Dietetic Placement Experiences

Aaron: 0:00

Hello and welcome to the first episode of the dietetics digest podcast. This is a monthly podcast that seeks to explore different areas of nutrition and dietetics hosted by me, Aaron Boysen. This episode focuses on dietetic placement. Throughout this episode we will discuss various different aspects of placement. We mentioned things like learning outcomes. Now that was something that was used at the specific university that we all went to that was used to assess us and our progress through placement. Finally, one more point before we get into the episode. It's important to remember the ideas and experiences discussed in this episode are that your experiences may vary. However, we seek to provide an honest discussion of our own personal experiences so that listeners can benefit from it and help them to prepare more effectively for their placement. So without further ado, let's get into the episode Okay, t hat we're ready to go. Thank you all for coming today for the first sort of recording of I’ve, called it dietetics d igest. So y eah, i t sounds good. I'm not too creative with the titles, but I try my best. Got a little bit of a rt w ork ready so that m ight be released sooner or later. So we wanted to focus this podcast on something I felt that I maybe missed starting my placement and we had certain tutorials i n university where we had our fourth year students come to us and discuss with us exactly what was required for year f or placement. And I just wanted to add to that with a little bit more. So I've got a few people with me. So I've got Claire with me who I know from, she's in my year a t university, w e're on placement together and Suyin, she's also a member of the BDA Yorkshire Branch and she's one of our, she's our treasurer, but also student. So, u m, thank you. Thank you both for be willing to do this, u h, with such sort of an amateur set up. U m, a nd I would say so myself,

Claire: 2:15

shall I introduce myself, introduce yourself

Aaron: 2:21

and I'll steal from those ideas and introduce myself. So,

Claire: 2:23

uh, my name Claire, I like, as Aaron said, I'm in final year and doing dietetics at Leeds Beckett and I'm 28 years old. And I chose to move to dietetics because I worked a lot with children in the past and I'd seen like the difference between their nutrition and sort of their concentration levels and I guess like fussy eating as well and how it was affected from um, from nutrition and cooking point of view. And so yeah, that's why I chose dietetics, I guess one of the reasons.

Aaron: 2:56

Thank you. And uh, Suyin.

Suyin: 2:59

U m, yeah. U h, I'm Suyin and I’m a dietetic student as well at Leeds Beckett. So I'm my second year. Um, so I'm originally from Singapore as you can tell, I'm not a british citizen and yeah, I just had a background in finance in Singapore and I just decided to do a bit of a career change from finance because I have a previous degree in accounting and just to change and move over to the UK to study dietetics.

Aaron: 3:25

Thank you. Thank you very much for introducing yourself. My, my name is Aaron Boysen. I am in the fourth year as well. I have done both of my placements. That's where my expertise in placement lies. But I've only done my placement so I can't speak for everybody else. And everyone else's experience is different because every place is slightly different. Um, and I originally sort of, I changed a little bit of my career trajectory, so I changed from being like a, an English as a second language teacher to move over to dietetics cause nutrition and food was something I was interested in from a young age and I just wasn't being fulfilled by my current career at that point. And I was always rabbiting on about nutrition and health and my sister said, why don't you become a dietitian? And I was like, I don't know what one of those is but I'll have a look. So I went back and sort of did one of those foundation degrees or access courses people call them. And obviously five years later I am here right now and I have my expertise in placement as we're going to discuss today. So, um, I mean, so me and Clara both been on placement and Suyin has been on a placement, so we both have expertise certainly on placement. So the first thing I wanted to discuss today was a little bit around preparation for placement. So things that you would do to prepare in advance or things you would do, sort of, to get ready to go on placement. Firstly, I want to kick off with is still the easy one was the first thing I found on placement a, it was really, really easy was choosing if you have to move accommodation going for accommodation that is close to your placement as possible instead of going for one that has all the bells and whistles and has the good night out. And the the amazing. Personally I was short of time on placement because not only are you there full time, you also have stuff to do maybe in the evening you have reflecting on your days learning and cutting out that commute was really valuable to me. On my first placement. I didn't know if the different, even with a short commute on um, a B and c placements, which were commutable. So I did commute. But I definitely, that's something that I've taken from it. So you want to move over to you guys and anything you can do to prepare for placement beforehand?

Claire: 5:40

Yeah, I definitely agree with Aaron on that point. So for example, before my A placement, um, I was looking at places that already had accommodation attached to them because I thought it was my first placement. I don't know what to expect. I don't want to be traveling around. I don't want to be late. I want to try and put my all into this. Um, and I felt like being on site, like at the hospital accommodation, it would then be easiest for me. And also because it was only three weeks long, it wasn't too bad. I know that sometimes if you have like a B placement or C placement there like 12 or 13 weeks long. Yeah I think it can be a bit dull for some of the students, cause you might not, you don't always have internet or TV. Um, so I chose that for my, a placement cause I thought it would get me. So have a good head start I guess. And then it gave me sort of ideas of how I would then want, like where I would want to live for my B and C placements so then for my B placement. I made sure that, as Aaron said, that I was in walking distance from the hospital and that I could easily travel in between the two.

Aaron: 6:48

Could I just go back to your A placement so; I remember something I wanted to ask you a question. So I remember in a placement you were actually bunking so I don't know how you say it you had roommate or rooms next to another dietetic student. Yeah. Did you find that beneficial or did you add, this is the thing I've always wondered. Was it beneficial for the comradery, you're going through the same thing or was it literally like a distraction.

Claire: 7:08

No I've always been on placement with someone, so my a placement, um, I was with a close friend of mine and then on B placement and on c placement as well. And I felt like it was really good because sometimes it's very emotional, the whole placement experience and stressful. And if you can offload that to someone, but it's just nice sometimes to feel that you're not the only one that's feeling, sort of, stressed or under pressure. And I know that if you can still talk to people, obviously over whatsapp and things, but if they're like living with you or if they're on the same placement as you I think is a really good support network from my experience anyway,

Aaron: 7:46

and you build that, build that bond with the other person. Yeah, definitely placement with you build that sort of really tight knit bond, because you've been through something together because it's difficult, but it is great as well. You do learn a lot and while you're learning a lot, you also fail a lot. I think the negative is just when you're comparing yourself against someone else, I think that's when it falls into sort of pitfalls. But I think there is a definite benefit to that.

