 I speak with students, schools, and preceptors regularly. Just yesterday, I had a conversation with a PMHNP whose intentions as a preceptor were good, but his students weren’t getting much out of the sessions because they were observation-only. Preceptors need to stay focused on the patient, but there are ways they can also provide optimal education experiences for students. In this article, I talk about ways preceptors can do both. More and more Psych providers are using Telepsych to see patients. Additionally, many psychiatric nurse practitioner students now complete a large portion of their clinical hours through virtual visits, medication management appointments, and telehealth follow-up care. However, many preceptors were never formally taught how to teach effectively in a telepsych setting. Some students are simply placed into a virtual room with cameras off, little communication, and no real clinical discussion throughout the day. Others spend entire clinical rotations silently observing visits without understanding the reasoning behind diagnoses, medication decisions, or safety assessments. The goal is not to turn every visit into a long teaching session. Most preceptors are busy, and students understand that. What matters most is helping students stay engaged, think critically, and gradually develop confidence in psychiatric assessment, medication management, and patient communication. We want to help make them ready for real-world practice! Common Problems NP Students Experience During Telepsych RotationsMany psychiatric NP students report similar frustrations during virtual rotations:
These experiences can leave students feeling unprepared despite completing the required clinical hours. Additionally, “observation only” does not meet clinical requirements for schools. Schools are required by accreditors to ensure students meet certain educational requirements, and observation-only, without some kind of engagement, does not meet these requirements. So, how do preceptors provide excellent care while still providing quality precepting that meets student and school needs? Preceptors do not need to create perfect teaching days. However, students do need some level of engagement, supervision, and clinical discussion to develop competency. Tips for Precepting NP Students in TelepsychThe following recommendations are based on real clinical teaching strategies that help nurse practitioner students stay engaged and continue developing clinical reasoning skills during virtual psychiatric rotations. 1. Before the Visit, Give the Student Some Context Ideally, before each visit, give the student a brief preview of the patient. If that is not realistic for every encounter, try to do this periodically throughout the clinical day. This can be very brief: “Before we go in, this is a 32-year-old patient with MDD and GAD. They’re currently on sertraline 100 mg and hydroxyzine PRN. Today we’re assessing mood, sleep, side effects, safety, and whether we need to adjust the medication.” Even a quick summary helps the student understand what they are listening for and why the visit matters clinically. Without context, students often spend the visit trying to piece together basic information instead of focusing on assessment skills, medication response, symptom patterns, or diagnostic reasoning. 2. Give the Student Something Specific to Listen For Students learn more when they have a purpose during the visit. Examples:
Students who are actively listening for something specific tend to stay more engaged and begin recognizing important psychiatric patterns more quickly. 3. Introduce the Student to the Patient If the Student is Participating If a student is going to participate in the telepsych visit, the patient should know the student is there and give permission for the student to observe or participate. A simple introduction works well: “Before we begin, I want to let you know I have a nurse practitioner student working with me today. They are here to learn and will be observing our visit. Is that okay with you?” If the student may participate: “My NP student may ask a question or two toward the end, if that’s okay with you.” For a deeper look at what it means to fulfill your role as a preceptor, see Your Role as a Preceptor: Key Questions & Best Practices. 4. Have the Student Visible If They Are Participating Students do not necessarily need to be visible for every telepsych visit, especially if they are only observing and the patient has agreed to that structure. However, if the student is participating in the visit, and the patient gives permission, the student should ideally be visible on video. This helps the patient understand who is involved and helps the student feel like part of the clinical encounter. 5. Let the Student Ask One or Two Focused Questions The student does not need to take over the visit. Even one or two focused questions can create a much better learning experience. Examples:
This gives the student supervised experience while allowing the preceptor to remain in control of the visit. Over time, these small interactions help students become more comfortable with psychiatric interviewing and patient communication. 6. Give the Student a Role During the Visit Depending on the student’s level and the patient situation, you may want to discuss potential topics or questions before the visit. The student may be able to listen for or ask about:
