
- What should be included in a new textbook that one of the callers is working on
- The role of supervision in our profession (or lack of it) and how to bring this into training for future RDs
- Incorporating concepts and practical aspects of collaboration in health care teams
- An interesting way to develop “cases” to use in nutrition counseling
practice
- Using discussion boards for responses in courses
Here's the recording.
The next call will be scheduled in the fall. Look for an announcement in
this newsletter.
Q. Should I introduce
supervision to
my students and interns?
A. Yes. Early and often!
The concept of supervision has been only sporadically
adopted in our field. In simple terms supervision is
any interaction with a professional colleague for the
purpose of maximizing the quality of practice. It is
used extensively in counseling fields both in
training and on-going practice. This process includes
case consultation as well as counseling designed to
advance the supervisee's skills.
Students, even at the undergraduate level can be introduced to the term and given an explanation
of it's purposes and value. In classes where
counseling skills are taught and practiced, the feedback process employed in the
training is a type of supervision. Urge
students to look for such support and guidance throughout their
careers.
Interns expect to receive supervision in their
work. They can be encouraged to continue this
learning process as they begin their careers and
on-going! Let them know that they will need to actively seek out
this feedback once they are practicing.
Resources
Here is a pdf of Counseling Tip
# 11, Professional Supervision. Feel
free to use as a class handout. It is included in
Chapter 11 of Counseling Tips for Nutrition
Therapists: Practice Workbook, Vol 1.
This recent article in the New York Times may be
useful for class discussion of the effect of health
professional prejudice on patients:
Essay by Harriet Brown: For Obese People, Prejudice in Plain Sight
March 16, 2010
Looking for Resources
Several callers on the recent conference call
asked for ideas of materials to help teach students
about body image. If you have some you like, e-mail
me and I will share them.
It's ready!
Step By Step: A Program for
Dietetic Interns to learn counseling skills
- Designed to complement Dietetic Internship
outpatient rotations.
- Focus is on the basic skills that are the
foundation of quality nutrition counseling.
- All on-line and available immediately upon
purchase.
Find out more.
June, 2010
In this
issue:
- Inspiration from the field: Giving interns
useful counseling experience
- Q & A: What teaching
materials will best support my program?
- Resources: New JADA review
article
- Updated on-line training for
Interns
Inspiration from the field: Providing counseling experience for interns
Melanie Brede, MS, RD, CSSD
Molly shared with me the program
she has developed for training interns counseling
skills. I tried it out this winter. The University
of
Virginia
interns spend one week each with me in the Student
Health
Center. They have one other outpatient rotation through the
hospital’s outpatient nutrition counseling center
(all sorts of patients), and bits of outpatient woven
into rotations through the oncology, diabetes, and
renal clinics. These clinic experiences are much more
education focused than counseling focused. My
department houses a Peer Health Education (PHE)
program with 40+ undergraduate PHEs who do limited
nutrition education in one-on-one sessions and group
presentations. I was able to use these PHEs to
enhance the experience for the interns.
All the interns very much
enjoyed using the materials. They were able to absorb
the content efficiently/effectively by listening to
the podcasts. They used the accompanying articles
primarily as supplements. The case examples helped
illustrate points. They also found the sample
“Protocols” helpful. For example, the list of
steps to take in dealing with resistance.
Prior to experimenting with your
new materials, to structure their rotation with me, I
had selected a number of your Tips as part of their
required reading for the rotation. Then during the
week I’d have them sit in on as many of my sessions
as possible and/or listen to sessions I’d recorded.
I’d have them complete the Counseling Session
Feedback Form for several of these sessions, and
we’d debrief after sessions. As much as possible,
I’d have them conduct some sessions and I would sit
in to evaluate their work and be available when they
needed help.
As we’ve experimented with
various strategies and your materials, I’m
beginning to find a structure that seems to flow
well. I have
one of our PHEs do a “practice session” with the
intern early in the week. I’m finding this step
extremely helpful in assessing their baseline skills.
I can more efficiently direct the intern in our
limited time. For example, if the intern is doing
well with open ended questions, I have her focus on
another skill. It seems that both I and the intern
feel more confident and less. And in situations where
it is hard to give the intern the opportunity to
practice with a real patient (patients that aren’t
well matched, cancellations/no-shows, etc), having
the practice session guarantees an opportunity for
the intern to gain some experience.