Suyin: 8:10

Yeah, just good advice actually. Just because, um, placement A me, I just chose the closest place, so I've had, and for me it was just walking to the hospital, but placement A isn't too bad. I feel like I'm in terms of the workload is not as bad as what it will be for placement B or Placement C, but I've never really considered like living with another dietetic student. I mean that's a really good idea, just so that you don't feel as lonely and you are able to like bounce ideas and questions with each other. So that would be something I would consider maybe for placement c but for placement B for now, I've just decided to commute.

Aaron: 8:49

Thank you. Thank you for sharing your inputs. I think that's, that's really valuable as someone preparing for placement might wanna know and things like that. So now I want it to move over to a little bit about sort of, we're going to shift gears a little bit and Suyin's going to, sort of, take the role as interviewer and Claire. Claire are going to be taking the roles interviewee. So obviously Suyin is going on placement. Pretty soon in a couple of days. Is it?

Suyin: 9:17

So yeah. So I start next week.

Aaron: 9:20

Next week. So from when you hear this, she's probably already already there working hard because if ever anything I know about Suyin already. She is a hard worker so the dietetic department that is getting her they’re going to be lucky people. Lucky, lucky people. You've got an easy job on your hands. Okay So, I remember, I'm going to start this off with a little bit of a sort of a introduction to how I was feeling before placement B and I remember having a lecture with one of our lecturers and how was asking, I think everyone was on the same page and they were just mortified because they were like, Oh why don't I do something wrong? What are the say something wrong? What have I done? I don't ever can remember everything I've done for the exams. I don't know if I can do everything correctly. I don't if I don't remember this specific, this specific condition anymore. It's been so long. How did you feel Claire?

Claire: 10:12

Yeah, I was like Aaron said, I was really scared. I was really worried that when I get to placement that expect me to do things like full feeding regimes that expect me to know like the dietetics manual, like straight out of my head. So I was really worried that I wasn't going to be up to scratch with like their knowledge and their expectations. But actually when I started placement that was completely opposite of what I was actually thinking. Oh man, my thoughts were, um, which was really reassuring and for me, I didn't really feel like that throughout my placement I felt they were really supportive all the time and it was ever really stepped approach into going onto placement as well.

Suyin: 10:53

Yeah, that's good to know actually. Just because I mean like you've mentioned Evan, like everything that you said, I'm just worried about it. I feel like, like in our, um, studies, um, apply clinical dietetics, we learn a lot about clinical conditions and there's just so much like liver disease, kidney disease, and just like, I'm not going to be able to remember everything when I get into placement and just about putting theoretical knowledge into practice and it's just going to be quite difficult and I'm quite anxious about it and

Aaron: 11:23

everyone feels sort of that way. And yeah, everyone's not. Sometimes I feel like, I dunno whether I get the same reception, but possibly the online conversation among student dieticians, if you're watching it, everyone's quite positive. I was like, Oh, I'm so pumped about placement and all of that in the background go. Actually, I'm actually really terrified. Like I don't know if I'm going to do it well. And I think understanding that a lot of people do feel the same way is important. Um, I think from my own experience when I first arrived on placement, obviously in the weeks before, I was like, okay, I've got to, I've got to look at the, um, the pocket guide to print, um, the clinical nutrition dependence booklet. I was looking through here, practicing the equations, got a few case studies ready and the first week week they go, okay, you're in pediatrics. So, uh, you need to get rid of those, get rid of those Henry equations that you had, those stress factors. We've got this other book that has all the child things in and the children are completely different than adults in various different ways. And I was like, oh, okay. Um, but from my own experience I found they like Claire, they did ease me into it. They did start off a little bit slower. Um, and that helped me to sort of get, get used to it. Um, I was even terrified going from pediatrics to adults cause it'd been so long since had actually done adult stuff. But Ah, that's a story probably for a little bit later.

Suyin: 12:48

Um, yeah, that's good to know. So, um, just a few of my concerns. Maybe I'll just share some of my concerns. Uh, going to placement B. So I know that the learning curve is going to be steep, but now that you've mentioned it, it's going to be stepped approach and makes me feel a little bit better. And I know like when I was in counseling placement as well, there was a lot of stuff about abbreviations and reading medical notes and I just, I couldn't get my head around it. There's just so many abbreviations and I couldn't even understand. Simple sentences. And do you have any like, ideas or any way to help me to v medical notes better? Is there any, any recommendations? Yeah,

Claire: 13:29

I guess when I, one of my first few days my supervisor took me to the ward and she got out, um, a patient's medical notes and then a blank record card. And she was like, okay, why don't you start reading through this and like tell me like what you think, what you should write down and things. Um, and I had so many questions, I felt kind of, I have actually felt really stupid cause I was like, oh, what does this mean? Abx and it means antibiotics. And I was like, like thinking, oh my gosh, I don't know anything. Um, but as you go along and as you make, you can have like a little lists, for example, off abbreviations. So obviously CVD is like cardiovascular disease and you can keep them like on a piece of paper in your folder that you can take around on the wards with you. So if you see something you don't know, then you can look back at it. But also, I know some trusts they have, um, they're only allowed, they only allowed certain abbreviations, so they have like a required, uh, required like abbreviations, trust policy list. So they could only use those and sometimes dieticians will print that out for you or you could ask about it and you can print it out and take up onto the wards. Um, well in terms of reading medical notes, how to make that easier. Aaron, do you know how to make[inaudible]

