What is advanced practice?   

According to the Academy of Nutrition & Dietetics, advanced practice, as it relates to dietitians is defined as demonstrating “a high level of skills, knowledge and behaviors. The individual exhibits a set of characteristics that include leadership and vision and demonstrates effectiveness in planning, evaluating and communicating targeted outcomes.” These individuals have graduate and/or professional degrees, have been credentialed as an RDN for at least 4 years, possess an advanced practice credential, practices ethically, and is committed to continuing education at an advanced level (in a general or focused area of practice). Research and expert opinion have identified many specific tasks, characteristics, and attributes have been associated with advanced practice RDNs. And while this program could not possibly address all of them, these are the attributes that guide the experiences and learning during the DNS APR 

Is this program required to be able to take the Advanced Practitioner Certification Exam offered by CDR? 

No. You are also not required to take the exam at the end of this residency, but you may choose to do so if you like. 

What is the time commitment for this program?   

"Residents can expect a time commitment of 1 – 6 hours per week depending on the nature of the assignment.  Assignments that review basic concepts in nutrition support (e.g. enteral nutrition formulas, complications, etc.) will take less time, while other topics require more of a commitment.  Subjects falling into the latter category would be anything having to do with reviewing literature or conducting research.   Time devoted to the capstone is variable.  Given the long-term deadline, it’s really up to the resident to manage that time accordingly but on average expect an additional hour or so every other week." - Austin Webb (Class of 2020)

Are there any technology requirements for this program? 

The APR is accessed via the Cleveland Clinic’s MyLearning platform using a login and password given to residents once enrolled in the APR. It can be accessed by residents anywhere (even on a smart phone!) and at any time. 

While not required, prior residents have reported better interactions during the program when they have a reliable network connection to the internet with video and audio capabilities. Some of the faculty set up ZOOM conferencing meetings during courses and you will also have periodic video conferencing meetings with the APR Director. You will also be expected to present a journal club and your capstone project presentation to an online audience. 

 We have found that by encouraging this type of communication, residents feel more connected to their peers and the faculty while helping to break down some of the barriers imposed by an online learning environment. You will be HIGHLY encouraged to utilize audio and visual capabilities throughout the year.  

 What kind of experiences occur during the supervised practice week?   

The supervised practice week offers residents the chance to synthesize prior professional experiences with knowledge and skills gleaned from the APR's online courses then apply them in a hospital setting under the guidance of an advanced practice nutrition support dietitian. 
Residents will be able to designate a preference for the location of their experience and choose from a variety of nutrition-support related activities during the week (for example: using ultrasound for muscle evaluation, placement of post-pyloric enteric tubes, hands-on review of NFPE and grip strength, observing transplant/critical care rounds). Each resident will be connected with an advanced practice preceptor to observe and participate in clinical care of patients requiring nutrition support. Many of the activities are designed to support further knowledge enhancement, apply clinical judgment in real-life scenarios, and share differences in professional practice as a means to improve patient care. Residents will also present a journal club to a live multidisciplinary audience.

Photo: Arlene Escuro discusses enteric access and devices with residents

Photo: Residents take group photo at conclusion of Journal Club presentations

"Residents should expect an eclectic array of experiences during the supervised practice.  Not every hospital grants the same autonomy as that afforded to dietitians at the Cleveland Clinic.  That being said, the supervised practice is a great opportunity to seek ideas for adoption at one’s own facility (e.g. using ultrasound to assess muscle loss, placing post-pyloric feeding tubes, etc.).  The best advice would be to take ideas and questions with you upon entering the supervised practice and then utilize the experts and experiences to try and answer those questions.  Remember, you are a resident, not an intern.  You are there to elevate your practice to a higher level, not bring you to a baseline you should already be at.  Take initiative.” - Austin Webb (Class of 2020)

What types of capstone projects have residents worked on previously?  

The purpose of the capstone is to allow residents to choose a subject of personal interest then pursue an independent project, in-depth, to addresses that topic. The capstone is either a research project or a quality improvement project that is designed with the help of the resident’s mentor and the residency’s Capstone Advisor. Previous residents have developed projects on a wide-range of topics including:  

  • Quality improvement: Adverse outcomes associated with inappropriate administration of Parenteral Nutrition  

  • Aligned delivery method for ICU Protein (ADMIn): Doses ordering as a medication improve delivery?  

  • Malnutrition Template Quality Improvement Project 

  • Impact of Implementing an Enteral Feeding Protocol in the Cardiovascular ICU on Nutrient Delivery and Outcomes, abstract accepted to ASPEN2020  



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