A defined role helps the student stay engaged and think like a future clinician. Students often perform better when expectations are clear and when they know exactly what they should focus on during the encounter. It also builds the kind of clinical reasoning that PMHNP preceptors need to cultivate actively. For a broader look at what that requires, Precepting a PMHNP Student: 4 Important Things to Consider covers the essentials. 7. Debrief After the Visit A one-to-five-minute debrief can make a huge difference. Even short medication management visits can become valuable learning experiences if the preceptor explains the clinical reasoning afterward. Helpful questions include:
These discussions help students connect assessment findings to treatment planning and follow-up decisions. 8. Explain the Medication Rationale Students need to understand the “why,” not just hear the medication decision. For example: “I continued the SSRI because the patient has partial improvement, no significant side effects, and they’ve only been at this dose for three weeks. I would not change too quickly unless symptoms worsened or side effects were significant.” This helps the student connect symptoms, diagnosis, medications, side effects, and follow-up planning. Medication management is one of the most important skills psychiatric NP students develop during clinical rotations. Hearing the reasoning process out loud helps students understand how experienced clinicians make treatment decisions. 9. Review Safety Assessment Safety assessment is a critical part of psychiatric care. Take a moment to explain what you asked and why. For example: “Here’s why I asked about suicidal thoughts, access to means, protective factors, and whether symptoms had changed since the last visit.” This helps students understand that safety screening is not just a checklist. It is part of clinical judgment. Many NP students feel anxious about psychiatric safety assessments early in training. Talking through these evaluations helps build confidence and clinical awareness. 10. If the Student Cannot Access the Chart, Verbally Review the Key Information If chart access is not available, the student still needs enough clinical context to understand the case. Consider briefly reviewing:
This can be done without sharing unnecessary details, but the student needs enough information to learn from the encounter. 11. Let the Student Present the Patient Back Even without chart access, the student can practice organizing clinical information. For example: “Give me a brief presentation: diagnosis, current medication, symptoms today, safety concerns, and your recommended plan.” This helps the student build confidence and develop clinical reasoning. Patient presentations are an important part of NP clinical education and help students organize their thinking in a more structured clinical format. 12. Use Short Teaching Pearls Throughout the Day Teaching does not have to be a long lecture. Short, practical teaching points are often more useful. Examples:
13. Ask One Clinical Reasoning Question Per Visit A single question can help students think more deeply. Examples:
These conversations help students move beyond memorization and begin thinking through psychiatric decision-making more critically. 14. Assign Small Follow-Up Learning Tasks Between visits or after clinic, assign quick, relevant topics. Examples:
Small assignments help reinforce concepts students are actively seeing in clinic. 15. Use “thinking out loud” as a teaching tool. Preceptors do not need to stop the visit for a formal teaching session. One of the most effective ways to teach in a telepsych setting is to briefly explain your clinical reasoning out loud. This helps the student understand how you are making decisions, and it also helps the patient understand the rationale behind the treatment plan. For example, instead of simply saying, “We’ll keep your medication the same,” the preceptor might say, “Because your mood has improved, your sleep is better, and you’re not having side effects, I think it makes sense to continue this dose a little longer before making changes.” This gives the student insight into medication decision-making while also reinforcing the plan for the patient. 16. Use a Simple Teaching Structure A telepsych preceptor can use this simple model: Before the visit: “Here is who we’re seeing and what we’re assessing.” During the visit: “Listen for this specific issue or ask one focused question if appropriate.” After the visit: “Tell me what you heard, what you think, and what plan you would consider.” That simple structure can turn a mostly observational telepsych experience into a much stronger clinical learning experience. Supporting the Future of NP EducationPreceptors play a major role in shaping future nurse practitioners. Psychiatric NP students often remember the preceptors who took a few extra moments to teach, explain reasoning, involve them in visits, and create a supportive learning environment.
