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Join us for an episode featuring Lynn McComas, a recognized expert in precepting nurse practitioners and advanced practice provider students. We’ll discuss the critical importance of hands-on training in medical education and the potential consequences for patient care when students are limited to observational roles. Lynn shares insights on the challenges health care organizations face and how we can advocate for a more practical, experience-based approach to training the next generation of health care providers.

Lynn McComas is CEO and founder, PreceptorLink, and a recognized expert in precepting nurse practitioners and advanced practice provider students.

She discusses the KevinMD article, “The future of health care depends on hands-on training: We cannot afford to cut corners.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome Lynn McComas. She’s a nurse practitioner, and she’s the founder of PreceptorLink. Today’s KevinMD article is titled “The Future of Healthcare Depends on Hands-On Training: We Cannot Afford to Cut Corners.” Lynn, welcome to the show.

Lynn McComas: Thank you so much. I appreciate it, and I appreciate you letting me have the opportunity to be on your show and to share your forum with nurse practitioners, PAs, and other clinicians. So, thank you for that.

Kevin Pho: All right. So, let’s start by briefly sharing your story and journey.

Lynn McComas: Yes, so I started many years ago. I was an RN, and I actually was even a travel nurse way back when, long before it was popular. I got my master’s of nursing as an adult-geriatric nurse practitioner, and this was more than two decades ago. Most of my clinical practice as a nurse practitioner was in primary care, and I loved being with people—adults and geriatric patients. So, that was my specialty.

Then, later, I got my doctorate in nursing practice, or DNP, from Duke University—go Blue Devils—in North Carolina. One of the reasons I did that was to help become a change-maker within my profession as a nurse practitioner. I’m one of those people who tends to get involved and hold leadership positions, and I’ve held a lot of different leadership positions in many different types of NP organizations.

So, I did this, and I was in our local chapter meetings in San Diego, and I started seeing more and more students come in looking for preceptors. And the NPs at the dinner meetings would look out the window and down at their plates. They weren’t interested in precepting. And I thought, gosh, you know, I’ve worn a lot of hats over the years as a clinician, as a mentor, as a preceptor, and now as a business owner. But at the time, I wasn’t, and I know how much work it takes to precept. And I thought, if we could simplify the process, streamline things, and even offer a little honorarium, people might be more willing to precept. And so, I started the business, and that’s how it was founded a decade ago.

Kevin Pho: All right. And for those who aren’t familiar with medical training in general, what exactly goes into precepting? What are the responsibilities of nurse practitioners who want to precept students?

Lynn McComas: So, it’s a little bit individual for the preceptor and also for the schools. Different schools have basic requirements that are mandated by the organizing bodies, but schools can also have their own requirements. So, the minimum currently is 500 clinical hours for a student. The student typically has different rotations they need to complete with various preceptors and in different specialties. It really depends on what area their program is in. If it’s psych, they would have to do different types of psych rotations; if it’s family, they’d have to do different types of family rotations.

The preceptor needs to be able to mentor the student for anywhere from typically eight weeks to twelve weeks of ideally hands-on experience, where they’re progressing them from maybe a few hours or a day of observation to gradually having more hands-on opportunities. Because that is the most important and critical part of the learning process—helping the student to progress to the point where they are seeing the patient on their own, with the preceptor overseeing things. But that’s how it typically works. And again, it depends on whether it’s acute care, psych, primary care, or a different setting. Each one is a little bit different, but the ultimate goal is to help a student progress from minimal observation to hands-on experience in a safe environment.

Kevin Pho: And your KevinMD article, of course, talks about that, and we’ll go into that in more detail. It’s titled The Future of Healthcare Depends on Hands-On Training: We Cannot Afford to Cut Corners. So, tell us about the events that led you to write this article in the first place, and then talk about the article itself for those who didn’t get a chance to read it.

Lynn McComas: Yeah, thank you. So, the article really came from a growing frustration that I’ve had with opportunities for hands-on training decreasing in clinical settings. We’re starting to hear from sites where students are really limited to their hands-on training, and they’re being told they can just observe. And really, obviously, that’s not ideal.