I’m also finding that when the
interns listen to the podcasts, use the notes, and do
the readings, they are more ready to use the
Counseling Session Feedback Form. Since the podcasts
are short, it is easy to productively and flexibly
structure their time between reviewing materials,
sitting in on sessions, listening to recorded
sessions, conducting their own sessions, and
completing other health promotion programming
assignments.
It makes sense that interns (and
all of us!) develop counseling skills over time. I am
hopeful that I will be able to coordinate with the
other preceptors in this internship program to have
the interns utilize parts of the materials you’ve
developed during their rotation with me and parts in
their other rotation(s). I think that the way
you’ve structured the materials will make this
easily doable, and I’m confident that we’ll be
putting our heads together before the next class to
develop a schedule and plan.
Q. What materials would best supplement our
internship or didactic program?
A. It depends.
I often get phone calls or e-mails from DI
directors and professors looking for books, videos
and other materials to help them teach counseling
skills to future nutrition professionals. Here are
some of my thoughts and suggestions...
1. Textbooks: I hear this complaint often. Professors struggle to find one text book that
provides the basics of counseling theories and
strategies along with case studies and ways to
practice the skills. For a discussion of what others are using,
you might want to listen to some of the conversations
we had on the Educators
Conference Calls over the last few years. Many
courses and DI programs are using my Practice
Workbook as either required or supplemental
reading. For a full course, the workbooks are not
sufficient alone. Because they were developed
to be practical guides for practicing dietitians,
they do not cover research on behavior change
theories and strategies. They are practical tips based on the
research.
2. Videos: There are several
excellent motivational interviewing training videos
available at www.motivationalinterview.org.
Many of the good ones are too long to show during a
class and I have gotten feedback that students find
it difficult to "translate" the skills
shown to nutrition settings. They may work better in
graduate courses. There are 18 short videos
demonstrating counseling skills in nutrition settings
included in the Toolbox
for Nutrition Counseling Education. These videos
are designed to fit into a course taught by a
clinician who is comfortable teaching counseling
skills. A professor can choose to develop his/her own
lectures or save some time by using the slides
included in the Toolbox. These materials also fit
into the didactic portion of an internship if the
program has a faculty person who is skilled at
counseling.
3. On-line learning: Modular resources that
interns or students can access in their own time can
fit well into a busy schedule. The Step-by-Step
Program uses short podcasts and supplemental
readings. It can be assigned either during the
introductory portion of a DI program and/or during
ambulatory rotations. Many Internships schedule
a counseling class in the first weeks of the program
and are then frustrated that the interns have
forgotten much of it by the time they reach
out-patient rotations. Adding the modules timed to
these rotations can layer in practical learning.
A final thought... I often hear that
Internship Directors (and some interns) are
frustrated with a discrepancy between the up-to-date, evidence-based skills
they want to teach and the skill level of some
preceptors. I anticipate that the Step-by-Step
Program will addresses this concern. The program
involves the preceptors in the learning process. They
are encouraged to listen to the podcasts and do the
reading in order to earn CPE credits.
Resources
In this month's JADA:
State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior
Change;
Joan
ne M. Spahn, MS, RD, FADA, Rebecca S. Reeves, DrPH,
RD, Kathryn S. Keim, PhD, RD, LDN, Ida Laquatra, PhD,
RD, Molly Kellogg, RD, LCSW, Bonnie Jortberg, MS, RD,
CDE, Nicole A. Clark, DCN, RD, LDN, CDE; J Am Diet Assoc, 2010;110:879-891.
It's ready!
Step By Step: A Program for Dietetic Interns to learn counseling skills
- Designed to complement Dietetic Internship outpatient rotations.
- Focus is on the basic skills that are the foundation of quality nutrition counseling.
- All on-line and available immediately upon purchase.
- Four credits for preceptors at no additional
cost!
Find out more.
September,
2010
In this
Issue:
-
Inspiration
from the field: Engaging students
-
Q and
A: Making the best use of shadowing
-
Resources:
Eating Disorders Webinar
Shelley
Mesznik, MA RD CDE CDN is an instructor at Teacher's
College, Columbia University. She has taught nutrition
counseling to graduate students for many years and loves
experimenting with new assignments.