Aaron: 14:39

Short answer... No. Uh, it's skills. Something that does actually scare me and makes me feel nervous. Um, reading medical notes cause often, but I think that one of the hardest things is reading those notes and keep developing like a crib sheet for the abbreviations. Yeah. Or depending on the rules of your trust. I don't know if it's the same every way. You can just whip out your phone and Google it. Yeah. You can go back if you, if you, if you want to just Google it then you can just Google the abbreviation medical afterwards and go, oh okay that makes sense. And as you do that you'll learn it. Um, some trusts don't allow that so I am, I am aware of that. So developing like a crib she asking a supervisor developing in your booklet like popular medications as well and popular abbreviations. Yes. Yeah. Is I have one of those small booklets. Yeah, pick those up and put it in your little tunic thing. And Yeah,

Claire: 15:40

I had a file that I took around to my placement and I had like, you know, the Polly pockets and I had a four pieces of paper in there and I had like little charts. So, for example, the medication, the name, the abbreviation, the group and what it did. And so that really helped me because my supervisors were quite keen on me knowing, um, the medication of what effect that would have, for example, on that intake and the bowels and perhaps their feed as well. If they're on a ng feed, even at a certain point, they don't expect you to know like the crazy metlife, not crazy, but like the, the really obscure medications. Yeah, just a few common ones, like in that certain area. For example, if you're in oncology, it might be like some chemo radiation. So like anti sickness, medications, diabetes, often from ureas you need to know, be able to identify those. Um, I think the hardest thing is, uh, just oh, you'll get used to it. And sometimes brand names can set you off. Yeah. Sometimes I've written as brand names or not. It is tricky. Um, but you can always[inaudible]

Aaron: 16:45

just, if you don't know what something means, just pop it into a search engine and have a quick look. If they use electronic knows. I don't know if the place you're using, you're using up, you're using electronic notes, you can often like right click and, but for those who are, um, you can often like right click and see that what the medication is or all the terms red cause it might be like, um, for example, one that is used a brand name, a metformin Sokola was one of the brand names I think I remember, I only ever read it, I don't ever want to say that out loud cause you always refer to it as yeah. Forming. But yeah. Yeah. And I don't think that's anything to be afraid of either. Cause I remember on my c placement I was asked, I think I asked one of the Dietitians, oh, what, what does that medication do? And she's like, Oh, I'm not sure if she had right. Did the right click and then read it. And she's like, oh, that's how you can, an easy way to work out. So yeah, it's nothing to be too worried about. I don't think, especially on B placement, you're just getting used to everything and you've not been in such a big like acute hospital before. So yeah, I guess you sort of, as you more exposed to it, you get more familiar with it. So it shouldn't be. Yeah, you get used to the medical, the medical, the way the medical notes were structured, the way people write, and then you move to a different section of the hospital and you have to learn it all over again. And I found that the hardest actually moving to a different part of the hospital. I was in quite big places and I, and they obviously give, gave me loads of experience in loads of different areas. But the double edge sword of that is you get loads, different experiences in loads of different areas, which is fantastic. But also when you move to another area you're like, oh, um, I think, ah crap, I can't remember. I can't remember exactly what the scores or anything like that. Cause it was so long ago and you'd been trying to learn loads and from my own experience it, they were actually really understanding about it then. Yeah. That especially if you just move there, they would help you and show you the way around. And um, often they'd give me like a few days to sort of find my feet in that area, which was often helpful, especially on placement B. Um, so that was my experience.

Claire: 18:52

Yeah. And um, usually they give you a timetable before hand, maybe sometimes before you start placement or in your first week. So then you can see which, eh, which specialties you're going to be going into. So maybe like the weekend before, what I would do is then I would prep for that like specialty for the week. Um, I kind of put the rest of the back of my head so I could just focus on that for that amount of time.