And so, when I received this particular message from one of our really beloved preceptors, who started a new job and was willing to take a student, it just—when the HR person forbade anything other than observation—I knew I had to speak up. And the article is not just about NP students. This also pertains to PAs and medical students. Because really, this is starting to happen across the profession, and it has broader implications for safety and for the quality of future health care. So, writing it was truly an attempt to bring awareness and advocate for change. We can’t just focus on productivity, financials, and liability concerns with student safety because we jeopardize the development of the next generation of clinicians. And ultimately, that puts increased liability risk on future clinicians after they’ve graduated. So, it really becomes a vicious circle.

Kevin Pho: And when you get those emails from HR people at medical organizations, are the reasons because of liability, financials, or productivity? What are the reasons that they’re giving you?

Lynn McComas: Well, most often, they don’t give reasons. But when we have dug into it with them, yes, it is, you know, they’re concerned about productivity, slowing down the preceptor. They’re worried about liability. In this case, it sounded like it was more concern about liability. And so, they have just eliminated the opportunity for hands-on experience altogether. It’s solely observational.

Kevin Pho: And for nurse practitioner students, PA students, and medical students in general, if they run into these roadblocks where more and more medical institutions are saying no and only allowing shadowing, what are the options available to them when they come to that point?

Lynn McComas: Well, you know, it just depends. I mean, most often in my world, we would replace the site because that’s not—it might be useful for a very small thing or for a very specialized situation or for a short period of time. But true observation is not ideal. They really need to get their hands on and progress with taking care of the patient. So, sometimes we have to replace, or sometimes we have to see if that is acceptable for the student and the school. So, it just depends.

Kevin Pho: So, are you finding that it’s because of the HR people at these institutions themselves that it’s a limiting factor? Or are you finding nurse practitioners themselves are a little bit hesitant to be preceptors? You mentioned that meeting where that was asked, and they just kind of looked down at their plates. Are you seeing hesitance from preceptors themselves, whether they’re PAs, physicians, or nurse practitioners? Or do you think it’s just an edict coming from above, from their HR people?

Lynn McComas: No, we actually see both. Sometimes, preceptors themselves are the ones. You know, we have preceptors who own their own practice. Whether it’s an NP, a physician, or a PA, sometimes they are the ones saying observation only. I think we’re seeing this more in psych, where there’s more tele-psych, and it’s a sensitive issue. I mean, I understand that because psych is something that’s so deep and personal, and the patient’s opening up about themselves. And so, it can be a difficult situation. But we’re seeing it in both institutions and within the preceptors themselves.

Kevin Pho: Now, let’s talk more in detail about the broader implications of this, and you, of course, alluded to that earlier. So, the fact that these students are finding it more difficult to get hands-on training—talk about how that’s going to jeopardize their education going forward.

Lynn McComas: Yes, so, as mentioned, they’re not going to be comfortable if all they’ve done is observation. They’re not going to be comfortable or prepared as clinicians in the real-world environment. If they haven’t done hands-on tasks, listened to heart sounds, or performed a pap smear, how in the world, when they have graduated, can they possibly be prepared to be a quality clinician?

Kevin Pho: So, what are some of the answers here? Because it sounds like this is just another aspect of business infiltrating health care, right? Everyone’s kind of worried about their productivity. And as you said, precepting takes time out of their day and reduces productivity. What are some of the solutions going forward? Because the infiltration of business in medicine isn’t going to abate anytime soon.

Lynn McComas: Right. So, I really think that it’s up to the individuals and our profession to advocate. You know, we have to advocate. And one of the best times we can do this is if you are negotiating for a new job. If you want to precept, that’s the time to bring it up, get it in writing, get it in your contract, and ask for the ability to be able to precept. Make sure that they understand that when you say precept, you mean hands-on, because it is something that is needed for the advancement of our profession. Get it in writing.

And then, when you’re also—you know, the other thing is that we should all advocate for change. This should not be something that institutionally is considered the norm. We can’t do that. We can’t do that as professionals. We can’t have non-hands-on training. It’s just going to backfire in the long run. So, I think we all need to advocate for this change within all professions—all medical professions.

