You passed the CDR exam. What now?

People freak the F out over the exam. I’ve seen people fail multiple times just due to test anxiety.

Every aspiring RD should take it seriously and passing it is definitely something to be proud of, but it’s just the beginning.

Passing proves is that you can spend $250, be a good test taker, and think the way ACEND needs you to think. The KRDNs in the classroom and the CRDNs in supervised practice. That is how most people get through the test.

The work of being a clinician starts after you pass and now that I have been doing this for a decade, I want to go back to how I felt when I passed, and what I wish I knew in the months and years that followed.

What I was like after I passed

I breezed through it. I had gone through my clinical supervised practice, studied for about a week, and took it kind of on a whim. I passed in like 45 minutes because I have really, really good rote memorization skills.

Then I went into clinical practice and it felt like wearing a completely different set of skin.

Passing your classes, passing your exam, passing your clinical supervised practice, and actually being a clinician are objectively four different skills. I had the first three. The fourth one was developed later and there is a lot I wish I knew in those first few months after I passed.

Clinical practice is human-oriented and so nuanced. A client suddenly cancels all of the appointments and gives you no explanation why. Patients are resistant to care that you provide for them. You get activated and overwhelmed when you’re talking with a patient who’s gone through something similar to what you’ve experienced. I had to learn every day in every session on the fly.

A lot of the skills from my clinical supervised experience were not enough to effectively treat all of the disordered eating I was running into professionally. You learn didactically in a classroom about how to conduct your clinical care. Having the background knowledge and the underlying understanding of how your field works is always going to be important in order to make valid and viable clinical decisions. At the end of the day real clinical practice works close to nothing like a didactic environment works.

In the classroom you make decisions one way, but with clients you make them differently. The assignments leave out the patient problems you actually run into. In supervised practice you are still making decisions underneath somebody who may not be making similar intuitive choices to you clinically. Insurance reimbursement, running a business, and independent clinical decisions show up later.

The most important skill to develop after you pass the exam

Developing your clinical intuition is the most important thing that you can do. You develop it by putting in years of working with patients, but the more aware you are of it, the faster it’ll develop.

If you’re going into disordered eating work, your clinical supervision needs a psychological professional in it. If that person is another dietitian, they need to be somebody who’s consulting with a psychological professional as their supervision. The work is typically a blend between the psychological and the dietetic.

I made a post about this the other day. To treat disordered eating you have to know all different kinds of skills from things like attachment theory and somatic science and dialectical behavioral techniques and cognitive behavioral techniques.

When I first started I was consulting on cases that felt particularly challenging. I still do. I would consult with a PhD clinical psychologist. What I was running into sat inside my scope and still sat a little more advanced than what a traditional dietitian would have been able to advise on. I deeply believe in interprofessional cross-collaboration. Sometimes I consult with the patient’s therapist as well. When I need supervision, more often than not I’m consulting with a clinical psychologist. They have the perspective I am often missing, if I’m missing any perspective at all.

How to stay a person in this job

Disordered eating work asks for really, really strong boundaries and a healthier relationship with food yourself. Helping a patient to true remission is work you do from your own relationship with food. If you as a clinician – which is to say, if you as a person – are still dealing with your own disordered eating behaviors, you will inevitably burn yourself out.

You will be trying to be supportive of a patient in a session and then suddenly they will say something that activates your body and then you’re performing two sets of emotional labor instead of one. You’re somatically trying to control your own experience while also trying to locate the patient inside your body somatically. That burns a person out at 18, 20, 30, 50, whatever hours per week, seeing tons of patients, trying to help them through their emotional ups and downs with food, when you don’t have control over your own internal reactions.

Clinical supervision makes this easier, especially with somebody who has the skills on a more formal level that your techniques draw from.

Patients who are struggling with disordered eating will inevitably – not even on purpose nor even realizing it – illuminate inside of you places where you have not yet solved your own relationship with food. Traditional dietetics has failed SO often because it was being conducted by people whose relationships with food were incomplete. A relationship with food is never actually complete or perfect or resolved, BUT there is certainly a level of “healed” that we must be in order to go into this work. Every place you are unhealed will inevitably be revealed to you like a mirror as you go into this work.

One of the things that can help you in your relationship with food and in your relationship with your patients is to take my Level 1 Psychonutrition course. You learn the skills and you get clinical supervision from me personally, directly. I guide you through all of these skills. I’ve been in this field for more than 10 years now and I’ve been working clinically for 7 years now. These somatic skills, attachment skills, and trauma-informed skills have completely transformed my ability to be an effective dietitian. I have seen patients go from a lifelong, decades-long disordered eating history to full remission without relapse for more than a year after they work with me. That can also be you. What we care about at the end of the day is helping our patients be healthy and be their best selves. You can get the care that you need, get the supervision that you need, and be a clinician who didn’t just pass an exam.

I passed in 45 minutes and still had to learn so much with my patients.

Be proud you passed. Then go get the fourth skill.