Course Syllabus

 

NUTR 560K VIRTUAL CLINIC COURSE SYLLABUS

 

Course:	560K	Virtual Clinic
Term/Semester:	Summer 2017
Credits:	4
Time:	7/10/17-11/3/17	Location:	Online
Course Instructor:	Use Email in Canvas whenever possible (available by clicking “Inbox” on the upper right hand tool bar of our course). Oscar Coetzee, MS (Human Nutrition), MS (Psychology), DCN (Doctor Clinical Nutrition) Linda Fleming, MS, CNS    Steven Lindner DC, MSACN, CNS
Office Hours:	Linda Fleming:  Tuesday 3:00-3:30 PM, Thursday 10:30-11:00 AM or by appointment Dr. Steven Lindner: Monday 11:30am-12:00, Friday-12:12:30pm Oscar Coetzee: Monday 7pm - 7.30pm, Wednesday 8.30am - 9am.

 

Course Description: This final semester course will incorporate critical thinking and scientific knowledge as you complete 4 monthly modules on clinical management online with different instructors. You will learn key skills in assessment, clinical test analysis, designing treatment plans for specific common health conditions, weight loss strategies and how to effectively start and grow your nutrition practice.  Prerequisites Nutr 560A,B,C,D,E,G,F,H ,I, and M. See more detailed description for each module below.

Course Format: Interactive coursework featuring multi -media presentations online with case study work and analysis.  Students will be required to create videos and detailed written analyses based on case assignments. See more detailed description for each module below.

Instructional Objectives: This course is designed to refine ability to counsel clients in nutrition and to provide virtual ‘hands-on’ practical experience in managing clinical cases and a nutrition practice. See more detailed description for each module below.

Expected Learning Outcomes: Upon the completion of this course students are expected to be able to:

1. Demonstrate successful strategies and skills in interviewing and obtaining client information and history.
2. Develop motivational counseling strategies for client personality styles.
3. Assess dietary intake and lifestyle as related to health and well-being.
4. Analyze clinical lab tests both traditional and functional as related to nutrition status.
5. Develop primary and secondary evidence based nutrition recommendations for common clinical conditions.
6. Create a five year business plan and strategy for practice development.
7. Demonstrate knowledge of nutrition program development and delivery.

See specific learning outcomes for each module below.

Required Equipment (for Module 1): Scale for measuring weight and body fat, tape measure, instrument for measuring blood pressure.  For this program, an instrument that measures weight and % body fat are the minimum.  You may want to purchase an instrument that can also assess muscle mass, fat mass, and body water for your future use in practice.  NOTE ON BLOOD PRESSURE:  A sphygmomanometer with stethoscope is the traditional method for measuring blood pressure and the most accurate.  Digital upper arm cuffs are also acceptable.  Wrist cuffs are less accurate and should not be used.

Module 1 requires the student to obtain ONE available, dependable and reliable nutritional client. You will need him/her to fill out an intake form during week 1 and have 3 day food diary filled out, along with current labs, so it’s completed for weeks 2-4.  (A few have been provided for you on canvas. You may modify them if you choose, or create your own). You will be using the same client for this module.

Please make sure you have all the required equipment to complete the anthropometrics by the beginning of the first week of module 1 so you can perform your assessment on week 2 without any delays.

Video submissions are required in the Virtual Clinic.  You must have equipment that allows recording, saving, and uploading/downloading of videos at the time the course begins. Most modern laptop computers have a camera and microphone built-in; you can also use a separate camera/microphone (or "webcam") for this purpose.  Your results will be best with a computer system made within the past 5 years.  In addition, Java and Adobe Flash (updated to their most recent versions) must be installed on your computer in order to make recordings.

Interactive coursework requiring preparation of a PowerPoint presentation (must have PPT software accessible to you) and/or video presentation of a business plan for your practice.

