Tips for Precepting NP Students in Telepsych

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.
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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 Rotations

Many psychiatric NP students report similar frustrations during virtual rotations:
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• Sitting through visits with no clinical context
• No explanation of medication decisions
• Limited opportunity to ask questions
• No patient presentations
• Cameras off for both patient and student
• Minimal interaction with the preceptor
• No debriefing after visits
• No discussion of safety assessments
• Feeling more like a passive observer than a future clinician

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 Telepsych

The 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:

• “Listen for symptoms of activation or hypomania.”
• “Pay attention to how I assess medication adherence.”
• “Listen for safety concerns.”
• “Watch how I ask about side effects without leading the patient.”
• “Think about whether you would increase, decrease, or continue the medication.”

This turns observation into active learning.

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:

• “I’m going to have my student ask about medication side effects.”
• “Can my student ask a safety screening question?”
• “I’d like my student to ask about coping strategies since the last visit.”

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:

• Mood symptoms
• Sleep
• Appetite
• Anxiety symptoms
• Panic episodes
• Medication adherence
• Medication side effects
• Substance use
• Therapy participation
• Coping skills
• Safety concerns
• Suicidal or homicidal ideation, with preceptor oversight
• Follow-up needs

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:

• “What did you notice?”
• “What diagnosis or symptoms were most important today?”
• “What medication side effects were we screening for?”
• “Would you continue, increase, decrease, or change the medication?”
• “What safety concerns did you hear?”
• “What follow-up interval would you choose?”
• “What would you document as the assessment and plan?”

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:

• Diagnosis
• Current medications
• Relevant medication history
• Prior medication failures or side effects
• Current symptoms
• Safety concerns
• Treatment plan
• Follow-up timeline

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:

• “When increasing SSRIs, watch for activation, GI effects, sleep changes, and worsening anxiety.”
• “In bipolar depression, antidepressant monotherapy can be risky.”
• “For ADHD, always think about sleep, anxiety, substance use, and cardiac history.”
• “With benzodiazepines, we need to consider dependence, falls, cognition, and controlled substance monitoring.”
• “In children and adolescents, always include family context, school functioning, and safety.”
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Students often remember concise clinical pearls more easily than long formal lectures.

13. Ask One Clinical Reasoning Question Per Visit

A single question can help students think more deeply.

Examples:

• “What would make you worry this is bipolar disorder?”
• “What side effects would you ask about with this medication?”
• “What labs might be relevant for this medication?”
• “What would make you choose an SNRI instead of an SSRI?”
• “When would you refer to a higher level of care?”

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:

• “Look up common side effects of lamotrigine.”
• “Review serotonin syndrome symptoms.”
• “Read about metabolic monitoring for atypical antipsychotics.”
• “Compare escitalopram and sertraline.”
• “Review ADHD stimulant contraindications.”

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 Education

Preceptors 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:

• Explaining why a medication was continued
• Asking what the student noticed
• Reviewing a safety concern
• Letting the student ask one question
• Talking through clinical reasoning for two minutes after the visit

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.