Telepsych may look different from traditional clinical training, but meaningful teaching can absolutely still happen in a virtual setting. Plus, students will likely be performing telepsych in real-world practice. It’s a great skill to learn. Sometimes the most effective teaching moments are also the simplest:
Those moments add up quickly over the course of a rotation. For preceptors interested in supporting future nurse practitioners through high-quality clinical experiences, our preceptor resources may also be helpful alongside additional guidance for NP clinical education, precepting, and student placements. PreceptorLink/AMOpportunities connects NP students with qualified preceptors across specialties, including psychiatric mental health. If you are a PMHNP student looking for a telepsych clinical placement or a licensed PMHNP interested in precepting students, contact PreceptorLink to learn more about how the platform works. About The Author Lynn McComas is the Chief Nursing Officer at AMOpportunities and Founder of PreceptorLink. She is a recognized expert in precepting nurse practitioners and advanced practice provider students and has been matching preceptors since 2014. With over two decades in primary care, Lynn has served as a coach, advisor, mentor, and preceptor for countless healthcare professionals, including NPs, nurses, and medical assistants. She co-founded a successful skills and procedures business and speaks nationwide on NP-related issues. Lynn is also a regular contributor on LinkedIn, KevinMD, Facebook, YouTube, Instagram @preceptorlink, X @LynnMcComas, and her blog, where she addresses the growing NP and PA professions and the urgent need for preceptor sites. Her unique perspective, shaped by her business, clinical, and educational experiences, positions her as a key voice in tackling preceptor shortages. Lynn is committed to driving change—through a paradigm shift in NP education, reducing barriers, offering preceptor incentives, and advocating for reforms within the profession.
0 Comments
 Clinical rotations are where everything you have studied finally meets real patients, real decisions, and real accountability. Before you ever step into a clinical site, one of the most important things you need to understand is how you are going to be evaluated. Not because evaluations are the point of rotations, but because understanding the process helps you show up prepared and grow in the right direction. The evaluation process is not a formality. It shapes your clinical development in ways that go far deeper than a grade on a transcript. It determines whether you advance in your program, whether your preceptor feels confident giving you more autonomy, and whether the skills you are building now will hold up when you are making independent decisions for your patients. So let me walk you through what preceptors generally look for, how the evaluation structure works, and what you can do starting on day one to set yourself up for evaluations that actually reflect how hard you are working. What Clinical Rotation Evaluations Actually MeasureWhen preceptors evaluate NP students in clinical rotations, they are not simply grading you on how well you memorize content. They are watching how you think, how you communicate, and how you handle real patients in real situations. Most NP programs use a competency-based evaluation framework, which means your performance is measured against specific skills and behaviors rather than solely on test scores. The evaluation criteria typically align with the National Organization of Nurse Practitioner Faculties (NONPF) core competencies, which cover scientific foundations, leadership, quality, practice inquiry, technology and information literacy, policy, health delivery systems, ethics, and independent practice. Your clinical faculty and preceptors use these as a foundation when designing their evaluation tools. In practice, this means your preceptor is asking questions like: Does this student know how to take a thorough history? Can they formulate a differential diagnosis? Do they communicate their clinical reasoning clearly? Are they safe with patients? Do they follow through on what they say they will do? These are the things that matter most on your evaluations. Who Evaluates NP Students During Clinical RotationsUnderstanding who is evaluating you and what role each person plays gives you a major advantage. There are typically at least two layers of evaluation during your clinical rotations. Your preceptor is your primary evaluator. Their input carries the most weight because they see you in action every single day. Your clinical faculty coordinator from your NP program also plays an evaluation role. This person typically makes site visits or conducts virtual check-ins, reviews your documentation, and confirms that your clinical hours and patient encounters are progressing appropriately. They may also ask you to complete self-evaluations, which are a significant part of many programs. Some programs also incorporate peer evaluations, standardized patient assessments, and objective structured clinical examinations (OSCEs) as part of the broader clinical evaluation picture. If your program