The day-one huddle
Ten minutes, in your office, before the first chart opens. Cover six things: how the clinic day is shaped, how you want a patient presented to you, what she says when she walks into a room, which parts of the exam she may perform this week, what she documents and what she leaves alone, and the signal you will use when you need her to stop talking. Then walk her to the front desk and introduce her by name.
Say the uncomfortable part out loud while you are there. You will interrupt her. You will take over an encounter without warning when a patient needs you to. None of that is a verdict on her ability, and you will explain each instance afterward rather than in front of the patient. A student who hears this on day one stops reading interruption as failure, which spares you both a hard conversation in week three.
Weeks one and two: shadowing and the history
Expect the first fortnight to cost you roughly one patient an hour. That is the true price of teaching and it is front-loaded, so put the block in a stretch of calendar that can absorb it. In week one she shadows. She watches how you open a visit, where you type, how you close, what you say to a patient who wants one more thing. She takes histories on cases you choose for low complexity and reports back in the hall.
By the second week the history belongs to her on most visits. Send her in first on the straightforward ones, give her six minutes, and take the story from her before you go in yourself. You are not teaching diagnosis yet. You are teaching her to gather an accurate history quickly and hand it over in a form you can use, because every other skill in the rotation stands on top of that one.
Weeks three to six: she sees first and presents
Now set the pattern that carries the rest of the term. She goes in, takes the history, performs the exam elements she is cleared for, forms an impression, and presents to you at the workstation. Ask for her commitment before you offer yours: what does she think this is, and what would she do about it. Then you both go back in, and you confirm, adjust or redirect in front of the patient without dismantling her in front of the patient.
Two teaching methods fit the ninety seconds you actually have between rooms. The five microskills of the one-minute preceptor work when you are driving the exchange. A learner-driven format like SNAPPS works once she is ready to run her own presentation. Pick one and use it the same way every time, because a student who knows the shape of the exchange comes prepared for it.
Week four: read the log
Open her clinical log at week four and read it against your own schedule. Three things matter: that the hours entered match the days she was actually in the building, that each encounter carries a plausible visit type and diagnosis, and that nothing is sitting unapproved while it waits on your signature. Schools watch these logs closely, and a backlog of unapproved entries discovered in week ten turns into everybody's problem at once.
Week four is also the last point where a shortfall is cheap to fix. Thirty hours behind at week four is one extra half day a week for the remainder. Thirty hours behind at the midpoint means the program has to extend her end date and reshuffle her next placement. Ten minutes with the log prevents that. Logging systems differ from school to school, and your coordinator can show you where the approval button hides.
The midpoint: the form and the first half of the fee
Near hour sixty the program sends a midpoint evaluation. It is a rating grid with a comment box, and the comment box is the part that does any work. Write two behaviours she does well and one specific change she can make by Tuesday, in words she can act on without interpreting them. Complete it before you meet, then read it to her with the door shut and hand her the copy.
The midpoint is also the money marker. The first half of the block's fee is released by direct deposit once that evaluation is filed, and the balance follows the final one. Say nothing about any of that to the student. Her evaluation and your invoice are separate documents and should stay separate. The only thing she needs to hear from you that week is what is working and what changes next.
Weeks eight to fourteen, and the final
In the back half she should carry most of a visit: history, exam, an assessment she can defend, a plan with a reason behind it, and a note you edit rather than rewrite. Your work narrows to confirming findings, adjusting plans and signing. Supervision does not loosen because she has become competent. You are in the building, reachable in seconds, and you lay eyes on every patient she sees. That line does not move in week twelve.
The final evaluation closes the rotation: the same grid, a summary comment, your signature, and the hour total reconciled against the log. Sign the last entries that week rather than next month. Then ask the placement office for a preceptorship letter while she is still on somebody's active roster. For the full arc of a rotation, including what you sign and when, see precepting NP students.
If a term with room in it is coming, <a href="/apply/">open your hours</a> and take the block that fits your calendar.
Apply to preceptQuestions
How long does a 120-hour rotation take?
It depends on the days per week. Two nine-hour days finish 120 hours in about seven weeks, and one day a week takes fourteen. Programs set the term dates and usually let the site and the student agree on the pattern inside them. Fewer, longer days generally teach better than many short ones, because the student sees whole clinic sessions rather than fragments.
What should a student do in the first week?
Shadow and take histories. She watches how you open a visit, document it and close it, then takes histories on patients you pick for low complexity and reports back to you before you go in. She is learning clinic flow, the staff and where supplies live. Assessments and plans start from about week three, once her histories are reliable.
How much does a student slow me down?
About one patient an hour in the first fortnight. It eases from week three, when she starts taking the history and drafting the note herself. If your pay is productivity-based, count that cost against the fee honestly. If you are salaried, it costs time rather than money. Choosing a term with no vacation or audit in it helps more than anything else.
Do I have to be in the room with the student?
You have to be immediately available, and you have to see every patient she sees. Programs describe that as direct supervision. In practice you are often not in the room while she takes a history, but you go in before any plan is acted on, confirm the findings that matter, and sign the note. Nobody gets seen unsupervised.
When does the midpoint evaluation happen?
Around the halfway hour, so near hour sixty of a 120-hour block. The program sends a rating grid with a comment box, you complete it, and you go through it with the student in private. It is also the marker for the first half of the fee, so filing it on time serves the program's deadline and your deposit at once.
Sources: AANP: Precepting With Purpose
Tamsin R., DNP, FNP-BC
Reads every application and every midpoint evaluation. Has precepted FNP students in a rural family practice since 2014 and still takes one a term. Writes the teaching-method pieces in Off the Clock.