We are eager to work collaboratively on brainstorming ideas for different models. Any idea counts in this post. We will collate the ideas and share them with the Task Force and any other groups our readers suggest. Thank you!
--iSAD
~~~~~~
Okay, so now we are going someplace.
What characteristics would students like to see in a different model? Realistic or not...
Write in positive words/phrases so that we do not offend anyone entity/being.
If you have a hard time with this which is understandable... emotions can play alot. write it out on a piece of paper then bring them together and post.
Looking forward to having this discussion.
45 comments:
What about using simulations with live actors to help provide practical training?
Is internship even necessary? With volunteer work, job shadowing and an undergrad we are very strong.
Consider providing the RD exam after university and let it be the test that determines if you've met the competencies.
I've been a dietitian for 13 years.
I really don't think you can eliminate the practical training program all together. There are many skills that are learned during admin, research and clinical rotations that cannot be taught in the classroom or during volunteer experiences (depending on the type of experience).
The university program now includes many practical opportunities and has evolved a lot over the last 13 years. You may be surprised to know how much we do in university now and how much more prepared we are.
Okay so we have some ideas being brought forward. Okay let's keep going forward.
the concept of how much training is needed seems to be coming out from post #2 and post#3. (i.e. eliminate all versus still have training component).
What else??? Keep moving forward.
How would one determine how much practical training is needed, exactly?
Do interns need to complete the same competency in every rotation?
We have posed a range from zero to many weeks.
Would this be something the task force has measured?
Could we receive a compensation for our internship period? I think that considering the amount of time we spend in the internship, and the difficulty of working outside of it, a financial compensation is appropriate. This may help lift some of the stress associated with completing an internship.
If it is determined that less training is needed, perhaps we can shorten the internship periods to allow for more positions (as someone had mentioned in another posting). By shortening the internship periods, two spots would replace one, and the number of internship placements could double. Is this feasible? I think we can learn a lot in 25-26 weeks, and perhaps 40-42 weeks is not necessary?
I think that's a fantastic idea. And we'd be willing to accept much less compensation than the dietitians too. Just enough to cover living expenses would make life liveable to a broke intern.
Another thought...
What if you could get your practical experience from any RD at any hospital and not have the need for formal programs. DC could set the competencies and we would get them signed off at LTC facilities, public health, small community hospitals, family health teams etc. No interviews, no bias, no competition - no need for lipstick!
These are all great and positive ideas. In an ideal world- and hopefully in the near future- I think the best solution would be to open up at least double the spots and include a small compensation. I would agree that the internship process in necessary, in addition to the undergrad program. I've heard from peers and colleagues that the internship provides a major learning curve, so I don't think it would be realistic, or the best solution to eliminate it.
-Current 4th year student.
Perhaps it could be assessed on a case by case basis - perhaps if someone had a lot of experience "ie - the posting listing all the experiences on the main page" - perhaps that person could complete her competencies in 8-12 weeks where someone else might need 20 weeks.
I also have heard from intern friends about being expected to work unreasonable hours and having to stay after the RD goes home - we need to make sure interns aren't taken advantage of in this way. A new model and compensation would help ensure the same basic rights as any hospital employee. If an RD stays late she is going to get overtime - what would we get?
Are the people posting on here students or dietitians?
It might be helpful to clarify your background, so that the readers can understand the context of your ideas.
Yes, would be good to distinguish between RDs and students. Being an RD for many years, I can kind of tell by the comments because some are just crazy....for example - I have never known an RD to get overtime as very few of us are unionized in Ontario. I have also known many RDs (including myself) who have stayed late to finish work because they were tied up with teaching interns all day. You need to consider that having an intern is extra work for the RD too - it is quite insulting to keep referring to yourselves as unpaid labour....you are not yet qualified and need to have your work supervised by law. I am not saying that internship shouldn't change and couldn't be done in much less time, but it is important to understand the value of the learning that occurs. For me, it was tough, but the most effective part of my education and I continue to be grateful to the preceptors who taught me.
