Expectations within the Profession

By Kate Miller

As a dietetic intern, you constantly make first impressions.  Among meeting new preceptors and their colleagues every two weeks, you must also make connections with volunteer coordinators, community members, patients, research associates and more.  Additionally, a dietetic internship experience can vary greatly depending on how much your preceptors appreciate your company or assume your ability.  The American Psychological Association states that a “snap judgment” takes only 50 milliseconds, which is less than the blink of an eye, and a 2010 Harvard study revealed that 55% of someone’s first impression is based on their visual appearance.  To add, the psychological concept of serial position effect, specifically primacy effect shows that people remember a person by their first impression of them more so than what comes after that.  Meaning, first impressions and pre-judgments for a dietetic intern matter, a lot.

It is no secret that within the dietetics profession, there is a profound lack of diversity.  As of February 2018, The Commission on Dietetic Registration lists 99,949 Registered Dietitian Nutritionists (RDN) in the United States.  Within that population of professionals, 89% are females (or more since 7.2% didn’t report), 76.3% are white, the average age is 40.4 and 45.2% received bachelor’s degrees in Health or Human Sciences.  This data implies that when preparing for a new rotation one can usually assume that their preceptor will be a middle-aged white woman.  Additionally, and potentially more detrimentally, this preceptor can usually assume that their next intern is a white female who the same education background and experiences as her.

So, this begs the question, what happens when you don’t fit this construct?  How do you make good first impressions, and have the best possible learning experience, when you aren’t what you’re “assumed” to be?

Research conducted at Cambridge University in England has shown that even the lowest levels of unmet expectations (such as an unexpected looking dietetic intern) are highly correlated to drops in neural dopamine levels and subtle increases in threat responses.  Dopamine is the neurotransmitter of desire, reward, curiosity and interest.  Meaning, that in order to best sustain a preceptor’s interest and curiosity in you, you must meet their expectations of what you’re “assumed” to be within that 50 millisecond first impression window.

My experience of the dietetic internship has been greatly impacted by the subliminal pressure for me to attempt to try and fit into the constructs that have been laid out before me.  Personally, that means that I must make a conscious effort to dress more feminine and cover all my tattoos while at internship.  Additionally, it means that I must always be aware of the way that I present to my preceptors, trying to be quieter, softer, less confident and generally less “me.”  It means making a choice everyday about whether its best for me to correct a preceptor who assumes I am straight, or assumes I share the same political viewpoints as her.  It means knowing I am going to stick out like a sore thumb when I enter a room with my classmates, and knowing that I won’t be able to relate to them on more topics than I can count in both hands.  Finally, and most importantly it means knowing that I am going to have different viewpoints on intervention plans than my preceptors and classmates, and knowing that I am going to have to fight for those opinions to be heard.

In order for our profession to grow and in order for RDN’s to give the best care that they can to every patient, every time, diversity and implicit biases need to be addressed more seriously.  Undergraduate and Internship programs need to make significant improvements on their recruitment process and they need to target more than one type of student.  The Academy needs to offer CEU incentive credits for diversity and bias training and financial aid so that all qualified students can actually attend one of these expensive internship programs.  Additionally, all potential preceptors should attend teaching trainings and be screened more thoroughly.  Finally, we need to create a conversation and a space for the RDN’s, interns and dietetics undergraduate students who don’t fit the construct of what they’re expected to be.

So, without further ado: my name is Kate Miller, I am your raging liberal tattooed lesbian dietetic intern, I have a loud laugh, a big smile and I’ll probably skateboard to clinic, but I’ll be there on time and I’ll be happy to make those copies for you.