What to Know: Sport Nutrition Interns and Fellows
Updated: Jan 9
Often, those interested in pursuing a career in performance nutrition reach out to learn more about my education and career path, and what I do in a typical day.
I’m going to split this topic into two parts.
In this article, I’m going to review the following:
How a student with dreams of working in sport should approach their education.
What to know about the dietetic internship.
What to know about a fellowship.
Throughout, I’ve listed in purple examples of scenarios in practice.
In part two, I’ll review what a day-in-the-life of a collegiate performance dietitian looks like.
July 2017: First day of fellowship at the University of Utah with Lisa and Palmer. Bless Lauren and Craig for believing in us.
Approaching Your Education
“Tell me what you think, not what you’ve heard.”
Joe Maddon, former manager of the Tampa Bay Rays, Chicago Cubs, and Los Angeles Angels.
I’ve been a preceptor for dietetic interns and working alongside and overseeing dietitians since the summer of 2012. When in school and the dietetic internship, we have to learn so quickly, absorbing information from multiple sources and regurgitating that information to have the perfect, correct answer.
And then you graduate and become the nutrition practitioner where the learning—or as it feels like initially—stops. You’ve mastered the textbooks. What more could you possibly have to learn?
However, what stops is the external expectation of projects, due dates, and grades. Someone else was assigning homework to you to complete. Now, you have to learn how to learn on your own.
I think that’s the hardest part about transitioning from student to practitioner, this immediate feeling of exhaustion, combined with still feeling as if you’re a student who needs a preceptor to confirm a nutrition care plan, to owning it and feeling confident in your knowledge.
Scenario in practice: When I was a dietetic intern at a hospital, throughout the day I would write bullet points of things I didn’t understand and foreign terms physicians used. At night, I would spend hours reviewing and researching my notes. Once I was hired on full-time, I continued this practice for months. I was the dietitian, but still didn’t feel fully confident. I leaned in and continued learning even when no one was watching (or handing out grades).
But then there’s the questioning of what have you learned from those professors and preceptors? The assumption is that the messenger was always right. That they interpreted the information and all those studies correctly. That they were without bias in how they received and then chose to disseminate that information.
Scenario in practice: During my internship, a dietitian I was shadowing kept using the Dirty Dozen as a list of fruits and vegetables to avoid when shopping in the conventional section at the grocery store due to their pesticide levels. At the time, I think organics were only sold at specialty organic markets and not the neighborhood grocer—meaning this wasn’t an accessible counseling recommendation for everyone wanting to eat strawberries. When I looked into the Dirty Dozen for myself, I learned the list is compiled annually by the Environmental Working Group—a registered lobbying group. The Dirty Dozen uses fear mongering regarding pesticides present on conventionally-grown fruits and vegetables. However, those levels are well below toxicity standards for human consumption. Ranked, you’ll always have a first place. But what is first place being ranked against? I've learned that the Dirty Dozen has zero space in my practice.
I often encourage new students, dietetic interns, and dietitians to go relearn topics. Learn enough to hold a conversation on a topic, speaking more deeply about it and not the surface-level answer any TikTok influencer could muster if they Googled the AI response. Curate the ability to speak to both sides of an argument, understand the physiology (i.e., if it even makes sense), and understand any nuances. Personalized nutrition entails that people will respond differently to inputs, and that one’s socioeconomic status can alter your response (e.g., Do I have to eat organic? Is alkaline water better than regular water? Must I eat grass-fed?).
The running joke in the dietetics world is that most nutrition questions could be initially answered with, “it depends.”
Dietitians are scientists. In the field of science, currently agreed upon facts can still change. They aren’t 100% bulletproof and as research design and technology, plus researchers asking more detailed and better questions, evolve, so does our understanding. When it comes to research studies, scientists only study questions they think to ask. There are grey areas and holes all around. As nutrition science advances, it’s OK to change your mind or disagree with the majority—so long as it’s rooted in reputable science that continues to be backed up by follow-up studies.
Some may call you a hypocrite for changing your mind, but I think it’s worse as a licensed medical practitioner to never change your mind when stronger research presents itself. My hunch is that those who are afraid to change their mind are those who are afraid to commit to learning, feeling vulnerable that they may not know everything. Or, that their personal beliefs and approach to eating doesn't align with the science (e.g., misguided recommendations to avoiding seeds oils and promoting coconut oil/milk). Ignorance can be bliss, but scientists should strive to rid themselves of ignorance. Continue to be curious and ask questions.
