Practice-based learning thrusts dietetic learners into a completely unfamiliar environment. Rejwana Ahmed gives her insights into how to handle the pressure.
Clinical placement is one of the most formative and challenging experiences of training as a dietetic student. The opportunity to apply theoretical knowledge in a real clinical environment is invaluable, but it comes hand in hand with pressures that can feel, at times, overwhelming.
During my most recent placement, I experienced this first-hand. Stress became a familiar companion and there were moments where it began to affect not just my confidence but also my ability to regulate my emotions in the moment.
My Placement B was a 12-week community and rehabilitation placement, and no two days looked the same. My week was structured around daily rotations: one day with the diabetes team, another working within the primary care network and two days split across different rehabilitation hospitals supporting patients with complex neurological conditions. It was a placement rich in variety and learning, and one that stretched me clinically in ways I had not anticipated.
But it was precisely that breadth, the constant context-switching, the diverse and often complex caseloads and the need to be across so many different clinical areas simultaneously that made it one of the most demanding experiences of my training so far.
I am sharing my experience here not to discourage those embarking on practice-based learning, but because I know I am far from alone. Stress among dietetic students on placement is widespread, and while there is an important broader conversation to be had about the systemic support structures that need to be developed across dietetic education, this article focuses on something more immediate: the coping strategies that helped me get through.
Think about what you can (and can’t) control
One piece of advice changed the way I approached the hardest days. When my supervisor noticed that stress was beginning to affect my ability to regulate my emotions at work, she advised something very simple in one of our weekly review meetings: think about what you can– and can’t – control.
At the time, one of my greatest sources of anxiety was patient throughput. To meet my benchmarks, I needed to review a set number of patients each day, which felt increasingly out of reach, particularly in my final weeks. What I came to recognise, with my supervisor’s words in mind, was that many of the barriers I was facing were entirely outside of my control. Patients spending extended time with other allied health professionals, unexpected medical rounds delaying my planned reviews, mandatory safety procedures and induction requirements – none was within my power to prevent.
What I could control was how I responded – how I prioritised, how I communicated with the team and how I spoke to myself when the day did not go to plan. Being able to recognise whether the cause of my stress was preventable or controllable helped me to be kinder to myself.
Stay grounded
Beyond reframing what was within my control, I found that the way I approached each individual patient interaction made an enormous difference to how I managed the pressure of the day. When stress mounted, one of the most effective things I could do was simply slow down. Feeling my feet on the floor, taking a breath and giving myself permission to read through a patient’s dietetic entries before walking into a review helped me to feel more grounded and prepared. It sounds small, but in a busy ward environment where the pace is relentless, these small acts of intentional calm became anchors.
I also had to learn that feeling ready before speaking to a patient was not unnecessarily delaying my consultations, it was good clinical practice. Rushing into a review before I had orientated myself rarely served me or them well.
Simplify the clinical picture
A significant source of my anxiety was the fear of not knowing enough – walking into a review without a complete picture of a patient’s background or not having a fully formed plan ready to present. In reality, I came to understand that holding myself to that standard was neither realistic nor necessary, and that reframing the purpose of each type of review was one of the most liberating shifts I made.
For discharge patients, I learned to focus my thinking on a few key questions – was discharge imminent and was there a clear plan in place? If a patient was moving back into the community, was there a prescription for oral nutritional supplements (ONS) economically sustainable in primary care?
For review patients, the priority was assessing progress: were they still on ONS and, if so, did the current prescription still reflect their needs? If a patient was struggling more with oral intake, did supplementation need to be increased? Conversely, if they were now more able to meet their nutritional requirements through food and drink, was it time to step that support down?
It was initial assessments, however, where I placed the greatest and most unfair pressure on myself. I felt compelled to know everything about a patient’s history before I had even met them, and to leave the bedside with a fully formed plan for every subsequent review. When this was not possible – which happened often – I spiralled into anxiety, and this in turn affected how many patients I was able to see. What helped me enormously was returning to the core purpose of an initial assessment: it is not an opportunity to have all the answers. It is an opportunity to meet the patient, understand their needs, hear what support they feel they want or need, and begin to build a therapeutic relationship.
The plan comes next. Giving myself permission to simply assess during an initial assessment lifted a weight I had not realised I had been carrying.
Where to turn if you are struggling
Stress during practice-based learning does not mean you are weak or unsuitable to work as a dietitian – it is an entirely human response to a demanding environment. If you are struggling, it is important to know that support exists and that reaching out is always the right thing to do.
If you are currently on placement, your first point of contact should be your practice-based learning supervisor or university tutor, both of whom have a responsibility to support your wellbeing alongside your clinical development.
Many NHS trusts and healthcare organisations also offer access to occupational health services, which can provide confidential advice, signposting and referrals for students as well as staff, so it’s worth checking whether this is available to you in your placement setting.
Many employers and placement providers also have employee assistance programmes that typically offer free, confidential counselling sessions and mental health support, often accessible 24/7 via phone or online portal.
Beyond the workplace, there are other organisations that offer dedicated support:
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Mind has a range of mental health support services, including its Employment Support Service, which can help those whose mental health is affecting their ability to work or study in a professional setting. Visit mind.org.uk or call the Mind Infoline on 0300 123 3393. I have used this before and it provided a listening ear and helpful advice when I was struggling
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Student Minds is the UK’s student mental health charity and offers resources, peer support networks and guidance specifically tailored to the challenges of student life, regardless of your background and identity. This can be accessed at studentminds.org.uk
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The BDA also provides member-support resources, and it is worth exploring what your student membership can offer you
You do not need to be in crisis to seek support. If placement is feeling overwhelming, speaking to someone sooner rather than later can make all the difference.
Placement is hard. It is supposed to challenge you, and I do think these challenges helped me build emotional resilience and become a better professional – although that is not to say that chronic stress or burnout is beneficial by any means.
I have implemented these strategies now I am on Placement C, and I have found this part of the course so much easier, even though the workload is much heavier. The strategies that helped me were not grand or complicated, and if even one of these resonates with you, I hope it helps.