I agree, the expectations of the internship need to be more reasonable... I am wondering when it became necessary to feel like you have to stay later during your internship. Perhaps making the hours more reasonable and taking away the pressure interns feel to stay later... this way many of us could have a part-time job outside of the internship.
I am sure it is a lot of work for the RDs training the interns, I can understand that completely. Therefore, lessening the length and time of internships could help lift some of the burden these RDs are feeling as well.
Yes - reduce the hours, expectations and workload of internship. After all we are not being paid.
I think it's hard when RD's complain about the work it takes to have us be with them. Usually interns are helping with the caseload, doing projects and running nutrition month. These are valuable things that don't seem appreciated. I've had RDs tell me that they have learned as much from me as I have from them!
an intern
Internship is a training program. It's kind of like school, but in a practical setting.
In undergraduate, you study for exams or prepare assignments outside of class. It would be unreasonable for the Professors to take time away from lecturing to give you in-class time to work on your assignments (like in high school or grade school).
In internship, you learn how to apply the knowledge you learned in undergraduate. After spending time working with the dietitian during the day, you are expected to study clinical topics/readings, or completing assignments, case studies or research during your evenings and weekends. It is important to emphasize that internship is NOT a job, it is a TRAINING PROGRAM. Just like school, but working on developing different chacteristics.
I feel that it is possible to shorten the lengh of the programs. However, taking two cohorts of interns in a year is not feasible for coordinators based on the current model. I'm not a coordinator, but I know how much work it is, especially since the class sizes of interns keeps increasing.
I like the idea of applying for an internship stream after 1st or 2nd year undergraduate. I think this is what they do in the eastern provices. That would allow that academically the strong students to move forward. It also exposes students to the program, and some may realize that they are actually not interested in dietetics after the 1st or 2nd year, thus saving a spot for someone truly intersted.
I really like reading the comments from RDs. Through this dialog we can break down many assumptions and skewed expectations about the internship and practice in general. I agree with the above comment. I see internship as a practicum, not as a job. And since it is considered to be training and we are not paid for it, I think it should be integrated into the undergraduate program so that students can apply for loans. This would alleviate some of the pressure for interns to work while they are completing their internship. It is very difficult for students to save money for 4 years while taking student loans to be able not to work during the internship. It puts some students at a disadvantage. I am lucky to be married and that is why I will be able to afford the internship next year. But unattached students whose parents cannot support them are at a very difficult financial position to be able to complete an internship. In my mind this is inequality in terms of access to professional training.
Student/Future Intern
Thank you Clinical RD in Ontario,
You said what I was having trouble saying!!
Some of you have commented that you need to get a job during internship and I can't imagine how you could work full time, study and complete assignments part time and work as well! So, for me, the answer is to take away the need for part time jobs during internship, by allowing access to funding, loans, grants, etc. If the process wasn't so competitive students wouldn't spend 4 years doing volunteer work and they could get part time jobs during undergrad to save up for the internship year if necessary.
An integrated program with an earlier decision seems the way to go. Everyone experiences disappointment in their lives, but decreasing how long you hope for something might help people see other opportunities out there and move on sooner - might also salvage relationships with friends, family and future colleagues that are strained by this current system.
After giving this a bit more thought, perhaps the model that works in other provices will not work in Ontario, since we have 3 universities with 2 being in cities (Guelph, London) separate from where the majority of training resources are located (the Greater Toronto Area).
Would it be possible to develop a program where students apply to a given Hospital internship program during their 2nd year university. The students could apply to 3 hospitals which are located anywhere in Ontario. Then in the 2nd, 3rd and 4th year (perhaps in the summer months) they go to that Hospital to complete the practical elements of the program? This would be in contrast to a University managing the internship placements. At least if it was hospital managed, one internship coordinator would follow the progress of the student, allowing for a more personalized program/experience. You would also have an investment/commitment from the hospitals in participating in such programs, which will gaurantee placement spots.
The only trouble with that approach is that is housing in a different city for 4 months is troublesome. For example, if you lived in Guelph and did an integrated internship with St. Michael's hospital, where would you live during that 4 month period if your family was not from Toronto?