"I gave a new assignment this year regarding your tips. It worked very well. I’ll
do it again next semester. Half the class bought Volume 1 and the other half bought Volume 2 of your tips. I broke up the class into 5 groups of 5 students each. I asked each group to read 10 tips assigned by me in such a way that all 50 tips were covered.
"Part 1
of the assignment was written. They had to summarize
each of their 10 tips (for practice paraphrasing) in writing and describe in writing how the tips tie in with what the student knows about Motivational Interviewing (review for the student of the spirit, principles and tools of MI).
They also wrote about which tip was most useful, which most difficult, and which they were already using.
"Part 2 asked the group to get together and select two out of the ten tips that they considered to be the best and do a presentation to the class.
They had freedom to do the presentation anyway they wanted to, but they only had 6 minutes for 2 tips.
"The groups were fabulous.
Some used PowerPoint. Most groups role played the tips. It was entertaining, educational, and creative.
The ten tips that were presented were then put into the Tip Olympics. The class voted and chose which tip it found best for a Gold Medal, second place got Silver, and third got Bronze.
"My
teaching assistant took the list of 10 tips and typed it up. The students received a handout of the 10 tips they had selected and would be voting on. I felt that
the list was a good handout for beginning counselors."
Q: How to give interns
useful counseling training when they are only
observing sessions? A:
Give them a specific assignment. It is a
challenge to provide real counseling experience to
interns in settings where it is not appropriate to allow
them to provide this service to patients. They may only
be able to observe. In most cases the intern's attention
is on the content of the session. This is, of course,
important. However, if we want them to learn quality
counseling process, it is essential to attend to the
counseling process as well. Experiment with
various assignments that focus the intern's attention on
process. For example:
- Provide a simple list of the phases of a session
and ask them to jot down a few words from each phase
that they observed.
- Review the process of reflection and ask them to
tally up the number of reflections they hear the
counselor make. Some interns may be able to categorize
the various types of reflections.
- Assign them to tally up all the change talk they
hear from the client. For more advanced
practice, notice how many of the change talk
statements were reflected. Pick a few examples of
the change talk and jot down how you could have
reflected it.
- Tally up the counselor's open and closed
questions.
- Attend to affirmations provided by the counselor
and jot down some that could have been offered.
Resources
Looking
for content on eating disorders for your students
or interns?
Here is a
link to a 75-minute
webinar you are free to share. It was recorded in
January, 2010 for the ARAMARK Dietetic Internship
Program. I serve as a volunteer for A
Chance to Heal, an advocacy and education non-profit
in Philadelphia and conduct several lectures per year
for future health professionals to ensure they will
respond appropriately when they encounter an eating
disorder. I share this to further this mission.
All I ask
in return is that you e-mail
me to let me know how many have seen it and whether they
were students, interns or practicing RDs.
March,
2011
Update on the Step by Step Program:
Twenty
Dietetic Internship programs and a few WIC programs
are using this all on-line training during this
academic year.
Some of the feedback from interns:
- Listening to the podcast and then practicing
right away really worked well.
- Hearing about resistance to change helped me
understand the patients better.
- I like that my preceptor listened to the
podcasts too. She showed me how she was using the
skills.
- I liked discussing the skills with the other
interns.
Preceptors have also benefited from joining in
with the interns. Many took advantage of the credits available.
Here is some of their feedback:
- I wish I had learned these skills early on in my career.
- Not only did it provide education on theories and skills, but it also allowed for role playing and critiquing to teach and enforce
the skills.
- This helped the interns establish rapport
with patients.
- Listening made me want to start putting the practical advice
to use right away in my own practice. Then I can better
assist the interns when they join me.
I am collecting suggestions to make the program
even better for the 2011-2012 year. Given the
need I hear from WIC Program supervisors, I may
produce
a separate WIC-oriented Step by Step Program.
Several DI programs have asked me if they can purchase
the 2011 program now when they have the funds available.
No problem, just mention that in the comments section
when you order on- line and you will be added to the
list to receive the 2011 link in July.
