Becoming an AGNP preceptor

The chronic panel is the curriculum

Adult-gerontology courses are built around the conditions that fill your afternoon: type 2 diabetes, hypertension, COPD, heart failure, chronic kidney disease, hypothyroidism. What a student cannot get from a textbook is the second visit. Let them own eight or ten patients for the whole term. They read the last note they wrote, they see whether the change worked, and they learn that titration is a series of small decisions rather than one clever one.

Give them the numbers to work with before the room. A student who has already pulled the last three A1c values, the home blood pressure log and the weight trend can present in ninety seconds and spend the visit on the patient instead of the chart. That habit also fixes the most common weakness faculty flag in adult-gero students, which is a plan that ignores what was tried in March.

The Medicare annual wellness visit as a teaching case

The annual wellness visit is close to a purpose-built student encounter. It has required elements, it is not driven by a presenting complaint, and it rewards a methodical learner: the health risk assessment, the medication list reconciled line by line, a cognitive check, immunisation status, screening due dates, and advance care planning if the patient wants it that day. A student can run all of it with you in the room.

It also teaches documentation discipline, because the elements have to appear in the note or the visit was not that visit. Have the student read your last completed wellness note first, then draft one of their own for you to edit against the same checklist. Two of these in a term and they understand structured visits better than any lecture on billing could manage.

Geriatric syndromes a student will not meet elsewhere

Falls, polypharmacy, cognitive change, incontinence, frailty, weight loss: these are the presentations adult-gero students are examined on and the ones an urgent care rotation never surfaces. Pick one syndrome a week. Have the student do the gait observation, the orthostatic readings, the timed cognitive screen, the home hazards questions, and then say out loud which medication on the list is contributing.

Deprescribing is the teaching set-piece here. Take a patient on eleven medications and ask the student to propose one to stop, with the reasoning, the taper and the follow-up interval. Then let them tell the patient. Most students have never watched anyone remove a drug from a list, and the conversation is harder than the pharmacology. Debrief it while the chart is still open.

Care coordination counts as clinical time

Half of adult-gero practice happens between visits, and students are allowed to log that time when it is patient care under your supervision. The home health order and the reason it will be rejected. The call to a daughter in another state. The medication reconciliation after a hospital discharge. The prior authorisation that decides whether your plan is real. Put the student on speaker for these instead of doing them after they leave.

The skinny transitional care visit after a hospital stay is worth building a whole afternoon around. Discharge summary read aloud, medication list compared against the pre-admission list, follow-up appointments confirmed, red flags written down for the family. Students who have done four of those become the new graduates who catch the duplicate beta blocker on day one of their own job.

Settings that fit, and the ones that mostly do not

Internal medicine, family practice with an older panel, geriatric clinics, long-term care, assisted living rounds, home-based primary care and PACE programs all place adult-gero primary care students without argument. What tends not to work is urgent care and retail clinics: single visits, no continuity, and none of the syndrome work the course requires. Subspecialty clinics can take part of a block when faculty want that exposure, rarely the whole thing.

Watch the credential line too. Adult-gerontology comes in two flavours, primary care and acute care, and a program will not accept the wrong one for its course. If you are AGPCNP certified, your students are the primary care ones. Inpatient and critical care students belong with an acute care preceptor, which is a different page and a different problem. Pay is unaffected by any of this.

In order

• 01

  Pick the teaching panel

  Eight to ten patients the student will follow for the entire term, chosen in week one.

• 02

  Book two wellness visits

  Schedule them where the student can lead, mid-morning rather than at the end of a long list.

• 03

  Choose a syndrome a week

  Falls, medications, cognition, continence. One focus, one screening tool, one conversation to observe.

• 04

  Name your rate and hours

  Pick a number in the band, twelve dollars up to twenty, for time the log records.

• 05

  Open your hours

  Certification, state, setting and weekly availability. A coordinator answers the next working day.

Questions