uses OSCEs, these are formal simulated patient encounters where trained evaluators score your history-taking, physical exam, and clinical decision-making in a controlled setting. The Role of Midpoint EvaluationsMost NP programs require a formal midpoint evaluation at the halfway point of each clinical rotation. I want to emphasize how important it is to take your midpoint evaluation seriously, because students sometimes treat it as less significant than the final. That is a mistake. The midpoint evaluation serves a very specific purpose. It gives your preceptor an opportunity to identify gaps in your performance early enough for you to correct them. It also gives you documented feedback that you can use to improve during the second half of the rotation. If your preceptor notes that your physical exam technique needs work, work on it. Check back in with them on your progress. The midterm evaluation allows you to have time to practice and demonstrate improvement before the final evaluation is completed. If your midpoint evaluation reveals any areas of concern (or if at any point your preceptor seems concerned about your performance), ask your preceptor directly: What does improvement look like, and what specific behaviors or skills do you want to see me demonstrate by the end of this rotation? Getting that clarity early is far better than finishing a rotation with a poor final evaluation and no idea it was coming. How Preceptors Use Evaluation Rubrics and ToolsMost NP programs provide preceptors with a standardized evaluation form or rubric. These tools vary by program, but they generally use a rating scale. Some programs use a numerical scale from one to five, others use descriptive categories like "needs improvement," "meets expectations," and "exceeds expectations." Still others use a developmental framework that reflects where a student should be at different stages of their program, such as early, middle, or final rotations. It is worth asking your program for a copy of the evaluation rubric before your rotation begins. I always tell students to read through the evaluation criteria carefully and use it as a study guide for your own behavior in clinic. If the rubric asks whether you can independently formulate a management plan for common conditions, that tells you exactly what level of performance is expected of you. Many programs also evaluate professional attributes alongside clinical skills. This includes things like punctuality, reliability, professional communication with staff and patients, receptiveness to feedback, and initiative. These may seem soft compared to clinical competencies, but they are weighted heavily by preceptors because they reflect the kind of provider you are becoming. Clinical Reasoning and Diagnostic ThinkingClinical reasoning is one of the most heavily evaluated areas in NP clinical rotations and one of the most difficult to develop. Preceptors are not just watching you order the right tests or prescribe the right medication. They want to see the thinking process behind those decisions. When you present a patient to your preceptor, they are evaluating how organized your presentation is, whether your differential diagnosis is appropriate and complete, how well you prioritize diagnoses based on the clinical picture, and whether your plan addresses the whole patient rather than just the chief complaint. Strong clinical reasoning is demonstrated through clear, structured presentations using frameworks like the SOAP format, and through the ability to explain why you are considering certain diagnoses over others. A common mistake NP students make is presenting a patient by reciting facts without synthesizing them. Your preceptor does not just want to hear what the patient told you. They want to hear your interpretation. Practice saying things like "I am most concerned about X because of Y and Z" and "I want to rule out A given this finding." That kind of language shows clinical thinking, not just data collection. Patient Communication and the Therapeutic RelationshipNP programs evaluate how you interact with patients because patient communication is a core competency, not a bonus skill. Preceptors observe whether you establish rapport, whether you explain diagnoses and treatment plans in plain language, whether you elicit the patient's concerns and goals, and whether you close the visit in a way that gives the patient clarity about next steps. From a cultural competency standpoint, evaluators also pay attention to how you approach patients from different backgrounds. This includes language barriers, health literacy differences, and culturally influenced health beliefs. Your ability to adapt your communication style to each patient is something that strong NP programs prioritize in their evaluation criteria. If you find patient communication challenging at first, which is completely normal, practice using open-ended questions consistently and resist the urge to cut patients off when they are describing symptoms. Letting patients finish their story leads to better assessments and better patient satisfaction, and preceptors notice when you do this well. Documentation and Clinical WritingYour documentation is