About Mr. Dino Soriano, MSN, FNP-BC: Mr. Dino Soriano is the founder and CEO of Clinical Match Me (CMM), a service that connects nurse practitioner students with qualified preceptors in their area and supports preceptors during the clinical placement matching and approval process. Prior to his founding of (CMM), Mr. Soriano worked as an Emergency Room Registered Nurse at Piedmont Healthcare, where he conducted medical assessments of acutely ill patients and worked on an interdisciplinary team to address and treat patients across the age spectrum. He also worked as an ER and Trauma Nurse at Memorial University Medical Center, where he conducted health assessments, implemented trauma protocols, and applied appropriate medical interventions as necessary.
Mr. Soriano earned an MSN in Leadership and Management in 2012 and an MSN in Family Practice Nursing in 2014, both from Walden University. He is also earning his Doctor of Nursing Practice in Family Practice Nursing from Walden University.
[OnlineFNPPrograms.com] What types of services does Clinical Match Me provide to graduate nursing students seeking help with obtaining clinical placements? What challenges have you seen them encounter in finding optimal clinical placement sites and preceptors, and how did you and your business partners detect a need for the services that you provide?
[Dino Soriano] When this all started, when I was in school to become a nurse practitioner myself, and I was a nontraditional student. I was in my 30s and a single parent. And going into a graduate program to become a nurse practitioner, I expected certain things that did not materialize.
At a graduate level program, students typically expect to be provided or afforded all of the tools, services, products, everything that they would need to successfully complete that program. And in the graduate nursing field, these things simply did not exist. The eye-opening experience for me was when my program said, “You need to find your own preceptors.”
I asked, “Give us the list of whom to call in our area.” That did not exist. I followed up with a request for a list of potential preceptors I could e-mail in my area. That did not exist.
I started searching for my first clinical rotation in family practice. And it took several months to find a preceptor who was willing to accept me. And this first preceptor, who worked at a family practice, was a four-hour drive away from where I currently lived. So even though I had just built a house and had two kids in high school, I packed my bags and went to Atlanta, rented another place to live and secured a position in an ER so that I would be able to search for additional preceptors, while having a flexible schedule and finishing school. This was a good decision at the time, because I had to find three more preceptors: one for pediatrics, one for women’s health, and a third in a family practice setting or across-the-life-cycle type of setting (i.e. primary care).
I was able to find pediatrics, and I was able to find my last preceptor for primary care. But being a male student, looking for a women’s health location that does a lot of women’s health, where I would be able to actually get experience, be able to see patients, learn how to do pelvic exams, learn how to properly diagnose and work with patients with other issues that I’m going to deal with as a practitioner–I could not find one.
Ultimately, I had to sit out for a semester. I eventually did find a preceptor to accept me, but because of having to sit out for a semester, delaying my graduation for four months or longer, delaying my ability to start my career, losing four months worth of income as a nurse practitioner, I decided, “There’s got to be a better way.”
I was shocked at the lack of support for graduate nursing students when it came to securing their clinical placements. So, I decided to figure out why preceptors weren’t taking students. What was the problem? And did students from just a few schools suffer from it, or was this a problem nationwide? And to my surprise, it’s a problem nationwide, across many schools. And so I created Clinical Match Me.
I decided to create Clinical Match Me with the ultimate goal of being a single point of contact for graduate nursing students in graduate nursing programs to be able to have a place to go for consistent, quality, hands-on clinical training.
And one of the initial thoughts behind Clinical Match Me was that there is no reason that a student should have to sit out for a semester from a graduate nursing program because he or she can’t get a preceptor. There is no reason for a student to change his or her educational track because they couldn’t get a women’s health preceptor or pediatric preceptor, or to drop out of the program completely and go to P.A. school or administration because they’re having such a difficult time finding clinical training and preceptors.
And so, I did the research. And Clinical Match Me was born, and started off by trying to find out the primary reasons why preceptors were not taking students, and the answers as to why preceptors are taking students. And it came down to a few of the same, consistent messages.
One, there’s an overwhelming number of schools, somewhere in the neighborhood now of over 650 graduate nursing programs in the United States. Very few, if any, share documentation. There are also over 250 programs online, I believe, and the same problem persists in that arena–few if any share any documentation. For example, when I started Clinical Match Me, no nursing programs had been accepting electronic signatures.