Aaron: 19:14

Not all trusts do that though. I'm not sure. The one, yeah, I think yours, the one you're going to do is we're not, well, I know others don't. Um, so for those listening, some of them don't. So to be honest I would just ask like I would, I would go up to them. Obviously I've never been in this situation but I would just try and, cause obviously they are busy. Um, they've got lots of things to do but I would just ask a couple of days beforehand. Yeah. Or even if you have a time table like I did in both of my placements possibly if it's a big place you're going is big hospital email the person beforehand and say hey I'm coming to you and explained the situation. I'm nervous. I may not just I think being open and honest first of all is the best policy. Like going in instead of like faking it till you make it. You really just can't if you don't feel confident. Yeah. I just go in be honest. Say I'm feeling really, really nervous. Yeah. I would like to look at some things. What do you suggest that I look at? Yeah. And some of them moving sent me like packs over like little PDFs or one of them, which is, which is, which is really, yeah, some of them are quite long. So if they do that, just say, just tell him like, could you narrow it down to a page or two or a couple of pages of what should I look into the most out of all hundred pages. Um, but, but to be honest, yeah, learning to read a hundred page document might be useful for one of your modules next year. Clara agree with that. Yeah, definitely. Yeah. Um, so yeah, that's, I mean it's good point. I guess like just emailing and asking, is there a point where students can be a bit annoying when he asked too many questions? You think? Um, I don't think so. I think I was always trying to ask questions because I think it shows that you're introducing mastic and that you're wanting to learn things. I think if you're sometimes sitting back there might think that you're not that interested or you're not that enthusiastic and you don't want them to think that. Yeah. So I would say just ask that there's no harm in asking. Yeah, yeah. I think Clermont know this. Um, from my personality, maybe like his names I am, I'm a nightmare asking questions, I ask questions about everything. Sometimes I even, and this is probably a warning for people, I ask questions to see if they contradict anybody else. Um, probably just, I like to think it's to aid my understanding and develop my knowledge. But I was, I was nervous about not being able to ask questions cause I might bug them. But I think the important thing about questions and talking to supervisors and people that in the BDA branch we, we know and we relate with, it's really about the timing of the questions. If you ask the questions at an appropriate time, um, like maybe not while they're trying to do something in their quite urgent, it might be worth, worth not asking a question, writing them down. But maybe at the end of the day or a quiet time back in the office. Go insert supervisor's name here. I've got a few questions. Do you mind if you are? I ask them and I think they'd be happy with that. Definitely. And I think if you're, for example, on a ward and it's quite busy and you're thinking, oh I have, I don't understand this. You could always say to them on the ward, oh could I, would you mind if I asked you a few questions about this later or when we get back to the office and they'll be more than happy to help you. I think they should be. Anyway, that's my experience. So yeah, mine too. Sounds good. Yeah. So another concern I have, I suppose it's just about meeting patients who are quite complex. Cause I remember when I was in placement aid, there was a patient who had, who had undergone imputations and it was really like complex patient with a lot of issues and I'm just afraid of meeting these kind of patients and like I don't know if I'm going to be confused and lost and so sue you and they expect you to do everything all by yourself, especially on the complex patients. So they expect from you. Obviously I'm being sarcastic that if anyone is not realized, um, it's important. I think from my own experience. They, they don't expect you to do everything. They understand the limitations of your practice. And I think that's, that's also something that I learned from placement. I learned that, I actually don't know a lot. It sounds really weird. It's like dunning Kruger effect. It's like you get, you get when you're at literally know nothing, you, you're a genius in the topic. You know, a little bit of information. You think you're a genius outside of all the self style gurus online or all think the geniuses. And then you'd go down like that. You'd go down on the graph, you get people that can Google this. It's called the dunning Kruger effect. You go down and you actually think, oh, as you learn more, you're, I know absolutely nothing cause you learn how much you actually don't know. And I think that's sort of what I'm, I'm sort of in that dip, uh, that I was on on placement. You say you sort of realized how much there is really to learn how much there really is to know. And I think the supervisors really realize that as well. And I don't, from my own experience, they didn't put me in any situation where I was like, Ooh, I don't know what to do. And then leaving me to make decisions. Oftentimes they would put me something that was completely in my scope, um, and I was able to do and I knew they might let me see how they would handle it or talk through a complex patient with me, like support me through that. But I didn't feel like I was, it was all up to me or this patient's care home in my balance, anything like that. What about Claire? What was your yeah, I agree with that Aaron. So I was just thinking that I can remember a time I hot the first time I would have had to tell someone that they might need an ng feed. I was really nervous about luck because that patient was quite there. They weren't happy there in a hospital. They're really unwell and I just, it was the first time, it's obviously a sensitive subject and I was really worried about it and I said to my supervisor, I'm not too sure about it cause I don't really know what to say. Can you help me? And she was kind of explaining to me what I should say, et Cetera, et cetera. But because I didn't feel comfortable, I said, would I be able to do this? Like next time someone needs an ng feed? And she said, yeah, that's fine. You can just observe me and then next time we'll try it again. So I think, again, going back to the being honest and open policy, how do you feel about Ng feeds now? Claire, are you scared about doing them? No, I really like ng feeds now. Yeah, that was a planted question. Yeah. Cause I knew she, yeah, she liked to um, calculate those requirements.[inaudible] scam me a bit. I've done like a feeding regimen as part of one of my modules and it just seems so intimidating and so complex. I mean, I think that module is not completely realistic of what it's like on the wards. Um, because every Dietitian, every supervisor has their self own way of doing things and every hospital does as well. Um, so what you learn here at university isn't, it doesn't exactly mirror what you do on placement necessarily. Every, every place has different protocols, different things in place. Even one placement doesn't exactly mirror another placement because they have different, different things in place. They might have a different company providing their feeds for them. Understanding that everywhere is slightly different also is helpful as well in that respect. Yeah, there's not one right way to do it and I think they tell you that in university, but it's really hard to get it. Like you're like, yeah, but yeah, what's the right answer? You Go, what would, what would you do? And so I think there is one right answer, but there is so many ways that you can, you can do something. Um, and there's, there's just a vacation for those and it is about justifying it and top tips, top tips, placement or placement. Placement is an illustration placement point is point.[inaudible] did you ever get to do one-to-one consultations with patients at[inaudible] or was it not? It depends on your trust. I did. Um, I'm not sure. Erin, did you want one to one? What languages you and the patient without any, so my experience, so my placement was, I never was, no, not really. My supervisor was always there. Um, and as I went through both B and c placements, they took different levels of role, like they make take them more, even on B, sometimes I could do the consultation myself. Um, and they just sat back and we reflected afterwards and we talked about where I was maybe could improve or what I could improve on. And yeah, so no, that wasn't my experience, but, um, sorry. So yes, so I was always supervised, but I could do the whole consultation by myself. Um, so it was almost like I was there with the patient, but they were observing me. And to be honest, I preferred that because what if I hit the, what have I hit the consultation out of the bag? And it was amazing as a best thing in the world and no one's[inaudible] I couldn't do an ITI or reflect on it because I want all the recognition for my hard work. So I want someone that to see my amazing work. So yeah, possibly a, that was my experience. So how about you Claire? Um, on B placement, when I did that, first of all, I, it started off with me. Um, obviously this is not in the first few weeks is quite late on and B placement. And I would go in and see a patient and the dietician, she might be seeing a different patient or writing up the notes. And so I would gather like all the information, um, what they'd been eating in the day, if there aren't any supplements, all the different bits and bobs like that. And then I would say to the patient, I'm just going to discuss with my supervisor a plan. And I would go out with the route out of the room and ask my supervisor any questions that I had. And then we would either go in together to discuss the plan or I could go and by myself and then, um, a few weeks after that, then I would call her on the phone. So I'd be on the wall by myself and then I'd call her on the phone, ask her any questions. And then in my last few weeks I was able to do it by myself. So, but it totally depends on your trust on the CFIs and the department and I think sort of how busy they are as well. Um, and the amount of students that they have,

Speaker 5: 29:46

I don't know.