evaluated both by your preceptor and by your clinical faculty. Writing clear, accurate, legally sound clinical notes is a skill that takes time to develop, and most NP programs grade it directly. Preceptors evaluate the thoroughness of your history and physical exam documentation, the accuracy of your assessment, the appropriateness of your plan, including prescriptions, referrals, and follow-up, and your use of correct medical terminology. Many programs now also assess documentation in electronic health records (EHRs), since the vast majority of clinical settings use them. One practical thing I recommend is to review your notes after your preceptor edits them (assuming you are allowed to chart). Preceptors often correct or refine student documentation without explaining the changes verbally. When you compare your original note to the edited version, you learn exactly where your documentation falls short and what stronger clinical writing looks like. This is one of the most underused learning strategies available to NP students. Professionalism and Clinical BehaviorProfessionalism is evaluated throughout your clinical rotations, not just noted as an afterthought. What counts as professional behavior in a clinical rotation goes beyond showing up on time, though that matters enormously. Preceptors also evaluate how you handle uncertainty, whether you ask for help when you need it, how you respond to constructive criticism, how you interact with the healthcare team, and how you manage your own stress and emotions in a clinical environment. Preceptors flag two behaviors as red flags more than almost anything else. The first is a student who does not speak up when they are unsure or uncomfortable with a clinical decision, because safety depends on honest communication. The second is a student who becomes defensive when given feedback, because growth in clinical practice requires the ability to hear criticism and act on it. One way to demonstrate strong professionalism is to arrive at each shift prepared. If you can, review your patients ahead of time. Even better, review relevant guidelines or drug interactions overnight, and come with questions that show engagement with the cases you are managing. Preceptors remember students who put in extra effort, and that shapes how they complete evaluations. Self-Evaluation and Reflective PracticeMany NP programs ask students to complete self-evaluations at both the midpoint and the end of each rotation. This is not just an administrative requirement. Self-reflection is a core professional competency, and your ability to honestly assess your own performance is something evaluators pay attention to. Students who consistently rate themselves excellent across every category, even when their clinical performance is average, signal to faculty that they lack self-awareness. On the other hand, students who can clearly identify specific areas where they are growing, name what they are doing to improve, and articulate what they still need to work on demonstrate exactly the kind of reflective practice that strong NP programs want to cultivate. Use your self-evaluations as a learning tool. Before you submit them, compare your ratings honestly to the feedback you have received from your preceptor and to the concrete patient encounters you have managed. Where do your perceptions line up? Where do they differ? That gap is where a lot of professional growth happens. How Grades Are Assigned for Clinical RotationsThe way grades are calculated for clinical rotations varies significantly between NP programs, but most programs use a combination of your preceptor's evaluation scores, your clinical faculty's assessment, your self-evaluation, completion of required patient encounter logs, and sometimes additional assignments like clinical journals, case presentations, or SOAP note submissions. Many programs use a pass/fail grading structure for clinical rotations rather than a letter grade, though others assign grades on a traditional scale. Even in pass/fail programs, the underlying evaluation data matters because clinical faculty use it to track your development across rotations and to make decisions about readiness for more advanced placements. Some programs also require a minimum number of specific patient encounters, such as a certain number of well-child visits or chronic disease management encounters, before a rotation can be signed off. Make sure you know your program's requirements early and track your patient encounters diligently. Running short on required encounters at the end of a rotation creates real problems. What Happens When Evaluations Reveal ProblemsWhen an NP student receives a poor evaluation in clinical rotations, the response from the program depends on the severity and nature of the concern. Minor performance gaps usually result in a remediation plan, which outlines specific goals and a timeline for improvement. Embrace remediation. Learn how to improve before boards and graduation. More serious concerns, particularly those involving patient safety or professional behavior, may result in a rotation extension, a failing grade, or even dismissal from the program. If you receive feedback that is not