This document discusses a webinar presented by Community Health Center, Inc. on their postgraduate nurse practitioner and physician assistant residency and fellowship programs. It provides an agenda for the webinar which will discuss the key program staff and their responsibilities, including the program director, clinical director, preceptors, mentors and other faculty. The webinar objectives are to identify drivers for implementing such programs, describe the implementation process, discuss program structure and highlight the roles of program staff.

1. Postgraduate
Nurse Practitioner/Physician Assistant
Residency and Fellowship Programs:
Discussing your Key Program Staff and Responsibilities
Wednesday October 12th, 2022
2:00-3:00pm Eastern / 11:00am-12:00pm Pacific
Charise Corsino, MA, Program Director of the Nurse Practitioner Residency Program
Nicole Seagriff, DNP, APRN, FNP-BC, Clinical Program Director of the Nurse Practitioner Residency Program

2. Continuing Education Credits
In support of improving patient care,
Community Health Center, Inc. / Weitzman
Institute is jointly accredited by the
Accreditation Council for Continuing Medical
Education (ACCME), the Accreditation Council
for Pharmacy Education (ACPE), and the
American Nurses Credentialing Center
(ANCC), to provide continuing education for
the healthcare team.
A comprehensive certificate will be sent after
the end of the series, Summer 2022.
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3. Disclosure
• With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship
between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which
would be considered a conflict of interest.
• The views expressed in this presentation are those of the presenters and may not reflect official policy of
Community Health Center, Inc. and its Weitzman Institute.
• We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under
investigation (not FDA approved) and any limitations on the information hat we present, such as data that are
preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.
• This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non-governmental
sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an
endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
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4. At the Weitzman Institute, we value a
culture of equity, inclusiveness,
diversity, and mutually respectful
dialogue. We want to ensure that all
feel welcome. If there is anything said
in our program that makes you feel
uncomfortable, please let us know via
email at nca@chc1.com
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5. National Training and Technical Assistance Partnership
Clinical Workforce Development
Provides free training and technical assistance to health centers across the
nation through national webinars, learning collaboratives, activity sessions,
trainings, research, publications, etc.
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6. Objectives
• Identify the drivers for implementing postgraduate training
program for NPs/PAs at your health center
• Describe the process of implementing postgraduate
training program
• Discuss the postgraduate training program structure
• Highlight the key program staff and responsibilities
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7. Polling Question
What is your primary goal for attending this webinar?
Already involved in a postgraduate training program
Starting a postgraduate training program
Thinking about starting a postgraduate training program program
Just wanted to learn more
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8. Primary Care, Psychiatric/MH and Specialty Postgraduate Training Programs –
Total 355 Programs Nationally
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9. CHCI Residency Program Today
• Started 1st program in 2007 – have been
operating for 16 years
• CHC has graduated over 142 alumni
• NP Residency Specialty Tracks:
– Family NPs (est. 2007)
– Psych MH NPs (est. 2015)
– Pediatric NPs (est. 2019)
– Adult Gero NPs (est. 2019)
• 1 year Post-Residency - Center for Key
Populations Fellowship (est. 2017)
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10. The
Residency
Experience

11. Overview of Implementing a
Postgraduate Training Program
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12. Why Start a Postgraduate Training Program?
Solve a Problem
• Address the shortage of expert clinicians, particularly for
vulnerable populations
• Give new primary care medical and behavioral health
providers the opportunity for postgraduate training in
fully integrated primary care settings
• Support the development of confidence, competence and
mastery in the FQHC setting
• Reduce attrition due to burnout and distress during the
initial postgraduate year
• Provide the depth, breadth, volume, and intensity of
clinical training to a model of care consistent with PCMH,
IOM/FON, and FQHC principles and services
• Prepare the next generation of leadership for FQHCs
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For the
common
good
For the
good of
clinicians
For the
good of
your
organization

13. 13
Student
Clinical
Placement
Postgraduate
Trainee
Full-Time
Provider
Preceptor/
Faculty
Framework for
Developing
Clinical Workforce

14. Program Drivers
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Your organization should ask:
Why do we want to start a
postgraduate training
program?
What are
your
drivers?
Recruitment
Training
Retention
Clinical
Workforce

15. Top to Bottom Support
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Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs for nurse practitioners in Community
Health Centers. Retrieved from https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf

16. The Road to Developing a
Postgraduate Training Program
• Answer the question: What are your drivers for starting a postgraduate training program?
• Learn the essential elements of a postgraduate training program:
– Accrediting standards
– State licensing requirements
• Assess your own resources (physical, human, financial)
• Consider creating an academic partnerships
• Secure board, leadership, and clinical buy-in
• Develop financial and strategic plan including potential partners
• Costs and benefits:
– Direct and indirect costs
– Return on Investment: immediate and longer term
– Benefits beyond the financial return
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17. Key Organizational Departments:
Finance, Human Resources, IT, Operations, Clinical and Support Staff
• Understanding the role and support
each department will need to provide
• Structure for communicating and
completing required tasks
• Identifying leads in each department
that your team can work with to
implement key program components
• Developing policies and procedures
that all parties agree to follow for key
program tasks
17
Flinter, M., & Bamrick, K. (2017). Training the next generation: Residency and fellowship programs
for nurse practitioners in Community Health Centers. Retrieved from
https://www.weitzmaninstitute.org/sites/default/files/NPResidencyBook/NPResidencyBook.pdf

18. Framework for Postgraduate
Training Programs
• 12 months, Full-Time Employment
• Full Integration into Home Site and
Organization
• Continuous training to clinical complexity
and a high performance model of care
– Team-Based Care
– Inter-professional collaboration
– Integrated care
– Data driven quality improvement
– Expert use of technology
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Clinical-based
practice
experiences
Regularly
scheduled
education
session
System based
learning and
Quality
Improvement
Population
health focus
Leadership and
professional
development

19. Evaluations and Assessment of
Postgraduate Trainee Performance
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COMPETENCY DOMAINS
1. Patient Care
2. Knowledge for Practice
3. Practice-based Learning and
Improvement
4. Interpersonal and Communication
Skills
5. Professionalism
6. Systems-based Practice
7. Inter-professional Collaboration
8. Personal and Professional
Development
Evaluation Element Frequency
Reflective Journaling Weekly
Trainee Self-Assessments 1, 6, 12 months
Preceptor of Trainee 90 days, 6 and 12 months
Specialty Rotations Monthly
Mid-Year Coaching Mid Year
Overall Program 6 and 12 months

20. Program Accreditation
• There are multiple pathways for accreditation
• Accreditation provides external validation of rigor, quality, and high standards.
• Where to go for additional resources in the development of a program (Accreditation
standards and self study guide)
• Website: www.nppostgradtraining.com
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21. Overview of Program Structure &
Key Program Staff and Responsibilities
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22. 1) Precepted Continuity Clinics (40%); Residents develop and manage a panel of patients with the exclusive attention
of an expert preceptor (NP, PA or Physician)
2) Specialty Rotations (20%); Experience in primary care specialty areas to expand and enhance resident practice
knowledge and skills
3) Mentored Clinics (20%); Work within a primary care team focusing on diversity of chief complaints, efficiency,
episodic and acute care
4) Didactic Sessions (15%); Topics that are high volume, complexity and/or burden topics in primary care. Includes
participation in Project ECHO sessions for managing chronic pain, treating HIV/Hep C, opioid addiction, complex
pediatrics
5) Quality Improvement Training (5%); Training to a high performance QI model, including front line QI improvement,
data driven QI, and leadership development.
Core Elements of a Postgraduate Training Program
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12 Months
Full-time Employment
Training to Clinical Complexity and
High Performance Model of Care
team-based care, inter-professional collaboration, integrated care,
data driven QI ,expert use of technology
Full Integration into Home
Site and Organization

23. CHCI’s Program Schedule - Week
23
Program
Staff and
Resources

24. A Month in the Life of an NP Resident
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• Precepted Clinic – generally 4 different
preceptors each for one half day
• Mentored Clinic – can be done at
residents home site, or other locations.
May be preceptors but can also include
other non-preceptor providers.
• Rotation – generally 1 day per week, for
4 weeks
• Each month rotation may be on a
Monday or Tuesday – alternating with
mentored clinic
• Education Day – includes alternating
educational components – Project
ECHO, QI Seminar, Cohort Meeting,
Office hours

25. Key Program Staff and Responsibilities
Administrative – Program Coordinator/Manager
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Responsibilities
Responsible for the
oversight of the
administration of the
program. Manage day to
day implementation and
logistics of the program,
as well as troubleshoot
issues.
Skills
Organized and detail
oriented
Knows organization
Experience and/or training
in program management
Time
Commitment
Dependent on size of the
program – could be
combined with other job
role
Starting out –
2 to 3 trainees-
.4 to .5 FTE

26. Key Program Staff and Responsibilities
Clinical – Clinical Program Director or NP or PA Lead
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Responsibilities
Responsible for the clinical
oversight of the program
including curriculum
development and delivery
Skills
Trained in clinical discipline of
the program
Commitment to training
Understanding of clinical
delivery of care in area of
training
Time
Commitment
Dependent on size of the
program
2 to 3 trainees
- .2 to .4 FTE

27. Key Program Staff and Responsibilities
Clinical – Preceptors
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Responsibilities
Responsible for
direct training
and supervision
of trainees
Skills
Expert provider
in their discipline
Commitment to
training
Time
Commitment
Postgraduate
Training
Program
– 4 to 8 hours
per week