Aaron: 29:48

I'm just thinking like what if you give advice to a patient? Like I dunno, I'm not sure what kind of scenario that will be, but so I don't think, I think you could do that. You could definitely give wrong advice to a patient that is, that is possible. But if I ever gave wrong advice to the patient, I wouldn't do what would happen then my supervisor would go, actually, you know, he's a student that's not right. And he would just correct me. So I was being observed and they just got Ha, you know, he's not right. He's wrong. Um, and I don't think I have it data actually because I think as I said before, you've got that sort of on placement within the first couple of weeks, you'll probably hit this wall and probably think, ah, I know nothing. I'm not as my work learning is worth anything. A joke. It obviously you learn a lot, but you start to learn how much you don't know. And I think overcoming that for myself was more important than being overly confident and just rolling out advice here, left, right, right. Left and everywhere. So I think I, I don't think that would be too much of an issue. I was scared about it as well. But because of those protections in place and because you have actually learned quite a lot, even though you may not think you've learned quite a lot because there is so much more to learn. Yeah. I, yeah. As my perspective. Yeah. Um, I guess it's a situation that could be possible, but I think there's a lot of things in place to stop that from happening. So for example, before you go and see a patient and even if you were going by yourself, you would still like ask any questions, you would hand over to the supervisor, ask them any questions and they usually ask you what advice do you want to give? Or what is your plan do you think at this moment going to be? Um, so I guess there is where like any problems can be ironed out and if you are really stuck on what advice to give and thought is, am I going to give the right advice to this patient? You could say, you could just say, I need to, is it okay if I talk to someone senior or my supervisor and I get back to you? Um, or you could ask your supervisor to come in with you if you were by yourself. But I think, I don't know if that will happen. In fact, I was so scared on placement, be nervous, scared, whatever. Semantics really, I can say scared. I don't know. It was like shaking in my boots, but I was, I was just nervous. I actually said, to be honest, I never actually gave advice without discussing it with my supervisor first. I always said to the, to the patient, I said, I'm a student, obviously. Thank you for sharing everything. I don't get a collection. So I'd collected all the information about how that, what's been happening, how they've been doing, all that kind of stuff. Then I went away and actually talked with my supervisor about the plan and yeah, especially near the end, I knew what to do. Like I knew exactly what place you were going to go and I think in the[inaudible] you actually didn't need to discuss this with me, but I was still nervous. Yeah. So they still gave me that opportunity and it was just then to go. Yeah, that's right. Yeah. And it just filled me with sort of a bit of reassurance and I could take that into my placement, see experience. I can tell you that into my placement c experience and it was, I could build on that and I could build up that confidence. I hope that's answered your question. Yeah, it's really good. Yeah, it's good to hear perspectives from people who have undergone that, you know, and obviously the, our perspective, it's not like Gospel and this is what every trust will do and your experience will be exactly the same as ours. But I think gathering on other people's experiences before you go and do something is valuable. Yeah.

Suyin: 33:25

So what happens? Um, you know, I'm just always like concerned it that patients are sleeping and like having to wake patients up. I Dunno. I feel like I don't want really wanting to wake them up, but I have to wake them up. Like, is it an issue? I know it's a minor issue, but I don't know. I'm a bit concerned about that Fascia question. What did your supervisor on placement do? Um, yeah, I mean he mentioned that sometimes. I mean, if it's necessarily he will wake them up, but if it's not here, try not to wake them up. So, yeah. So I think,

Aaron: 34:00

I think that's probably what I would say my experience was like if it is necessary, you might have to wake them up and yeah, I was always a bit nervous about that.

Suyin: 34:09

Yeah. I don't know. I'm just, I feel like nervous we can people up. It's like bothering them. And what if they get mad at me for we can them up from their neck.