 Recommended Resources for all modules:  There are no required books for this course.  However, the following books may be helpful resources:

 Advancing Medicine with Food and Nutrients, 2^nd Edition, Ingrid Kohlstadt, CRC Press, 2012 ISBN# 978-1-4398-8772-1

Blood Chemistry and CBC Analysis, Weatherby D & Ferguson S.  Bear Mountain Publishing, Jacksonville, OR, 2004 ISBN:  9780976136712

 Integrative Medicine, 3^rd edition, by David Rakel, Elsevier Saunders, Philadelphia, 2012.  ISBN-13: 978-1437717938

 Laboratory Evaluations for Integrative and Functional Medicine, 2^nd edition (2008), by Richard S. Lord and J. Alexander Bralley (eds) ISBN:   978-0-9884322-0-8

Mosby’s Manual of Diagnostic and Laboratory Tests, 4^th edition, by Kathleen Deska Pagana, Timothy J. Pagana ISBN-13:  978-0-32-305747-9

Nutritional Assessment, 6th edition, by Robert D. Lee, David C. Neiman ISBN:  978-0-07-802133-6

Personality Plus:  How to Understand Others by Understanding Yourself, Florence Littauer, Revell, 1992. ISBN-13: 978-0800754457 (highly recommended for learning how to effectively interact with others)

Textbook of Functional Medicine, Peter Bennett, Jeffrey S. Bland, Leo Galland, Robert J. Hedaya, Mark Houston, Mark Hyman, Jay Lombard, Robert Roundtree, Alex Vasquez, Sidney MacDonald Baker.  Institute of Functional Medicine, 2010.  ISBN-13: 978-0-9773713-7-2

The Delicate Art of Dancing With Porcupines:  Learning to Appreciate the Finer Points of Others, Bob Phillips, Regal Books, 1989 ISBN-13: 978-0830713332

References from current peer-reviewed literature may also be used to support your thoughts on the case studies.

Student Assessment Criteria: A grade for the course will be assigned based upon the percentage of total points earned for performance in the areas as defined below:

Criterion	Points	Percentage of Grade
Module 1 Client First Interview- Intake and Counseling Skills	200	25
Module 2 Case Studies, dietary and lab assessment	200	25
Module 3 Case Studies, Therapeutic treatment plans.	200	25
Module 4 Practice Development and Management	200	25
Grand Total	800	100%

To successfully complete the Virtual Clinic, students are required to earn a grade of C (75) or better for each module, which is equivalent to 150 points for each module.  If a student fails to earn 150 points in one module, but successfully completes the other modules, they will receive a grade of “I” for the course and the failed module can be re-taken the next time the course is offered.

See grading criteria for each specific module below.

Course Schedule:

WEEKLY ASSIGNMENTS MUST BE COMPLETED AND SUBMITTED EVERY SUNDAY BY 9PM EASTERN TIME. THE EXCEPTION IS THE LAST WEEK OF CLASS. END OF COURSE IS ON A FRIDAY, SO THE LAST ASSIGNMENT OF THE COURSE WILL BE DUE ON A FRIDAY. Refer to Canvas schedule for exact due dates for each assignment.

Late Assignment Policy:  Assignments submitted after the 9:00 PM due date, but within 24 hours of the due date, will be subject to a 25% grade deduction. For each day thereafter, an additional 10% will be deducted. The grading policy for this Virtual Clinic course is different as it is fast paced and rigorous, much like clinical practice can be, and is designed to enable students and faculty to advance to the next module cleanly and be prepared for the next phase of their clinical training. This firm policy allows instructors to offer timely feedback to students which will allow them to build on their experience as they progress through each assignment.

Additional Notes: 

Students will be randomly assigned to a module prior to the course opening date and given their module sequence.  Requests for specific module assignments are not available.  Students will have access to the module to which they are assigned only. 

These modules are designed to stand alone. Each module will focus on an area of clinical practice utilizing case studies.