We had programs whose preceptors were telling us, “We’re not getting any support from the schools. They don’t tell us what they want us to teach the students. We don’t get any formal training. We have to beg for a syllabus or tell a student, ‘Give us your syllabus. Tell us what we’re supposed to teach you. And we’re not getting paid from the NP programs. If we precept Physician Assistant students, the schools pay us. Medical schools both nationally and internationally pay us to take students. Why is it that our own profession isn’t taking care of compensating us for our experience and our time and our talent?”
So what I said to nurse practitioners was, “If I helped you manage the paperwork, and if I helped manage the process of getting the student to you with all the proper documentation that you need to be able to make a good decision on a student, along with a student syllabus so you know what you’re going to be teaching them, provide you with a little bit of guidance and training, and pay you for doing this, would you take students?”
We got their attention and overwhelmingly they started saying yes, because we took the pain out of taking students and being a preceptor. So, the student then has somebody to go to and say, “Hey, I need a preceptor,” because we’ve now created this place to go to that has preceptors that are fully credentialed and willing to take on students. We credential the preceptor once so that whatever the school requires, we have that available on file, particularly their résumé, a professional photograph, their state licensure, their national certifications, whether they have one or multiple. And then we make sure that we keep an up-to-date and accurate file on that particular preceptor.
Then we gather all of what we call the critical data about this preceptor. As an example, say we have Preceptor Jones who is a pediatric preceptor. She works in X number of rooms, sees 40 patients a day, and works with ages from newborns to 18. Preceptor Jones is willing to take two students at a time, and she is located in Kalamazoo, Michigan. And here is her office manager’s name and contact information.
So, now, when a student reaches out to us and says, “I need a preceptor. I’m just outside Kalamazoo, Michigan, and I’m an FNP student at the University of Michigan, and I’m in their online program, and I need a pediatric preceptor for summer of 2016. Can you help me?” We can tell them what we do and how we do it, and tell them what they need to complete the process. And we tell them the best part about the process is our company is set up to only get paid when we deliver. And what we mean by that is until we deliver you a school-approved preceptor, at an approved clinical location, you don’t owe us any money because until it’s approved by your educational program, it’s not real. But once it’s confirmed and it’s real, then we charge a nominal fee of $15.00 per clinical hour as required by your school. It’s a $1,200.00 minimum payment.
Some schools require 80 hours, some 350 hours. So, the only fair way was to charge by the clinical hour required. So, the student then has to do the registration process. They’re responsible for getting us their paperwork online in a timely manner. They have to go on the website, register, and give all their contact information.
Then they have to send us their résumé, their headshot, their school’s preceptor package so that we know that anybody we match them with meets their school’s criteria. And they have to send us their medical malpractice insurance. And in some cases, depending on what preceptor or clinical location that we send them to, they may need to get an additional background check, and they have to provide their immunization statuses. And they might have to do an interview – on the phone, typically, but some clinical sites want them to go in person to human resources and go through the onboarding process. In such cases, the preceptor usually wants to talk to them and find out, “Are you a good fit? Are you ready to see patients, do you have a good basic knowledge and are you going to be a competent student?”
I still precept students myself, I want my students to be prepared. I don’t want a wallflower. I want a student who does not expect to be spoon-fed every single thing they need.
So, the student talks to the preceptor, and the preceptor will give us a nod, “I’ll accept these students,” or, “I won’t accept the student,” and why. But typically, it’s, “We’ll accept this student,” and we move forward.
We then fill out all the paperwork for the school, which typically includes a preceptor contract and a clinical site contract or agreement.
While we work for and interact primarily with students and preceptors, we also work directly with some schools that actually have hired us to place students. Others use us as just a recommendation to their students. I’d say we are about 98 percent focused on working for the student directly.
A student said this to me at some point, and I wish I knew the student’s name so I could give him the proper credit for his quote, but he said to me, “At $30,000.00 a year for an education, you don’t make me pick my own professors to go to your college. Why do you make me pick my own preceptors?”
I’ve been there–at one point during my graduate nursing education I hired people to call medical practices to try and find me a place. Graduate nursing students are responsible for so much: graduate school, working full time, most of them have families. They’re incredibly busy. And then finding preceptors is a full-time job on top of that, and many students need at least four clinical rotations in different settings. Some need more. And they’re expected every few months to undergo this search process and approval process every quarter for every rotation.
We’re kind of unique, in that when a student comes to us and asks us for help in finding a preceptor, they can come to us two or three weeks before their semester starts, and say, “I want to thank you guys for everything you did, but I got a preceptor on my own.” We’ll send them a congratulations–we wish them the best and we say, “Hey, give us a call if you need something for next semester.”