Aaron: 34:17

Yeah. I mean sometimes if it wasn't too urgent, I would just sort of go see another patient on the same ward or yeah. While they were sleeping and then come back later. But I think it is one of those things you might have to just, yeah, I think you get used to it as well. Like when you first start be posting, you're so scared to even like say hello to a patient or introduce yourself that by the time that you finished your placement, it's so natural. Because I think at the start you think, oh, they're gonna think I'm, I'm a student. They might think I'm not good enough, blah, blah, blah. And you're really self conscious and nervous. Um, but I think as you get used to it and you see patients in a lot of, I guess it comes easier really and a bit more part of normal hospital life. My experience is the majority of patients are really nice and lovely and, and even the ones that possibly get angry, they're not really angry at you. They're obviously going through a lot of stress and a lot of things are happening, have that current period of time and they're in sometimes in a bit of pain. So it's important to also remember that often it's not, even if they do get angry at you, which actually never happened to me, it's important to understand why they're getting angry. Might be, it might be also other reasons as yeah. Um, but just be as respectful as possible. Don't shout out to them all, just try and wake them up with stuff. Um, yeah. So that, I think that is, um, that is a good question. I think really important question. Question, did you, did you ever encounter like cases of the feeding? You know, that's quite complex to me. And Yeah, I think a lot of the time, I think maybe more, well I think maybe more than you expect. It depends which kind of um, waltz you are on. For example, I was on a lot of oncology boards, so a lot of the people there weren't eating much for long periods of time and they'd lost a lot of weight and they had really low BMI eyes. So they was quite out for me. Am I experienced? I had quite a lot of experience with re feeding. Um, but it also depends on the hospital you are at. For example, if you're in community based or if you're more clinic based, for example doing diabetes clinics, I think it's rare that you would come across, um, we feed in, but the trusts do have policies and your supervisor is definitely going to be there so you can definitely discuss it with them. And um, there were a number of times where I would like forget that there could be at risk of re feet in and the supervisor would remind me like, is there anything else? Is there anything else do you think are risk of reef? He didn't have a, Oh, actually, yeah. Um, but I guess when I was saying you have your, like your files to carry around, you could write it down for, for me, I had it brought in like big capital letters, like re feeding in star so that I would remember to address it with patients so I wouldn't forget it. Yeah, it is, it is something that you are, because you've got so many other things to remember. It might be quite easy to maybe forget. I'm not sure. Perfect. Of course. Um, um, so it's one of those things that maybe as we have this conversation, you'll be just like hearing these bells in your way. A guy in refitting wifi light. Um, and it's probably a good idea, but I think it is something that you will learn to notice and you will need to notice. Um, so that's, that's a really, um, so you do see cases of it or people that are at risk of it and you mitigate those risks by implementing the, uh, appropriate strategies. Um, one more question. I think, um, so did you ever get the chance to participate in like MTT meetings and did you have to, you know, voice out any opinions or anything? Tazza I did actually. Oh, and do you know why intake was it, it was, um, it was, I want to explain the scene because I think it really does help. I want to try and be as detail rich but as information poor as possible. Um, so it's on a, it's on a ward. It's really see various, obviously locations anonymous, none of us work. Okay. So it's hidden and there's a really serious, um, surgeon and they're quite stern and quite probably you described them as intimidating. And I was in first couple of weeks and I, uh, he asked a question that was nutrition related in their sort of meeting that they were having. And my supervisor, my, uh, um, my supervisor looked over at me and she was just outside so she could hear what was going on. And she sort of nodded at me cause she knew that I knew the answer but I was obviously too, obviously we've already established, I was scared of everything. Um, I was scared to give the answers. She nodded at me and I understood that to mean go say it and I just said it and said the information that was needed and he goes good. He didn't find. But for me that was the way for me to refer and it was an achievement for myself because I felt quite chuffed myself. Um, but that there is opportunities like that and you can I think looking to seize those opportunities. I think it's a learning outcome as well. I think it was a learning outcome six. So yeah, I think planning for those things and inputting them into MDT as useful, it can be quite nerve wracking. But remember that you know more about nutrition than the other people in that MDT apart from maybe your supervisor and a few others that are there to remember. You still have gone through quite a lot of training and quite a lot of experience. So you're able to give them something, they're obviously more knowledgeable you in other areas, but you can still give them information. So I think understanding your scope of practice is important, not in a limiting sense, but in like an empowering sense to actually, you can, you can offer help to them because they, they're actually asking, they need that help. It's not, it's not something that you're just being a nuisance by they to give the best care. They need your expertise. Yeah. I didn't get, I didn't speak in an MDT meeting from Walker, I remember. Um, but obviously I spoke to medical staff and other nursing staff and allied health professionals on the ward. Um, and there was a time where I did not, um, for example, they wanted to remove their patients and g feed and I didn't think that was the right thing to do. And I discussed it with my supervisor and, um, she, like, she just told me to like, go ahead and speak to the doctor about it. So I think if you just, it's just like a confidence thing, really just building on your confidence. Try not to be afraid to speak to people on the ward, um, at all. And then I guess when you're in those situations where it's more intimidating, you've sued. So I've got like a baseline. They have confidence there, I think. Did you speak to the doctor about it? Um, I th I think I did. Or maybe it was the nursing stuff. I can't remember. But I explained to them because they weren't eating enough and um, they, I think their sodium was high and they were at risk of dehydration and they hadn't, yeah. They hadn't been on a food shop long enough for me to see if they could eat by themselves. So they didn't come off the NGO. Yeah. I always feel that just because they're doctors, they're not everything. We're all working to help the patient and you[inaudible]. Yeah. Yeah, definitely. Um, so that's at the end of your questions then. Yeah. Yeah. So more or less, yeah, I think it's time. I mean maybe me and Claire can run through a few things that we possibly think may be important tips. One that was, I was actually asked by a friend the other day who was going through an experience and I think would be valuable to point out on placement. Quite often you with a lot of different supervisors and they might say something slightly in conflict with one another. So one supervisor might say something in conflict with another and um, obviously your, as a student you're like, oh my goodness, oh my goodness. That conflicting with each other. Let's let, let's break the news to the entire department. Um, this dietician, this dietician said something different. However, what I found really helpful for my learning, that was my immediate reaction. Um, and I think it is a lot of students' immediate reaction. What I learned from actually being on placement is they, they're allowed to conflict. And I think phrasing the question is not in a sense of put such and such as this, but phrasing it in a question of like, oh, that's different than the way such and such did it. Have I missed something? Is the context different? Is there something that I haven't quite grasped and phrasing it in that kind of sense. One helps you to understand a little bit about difference of context. So a patient being in a completely different situation and understanding how context might change things slightly in advice and secondly also is a slightly more polite in less of a way of Oh I've got yeah or a trip chair or whatever. It's, it's been more inquisitive and really asking why instead of saying ha you're wrong or oh this is conflict cause you might actually be wrong. There might be a certain level of information that you might have missed that might be a completely different context or such and such. Told me differently. Yeah. Because the patient had a completely different condition so therefore the recommendations are different or it was a completely different stage of the condition. So I think it's important to remember, um, that and the way you ask questions is important as well and being sometimes as respectful as possible. Yeah, I think that's a good tip parent. I think you have the most experience regarding that. I don't know if I can add on anything to that. Um, but I guess one of my points I would say, um, as a tip for placement would be try and be as organized as possible. Um, so on my seed placement we had, there was a a period about three weeks. That's why we just had clinics and I didn't have a car, so I was relying on public transport. So I had to plan out my routes to make sure that I was on time for the clinics. I left the clinics at the right time. Um, and I think for me that was a key thing for the placement and not being stressed out because the last thing you want to do is be rushing around worrying which bus to get or if you're lost. And I think just planning those things really helps.