 

Module 1 specific information:

 

Course Description: Module 1 of the Virtual Clinic will emphasize the importance of the initial interview with a nutritional client. Students will be expected to use their knowledge to critique pre-recorded initial interviews. This module is designed to help you identify different personality types that clients may have in order to prepare you to perform a motivational interview that includes a physical assessment.

Course Format:  Module 1 of the Virtual Clinic is a 4-week long section of the total course.

• During week 1, the student will be required to watch and critique several pre-recorded
• During week 2, the student is required to perform and record a nutritional physical assessment including anthropometrics.
• Week 3 requires the student to write up a plan around the client’s chief complaint and obstacles, set 1-2 realistic dietary and lifestyle goals, and set up a plan for follow up
• The 4th week puts together skills from the 3 prior weeks by having students create their own mock interview with a client to demonstrate their

 

Instructional Objectives: This module of the Virtual Clinic is designed to refine skills in personality identification, motivational interviewing techniques, physical assessment, and dietary and lifestyle goal setting.

 

Expected Learning Outcomes: Upon the completion of Module 1 students are expected to be able to:

 

1. Critically appraise client-nutritionist interviews for effective interviewing technique and collection of dietary, anthropometric, health, and lifestyle
2. Demonstrate competency in performing and recording anthropometric measurements and physical assessments related to nutritional status on a
3. Perform mock client interviews that demonstrate effective techniques, appropriate data
4. Formulate an initial plan using data obtained from mock interviews that identifies the chief complaint, sets realistic expectations, and provides 1-2 appropriate dietary and lifestyle goals for the client to implement

The grade for Module 1 is based on the areas as defined below:

 