I am, however, partial to this approach because it allows for equal distribution of resources. For example, why should the Guelph program only have access to smaller community hospitals in the Guelph area? Conversely, why should Ryerson students be the only ones to have access to the most acute care hospitals, with specialized advanced-practice programs? Such an approach that I mentioned above would provide equal opportunity for all.
That's my idea :)
A more manageable way to integrate would be to assign the current programs to various universities: ie - the programs in hamilton, barrie and kitchener become part of the university of guelph etc. The universities could then subsidize the pay of the internship coordinator (reducing the burden on cash strapped hospitals) and provide a financial or educational stipend for the RDs taking on interns thus recognizing their time and added workload. This cost would be covered from the tuition paid by the students just like the salaries of university professors are paid.
Such a system might actually be incentive to some hospitals to start an internship program where none currently exists. Low risk, guidance from the universities and incentive for the in-house RDs. Currently very little support exists for RD preceptors.
For those of you who feel prepared to become an RD based on what you've done already - I will say this: internship doesn't teach you everything but it most certainly gives you an appreciation for how very much you don't know yet.
RD
We need to have internship programs that are in existence still there to have their programs support our training. They have specializations and skills that are essential for us to be exposed to. There are some programs out there like the one I am doing right now that totally fits my career interests and I think by thinking you are not going to have these programs around it would be huge mistake. I am proud to be in the program I am in and I have been exposed to soo so much. I think each program is unique and taking this away would be a huge disadvantage.
Also... like these programs are there to teach unlike some other institutions which don't have to teach nor are they paid to teach. Trust me... I tried to get exposure to different areas as a student and so many other places are not required to do so. So I would worry abou the quality out there. I like the last post's idea.
I think the internship programs should be affiliated with a university in some manner. The internship coordinator's position should be paid for by the university and the RD's who take interns should recieve a stipend in consideration of the extra work and time. This should be funded via tuition and interns would be able to get OSAP and other loans. Each program could choose a university to affiliate with. This type of program would encourage hospitals currently without an internship program to start one since the HR costs would come from the schools. It might also result in improved support for RD preceptors.
For those who feel prepared to be an RD based on past experiences and university alone I will share with you my own experience. I truly did not appreciate how very much I didn't know until I got to internship. Even as a new RD there is a huge learning curve. Don't dismiss the value of practical experience and the security of doing it in an internship setting.
I agree that an internship is absolutely necessary. I learned so much personally and professionally during my internship. However, in retrospect, I did feel that I had already achieved some of the competencies, especially in my admin rotation, since I had worked in a hospital food service department for 3 years prior to internship. Perhaps a learning assessment could take place if an intern feels they are strong in a particular area. One of my fellow interns had a MSc degree, and she didn't have to do research. Perhaps other competency areas could also be considered.
I agree with all the suggestions above, that the coordinators receive financial support from the university. I did my undergrad at Guelph and my internship in Toronto. I was extremely happy with my internship program and it was the perfect "fit" for me.
I think if I was only able to do internship in Hamilton, Kitchener or Barrie I would not have had the same experience. I'm not sure if it is fair to limit the choices of the students. I would not have chosen to go to my undergrad Guelph if my internship was limited to those hospitals. I'm not sure if that is fair to Guelph, it may limit that program from attracting the best students - and it's an excellent program! I think students need to be given the opportunity to choose.
And I agree that we should be able to get OSAP to support us during internship. Doctors get paid something like $50,000/year during their residency programs and are able to get OSAP during medical school. Therefore, doing an internship is not the same as becoming a doctor, as someone identified in another post.
RD
You can have affiliations however they should NOT be designated by where the person goes to university. Just because I am a guelph grad does not mean that I should not have the opportunity to be placed a downtown teaching facility. I am from Toronto!!! Just chose to go to school in Guelph.
So I think this is a limiting idea!!!
I don't agree with coordinators being paid by university as coordinators roles currently are more involved within the current institutions than people really know. They have different internal hospital responsibilities beyond internship related duties. Most people don't know half of the teaching responsibilities coordinators have within their own institutions.
Signed: RD who advocates for coordinators.
Great to read all the ideas in this this thread!
