Precepting the Next Generation: Best Practices for Training Students While Managing a Full Patient Load

You have 6 critically ill patients, two admissions coming, and now there's a wide-eyed NP or PA student following you around asking questions. Precepting is a privilege—but it's also work. Here's how to do it well without sacrificing patient care or your sanity.

Why Precepting Matters

For the Profession

• We all had preceptors who shaped us
• The profession grows through mentorship
• Quality precepting produces quality providers

For You

• Teaching deepens your own understanding
• Leadership and teaching experience strengthens your CV
• Many institutions offer compensation or benefits for precepting
• It's genuinely rewarding to watch someone grow

For Patients

• Students often have more time for patient/family communication
• Fresh eyes catch things you might miss
• Future workforce development improves care system-wide

Setting Expectations: The First Day Conversation

Before the clinical chaos begins, establish:

Learning Objectives

• What does the student need to accomplish this rotation?
• What are their specific goals? (procedures, patient populations, confidence areas)
• What will they be evaluated on?

Role Clarity

• "You are here to learn, but patient safety comes first"
• "I will let you do as much as is safe for your level"
• "Speak up if you're uncomfortable or confused"

Communication Norms

• When/how to ask questions (not in front of patients mid-sentence)
• How to present patients to you
• What to do if they don't know something

Ground Rules

• Attendance expectations
• Attire and professionalism standards
• Phone/device policies
• Documentation requirements

The "See One, Do One, Teach One" Framework

This classic medical education model still works:

See One

• Student observes you performing a skill or assessment
• Narrate what you're doing and why
• Encourage questions afterward

Do One

• Student performs with your supervision
• Provide real-time coaching
• Intervene if patient safety at risk

Teach One

• Student explains the skill to you or a peer
• Solidifies understanding
• Reveals gaps in knowledge

Practical Strategies for Busy Shifts

The Huddle (5 Minutes)

At shift start, review:

• Today's learning priorities
• Which patients the student will focus on
• When you'll round together

Delegated Learning

• "Go read about ARDS and give me a 3-minute summary"
• "Watch the RT do this extubation and tell me what you observed"
• "Attend the family meeting with social work and debrief with me after"

Parallel Processing

• Student sees patient independently, then presents to you
• You verify and add teaching points
• Student documents (you review and co-sign)

Procedure Opportunities

• Even if you do the procedure, the student can:
  • Gather supplies
  • Position the patient
  • Observe closely
  • Perform steps when safe

Quick Teach Moments

• 2-minute teaching points during downtime
• "While we wait for pharmacy, let me explain why we chose this antibiotic..."
• Use clinical context to anchor learning

Giving Feedback Effectively

The Sandwich Myth

Don't bury critical feedback between compliments—it dilutes the message.

Better Approach: Ask-Tell-Ask

1. Ask: "How do you think that went?"
2. Tell: Provide specific feedback (positive and constructive)
3. Ask: "What will you do differently next time?"

Be Specific

Not: "Good job today" Instead: "Your H&P on room 4 was well-organized and you identified the key issue quickly"

Not: "You need to be more confident" Instead: "When presenting, try eliminating filler words and speak more slowly—it projects confidence"

Timely Feedback

Give feedback as close to the event as possible. Waiting until end of rotation is too late.

Handling Struggling Students

Signs of Trouble

• Repeated basic errors
• Resistance to feedback
• Unprofessional behavior
• Unsafe clinical judgment
• Attendance issues

Approach

1. Document concerns in writing (objectively)
2. Have a direct conversation: "I'm noticing X. Help me understand what's going on."
3. Create an improvement plan with specific goals
4. Involve the program early if concerns are serious
5. Don't pass a failing student: Doing so is unfair to future patients

When to Escalate

• Patient safety concerns
• Repeated issues despite feedback
• Professionalism violations
• Concerns about fitness for practice

Protecting Your Patients

Student involvement should never compromise care.

Guidelines:

• Always verify critical assessments and treatments yourself
• Co-sign or directly supervise all documentation
• Don't let students do procedures beyond their competency
• Intervene immediately if patient safety is at risk
• Never leave a student alone with a patient who might decompensate

Protecting Yourself

Documentation

• Document precepting hours (often required for compensation)
• Keep records of evaluations and concerns
• If a student is struggling, create a paper trail

Time Boundaries

• Precepting shouldn't consistently add hours to your day
• If the student is creating unreasonable burden, discuss with your manager and the program

Know Your Limits

• It's okay to say no if you're already overwhelmed
• Quality precepting requires bandwidth
• One well-precepted student beats three poorly supervised ones

Making It Sustainable

Rotate Responsibility

If your unit has multiple APPs, share precepting duties.

Seek Preceptor Development

Many programs offer training on effective precepting—take advantage.

Get Compensated

Advocate for preceptor pay or benefits if not offered. Your time has value.

Connect with Programs

Build relationships with NP/PA programs; provide feedback on student preparation.

Remember the Big Picture

On hard days, remember: someone precepted you. Pay it forward.

The Bottom Line

Precepting is challenging, but it's one of the most impactful things you can do for the profession. Set clear expectations, teach in the flow of clinical work, give honest feedback, and protect your patients. The students you train today will be the colleagues you work with tomorrow.

Shape them well.