[inaudible] preventing extra stress. Yeah. Google maps is a, is, I haven't seen other mapping software is available. Okay. Were you ever late for any clinics? I'm never really late. I'm just obsessed with being on time, so I'm oddly like, that's good. I think I have been like, um, I, my own experience was yeah, follow the policy of the trust that was basically like, cause the thing is what can you do like Eh, while I was on placement, we had winter months and it was snowing and that affected transportation into university. A lot of people, no university into placement. Um, a lot of people didn't come in and just making sure, one of the Times I was calling up and obviously no one was in the office because the snow was so bad. So I was calling like different Dietitians around the office and I was like, in the back of my head I was like, at least they know if I leave a message and everyone's cancer machine. I tried, I tried to contact them. Um, Saturday night, that's better than doing nothing. But I think, I definitely think they appreciate that. I definitely, yeah, I definitely the instead of just turning up and say, oh I tried to call one dietician. Yeah. And then it failing clients to call, like try your best, try the best possible way you can do and contact them as early as possible. Saying I actually might be late, um, because of this reason or this reason. Um, and just calling them or and t and the number beforehand, um, in case something like that happens. I was going to say, I guess another tip, um, I was thinking about is when you're on placement, as Aaron said, you're there until about half past four or five o'clock and then when you go home you've got extra work to do. Um, we have a[inaudible] nine outcomes and we have different pieces of evidence for in each ones. For example, learning outcome one, they're not be five mini outcomes within that and you might have to either get one piece of evidence for each of those mini ones or multiple ones. Um, so I think what I did on my c placement was I had a look at which areas, um, on my timetable I would be able to meet. He used to meet those outcomes, if that makes any sense. Um, so that I would be able to collect the evidence in a timely manner for like my halfway meetings, my final meeting. Um, so that you're not sort of scrabbling around in your final few weeks try and piece bits of evidence together. Um, what do you think from that Aaron? Yeah, I think that's a planning out. I actually, that's a really good idea and I didn't do that. Um, to a certain respect and obviously it is, it is important to plan out where you can get certain pieces of evidence and, and I think I didn't do that until later weeks to be honest on seed placement. And I think I did feel for a couple of weeks there was a mad rush. Um, so I think that reducing stress would be to look at your timetable or look at what's going to happen in the future and plan out what sort of outcomes you can hit, what kind of situations you're going to get into that will allow you to achieve those outcomes and you might not have specifics on your timetable. Um, that's why doing it regularly book like a little weekly planning session. Uh, and then a nightly planning session, like little goal if you like that kind of stuff. You might be one of those people at like nine o'clock. I always do my nightly planning before I get ready for bed. I sit down for half an hour, plan out your trips for the next day. You could do something like that or you could just do it at the end of the day in the office if you wanted to do it, get it done them. So it doesn't take much time to plan everything. Like it depends what you do in Maili. Yeah, I mean I didn't do all my bee placement. I was just kind of winging, collected the evidence I guess by worked, but all my CE placement, um, it was kind of a step up in terms of evidence collection. So I was like, right, I need to be focused here. Um, so I would, I think I looked at all the outcomes until week six and then sort of wrote down which areas I could get things in. For example, communication on, you'll be able to get that in diabetes. So some you just can't get until you're in that setting. Um, but I just looked at step-by-step. So from example, between weeks one to three, I thought, which ones can I get this week? Um, which ones can I get next week? And then I looked from week three to six and 69 and then nine to 12. So I just kind of did lot like that. Rarely. Yeah, I think that he's better than the way I did it because I didn't do that. And the way I did it was I'd asked, attacked it and thought, what evidence can I get? And I wasn't thinking about it in the case or learning outcomes. I was thinking about what tools can I complete? So I did a consultation. I was like, oh, let's do an ICAP for that one. Let's do another cat for that one. Let's do it. Let's do a reflection for this lesson. What happened in the end? From what I can remember, I got loads of pieces of evidence that I didn't quite need. So I did a lot of work that really wasn't needed. Um, so I definitely think planning out would have helped me to eliminate that extra work that I had to do. Yeah. And I think in terms of, okay we have to get so many different outcomes. I think if you have one of evidence you want it to try and match a lot of different outcomes more than one. Otherwise you're just doing it. For me it's kind of pointless really. There's no point in doing it if it's just for one cause you're going to end it with so much pieces of ever and so many pieces of evidence it's going to be too hard to track and for supervisors to sign off. You mentioned like before we started recording about like a celiac consultation as well. Oh yeah. Yeah, yeah. A quick tip for that one is it's a plug for a Sila. UK actually have like a resource of everything you should mention in a consultation with a new patient. So they literally have a big list of everything. So that I found really useful to make sure I covered everything that I needed to do. And I obviously adapted it and added things to it and change things and make customized it myself. But it ensured that I gave the patient all the information that they needed in that first appointment. Cause there is a lot to cover it. It's very much information delivery appointment. So see that UK do have that resource. Um, and uh, if I can get the podcasting sort of things right, I will put it in the show notes. It's helpful. I'll put a link in the show notes and I can find it again. Uh, maybe just a quick question. Like, so Claire, if you could have one tool on placement, okay. Right. One thing you just sort of couldn't live without that you probably wouldn't have expected, what would it be? Uh, so Yanna I'll ask you that for a placement. I'll ask it for myself. I'm just going back to the tables I had in my Polly pockets again with my medication and also what one of the Dietitians they printed out for me. It was um, all the different feeds they had, their had per hundred meals, the amount of calories, protein, um, potassium and sodium and it was per photo per 500 mils, 1001.5. Um, and that really helped me because then I could, I'm not that confident with math. So when I was doing my feeding regimes and I could definitely check that everything that I put down was right. And that really helps me I think. So in, in, in brief his cheat sheets basically. Yeah. A lot of cheat sheets. So yeah, he could spend your first couple of, in fact on the first couple of weeks you might not get any evidence. Yeah. It might be worth on the first couple of weeks thinking about what sort of cheat sheets can I make, what do I need crib cheeks for? And then use your time outside of that to make those cheat sheets. Cause in later weeks when you're trying to call off minutes in your compensation, making quicker, make yourself more efficient, those cheat sheets will come in handy.