Q: What can we do as educators when we get stuck in class while trying to model the client-centered process!!
A: Keep it simple and focused.
Determine ahead what specific techniques you want
to demonstrate and limit the demo to a short section
of a client session. Students will likely be able to
take this in better anyway. For example, demonstrate the
opening of a session with rapport-building
strategies, or just focus on agenda-setting or on the
advice-giving section of the session.
Avoid the "client from hell." When
we ask someone to role-play a client they will
naturally take on a negative stereotype. (For an
example, see this humorous YouTube
video.) This is kind of role-play is of
minimal value to demonstrate effective counseling
process. When asking a student to "be a
client" direct her to be real and actually
engage with you as herself.
Consider developing a relationship with a colleague
who is willing to come into the classroom and model
the client. Talk ahead about the purpose of your
demonstration and the elements of the case you want
to point up. Then run the session ad lib.
If you do not feel competent enough to spontaneously
demonstrate in class, stick with using videos.
Consider working on your competence by practicing
specific skills one at a time with our own clients or
with a colleague.
Finally, if you get stuck in front of
the students use it as a learning experience for them
on how difficult these skills are and how much they
will need to practice to gain competence.
Resources
Looking for nutrition controversies to provoke
discussion in your classes? Check out this
article by our colleague Jule Anne Henstenberg of
LaSalle University.
Taxation of Sugar-Sweetened Beverages for Obesity Control:
The Need to Talk in “Code”
Jule Anne Henstenburg, MS, RD, CSP, LDN
May, 2011
Inspiration from the field: An
externship for more counseling practice
Dawn Clifford, PhD, RD
Assistant Professor and Director,
Didactic Program in
Dietetics
California
State
University
,
Chico
Our
undergraduate dietetic students take a Nutrition
Counseling and Education course. In the counseling half
of the course, I cover the characteristics of a
counselor, applying the nutrition care process to a
counseling setting, motivational interviewing, non-diet
approaches to counseling as well as physical activity
counseling. At the end of the semester, students
participate in a videotaped role play experience, but
this just whets their appetite. On our exit surveys each
year, many students stated that they wanted more time to
get comfortable with nutrition counseling. We couldn’t
split the course into two and add more units, so we came
up with an alternative:
an optional 1-unit nutrition counseling training
internship for students.
One
unit at
Chico
State
means three hours each week learning and practicing
their skills. The unit is a pass/fail. They are asked to
keep track of their hours, and as long as they complete
their hours, they pass. One hour each week is spent in
class. They are given ideas for spending their other two
hours each week. They can (1) read articles and books on
nutrition counseling, (2) watch counseling videos that
have been uploaded to their class page, (3) practice
their OARS (open-ended question, affirmations,
reflections, and summaries) during conversations with
friends, or (4) shadow other nutrition counselors
through a program we have on campus, FitU (www.csuchico.edu/fitu).
(Note: Our FitU counseling office has a mirrored window
and clients sign a release stating that they agree to
observation by others in training.)
During
the one hour nutrition counseling training class each
week, we revisit the topics covered in the Nutrition
Counseling and Education course. We mainly focus our
attention on motivational interviewing and incorporating
non-diet approaches into counseling sessions. Towards
the end of the semester, we cover MNT-based counseling.
During the hour I spend the first 5-10 minutes
revisiting a topic from their Nutrition Counseling and
Education course. Next, students spend 30 minutes
practicing that technique/skill with a partner in a role
play experience. We spend about 10 minutes debriefing.
We also discuss any counseling experiences they either
had or observed the week before. This exposes them to
the concept of professional supervision and the
importance of de-briefing with other counselors.
The only assigned reading is Secrets of Feeding a
Health Family, by
Ellyn Satter
. I’m a big fan of the Satter Eating Competence Model.
I ask them to read this book prior to the start of the
semester. Throughout the semester, as we discuss
counseling techniques, we refer back to the ultimate
goal of producing competent eaters.
While
I haven’t conducted any formal assessment, students do
report feeling more confident in their motivational
interviewing skills by the end of the semester. They
seem to appreciate the additional opportunity and I
encourage them to include this internship opportunity on
their resume. Completing this internship experience is a
requirement for serving as a nutrition counselor for our
FitU program.