Scenario in practice: When I was a sports nutrition fellow, at the time the understanding was that a deficit in sodium and/or fluid led to exercise-associated muscle cramping (EAMC). As I continued to work in sport, often support staff and coaches would track me down for electrolytes for preventing and treating EAMCs. Electrolytes were everywhere. Then I read an article by Miller et al. (2022) on all the proposed mechanisms that can contribute to an EAMC. When I changed my practice, educated coaches and other support staff (some disliked this and my decision to pull back on heavy electrolyte distribution), and began to harp on carbohydrates, muscle fatigue, fluid, sleep, recovery, stress, and sodium (although for the latter not as a massive priority), I noticed EAMC prevalence decreased across the athletes I was working with.
Approaching Your Dietetic Internship
The internship is a structured, mandated experience that all future dietitians must complete prior to sitting for the national exam. During the internship, interns are placed in rotations where they're overseen by a dietitian (the preceptor). Dietitians do not receive payment for hosting and teaching an intern. They're a heavy lift by adding work to the dietitian's day. However, I love hosting interns and see it as a duty to inform the next generation of dietitians and as a payback for all those dietitians who helped me during my internship.
What Kind of Intern Will You Be?
I always tell interns that I’ll evaluate them based on their progress from day one through their last day. I make it clear that I expect growth and that I have high standards, but that I want them to learn, become more confident in themselves as a practitioner, and leave with a solid understanding of what the sports world is like. Sports is a difficult field to work in and coaches won’t mince words. It takes a certain personality to succeed. Don't be a jerk, but rather be kind while being able to stand up for yourself, know when to be quiet, and thicken your skin temporarily. Oh, and laugh.
I’ve hosted some fabulous interns who take hold of the opportunity and come with questions, show interest, and add value to our staff. They’re on time, submit assignments timely (and follow directions), and assist the dietitians. These interns leave the program on a high. You consider them when a fellowship spot opens and can speak fondly to them when they apply for work elsewhere and a Director calls you for a reference (whether you're listed as one or not).
I’ve also hosted interns who don’t submit assignments because they thought they were “thought experiments for their own benefit” (actual quote, despite being provided specific instructions), are late, show up to practice acting like a fan or a best friend to the athletes, overstep, and submit assignments citing a blog written by a gym buff as evidence of best nutrition science practices. They’re the intern I flag with their program director. They’re the intern I don’t interview when a position becomes open within the program I oversee. They’re the intern who does not receive a glowing recommendation when called for a reference.
Be like the eager intern. Sports is an internship elective and I can appreciate that even those interested in sport may not love it once they're in it. That's fine and that's expected in the internship, as its purpose is to expose you to a variety of dietitian roles to help frame your future specialization. However, still show up, do the work, and be enthusiastic.
Don't Sleep on Clinical Nutrition
Many times in my sports career, prospective students and interns talk down to clinical nutrition. “Ugh, I’m so not looking forward to my clinical rotation. It’s such a waste of time. I don’t want to work in hospitals. I only want to work in sport.”
Scenario in practice: I became a dietitian in Canada and my program director knew that me and another intern were interested in sports. She sat us down and told us that in Canada in 2012, there were very few opportunities to work in sport. Our best bet was to work in the hospital for at least a year, and then figure out some sport work as a side gig. At the time, I was dumbfounded. I admired my director, but was shocked she would say something I felt to be so brutal. But, I admired her and accepted her wisdom. When I interviewed for my first full-time job in sport, I was asked, “how do you think your work in the hospital helps you in sport?” At the time, I was working in oncology and chemotherapy, where patients were tired, spent hours in chemo (alike a long training session), were experiencing unintentional weight loss, needed creative strategies to increase their protein and calories… the same things we experience when working with healthy patients. Nutrition practice is translational across environments.
First off, there are much fewer positions working in sport than in clinical. The likelihood of a first job out of one’s internship working in the hospital is very high.
Second, many sports dietitians are board certified to work in sport (the CSSD). In order to write this exam to be certified, you must be a dietitian with a track record of working in sport. Heavy emphasis on you have to be a dietitian, with the CSSD being a layer you earn thereafter. Sport dietitians are clinical dietitians first, with a specialty in sport second.