		Skill	Points
1.		Interview Skills- Student will critically appraise each interview noting the presence, absence of content, and effectiveness of the following techniques:	20
	1a.	Identify the client according to personality type, based on D.I.E.T. classification. Support the rationale for your decision.
	1b.	Establish rapport- Can you hold some casual conversation without getting off key topics? Can you put the client at ease, and have them open up to you. Can you demonstrate the client has faith in your skills.
	1c.	Use of the techniques demonstrated in the video “Motivational Interviewing Techniques”. O.A.R.S. from video 2 and those discussed in video 1. Explain with examples of how each was used in mock interviews.
	1d.	Identify the chief complaint/s
	1e	Obtain accurate diet history. Describe from mock interviews.
	1f.	Obtain appropriate health and lifestyle history. Describe from mock interviews. If clinician didn’t do it, then discuss what you could have asked the client.
	1g.	Observe nutrient-focused physical findings. Describe from mock interviews, or if it was not done, discuss what you would have assessed and why.
	1h.	Formulate a summary- Can you demonstrate that you have been following the client all along, and have picked up on what’s important to the client. This summary proves to the client that you picked up on the key points, and have a strategy of approach. If clinician didn’t do it, you must.
2.		VIDEO Must be recorded and uploaded using Panopto. Physical Assessment- Demonstrate competency in performing and recording the following physical assessments on a mock patient of the students’ choosing:	40
	2a.	Measure client’s weight and body composition using a BIA scale/machine. Use professional technique, and explain thoroughly.
	2b.	Perform a waist-to-hip ratio. Use professional technique and explain thoroughly.
	2c.	Access blood pressure measurement, Omron digital readings or you can use sphygnomometer and stethoscope if you choose. Discuss the results, and the functional medicine relevance.
	2d.	Assess activity level of your client. Using the info obtained form the intake forms, and interaction with the client, estimate the BMR.
	2e.	Note and record nutritionally relevant physical findings (skin turgor and integrity, appearance of subcutaneous fat/muscle mass, etc.), any relevant findings from hair, eyes, mouth, lips, teeth, tongue, skin, nails. ( see PDF files and power-points to guide you).   Discuss Drug Induced Nutrient Depletions if they are taking any medications.
3		Formulate an initial plan using data collected from an intake form (your own or one of the examples provided). Please include the following in your plan:	60
	3a.	Identify the chief complaint/s
	3b.	Identify potential obstacles and solutions to them.
	3c.	Develop initial goals/set expectations, relating these back to the chief complaint
	3d.	Suggest 1-2 appropriate dietary goals for the client to work on immediately. If you reference a specific dietary plan or recipes, please submit the hand-outs as part of this assignment.
	3e.	Suggest 1-2 appropriate lifestyle goals for the client to work on immediately. If you reference any specific exercise or lifestyle modifications, please submit the hand-outs as part of this assignment.
	3f.	Suggest a plan for follow-up visits. This should include a review of current available lab work or suggestions for necessary lab work with rationale. If you have lab work, please submit a copy with this assignment.
	3g.	Make sure you submit the completed intake form as part of this assignment.
4		VIDEO Must be recorded and uploaded using panopto. Perform a mock client interview, demonstrating and recording all of the following:	80
		Interview Techniques:
	4a.	Establish rapport- Can you hold some casual conversation without getting off key topics? Can you put the client at ease, and have them open up to you. Can you demonstrate the client has faith in your skills.
	4b.	Use of the techniques demonstrated in the video “Motivational Interviewing Techniques”. O.A.R.S. from video 2 and those discussed in video 1.
	4c.	Identify the chief complaint/s
	4d.	Formulate a summary- Can you demonstrate that you have been following the client all along, and have picked up on what’s important to the client. This summary proves to the client that you picked up on the key points, and have a strategy of approach.
		Data Collection:
	4e.	Obtain appropriate health and lifestyle history
	4f.	Focused physical findings Discuss and explain to the client nutritionally relevant physical findings (skin turgor and integrity, appearance of subcutaneous fat/muscle mass, etc.), any relevant findings from hair, eyes, mouth, lips, teeth, tongue, skin, nails. ( see PDF files and power-points to guide you)
	4g.	Obtain an accurate diet history.
		Use collected data to determine the following:
	4h.	Identify the chief complaint and major functional assessment results
	4i.	Organize the information to formulate an initial plan
	4j.	Identify potential obstacles and discuss solutions
	4k.	Develop initial goals/set expectations, relating these back to the chief complaint
	4l.	Suggest 1-2 appropriate dietary goals for the client to work on immediately. Explain the rationale for these suggestions to the client.
	4m.	Suggest 1-2 appropriate lifestyle goals for the client to work on immediately. Explain the rationale for these suggestions to the client.
	4n.	Suggest a plan for follow-up visits. Include a discussion of current available lab work or suggestions for necessary lab work with rationale.
		Total Points	200

 

Module 2 Specific Information:

 

Course Description: Module 2 of the Virtual Clinic will emphasize dietary assessment and clinical laboratory analysis of presented cases. Students will be expected to use their knowledge to assess each client and formulate preliminary recommendations based on the data.

Course Format: Module 2 of the Virtual Clinic is a 4-week long section of the total course. During each week, you will be presented with two case studies that include a variety of client data followed by questions about each case. Students will be required to support their analysis and recommendations using evidence from text books and/or nutrition-related literature.

Instructional Objectives: Module 2 of the Virtual Clinic is designed to refine skills in assessing client diet intake and laboratory data and making preliminary recommendations based on these assessments.

Expected Learning Outcomes: Upon the completion of Module 2 students are expected to be able to:

1. Identify client physical information that may be related to nutrition status/issues.
2. Analyze client dietary intake using client food log or dietary recall, noting positive dietary habits as well as those that may be contributing to the client’s chief
3. Formulate a preliminary plan for further investigation using presented data (clinical, medical and lifestyle history, anthropometric, and biochemical).
4. Interpret clinical laboratory results, identifying abnormal values and relating these values to the client’s chief
5. Evaluate whether or not follow-up testing is necessary and select appropriate follow-up
6. Suggest preliminary dietary and/or lifestyle changes to support the client, based on collected

The grade for Module 2 is based upon the analysis of 8 case studies. For each case, points will be earned in the areas as defined below:

	Skill	Points
1.	Interpret client physical assessment information as it relates to nutrition status/issues.	3
2.	Analyze client dietary intake using client food log or dietary recall.	4(divided between a, b)
2a.	Identify positive aspects of client intake.	2
2b.	Identify areas of client intake that may be contributing to the chief complaint and should be revised. Support these recommendations with evidence from the literature.	2
3.	Formulate a preliminary plan for further investigation using presented data (clinical, medical and lifestyle history, anthropometric, and biochemical) to:	6 (divided between a, b)
3a.	Identify 2 or 3 possible explanations for the chief complaint related to nutrition. Support these possibilities with observations from the client history and evidence from the literature.	3
3b.	Choose the most likely explanation for the chief complaint with citations from intake and data.	3
4.	Interpret clinical laboratory results.	8 (divided between a, b)
4a.	Identify and explain the significance of abnormal test results.	4
4b.	Synthesize available data to explain reasons for the chief complaint. Support your explanation with evidence from the literature.	4
5.	Evaluate when follow-up testing is necessary and select appropriate assessments.	4 (applied to a OR b)
5a.	Identify a case when a clear course of action is apparent with minimal  or no further follow-up testing. Support your course of action with evidence from the literature.
5b.	Select assessments that will aid in development of a therapeutic plan. Support all suggestions with evidence from the literature.
	Total Points	25

 

Module 3 Specific Information:

 

Course Description: Module 3 of the Virtual Clinic will emphasize detailed analysis of presented cases. Students will be expected to use their knowledge to assess each client and formulate a therapeutic plan based the data.

Course Format: Module 3 of the Virtual Clinic is a 4-week long section of the total course. During each week, you will be presented with case studies that include a variety of client data. Students will be expected to analyze the data and formulate a detailed therapeutic plan based on their analysis.

Instructional Objectives: Module 3 of the Virtual Clinic is designed to refine skills in assessing client data, critically analyzing the data, and formulating a therapeutic plan based on a thorough analysis.

Expected Learning Outcomes: Upon the completion of Module 3 students are expected to be able to:

1. Demonstrate comprehensive pathophysiologic and therapeutic knowledge of common complex clinical conditions through the functional nutrition
2. Identify and critically appraise key nutrition assessments and therapeutic interventions for specific cases involving Cancer, NIDDM, Menopause, PCOS, Thyroid, and Autistic Spectrum and Autoimmune disease.
3. Compose a detailed therapeutic plan for clients with these clinical conditions complementary to allopathic treatment.
4. Present a written presentation of case strategy and case management plan suitable for a client
5. Demonstrate ability to progressively "pick" through cases and determine order of potential intervention strategies in more diverse cases with multiple clinical issues

The grade for Module 3 is based on the areas as defined below:

 

	Skills	Points
1.	Definition of therapeutic plan to include:  1.    diet 2.    supplementation 3.    lifestyle changes 4.    expected term of therapeutic interventions	80
	5. all with supporting citations (anecdotal, peer reviewed, case studies, RCT, Meta-analysis - may be cited)
2.	Provide knowledge of pathophysiology of this specific client’s condition(s) a. Analyze lab work provided and identify potential missing items to be addressed/tested Identifying order of importance patient health issues and clinical status	50
3.	Comparison of allopathic versus nutrition therapies and when to refer a.  Detail expected outcomes and timeframes of nutritional interventions b. Detail to client on when to be monitored for potential medication changes c.Setting client expectations/potential impact of therapeutic plan   1.    short term 2.    long term	25
4.	Identify potential drug interactions or drug nutrient/botanical interactions	25
5.	Explain monitoring plan and criteria for client improvement (ie specific lab tests, Sx reduction, functionality, status of chief complaint, referral for dr. monitoring of medication for changes, dietary and  behavioral changes etc) Delivery of therapeutic plan summary	20

 

Module 4 Specific Information:

 

Course Description: Module 4 of the Virtual Clinic will emphasize business, legal and marketing aspects of building a successful practice

Course Format: Module 4 of the Virtual Clinic is a 4-week long section of the total course. During each week, you will be presented with power point presentations, material to read and certain student requirements and projects to complete.

