Real World Precepting with D.M., PMHNP

Today I spoke with a new preceptor who really sounds like a great clinician and preceptor!  I thought I’d share this PMHNP’s precepting style and method. 

A few details about the preceptor: 

• PMHNP with nearly a decade of PMHNP experience. 
• Sees patients mostly in person but can also do telepsych.
• PMHNP practices independently but through LifeStance Health. The preceptor loves LifeStance because they are W-2 employees, and they have competitive compensation and benefits packages.  Providers have a good work-life balance because clinicians have control of their schedules. (We get nothing for mentioning this company. We’re just passing the info along!) 

Interview with D.M, PMHNP:

I see patients of all ages with all conditions. The top 5 conditions I treat are as follows: 

1. Depression
2. Anxiety
3. Sleeping Disorders 
4. Trauma and PTSD, particularly among veterans 
5. ADHD. 

Philosophy: I consider psychiatric care to be an art form that thrives on collaboration, interaction, and customization for each individual client. 

Precepting: Students will learn not only the clinical but also the business side of running a practice, including time management and CPT code selection. Medication management and psychotherapy occur with every appointment.

Students sit adjacent to me as I interview clients, chart, diagnose, prescribe, and bill insurance companies. I do this mostly in person, but I can also do telepsych with students.

The student reviews my charts in the morning. I give the student a brief synopsis, about a minute long, about the patient that he/she's going to see before I see the patient.

I'll give the student a brief synopsis of the diagnoses, what's going on, and what medications they're on. My patients are back-to-back, and I see patients from 8:00 in the morning to 4:00 in the afternoon. I do synchronous charting, so I never take charts home. I’m done charting when I am done seeing a patient. If the student has any questions, I tell them to write them down during the patient visit. Then I will answer them either immediately after the appointment, or I will sit with the student and answer them later in the day. Also, anytime that we have a break or if a patient doesn't show up, I’ll answer questions. 

But I'll ask the students questions, too. I’ll ask things like, “What do you think about this? Do you have any experience with this? Why do you think I picked this medication? I really like to have that full feedback. It helps make them use their critical thinking skills. When I was a student I was with a preceptor where the students were just allowed to observe, and they didn’t provide feedback. Students just don't learn well that way.  Students are just basically going off whatever their preceptor's favorite medications are, and then they adopt them as their own.

And that's why I always tell people, I'm not going to give you any medication recommendations at all until I hear the full feedback.

I'm going over what's going on, from sleep to anxiety to panic attacks to depression to whatever the case may be. You're not going to know all of that usually until towards the end of the interview. So I have the students do that for several encounters and usually the goal is, by the end of the rotation, that now they can do an Initial or a follow-up. 
 
Students should be able to take my notes from my last appointment and effectively do a follow-up because I write really good notes.

That's one thing that I really train them to do as well. If any type of new medications or something that's kind of interesting shows up, I'll give them a little bit of homework. I might say, “Hey, teach me about X medication. That's a newer medication.” Or “Teach me about Rixalta. You don't hear that too often for bipolar patients. I give them a little useful homework.

Preceptor’s choice for their EHR: 

So we use a system called Advanced MD EHR. It helps with practice management so I can focus on patient care. It even does marketing. It has about four tabs: 
1) HPI
2) Mental Status exam
3) Patient vitals and current mood
4) Your medication recommendations, plan, and assessment. 
It's very user-friendly. 

Something that I always teach students is synchronous charting. I never bring charting home. I'm a very quick typer. I finish charting between each patient. I see a lot of patients in the day. A lot of people are going to have depression, anxiety, sleep problems. I pretty much see that across the board. So it's not good to get confused, and it's good to chart properly. That’s important. 

Overall, I love to teach, and I try to teach students how to do it right and do it efficiently. 
We think D.M., PMHNP, sounds like a fantastic preceptor and provider. We hope you found this Real World Precepting case helpful! 
Can you share how you like to precept? Let’s all learn from each other. (We generally don’t share names, so preceptors aren’t inundated with requests to precept!) 

About the Author: Lynn McComas, DNP, ANP-C, is an experienced nurse practitioner and an expert on the topic of precepting. Determined to make a difference in “the Preceptor Problem,” Lynn went on to obtain her Doctorate in Nursing Practice (DNP) at the esteemed Duke University, where she focused on finding solutions to the preceptor shortage. She is the owner and founder of PreceptorLink®. The company’s goal is to simplify and streamline the process of preceptor matching while maintaining quality and professionalism throughout. www.PreceptorLink.com 

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