1. Ask your preceptor, before the first day, to name the top five diagnoses seen in the practice. Then, learn them cold. This will wow your preceptor and make you feel more confident.


2. When you enter the exam room, remember, you know how to do a health history, symptoms analysis and physical examination. This is where all health encounters start. Do these before you decide you do not know what is going on with the patient.


3. Learn how to dig for information in texts, references, etc. Before presenting a patient to your preceptor, do the digging; come in with a working diagnosis. Remember: your learning will never end!


4. Focus your visit on the patient's complaints, keeping their pertinent health and exam history in mind. Learn how to extract information from the record that need not be repeated (i.e. remote surgical history, OB history in a 67 year old woman, etc.). Patients can get most annoyed with a protracted student visit, especially when they feel that the information should be known.


5. Learn, from the start, how to write a note directly into the patient's record. You may wish to allow 1-3 weeks of "paper towel" notes with students, then have them enter the information directly into the record. This is baptism by fire, but will help with your thought process and make you more productive.


6. Love your preceptor and your patients. They are volunteers in your education.


7. Thank the ancillary staff every day you are at the clinic. By your presence, their workload is increased. They are also volunteers in your learning.


8. Ask your preceptor to save lab results, ECGs, other diagnostics for you to review the next session. Do so with a clean eye, as if you were developing a plan of intervention/ further diagnosis for the patient. This will help hone your skills.


9. Think long term. Envision working with patients for the years ahead. If you see a poorly controlled 40-year-old diabetic today, think of the difference that you may make in his/ her life in 10, 20 years, working with the person on disease control. Single days of practice can be frustrating, but years of practice are greatly rewarding.


10. Be mindful, thankful you have been blessed with the cognitive ability, educational opportunity, and experience to do this work. You will help shape the life and health of individuals, families, communities and nations. This is a tremendous responsibility and awesome privilege. Do it well.

These tips were excerpted from "A Comment on Clinical Practicum" by Margaret A. Fitzgerald, MS, RN, CS-FNP, Greater Lawrence (MA) Family Health Center; President, Fitzgerald Health Education Associates, Andover, MA; and Adjunct Faculty, Simmons College, Boston, MA.