Resources
A You Tube Video
that will help students attend to the effect of their
language and tone.
August, 2011
Coming to FNCE?
Polish your own counseling skills and
learn new ways to teach them at the Counseling
Intensive, Friday, September 23, near the
Convention Center. $50 discount if you are using the
Toolbox or Step by Step program.
Stop by my booth at the Member Marketplace
on Sunday. Share your successes and struggles!
Inspiration from the field: Using
real client session recordings
Students and interns often say
they want to hear/see real client sessions. Several
preceptors and a DI director have told me they make
use of their own client session recordings. (I
believe they are all audio recordings. This makes
obtaining permission easier. )
Or course, confidentiality is a
concern. I will share here the process I use when asking
a client to record a session. I first say that I have
a request and it is fine with me if they say
"no" to it. I tell them I am working to improve
my counseling technique and that it is useful for me to
go back over my sessions. I would be interested in
audio-recording this session, but only if it's OK with
them. The majority of my clients agree readily. If I
sense any hesitation at all, I say, "let's not do
it then." During the recording I make sure not to
use the client's full name. If after
recording it, I believe I might wish to share it with
other professionals, I then ask the client for
permission to do that, making clear I will not put it on
the internet, only let a few colleagues listen. Again, I
make clear that it's fine if they say
"no." When you let students/interns know
the careful process you used to obtain permission you
are also modeling professional behavior.
There are lots of ways to use
session recordings:
-
Listen for the client's
"change talk."
-
Listen for the open-ended
questions that elicited the most useful client
responses.
-
Tally up the number and types
of reflections the counselor made.
-
Tally up open and closed
questions.
You may feel uncomfortable letting
interns listen to your less-than-perfect sessions. All
of our sessions are imperfect and we are always a work
in progress. You can share this with the interns and
even go over the moments you wish you had done something
differently. They learn even more this way and will see
you model on-going improvement toward excellence.
Q. What materials would best
supplement our internship or didactic program?
This time of year I get lots of
questions like this. Click above for the answer from a
past newsletter.
Learning from recent graduates:
You may wonder if your students or interns remember
and use any of the skills you teach. I have had the
honor recently of meeting new dietitians who were
first exposed to counseling skills in courses or
internship programs that use my videos, books and
other materials. This isn't publishable research, but
I've been talking with them and have begun to form
some impressions.
There is no question that in the last few years there
is noticeable improvement in the exposure future RDs
have to counseling processes. They all say that they
learned at least counseling theory and some got meaningful
practice. All have found their pre-registration training
of value. They became aware of the depth involved in
quality counseling and had their appetite whetted for
more training. Several wanted to pass on advice to
those still in school. They said that the best time to
pursue further training is after at least a year of
practice that includes some outpatient experience.
Feel free to pass this on to your students and interns.
Resources
Melanie Brede, a preceptor at the University of
Virginia, has developed some forms for tracking
interns' counseling experiences. She finds these
especially useful to keep track of the various
experiences they have with the other preceptors. She
gave me permission to share them with no limitations.
March, 2012
Q: Many
of my students seem to think they will not need
counseling skills as a dietitian. They are just focusing
on what to tell their patients, not how
they will tell them. Any ideas for getting through to
them?
A: W
e all know that dietitians are more effective in
all settings when they have good communication and counseling
skills. For example, those in food service need to
supervise the work of others and this can involve urging
an employee to make a behavior change . In
research settings where subjects in some groups are
asked to make diet changes, the research will be most
effective if we are effective change agents. Clinical
dietitians are generally asked to do little behavior
change counseling. However, interactions with their
patients (and other medical staff) will be more
successful if they are skilled at effective
communication.
You can, of course, make
the above points and more. In addition a simple
experiential exercise will have more impact. Here is one
for students who still think all they need to do is tell
patients what to do and they will do it.
1. Ask for one student to
volunteer to discuss a health change she wishes to make.
(Be sure it's real, not made up.) Examples might be:
flossing more, eating more fruit, exercising more,
drinking more water, etc. Ask her to briefly tell the
class what the change is and then to leave the room for
a few minutes and jot down all the ideas she has to
address the issue.