Third, when working in sport as a dietitian, my day is not 100% carb and fluid recommendations, ergogenic supplements, and hanging out at practice. The vast majority of my time spent in clinic is with athletes for the management of eating disorders, gastrointestinal disorders and symptom management, type 1 diabetes, reviewing and requesting bloodwork, injuries and post-surgical management of athletes, addressing an athlete’s depression medication and its side effects (e.g., weight gain/loss and how their eating has been affected), communicating with physicians and psychologists—this is all clinical nutrition.
Embrace clinical nutrition, show interest in understanding the body’s physiology and all things nutrition, and keep your walls down in what you will consider as future work.
Scenario in practice: Working in collegiate athletics, all full-time dietitian hires I’ve overseen have had clinical nutrition experience beyond their internship. For me as a supervisor, I can teach dietitians the sport side of nutrition. It’s much harder to teach clinical nutrition because it’s so vast.
Approaching Your Fellowship
A fellowship in the sports nutrition world is not academic based. It’s a temporary role, usually 6-12 months, for a dietitian without the resume to land a full-time role in sport to gain experience and build their resume. For instance, a brand-new dietitian with volunteer experience in a collegiate fueling station or a seasoned dietitian interested in working in sport. Fellowships are busy, where the fellow is often handed over a few sport teams to design and manage all their nutrition programming for, organizing catering at home and/or on the road, and counsel the athletes, plus gaining experience in food service (e.g., managing a fueling station).
Dietitians end their fellowships ready for a full-time role and joining a department with other dietitians or as the sole dietitian for a program. For the latter, that’s who I consider when structuring a fellowship program for. I need them to learn a lot quickly, especially in the management and food service side. I need them to build their confidence. I need them to learn how to problem solve independently.
I always remind new fellows that the fellowship is not an extension of a dietetic internship, one where I’m going to provide them with reading assignments or tell them exactly what to do every step of the way. I want them to now question what they’ve learned and become a self-learner and an initiator.
Scenario in practice: I once had a fellow tell me that they shouldn’t have to know X because they were a new dietitian. My counter was that they didn’t become a dietitian the day they passed their exam, being the day they began learning about nutrition. I wanted the fellow to understand how much nutrition knowledge they had acquired over the years in their classes, researching projects, listening at conferences, and throughout their dietetic internship. I find the two hardest parts when managing fellows being:
Getting the fellow to start… anything: I attribute this to nerves. What if they’ve never been asked to do X before and freeze because they don’t have a script to work from? Most sport dietitians are often asked to do things they don't have a script for. What if they’re overthinking how their plan may not work or not be perfect, impairing their ability to start? The best thing for a fellow to do is jump in and try, ask clarification questions up front, and continue to ask for guided assistance along the way--but for the fellow to own it and take the lead. Rip the band aid and have confidence that it’s going to be OK. If it doesn't work out perfectly, that's reality and helps inform future approaches to similar scenarios.
Buying into what I call the “value add” of the dietitian: How can the fellow elevate themselves as a dietitian on the care team? If an athlete has low iron labs, anyone could tell them to add an iron supplement and increase their dietary sources. The value add of the dietitian is communicating to the athlete how to take their supplement (e.g., what nutrients to pair with the supplement and what nutrients to avoid) and what specific types of dietary iron could they include, plus specific snack or meal combinations? Get into the details to help the athlete make actionable improvements.
Be honest about what you know and what you don’t, while making a plan to intentionally fill those gaps. Review journal articles, attend webinars and conferences, and read a textbook. I always tell any intern, fellow, or dietitian I work with that my blog and monthly learning lineup is a public example of what I don’t fully understand, but want to learn more about and educate others on.
Lastly, take ownership of your fellowship. What sports or positions are you interested in gaining experience with? Is there a dietitian you admire who offers a fellowship and you can learn under that mentor, regardless of the teams the fellow would be assigned? Can you shadow a dietitian with one of their teams to gain experience, or sit in on an eating disorder consult to better understand the condition’s management? Can you take on a departmental project for the Director, or assist with gathering research? Do you need experience learning how to build a budget? Avoid turning down a fellowship simply because you don't want to work with X team.
My overall advice is to lean in, own it, create intentional plans to expand your learning, and prioritize learning and doing over perfection.
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