A very unique business model. It’s all about paying it forward and changing a culture. And a lot of those students have all come back to us for future placement. So, for us, we’re happy for them.
Many of the students whom we help–they’re at their wits’ end by the time they come to us. They are going out and seeking people on Facebook, on LinkedIn, at individual association meetings. They go to faxing people, calling through the phonebook, visiting them in person, passing out résumés, e-mailing whomever they can, praying, prying, and begging for a preceptor. We’re not the answer for everybody, but we are a unique and much needed option within the country.
[OnlineFNPPrograms.com] What kind of clinical placement support is typically available for students at the majority of nursing schools?
[Dino Soriano] At the majority of the nursing schools, they have a clinical placement center and they all have a database where they list people who have precepted for them before. Unfortunately, they don’t often provide e-mails and phone numbers and everything with the student body for the most part because the preceptors would get inundated. If they have 100 students, and they all get the list at the beginning of the semester, everybody on that list is going to get 100 phone calls, 100 e-mails. So, they don’t give out that information readily.
If you go to the clinical placement center to ask specifically, they may give you five or so names, and they’ll say, “You go try these people,” but again, they don’t give out their personal e-mails or phone numbers. You’re then stuck looking them up.
There are a few schools, and I want to say University of South Carolina is one of them, that does an excellent job. Now, they’re a small program, and they’re directly connected to a large hospital group of a medical school. So, they have ready access to a built-in number of preceptors to handle their student body. And they don’t take more students than they can handle.
Some of the schools have 600 students in an online class, and it’s physically impossible for them to maintain any business relationship with preceptors where they might have students that semester. ‘Cause they might have 20 students in Florida, 30 in Ohio, 1 in Colorado and so forth. They just don’t have the infrastructure or training to handle this need. They also don’t have the financial ability to have enough employees on staff to find preceptors in every area for their students, because it’s very, very time consuming and very expensive. So students as a result end up responsible for this process in the majority of cases. Some schools tell their students, “You cannot enroll in the program unless you start looking for preceptors and have some identified before you even enroll in the program.”
And that’s a great ideal, but you’re talking about a year’s worth of clinical sites and preceptors prior to even starting one’s program, and even when students have secured both a site and a supervisor, a lot of things can happen in a year–preceptors’ availability can change due to unforeseen circumstances, or an online student may need to move residence due to family needs, for example. And another issue is that some of the sites that students are contacting are going to have students booked out two years in advance.
You have to understand the culture of nursing and the culture of the world of academia. When you’re a department at a university you have to deal with budgets and limitations of number of staff. So, then when they say, “Hey, look, we’ve got all these students. How are we supposed to deal when so many of our students are having trouble finding preceptors? We want to add four more people to our clinical department so we can find more preceptors.” And they might get one approved for next year’s funding. So, things move slowly and are subject to limited resources in nursing programs.
Whereas a company like Clinical Match Me, working directly for students, we live and die by the market. As long as students, like myself when I was a student or the students who are out there right now, are being forced to take on this burden, this is something that we will be there to help them with. Because we can reach out and hire more people. We can reach out and recruit more preceptors on a nationwide basis.
We have the ability in our budget to pay preceptors well for doing good things and teaching students. And we all have the same mindset of doing our part to educate, as we put it, the next generation. We’re preparing passionate and competent health care providers.
[OnlineFNPPrograms.com] If students do not work with Clinical Match Me, what steps and processes would they need to follow in order to secure a clinical placement? What is the average student’s experience and the requirements they must fulfill?
[Dino Soriano] The first thing they need to do is to find out what the requirements are from their school. Every school has a clinical package, a clinical placement package for a preceptor. And it can be as simple as 2 or 3 pages, or I’ve seen them 28 pages long. And it will tell them that if you’re in the FNP program, here are your four classes that require you to complete clinical practicums. In this class, you need 80 hours of advanced health assessment. The clinical package provides all the logistics and requirements of the clinical practicum aspect of the program.
For example, the package will outline, ‘For your next class, this is your primary care or your family practice,’ and you can do this at a private practice or a private primary care. Most programs have fairly stringent requirements around what qualifies as a particular type of setting (ex. women’s health, primary care, acute care, etc.), though some schools allow for some flexibility–for instance, certain programs are allowing students to complete their primary care clinicals at urgent care centers.