In response to the previous post, I actually agree that the coordinators should not be soley paid by the University, but their salaries could be supplemented by the University. Internship coordinators do have many responsibilities beyond internship. But they could be paid for their internship-related activities. Why should all the tuition money go to the university if hospitals are partnering with the University to provide training for a University-based program? Interns cost money. Even a little money would help and be fair.
There are always threats that the internship program will be cut (at least in our hospital). It will provide an additional income stream for the Coordinator position, and thus ensure ongoing support from the hospital.
Respectfully,
~ dietitian
Doing an dietetic internship is not the same as an MD. Sorry to disappoint but it is not. Physios, OTs etc... allied health professionals are not paid so why do people feel entitled to be paid? It is not idealistic nor is it appropriate.
I would like to pose a slightly different point of view...
Currently the direct cost of doing an internship is nothing - no tuition, no fees. Yes you have living expenses but the hospitals pay staff to organize, train, evaluate and mentor students and get no financial compensation in return.
Universities charge you plenty and you still have to pay to live. The key is to get the gov't to provide OSAP during the internship year.
If I was a hospital administrator I would wonder at the value of maintaining these costly programs and I can guarantee that I would not be willing to pay the students! As an RD it is hard enough to justify our own role in the hospital and trying to increase staff is a major challenge. Paying students is a non-starter.
We take interns because we see mentoring as part of our professional role but none of us are going to be willing to lose RD staffing so that dollars can be allocated to pay the interns.
I don't mean to be harsh - just honest.
I think the important piece is that we need to know how many RD's are going to be out there for the workforce.
Remember what happened to teachers in the 90's they graduated so many that many did not have jobs. They were stuck serving coffee just to pay off loans. So... i think the question right now should be why do university programs keep opening up class size? Why do they keep putting in more students?
I can see how we would be producing too many RD's and then what are people going to do? End up working at Starbucks and paying of student loans? The competitioin will then be for jobs so we will just be pushing the competition to a later point in time.
There are not a lot of jobs out there within GTA. Let's face it ... not that many students want to go outside of the GTA so.. what does that say?
I don't think just making something integrated will solve the problem. We have too many students entering nutrition programs in universities. There is the problem!
I agree with the comments posted by the RDs, for the most part. In theory, why should interns be paid if it is an educational process? I really want to do an internship (didn't get one), but I'm honestly not sure if I can afford it. Coming out of school, I have a massive OSAP debt. At best I may be able to freeze my payments during internship- at best. But even then I am not sure how I will pay my rent (and support my child). I have my family's help- luckily- and perhaps they would be able to help me with small purchases. So I guess my point is that internships are a bit exclusive. I come from an educated family, and I still may not be able to afford doing an internship. So how about people with fewer means?
I am not saying to pay interns (stipend perhaps), but maybe we should be OSAP eligible- not that I want a larger debt- but at least I can live without financial worry, like now.
It's definitely complicated. How do you please all sides?
Along with integrated programs comes other streams for the students who are interested in food and nutrition, but will not end up pursuing a dietetics internship. We must not think of integrated programs as limiting, but as one of several options that undergrad students can enrol. UBC does this as I am sure many other integrated. The universities must keep their funding nice and healthy, right?
It's disappointing to read that RD's don't want interns to be paid because they are afraid it will negatively affect them. Apprentices are paid in technical fields.
I think you will read in a previous post that its not about wanting an intern to be paid or not. It is that hospitals CANNOT AFFORD to pay interns. Hospitals can hardly afford internship programs. There is no money. Hospital staff wages are frozen and there are hiring freezes. As much as hospitals would like to pay interns, there is simply no money.
I think the idea is that students should be able to get OSAP during their internship, which is one of the bonuses with integrated programs.
To April 9 at 11:54 PM
I think you raised an important issue. My fear is also that we will end up like the teachers in the 90's. There are still teachers out there without full-time contracts working as servers in restaurants. That would be unfortunate for our profession.
RD
I voted for on the job training, but would like to elaborate as to why I voted this way.
Internship as it is currently conceived, no matter how one gets in, is fairly clinically focused. Although there are rotations in community and admin offered, this is relatively brief compared to the numerous weeks of clinical training.