going well, the worst thing you can do is ignore it or minimize it. Clarify things with your preceptor. Depending on the situation, you may want to contact your clinical faculty coordinator. Please be honest and self-reflective about the challenges you are experiencing, and ask for specific support. Please remember, this affects students who use that preceptor after you. Programs want students to succeed, and most have academic support resources, including additional clinical skills practice, tutoring, or counseling, available to students who are struggling. It is also worth knowing that you typically have the right to review your evaluations and, in some cases, to respond to them formally if you believe they are inaccurate or unfair. Understand your program's grievance process to know what options are available to you. How to Prepare for Strong Clinical Rotation EvaluationsKnowing how you will be evaluated is only half the picture. The other half is knowing how to prepare effectively. Here is what consistently separates students who thrive in clinical rotations from those who struggle. Start each rotation by establishing clear expectations with your preceptor in the first week. Ask them directly what they want to see you accomplish by the end of the rotation and what they consider the most important skills for you to develop. This conversation sets a collaborative tone and gives you a concrete target. Review the core guidelines relevant to your rotation specialty before you begin. If you are in a family practice rotation, brush up on USPSTF preventive care guidelines and common chronic disease management protocols. If you are in a pediatric rotation, review developmental milestones and well-child visit schedules. Coming in with that background knowledge makes you more effective from your first shift and signals to your preceptor that you are serious. The PreceptorLink resources page has specialty-specific resources for primary care, pediatrics, women's health, and more that are worth reviewing before you start. Build feedback into every shift. Do not wait for formal midpoint evaluations to find out how you are doing. At the end of each day or week, ask your preceptor one simple question: What is one thing I could have done differently today? Over the course of a rotation, those small pieces of feedback compound into significant improvement. Finally, protect your energy so you can show up consistently. Clinical rotations are physically and mentally demanding, especially when you are managing coursework alongside patient care. Sleep matters. Preparation matters. Your preceptor can tell the difference between a student who came in rested and prepared and one who is running on empty. Final ThoughtsUnderstanding how NP students are evaluated in clinical rotations gives you a real advantage as you move through your program. Evaluations are not something that happens to you. They are a structured reflection of your growth as a clinician, and the more intentionally you engage with the process, the more you get out of it.
Know your competencies. Build a genuine relationship with your preceptor. Ask for feedback early and often. Take your documentation seriously. And approach every patient encounter as an opportunity to demonstrate not just what you know, but how you think. That is what strong clinical rotation evaluations are built on, and it is exactly the foundation you need to become a confident, competent nurse practitioner. And if you are still working on securing your clinical placement, PreceptorLink/AMOpportunities is here to help you find the right preceptor so you can focus on what matters most: learning. About The Author Lynn McComas is the Chief Nursing Officer at AMOpportunities and Founder of PreceptorLink. She is a recognized expert in precepting nurse practitioners and advanced practice provider students and has been matching preceptors since 2014. With over two decades in primary care, Lynn has served as a coach, advisor, mentor, and preceptor for countless healthcare professionals, including NPs, nurses, and medical assistants. She co-founded a successful skills and procedures business and speaks nationwide on NP-related issues. Lynn is also a regular contributor on LinkedIn, KevinMD, Facebook, YouTube, Instagram @preceptorlink, X @LynnMcComas, and her blog, where she addresses the growing NP and PA professions and the urgent need for preceptor sites. Her unique perspective, shaped by her business, clinical, and educational experiences, positions her as a key voice in tackling preceptor shortages. Lynn is committed to driving change—through a paradigm shift in NP education, reducing barriers, offering preceptor incentives, and advocating for reforms within the profession. |
About Lynn:As a longtime NP with a desire to help and make positive changes to her beloved profession, Lynn often writes opinion pieces about the NP profession. Archives
May 2026
Categories
All
"Why NPs train on the backs of physicians"
from KevinMD |
RSS Feed
|
PreceptorLink®️/AMO
[email protected] www.PreceptorLink.com https://www.amopportunities.org/ 760-604-0913 
|
Jeremiah 29:11
PreceptorLink, Inc.®️ All rights reserved. Website Design by WCW Designs
|