Students will go about researching potential preceptors in a number of ways–they may go to Healthgrades, or grab a phonebook, or a provider list for their insurance company. They may contact hospitals or research on medical centers’ websites. Students will pick up the local provider directory, search Google, or go to the local association for nurse practitioners. They’ll ask their family doctor; they’ll ask their pediatrician. They’ll ask all the doctors they work with, “Could you precept me at your practice?” The thing is, they don’t realize that the other 250 nursing students in their program have already asked the staff at this hospital.
And for every single clinical rotation, the graduate nurse practitioner student is not only competing against other nurse practitioner students that are in online programs, they’re competing with brick and mortar programs, they’re competing for the same preceptors with P.A. students and medical students, foreign and domestic.
If a student cannot find a clinical site and preceptor near their residence, they will need to reach out to settings and nurse practitioners in areas they don’t mind traveling to, perhaps where they have family with whom they could stay or don’t mind paying for lodging. Once students successfully find a preceptor in, for example, a primary care setting, they need to reach out to them and make the request.
You might have to reach out to 300 or 400 people to get to that point. Once you find a preceptor who says yes, you have to get them the school’s paperwork and get them to fill out the requisite paperwork that the school provides. This paperwork can post a huge barrier to many nurse practitioners agreeing to be a preceptor, because it takes (unpaid) time that they would otherwise be devoting to their profession. And interestingly enough, if a nurse practitioner has precepted for a school in the past, it is almost inevitable they still need to fill out the paperwork again.
Once filled out, the paperwork must be faxed or mailed to your school, and you must supplement it with a copy of your preceptor’s credentials, his or her license, certification and so forth. You have to find out who can find the Facility Site Agreement and take that to your preceptor as well, have them sign it, and send it to your school.
And a lot of the schools have told us that, “You know, we get a lot of incomplete packages, where they didn’t have the nurse practitioner’s CV, or the license they sent in was expired because they got it from them eight months ago.” In these cases the student will need to obtain the most up to date version of his or her preceptor’s license, and send that along to the school. Typically, students have to turn that paperwork in the semester before that class is actually due to start.
So, if you’re starting in summer, you need to turn your paperwork in in January. Or if you’re starting in fall, you need to turn your paperwork in in April or May. And then the school will let you know sometime prior to the week before class that your preceptor has been approved.
We get a lot of phone calls the week before class, or the first week of class, with students saying, “My school said I couldn’t use my preceptor,” “My preceptor died,” “My preceptor changed jobs,” “My preceptor’s practice got sold, and now they can’t take a student.” Things happen. “My preceptor’s on maternity leave and won’t be back for five weeks; that doesn’t give me enough time to get all my hours in, and her partner won’t take me.”
So, the student is then burdened with all of that on top of learning a very difficult subject, whether it is primary care, women’s health, or pediatrics. And the student is also burdened with working full time and taking care of his or her family. And when you add to that the added stress of managing your own preceptorship, it’s no wonder some people say, “You know what? I’m just going to do adult. Forget this pediatric stuff; I’m just doing adult.”
Or they can’t find women’s health, and they say to themselves, “You know what? I’m just going to go with pediatric, as my pediatric preceptor said she’ll take me for two more semesters.” Or they just say, “You know what? P.A.s provide students with preceptors; I’m just going to be a P.A.” And they literally will just jump programs. And they pass their boards for adult gerontological, but they can’t work in family practice, and they can’t see kids. So, if they want to get that additional marketability for their licensure and their career, they have to go back and do additional trainings and/or certifications in pediatrics or women’s health.
Interestingly enough, it’s actually pretty easy to get clinical placements within nurse midwife programs, but then again, you’re usually with one or two preceptors for your whole program. But you can’t do anything else; you can’t work in family; you can’t do kids. You’re a nurse midwife.
The nurse anesthetist programs also do not have this problem, because they’re all connected to teaching hospitals with anesthesia programs. And there are not nearly as many nursing anesthetist students as there are all the other students.
[OnlineFNPPrograms.com] What makes an optimal match between a nurse practitioner student and the preceptor? And how does your company optimally match both students and preceptors? Do you interview both parties?
[Dino Soriano] The optimal match is a student who wants to learn and a preceptor who wants to teach, where the preceptor is available when they need it, where they need it. In my opinion, personality is not a huge deciding factor, because, as a nurse practitioner, you’re going to have to deal with all kinds of personalities.