I am not suggesting I have the answer to solve the problem, but I think that needs to be considered.
Do we want to stream on-the-jobs training?
I think comparing a potential dietitian "surge" to unemployed teachers is somewhat misleading....I was an RD during the 90s and many nurses were also laid off, and enrolment rates increased to combat this. There was concern that these nurses wouldn't have work as well. You will find that on any given day there are countless jobs for nurses (and I just looked at Workopolis and there are 28 pages of jobs for teachers). If we find ourselves in the position of not enough jobs to go around, we will need to be even more creative about where we work and the type of work we do. That is one of the differences between teachers and dietitians - we can work in a much more diverse number of settings. In addition, teaching positions are dependent upon the numbers of children in the educational system - a number that is actually dropping in Canada, whereas our work tends to be related to health and wellness, which is not necessarily population growth rate specific.
I say bring it on! Maybe that way we will have the numbers to effectively lobby for all sorts of things that would benefit the profession and the public.
It's not just having jobs available but also jobs that are permanent, well-compensated and offer a reasonable number of hours. Many of the RD positions in LTC are one day a week and many FHT and community based healthcare jobs pay way less than hospital RD's. When the FHT's couldn't find anyone willing to work for the ridiculously low wages - they increased them.
As an experienced RD with many years under my belt I have no fear for my own career but I do think it would be a tough start to enter the field with a surplus of RD's.
Brainstorming ideas for internships and other avenues for obtaining RD status....
1. Students find RD mentors that are willing to sponsor (no funds, training only) and the student works/learns under the sponsor that is accredited and approved by the college.
2. This could also extend to more Rural hospitals....I'm sure there are many RDs working with hospitals in Ontario outside of major city centers that would love to have a dedicated student working with them. I guess this sort of goes with the above suggestion.
3. Integrated, so students apply to the RD stream after 2nd year, but then they must be guaranteed the opportunity to write RD exam.
I believe there are probably many qualified RDs who would be willing to mentor an intern and provide training. Of course this would not be compensation based (nor should it be...it is career training), but this type of model may open up more avenues for writing RD exams. Also, maybe there should be specialties within the RD body? Much like the medical field....one avenue of training gives you the ability to work in a very clinical setting, another is aimed more towards community practice, another toward private?
Just some thoughts.
I like the idea of streaming of practice areas for training. As a RD we need to appreciate all practice areas and provide training. So one internship program stream that would be integrated could be a) acute care focus (major) with a minor in public health.
Or perhaps the idea of advanced practice areas for specializations such as: Nutrition Support, Intensive Care, Business management etc...
We need to think broad if we are to advance ourselves so that we open up opportunities and doors.
And yes...having training model that still encompasses and internship component is important!
A note on compensation: We need to work on this. We are not on the equal playing field of other allied health. Maybe the model should take into consideration Masters qualified designation??? Physios have it why should we not have it.
I think the internship model is still a good model but can be altered. I think we need to define internship model b/c that means a lot of things to different people.
I see internship training model as a specific period of time within designated areas to be trained by professionals in the field in a specific area of practice for a designated period of time. The model is integrated in BC and the internship programs are still in existence. Just tweaked a bit differntly so that the interns have opportunities outside of the acute care centres.
I think interns should be compensated. If no-one applied for internship next year that wyould really give the programs something to think about!!
Would the universities be willing to assist with compensation?
As mentioned above, hospitals do not have the budget for students. There are already staffing challenges.
If the hospitals have no money, and the universities are not willing to provide funding, then who will?
RD
Based on the most recent post "Another Perspective," I am wondering how the internship might be streamed for those who want to work in hospitals, or public health/community, or industry, or research, or LTC, or private practice? This does seem quite limiting though, doesn't it.
Shouldn't it be the case that if you are a RD, you can work in any sector?
Based on that post, if you have a MHSc and are a RD, you are excluded from clinical practice in a hospital setting. Hmmm.
Do students know this when they decide between accepting their internship offer and their Master's degree offer? Maybe someone should tell them!
Signed,
Hierarchies are Alive and Well in Dietetics!
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