Instructional Objectives: Module 4 of the Virtual Clinic is designed to refine skills in business and legal development.

Expected Learning Outcomes:  Upon the completion of Module 4 students are expected to be able to:

1. Formulate a business plan for practice development that includes financial analysis, evaluation of market share, a marketing plan, and sample protocols/interventions/strategies for the
2. Prepare and present a video selling their business plan and business model to a hypothetical
3. Write an organized nutritional “report of findings” using accurate medical terminology that will convey meaningful information about a client to another healthcare
4. Write and “informed consent document” to demonstrate the understanding and importance of this legal protection for a nutritionist in practice
5. Explain the issues nutritionists must address to ensure they are working ethically, within their scope of practice and within the
6. Summarize the legal requirements and scope of practice for nutritionists in their state of residence and compare these requirements to those of an adjacent

The grade for Module 4 is based on the areas as defined below:

 

		Skill			Points
1.		Business Plan Development Skills- Student will need to develop a business plan for a hypothetical Nutrition Practice with a specialization – Business plan needs to contain:
	1a.	Cover Page			4
	1b.	Executive Summary			6
	1c.	Company Description			8
	1d.	Market Research			10
	1e.	Product/Service Line			10
	1f.	Marketing and Sales			10
	1f.	Profit and Loss			10
	1g.	Cash Flow			6
	1h.	Balance Sheet			6
	1i.	Break Even Analysis			6
	1j.	Assumptions			4
2.		Design a PPT (Power-point Presentation) of less than 20 slides of your “practice” promoting and selling your “business model” to an Integrative Medical Group (Oscar Integrative Medical), potentially wanting to invest and incorporate your model into their practice. This is all a hypothetical but a very good exercise of “selling yourself and product” to a potentially interested party. You may do a video presentation for this but is optional
	2a.	Quality of presentation, background, use of PPT, graphs etc.			14
	2b.	Ability to bring point across of uniqueness and potential additional revenue stream from adding your “program or practice” concept to medical group.			18
	2c.	Integration of Business Plan into Sale Presentation: Statistical data for area of specialization, sample protocol, convincing “investors” of uniqueness or need of product sold			18
3.		Please review AV case - and complete your indepth nutritional diagnostic coding associations, by clearly indicating what in your assessment lead you to the diagnostic coding from the ICD-10 document. You can use as many of the codes as you feel are associated to the case but be specific, like for instance Triglycerides are high due to diet, ETOH - nutritional diagnosis code for "hypertriglyceremia" and so on.  As nutritionists we may not diagnose, treat or cure, however the main concept behind this exercise is to speak the "Medical Language", therefore we make mention of these diagnosis codes. On many occasions in clinical practice I have written up a report to a doctor in which I took apart a case and wrote up some of these nutritional associated diagnostic codes for their review.
	3a.	Show proficiency in understanding and usage of diagnosis codes			6
	3b.		Show proficiency in what is “referred out” and requested in ROF – suggest additional testing	10
	3c.		Interpreting and documenting entire case study for MD review by completion of ROF	14
4.			Legal: Demonstrate various understanding of legal protection by interpreting informed consent, scope of practice, state laws of where student will practice
	4a.		Interpret and evaluate the differences between ADA, CNS and NANP – Scope of Practice	10
	4b.		Demonstrate the ability to understand the importance of “Informed Consent” and write a mock version of an “IC” for your hypothetical nutrition practice	14
	4c.		Student needs to investigate state or adjacent state nutrition laws and how they apply to potential issues in practicing nutrition legally. Write a professional letter to the correct “assembly person”, by viewing their concerns of practicing in that state after graduation from an accredited University with a degree in Human Nutrition. (Actual action)	16
				200