BROOKLYN COLLEGE DIETETIC INTERNSHIP

INTERN TRACKING FORM

Name______

Facility______

Completed / Date Received / Completed / Date Received
1 / Physical exam / 6 / Evaluation of DI
2 / Health Insurance / 7 / Intern self-evaluation
3 / Liability Insurance / 8 / Preceptor evaluation of DI
4 / ADA Membership / 9 / Preceptor evaluation of intern
5 / Completed Portfolio
Clinical Assignments / Date received / Food Service Assignments / Date Received
1 / Professional meeting (CD3) / QA project (CD14, 15, 16)
2 / Professional meeting (CD3) / Calculate nourishment costs (CD18)
3 / Professional meeting (CD3) / Job description (CD20)
4 / MNT case study (CD13) / One-week foodservice schedule (CD20)
5 / Case study Presentation (CD13,6, 32,33,34) / Flow chart of food service area (CD21)
6 / Code of ethics (CD1) / Administrative skill development (CD22)
7 / Legislation project (CD5) / Supervise meal service (CD23)
8 / Patient 1 (complete nutritional assessment) (CD7,31,32,33,34) / Recipe development, analysis and evaluation (CD24,27)
9 / Patient 2 (CD7,31,32,33,34) / Cycle menu with nutritional analysis (CD25, 6)
10 / In-service (CD10) / One week menu for modified diet (CD26)
11 / Education materials for target population (CD11) / HACCP trail (CD 29)
12 / Self-evaluation for MNT / Self-evaluation for Food Service
13 / Intern evaluation of preceptor/rotation/facility / Intern evaluation of preceptor/rotation/facility
14 / Preceptor evaluation of MNT / Preceptor evaluation of Food Service
15 / Preceptor evaluation of intern / Preceptor evaluation of intern
Community Assignments / Date received / Independent Practice Assignments / Date Received
1 / Summarize agency’s role / Develop business/operation plan
2 / Develop lesson plan with learning objectives and evaluation strategy (CD10) / Analysis of alternative medicine practices in diverse population
3 / Present a group education class and evaluate comprehension. Analyze results (CD10) / Educational materials addressing use of alternative medicine
4 / Develop nutrition education brochure and evaluation tools, pilot test (CD11) / Barriers to change
5 / Develop posters and flyers for health day (CD12) / Develop educational materials using self-management techniques
6 / Write article for local newsletter (CD12) / Self-evaluation for Independent Practice
7 / Nutrition screening analysis (CD 40) / Preceptor evaluation of Independent Practice
8 / Specific dietary habits of diverse cultural group. Develop handouts. (CD42) / Intern evaluation of preceptor/rotation/facility
9 / Develop and evaluate community based-food and nutrition program Submit report (CD 44) / Preceptor evaluation of intern
10 / Supervise meal served as part of community-based food and nutrition programs, write report and recommendations (CD45)
11 / Self-evaluation for Community
12 / Intern evaluation of preceptor/rotation/facility
13 / Preceptor evaluation of Community
14 / Preceptor evaluation of intern