Medical Nutrition Therapy Competency Evaluation with associated learning activities
Please evaluate the intern on the competencies listed below.
Scores of 1 require remediation for successful completion of the rotation.
Rotations of no longer that 3 weeks do not require a midpoint evaluation; however the preceptor may mid-point evaluate as he or she sees fit.
Competencies not accomplished due to practice site limitations should not be completed and noted in the comment section.
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Email *
Student Name *
Student email address (required for receipt of evaluation) *
Practice Site *
Date of this evaluation: *
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Preceptor Name and Title/Credentials *
This evaluation is being completed by *
I testify that _____ hours were completed for this rotation. *
CRDN 1.3: Justify programs, products, services and care using appropriate evidence or data. (Learning activity: assess tolerance of tube feeds and recommend necessary changes to rate or formula type in ICU)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 1.4: Evaluate emerging research for application in nutrition and dietetics practice. (Learning activity: conduct research for mini case studies)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.1: Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics. (Learning activity: demonstrate adherence to HIPPA guidelines during patient care activities)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.2: Demonstrate professional writing skills in preparing professional communications. (document nutrition assessments for patients in acute care utilizing NCP)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.4: Function as a member of interprofessional teams. (Learning activity: participate in interdisciplinary care meetings and rounds in the ICU)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.5: Assign patient care activities to NDTRs and/or support personnel as appropriate . (Learning activity: complete nutrition screens and delegate to nutrition department staff as appropriate)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 2.6: Refer clients and patients to other professionals and services when needs are beyond individual scope of practice. (Learning activity: demonstrate effective communication with interdisciplinary team while participating in patient care)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 3.1: Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings. (Learning activity: conduct nutrition assessment, diagnosis and interventions with patients utilizing NCP)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 3.8: Deliver respectful, science-based answers to client questions concerning emerging trends. (Learning activity: conduct Q & A with patients and caregivers following acute care nutrition discharge education for CKD or CVD)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.3: Conduct clinical and customer service quality management activities. (Learning activity: conduct patient meal rounds in an acute care or long term care setting)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.4: Apply current nutrition informatics to develop, store, retrieve and disseminate information and data. (Learning activity: utilize computer based data system to retrieve and document patient information)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.5: Analyze quality, financial and productivity data for use in planning. (Learning activity: Conduct plate waste study)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.6: Propose and use procedures as appropriate to the practice setting to promote sustainability, reduce waste, and protect the environment. (Learning activity: conduct and evaluate results of facility enteral formulary study to determine future needs.)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.7: Conduct feasibility studies for products, programs or services with consideration of costs and benefits. (Learning activity: evaluate the results of facility enteral formulary study to determine necessary modifications to ordering protocols)
Does not meet expectations
Exceeds expectations
Clear selection
CRDN 4.10: Analyze risk in nutrition and dietetics practice. (Learning activity: assess patient intake during meal rounds)
Does not meet expectations
Exceeds expectations
Clear selection
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