2. Ask the remaining
students to brainstorm advice and ideas they would give
the volunteer. Encourage them to be creative. Write all
the ideas on a board.
3. Ask the volunteer to
come back in and review the list of ideas on the board.
Ask her to cross off things she already has on her list,
has already tried that didn't work or just doesn't like
for any reason. Encourage her to tell the others why she
is crossing off each one.
4. Discuss what they
learned from this. How might they do something
differently than they had planned with patients. If they
don't mention it, point out that the volunteer had some
ideas already that the counselor could elicit with an
open-ended question.
July, 2012
Step By Step: A Program
for Dietetic Interns to learn counseling skills
Designed to complement Dietetic Internship
outpatient rotations.
- Focus is on the basic skills that are the
foundation of quality nutrition counseling.
- All on-line and
available immediately upon
purchase.
- Four credits for preceptors at no additional
cost!
Find out
more. Revised 2012-2013 version now available
Almost 40 Dietetic Internships used this program in 2011, up from 17 the year before. I received valuable feedback and have made some tweaks.
- A few more supportive readings have been added
- Some of the podcasts have been revised to include more practical ways to practice the skills.
If you purchased the 2011-2012 version, it will
only be available through August, 2012. After that date you will need to purchase the new one.
Here is an e-mail correspondence with Caroline
Webber, Dietetic Internship Director, Western
Michigan University. I thought it might be useful
to others.
Q:
Our internship program subscribed to the
Step-by-Step Program last year. We found
that some of the interns got so swept up in
everything they had to do that they forgot
this was available to them, and it seems
that preceptors weren't very good at
including this in the curriculum. My thought
now is to assign at least some of this over
the summer to next year's class while they
are excited about starting the program.
They could at least do OARS and practice in
daily conversation with family and friends.
I'm wondering what your thoughts are based
on other feedback you have received and
changes you've made.
A: Caroline, I
can see that you work to make improvements
in your program every year! Great idea to
assign them to go through the program once
over the summer. Maybe assign them to write
a brief (few paragraphs) response piece on
one of the units of their choice after they
have found ways to practice it. There may
also be opportunities to bring up these
topics in your first few weeks during class
time. Repetition!
As to bringing this
right into the practicums… several other DI
directors have noticed that it is not easy
to get some preceptors to integrate this
into what they are used to doing. Some
directors have chosen to “assign” one or two
skills to each of their preceptors who
provide some counseling experience. The
interns will then focus on just that one
skill or concept for that rotation. Do make
sure the preceptors know that they can
receive CEUs for themselves. Might there be
time during class time each week to briefly
discuss the skills and ask the interns how
it’s going, what they have noticed and what
they will practice next? You could choose to
point out to them that the step by step
process with practice and revisiting the
basics is the way they can make real changes
and very similar to the process that their
patients who make successful changes will go
through.
Q:
I only have the luxury of meeting with
interns once a month, so I do count on
preceptors to discuss counseling skills with
interns. Perhaps we can put more specifics
into the handbook - program outline,
discussion questions, reminder about CEU
credits - in order to stimulate involvement
on their part. I do have interns keep a
weekly journal. This is another place for
reflection, but prompts on specific topics
are always useful.
A:
Great idea to make use of the weekly
journals in a more focused way. Keep
tweaking your process!
Wonder if you are
demonstrating counseling
skills well for your students?
Polish your own counseling skills and learn new ways
to teach them at the
Counseling
Intensive.
$50 discount
if you are using the Toolbox or Step by Step
program. 12 credits.
Philadelphia, PA: near FNCE
: Oct 5, 2012 (6 credits)
Seattle, WA: Oct 26 - 27, 2012
Atlanta, GA: Nov 30- Dec 1, 2012
Los Angeles, CA: Jan 11-12, 2013
Kansas City, MO:
March 8-9, 2013
Boston, MA:
May 3-4, 2013
St Paul, MN:
June 7-8, 2013
Houston, TX: Oct 18, 2013 (6 credits)
New York, NY:
December 7-8, 2013
Here's an article you might find useful as
a class handout...
"Nutrition
Counseling: Common Mistakes"
You are welcome to print it out and/or
share digitally in whatever way you find
valuable.
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