Kevin Pho: Tell us about some of the rewards of mentoring or precepting students.

Lynn McComas: Well, it really helps keep you up to date on some of the current literature. Sometimes, students may even have some of the more recent information that we don’t have at our fingertips. They may have recent research studies, protocols, and things like that. It really does help keep you on your toes. And if you—most of us in the medical world, we like to teach. We like to share our knowledge. So, it’s very rewarding to see someone progress and to be able to help them grow in their field.

And then, of course, some institutions are allowing preceptors to receive an honorarium, to receive payment. So, that’s always nice. Other things that you can get, again, you can negotiate for—library privileges, adjunct faculty status, different things like that. So, think about what you might be able to ask for when you’re being asked to precept, because there are things more than just honorariums and payment, or, you know, a coffee mug. Sometimes you can get a little something extra for precepting.

And really, you know, it’s also about helping educate the next generation.

Kevin Pho: And how about our professional societies? Certainly, in the nurse practitioner world that you’re very familiar with, what kind of initiatives or advocacy or policy efforts are being advanced from a professional society standpoint?

Lynn McComas: You know, I am not aware of what is being advocated from a professional society basis. All I can answer is from my own personal experience.

Kevin Pho: And for those students looking for a preceptor, what kind of advice do you have for them?

Lynn McComas: So, if their school is helping them, that’s great. It’s always good to do your research ahead of time and try to find a school that does help. But even if they do, sometimes you don’t end up getting the place you want or the type of preceptor you need. So, you need to dig in, use your networks, use your LinkedIn, and use every contact you have. Get your resume buffed up, make it professional, and have a cover letter that’s directed toward the particular rotation that you want.

It’s basically like a job interview when you’re looking for a preceptor. Take it seriously. It’s very competitive out there, and you need to put your absolute best foot forward. And if you need to, we are here to help.

Kevin Pho: And in terms of current trends, what do you foresee in the next year or so when it comes to these students finding preceptors? Are you hopeful that there’s going to be a turnaround? Or do you see that the number of willing or able preceptors is continuing to decline?

Lynn McComas: Well, I wouldn’t say that the number of willing and able preceptors is declining, because we get new preceptors all the time, and we lose preceptors all the time. It’s just a normal attrition process. So, I wouldn’t say that there are fewer preceptors. There are just sometimes challenges and headaches that go along with finding a preceptor.

But there are some things that I hope will help. I do hope that nursing will start incorporating more AI. I think there is potential there. I would love to see more virtual reality used within nursing as far as precepting goes—not in lieu of, but as an adjunct for preclinical. I think there’s so much potential. If you can imagine having virtual reality as you’re performing a procedure the first few times, it helps to make it so much more comfortable when you go in to see Mrs. Smith in room one, and she’s your first real hands-on patient. So, I would love to see that happen more, and we’ll see—hopefully, it does.

Other things—well, I do hope that the profession will do more with this. They will take it on more and help students find preceptors. Ideally, it should be something that the profession is doing. I feel terrible for these poor students. This is something that I took on out of what I felt was necessity because students were really struggling to find preceptors. But hopefully, as time goes by, the profession will step up more to help with this difficult and burdensome task.

Kevin Pho: We’re talking to Lynn McComas. She’s a nurse practitioner, and she’s the founder of PreceptorLink. Today’s KevinMD article is “The Future of Healthcare Depends on Hands-On Training: We Cannot Afford to Cut Corners.” Lynn, we’ll end with some of your take-home messages that you want to leave with the KevinMD audience.

Lynn McComas: Thank you. You know, I would say that, please do advocate. Advocate for hands-on education and advocate for preceptor education too. If we have more preceptor education within the different institutions and within the profession, that will help the hesitant and the novice preceptor be more willing to precept. So, thank you so much for letting me have a voice and an opportunity to share. And let’s get the next generation of preceptors educated.

Kevin Pho: Lynn, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Lynn McComas: Thank you.