What to expect on B placement in dietetics

I’ve recently started my B placement at a large acute hospital, and it’s been an amazing experience so far! Coronavirus means my B placement has been cut from 12 weeks to 7 weeks but I’m still making the most of it. I wanted to write this post for anyone that’s considering dietetics so they can get a better insight into the course. I definitely would’ve appreciated something like this when I was researching the course. It could also be helpful for people already on the course and waiting to go out on placement.

What I’ve been doing:

I’m really lucky to be at a big acute hospital that has loads of specialities. So far, I’ve seen: oncology (cancer), critical care, gastro (patients with coeliac disease), renal (kidney disease), neurological rehab, home enteral feeding (tube feeding), diabetes, cystic fibrosis, and stroke.

Normally, the first couple of weeks of B placement is just shadowing and observing dietitians but as we’ve got a shorter time frame, we had to jump right in.  By the end of the first week I was speaking to patients and had a go at writing in the medical notes! 

Now I’m about halfway through and I do a lot of the consultation myself, but the dietitian is there to chip in as needed. Before we see the patient, I’ll go through the medical notes and gather information to help inform my assessment. This includes things like blood test results, bowels (us dietitians talk about poo a lot!), fluid intake and output, medications, any symptoms like nausea and vomiting, and skin integrity. 

Then, taking this all into account, we go to speak to the patient to find out more about how they’ve been getting on and how they’re eating. Based on what they say, we make a plan as to how best to support them, whether it’s giving them extra snacks, giving them nutritional supplements, or tube feeding. We’d always encourage a food first approach but if people aren’t eating well, they need other options. After seeing the patient, I’d then document in the medical notes and write down what happened during the consultation. The medical notes are a legal document, so you have to write down everything that informed your assessment and your plan with the patient to justify what you’ve done.

I’ve also done some telephone appointments with outpatients and had to write letters to their doctors summarising the appointment so they're up to date. I did 2 review appointments for patients with coeliac disease. And I did some home enteral feeding calls. This is patients that are living in their home, but they get some of their nutrition from a tube feed. The tube normally goes through their stomach and a special feed with all the nutrients they need is pumped in. The protocol with outpatients is the same as with patients in the ward in that you gather information about their previous appointments from the medical notes to help you assess them. But the notes for outpatients will usually be electronic and you might not have up to date blood tests for them. We normally go to do home visits with these patients as well but COVID stopped that.

I’ve really got stuck in and have had such a varied experience so far.

What to expect:

Tiredness - one thing I wasn’t quite prepared for is the tiredness 🤣. We do 8.30 to 4.30 Monday to Friday and I think my body is just about adjusting to the full working week. It’s also extra tiring knowing that you’re constantly being watched and observed by the dietitians, you have to be ‘on’ all the time. But the team at my hospital are all so lovely and have really made me feel welcome so I don’t even think about the fact that they’re assessing us.

Nerves – it’s natural to be nervous about starting placement but don’t worry! I was worried about it for nothing, the dietitians are really supportive, and they always ask you what you're comfortable doing. It’s a learning experience and the dietitian will always be there in case you’re not sure of what to do.

Atmosphere – the hospital can be a sad place. It is full of people that are unwell, and some may be terminally ill. It can take some getting used to being in that environment all the time. You’ve got to remember that you’re doing what you can to support patients and help them improve their nutrition as much as possible.

Intensity - placement can feel really intense and like a lot is going on. You’re essentially learning and working full time while also being constantly observed by other dietitians. As the weeks go on you’re expected to do more and take on more responsibility with patients. It can be easy to feel burnt out as you’re always on the go. One way I deal with this is by having weekends off and not doing any placement related work. I complete all my paperwork during the week when I get back from the hospital. I take my weekends to relax, meal prep and watch Netflix. If you go at 100% everyday of the week you’re going to feel drained. You’re allowed to take some time off to breathe. I also catch up with family and friends regularly as a way to de-stress.

Paperwork – we have learning objectives to meet on placement and the way you show that you're meeting them is via ‘tools’. We have forms to fill out when we do a consultation by ourselves, a general reflection form, a weekly reflection form, a team working form, a group presentation form, a professionalism tool, and witness statements. My uni requires certain numbers of each of these forms to be filled out by the end of placement so we have to make sure we fill these out regularly to keep on top of it. It’s better to do some forms week by week rather than leaving it all last minute and having to get everything completed and signed off in the last week. There is a lot of time spent in the office while waiting for dietitians so you can use this time to get some forms completed too.

Hunger – one thing that has made it so much easier is meal prep. On Sunday I meal prep my lunches and dinner for the first few days of the week. Then one night during the week I’ll prep again. Everyone has a different way of doing prep, but this works for me. It means I get different meals during the week and that the food is a bit fresher. It is a bit of a pain cooking when coming back from placement, but I always plan something quick like pasta to not take too much time.

I hope you enjoyed this blog post! I wanted to give an insight into what placement is like. This is just my experience, and everyone’s will be different. But if you’re considering a degree in dietetics, it’s always worth having a bit of insight into what it’s really like before you start!

Bye for now! 👋