The preceptors sometimes want to talk to the students just to make sure they’re a good fit, but for the students the main concerns really are, “Do you have what I need, when I need it, and do I have to travel across country?” So geography, clinical setting, qualifications to precept, and timeframe of availability. That’s where we start.
The goal is to find somebody close to you when you need it. But if that’s not possible, then we open the circle up to the students and ask them, “Where are you willing to travel?”
We try to get an answer from the preceptor for an acceptance as soon as possible so that we can get the paperwork started for the student and move that process forward, as the preceptors must be officially approved by the student’s program. No matter how much we think they’re great, until the school says yes, it is not a yes. And sometimes the school will say, “Hey, this would be great for your next class, but we need you to get somebody different for this class.” And then you go back to the student, and we say, “Hey look, we have another option; it’s about an hour away,” or, “Where can you go?” We do a lot of this troubleshooting and coordinating so that the students and the preceptors do not have to.
And some of our preceptors are great in that they go out of their way to accommodate students’ schedules or geographical difficulties. We have some preceptors who will say, “You know what? If the student’s traveling from out of the area, they can come five days a week and get all their hours done in four or five weeks.” So, a student will take a leave of absence from their job and travel for four or five weeks to get their clinical education taken care of, and we help them through the process of getting licensed in that state, if they don’t already have a compact license.
The paperwork for licensure to practice in another state can be a huge barrier. And we know which states are pretty quick at getting licenses to people. So, if somebody wants to come to Georgia, it’s about a two-week process; if you want to come to Florida, it’s about a two to three-week process. If you want to go to Washington, D.C., it’s about a four-week process.
We let them know ahead of time, “Hey, this is what we’ve seen; this is what you’re going to have to do; here’s a copy of your paper work; here’s the electronic link you’ve got to go to in order to file your license application.” Or, if they have a compact license, it’s really easy for them to change.
[OnlineFNPPrograms.com] In addition to helping match students with preceptors and clinical sites, in what other ways do you support students during their securing and completion of their clinical placements?
[Dino Soriano] Every student who registers with us, we send them a student statement that they have to sign and agree to, which tells them our responsibilities, their responsibilities, what to expect and why. We tell them, “Here’s your Student Survival Guide. Here’s an interactive calendar for you to put your schedule on when you work out your clinical schedule with your preceptor. Just load it into your Microsoft Office. Here’s a list of reference materials that you need to have on hand. Make sure you have your tablet.”
Our guide also lays out logistical matters such as: “Here’s your checklist of action items. A week before your clinical, you should reach out to your preceptor, talk to them on the phone, find out who the officer manager is, where do you eat lunch, where you park, and what the dress code is. How do they want you to call them if you’re going to be late? How do they want you to engage with staff and patients, so that you are conducting yourself as both a guest and as another provider? You’re learning to be a provider. You’re not going to be an extra helping hand.
Students need to ask questions such as, “Do I need to learn your software, or will I not be documenting on your computer? Do I need a login?’” We give them checklists, and tell them, “So, you’ve got to do all these things just before you go if you want to be successful.”
Before students start clinical, we recommend they get their board’s review from Barkley & Associates. It helps them be better prepared when they walk into their clinical rotation the first day. They’re going to be there with a deer-in-the-headlights look hoping to God they don’t hurt anyone. Because even though they have someone there to guide them, they are making decisions for somebody else’s life. And that is a weighty responsibility.
Whether it’s as simple as an antibiotic, or if it’s diagnosing an earache or strep throat for the first time, when you are a provider you’re no longer following orders; you’re writing orders, and you’re learning an entirely different way of thinking. And that is the challenge for a lot of people. So, you better have the rest of it down. Better to have a listen to somebody’s chest and look in their ear, nose, and throat and understand that part of it and make clear and correct recommendations based on your observations, because you’re not there to be a nurse; you’re there to be a practitioner.
And even though the first day is scary like that, as you grow, your second week, your third week, your third month, you’re going to feel more confident, and you’re going to understand how to run an encounter as a student. And during the process you can ask your preceptor questions. Ask your preceptor questions if you don’t understand something. Some preceptors even send their students home with homework.
Something very important for students to understand is that not all of their preceptors are always going to be nice to them. My best preceptor was probably one of the most frank individuals I worked with, and boy did I learn!
It’s not just learning how to choose a medicine, it’s about best practices to ensure patients’ safety, comfort, and recovery. Things like don’t ever not change the paper on the exam table–whether it’s your staff that didn’t do it or not, never, never put a patient in a room that isn’t clean. Never walk into a room without looking at the patient’s record prior to seeing the patient and knowing who they are or what medications they’re on. Ask yourself, “What’s their history? Why are they here?”