[inaudible] and also I had another kind of cheat sheets. It was split into a, B, c, d, e. Um, for people who don't know what it means. So a means anthropometry B is biochemistry, CS, Clinical Diaz, dietary and ease environments. And I had this for like a standard o and s patient and under mia box I would have different things of which measurements I could ask for or collect like wait history, current way, um, most weight loss. And then I would do that for each single box and carry that around with me on the wall. And you use that as like a little checklist to make sure I'd got everything at the end of each consultation. One of the things I found useful actually was, it sounds weird thing, but I found do you have the feed companies? They make their own applications? Ah, yeah. I really, you know what the Nutricia did not work on my phone. Okay. So there's lots of different feed companies and obviously it depends on the place where you are. So having a printout or having the application, the application is good because it's updated regularly. Um, but I, I am aware that not all trusts allow you to use the application on your phone, printing off things like that or having the application and a lot of the applications they have extra features like calculating requirements. Um, and obviously things like that can, I found it quite helpful, especially for the, for the feeds and it can change and things like that and pop and things like that, you know, really quite useful. So they have applications in are available on Ios and I think we've got an android user over here. I'm not gonna, I'm not gonna disclose who that is. Um, but uh, definitely available on android all day. Yeah. So just cause they're taught so many different kinds of like feeds and stuff that you get confused was really useful to disc, something like that. Yeah. Yeah. I think another one might be just to cancel your plans. Yeah, that's actually true. Don't try and plan anything. Bake during the placement period is to try to cut your workload down as possible much as possible. And to be honest, sometimes I really could do things that I didn't expect. I was able to do but other times I would have worked to do that. I didn't realize was as much work as I needed to do. So is it a lot of work, like do use like burn weekends and stuff? Preparing for placements? It depends. It depends on the trust, depends on the trust. Depends on you. Depends on, yeah. Your confidence depends on how much you want to wing it, how much, how confident you are, how, how, how long it takes you to write. I think. Yeah, everybody's different. Yeah. It's intense. That's all I want to say. It's intense one because you're learning so much one because your, you're also um, basically like you reflecting on everything and you're going deep into your weaknesses and your shortcoming. That's really true actually. I actually started like doubt yourself a lot on place and I think Aaron said to me on placement, it's really hard when it's not only you critiquing yourself, but it's the dietician and multiple people and that's every single day for six months. It is really hard. Um, soft emotionally as well. Um, yeah, I think, I think that is the case. And I'm not saying that anyone was particularly nasty about it, but that constant thing is something that I'm, I would just wasn't used to and I don't think every single consultation you're reflecting on your going really deep into it. You're talking about it with another person and that is quite an adjustment and it is quite difficult. Um, so I think the point of mentioning this is just to understand that if you're on placement right now we are going on placement. Remember that you're not alone in feeling that way. You're not the only person who sort of, yeah, definitely talk to other students or if if you don't want to talk to other students, maybe your like tutor from university. I definitely think you need to talk about it. Otherwise it just make the situation worse. Really. Yeah. I have not seen a good thing but I also just don't come. Yeah. I think one thing, don't compare yourself to anybody because one thing that I learned is every one is different in a different situation, in a different place. Like from it from my own example week for placement B, I was terrified of doing a calculation cause I had not done an adult calculation on either placement yet by seven weeks into place. I had not seen an adult patient. So I was on a pediatric[inaudible] placement and then I was on p in the pediatric ward for the four first four weeks of my B. So I was terrified. But nobody else could relate with that. So you've got to make sure that your not comparing apples to oranges. Yeah. You know, you've got, you can pair, you're not, you're not overly being critic critical of yourself and remembering everyone's different. And even if someone was in the same trust as I was there, I've been in pediatric for four weeks. I had a completely different experience and where that when they're in pediatrics on the last week, they don't have a clue about calculating children's requirements. Whereas I'm a whiz. Like, you know, everyone comes at things slightly differently. Yeah. And I think when you compare yourself, you can often be over critical of yourself and under critical of other people. Um, and just remembering that I think on one of the dietician offices they had on one of the walls is comparison is the thief of joy. And which I think is a really good, I'm saying especially for placement. Yeah. Um, I think it's important to talk with other students, but try to avoid an, oh, even if you do remember what I said here, what class at here? Yeah. Every situation is different. Even if someone is in the same trust. Yeah. Perspective. Yeah, I agree with that. Um, yeah. I don't compare yourself. Yeah. That's a good advice. Even for life. Nice and fine. Yeah, definitely motivational. Yeah. It's not, listen, put it on Youtube, like motivation. I should've got the video weapon, they couldn't really see my face during that, during that emotive sequence. But I also wanted to clarify something. So throughout the podcast we've, maybe you could construe it as we've been sort of, we've talked a little bit about the struggles placement, but I just wanted to conclude with the fact that I actually, looking back now, I learned so much. It was difficult. It was hard, but I learned so much. I developed relationships with fellow students that are really strong cause we've been through that. Um, I also looking back, I actually sort of have really fond memories of it. Like I remember certain things and you're like, oh, remember when we did this or lot more we did this. It's actually quite enjoyable looking back. Um, and you have moments where you cry. Well, I had a few moments where I cried, um, because it's just really difficult. Um, and I don't want to shy away from that, but I also don't want to shy away from it is a really big learning experience and a really positive one for myself. So, um, I just wanted to make that sort of final remark and on a positive note, I'm looking forward. Yeah. Yeah, you pumped kind of pumped, you know, to be honest, I think it's normal to be nervous about these things. Um, but remember that again for CNN, anybody actually, to be honest, most dieticians that I've talked to who've been through placement recently understand and if you message me on any of the social into web platforms and that kind of thing, I'll message back in it. If anyone, I don't know, you might want to talk, I suggest someone in your same university's going through the same thing, but anyone is willing to, if you just want to message me or open up to anyone, it's perfectly fine and a, if you want any advice or help, I can offer it. But remember when the offer advice is only by advice based on our own perspectives and it's not to be taken as Gospel for all different situations and listen to your supervisor and the trust where you are on what is required for your placement as a doc student. Um, just to make that clear. Um, the thoughts and opinions shared in this podcast. So false and opinions. I'm not officially endorsed by the beat or anyone affiliated with the, um, yeah, I'm going to see really good. Yeah, Aaron for providing all the equipment. You a great set up. Yeah. I also thought be really good in the future to get back together and uh, probably be remote. Um, uh, but to get back together that when me and Claire have had experience of[inaudible] yeah, that's true. Wow.[inaudible] been on placement. That was really good idea. And then be like, how have our perspectives change? Because obviously they're just opinions based on our experiences. So when we've had experience, I actually supervising people, it might change. Um, so I think we might be able to offer something in a slightly more, as we get more, yeah. Get a different perspective. Yeah, definitely changing perspective teaser for the future. So, uh, thank you all for listening and a goodbye.