Because you need all that information to be able to make a good decision for that patient. And as a student, that’s what you want to learn how to do from your preceptor. And we try to tell them this in our Student Survival Guide, but we also don’t spoon feed them.
Be open-minded, be prepared, don’t take criticisms personally, and don’t be a wallflower, because you might be the only student at that practice, or you might be one of nine students, where they only have one nurse practitioner, but they might have three P.A. and five M.D. students there, and you need to fight for patients to see. So, be proactive, because you really get out of it what you put into it.
[OnlineFNPPrograms.com] As you mentioned, clinical placements are often the first time that students must manage complex patient cases and the responsibility of being a provider. How can they deal with that stress in a good and constructive way?
[Dino Soriano] This is why reference materials are important in this field, and can be a very helpful tool. There is nothing wrong with looking up an antibiotic before you prescribe it. There’s nothing wrong with looking up a medicine to make sure that if you’re going to give a starting dose for a hypertensive medication, that this is the appropriate dose; this is the proper starting dose; that it doesn’t interact with another medication that the patient is taking. Looking that up is not being timid; it’s being safe and smart. Because you’re not going know every medication by heart, and you need to be safe.
And as mentioned before, asking your preceptor intelligent questions. For instance, you can tell him or her, “Hey, this person has strep throat. What is the medication of choice or treatment of choice or clinical best practices for strep throat? I can’t seem to locate it.” That’s okay to ask. They might tell you what it is, or they might tell you where to find it. Either answer is okay, but don’t ask them again tomorrow, because you better have looked it up by tomorrow and know it.
Because tomorrow is going to bring a whole new set of challenges, where it might be a situation in which you encounter the same diagnosis, but this person’s allergic to all penicillins. Now what are you going to do?
Encountering these challenges is a good sign, and the first clue that you should ask a question. And what I tell my students on day one is, “I don’t except you right now to know what’s wrong. I expect you to know what’s normal, and I expect you to be able to identify when something is not. If you come to me and say, ‘This doesn’t look right to me; let me show you what I found,’ I will be happy, because you’re able to identify what’s not normal. That, on your first couple of days is perfect, because you’re questioning and being observant. You’re not simply typing down WNL, which a lot of people say is ‘within normal limits,’ but in reality it means ‘we never looked.’ Don’t put that down unless it’s genuinely merited. If something doesn’t look right, ask a question. And that’s what I try to teach my students as a preceptor. If the picture doesn’t match the story, keep asking the questions.
[OnlineFNPPrograms.com] How should students’ knowledge, skills, and approach to nursing be different at the end of a given clinical practicum rotation, relative to the beginning of the term?
[Dino Soriano] To answer this question, let’s take a hypothetical student as an example. We’ll take a student in a primary care setting, and they’re going to look at a lot of ears, noses, and throats, and many upper respiratory ailments. In the beginning, they’re not going to know what antibiotics to use; they’re not going to know what tests will work. They’re not going to know how to run an encounter.
The last couple of weeks of the rotation, they should be able to look at the board of patients who are waiting and go, “Okay, this is a 35-year-old with a complaint of upper respiratory or a complaint of a cough.”
They should be able to look at that patient’s history and then go in and run the encounter, come up with a differential diagnosis and a plan of care, do patient teaching, make sure that they’ve chosen medicines that are appropriate that don’t conflict, and then come and give a report to the preceptor and say, “I have a 35-year-old, Caucasian female. She has purulent fluid behind both ears, runny nose now for purulent drainage, and rhinitis for seven days. And she has a positive rapid step test. She’s not allergic to any medications; she’s not on any other medications. I feel it would be appropriate to prescribe this antibiotic, this for her cough, and give her a Medrol Dosepak to help with the swelling and inflammation. And this is how I would prescribe it for seven or ten days.”
So, by the end of it, they should be able to come to you and say, “This is what I see, how I interpret it, and what I recommend.” If they can do that for an ear infection or a urinary tract infection or nausea and vomiting, that would count as excellent progress. But students should also learn how to run an encounter when they don’t know precisely what the patient is suffering from. In such cases, they can approach their preceptor and say, “Hey, I’m running the encounter, but I don’t know how to treat this particular thing that I’m finding. But this is the encounter, and here’s the type of patient; here’s their history.” That is the difference. In other words, go from asking to reporting.