28. Preceptors
Roles and Responsibilities
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29. CHCI’s
Precepting
Policy
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30. Preceptor Roles and Responsibilities
Be dedicated to teaching and supporting the postgraduate
trainees during your assigned precepted sessions:
• Utilize leadership skills by assisting in and providing
direction, when needed, for all aspects of patient care
• Be present and fully available to the postgraduate
trainees until the last scheduled patient is seen
• Employ teaching strategies during the sessions
• Advocate for other providers to inform postgraduate
trainees when good teaching opportunities arise
(physical findings/procedures, etc.)
• Review notes and create addendums to notes
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31. Preceptor Roles and Responsibilities
• Discuss clinical issues as well as lab and
diagnostic imaging results and ensure
timely and efficient review
• Supervise and assist with procedures
when applicable (with which the
preceptors are comfortable themselves)
• Encourage critical analysis and evidence-
based reasoning in the ordering of tests
and laboratory studies
• Support the organization’s model of
providing fully integrated care
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32. Preceptor Roles and Responsibilities
• Assistance in time management skills of balancing
a panel and other clinical demands (example:
phone calls, paperwork, urgent results)
• Provide direct patient care in the event that a
postgraduate trainee falls behind in the schedule
or needs assistance
• Assist postgraduate trainees in achieving mastery
of the general competencies and areas of
particular interest of the postgraduate trainees
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33. Specific Roles and Responsibilities (timing)
Early Months (September through January)
(or at Stage of 1-2 patients per hour):
The preceptor should see all patients with the postgraduate trainees initially, for the
first few weeks (3-4 weeks)
• After the first few weeks, the preceptor should see the patient at some point during
the visit, observing and repeating physical exams and relevant history taking, as
needed
• Provide guidance and instructions on all aspects of the patient visit, including
charting, the verbal presentation and the written note
• Create an addendum in the patient’s progress notes or co-sign the note after the
postgraduate trainee has completed the note.
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34. Specific Roles and Responsibilities (timing)
Later Months (February through August)
• Reassess the postgraduate trainees’ comfort and mastery with clinical decision-making, physical exams,
concise history taking and develop a precepting plan that meets the needs of the trainee
• Help with time management and efficient practice skills in an ongoing fashion
• Review all cases and repeat/observe history and physical exams, as needed
• Provide guidance and instruction on all aspects of the patient visit (review entire written note and
provide feedback as indicated)
• Create an addendum or co-sign the patient’s progress note after the postgraduate trainees have
completed the note
• As the postgraduate trainees become more skilled, the preceptor should become more focused on
guidance with time management, practice and panel management
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35. Reviewing Postgraduate Trainee Notes
• Great opportunity to support learning:
–Clinical level:
• Insight into their understanding
–Organizational level:
• Train to your organization – especially if plans to stay a second year
• Recommended throughout the year
• Important to sign off on notes
–Helps people know who helped them with the case (trainee and
those following up)
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36. Selecting your Preceptors
• Precepting is a privilege granted to
providers who are skilled,
experienced, motivated, productive
and have demonstrated clinical
excellence and high quality care
with good outcomes
• Preceptors are selected annually by
leadership Staff and Postgraduate
Training Program staff
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37. Preceptor Recruitment and Training
• Start having conversations with providers about the launch of your program
• Describe the role and give providers an opportunity to express interest
• Your team should decide on the kinds of qualities you want in your preceptors
– Should be expert providers, in good standing with the organization,
commitment to training
• Provide preceptors with initial orientation/training
– Overview of residency program, roles and responsibilities of the preceptor,
expectations of trainee and preceptor, evaluation expectations
• Include additional points of check in and training for preceptors during the year
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38. Preceptor Evaluation
• Important to have postgraduate trainees evaluate your preceptors
– Allows you to identify strengths and areas for continued development for
individuals and the group
– Allows the opportunity for postgraduate trainees to share feedback
• Outline clear expectations about how and when evaluation will be collected and
shared
– Important for preceptors to get direct feedback about how they are doing
– Concerns about anonymity and confidentiality
– Have another way for postgraduate trainees to share more sensitive or critical
feedback about a preceptor with your team
– May want to do more frequent evaluations in the first few years of the program
• Have a plan for addressing remediation concerns
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39. Mentors
Roles and Responsibilities
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40. Mentored Clinic Providers
• The postgraduate trainees work along side the provider as part of the
medical team, seeing patients off of the provider’s schedule.
• Providers* should hand pick patients in their schedule for the
postgraduate trainees to see (acute visits, overbooks, brief follow up
appointments).
• Initial visits should not been seen by the postgraduate trainees during
mentored clinic, unless the postgraduate trainees will become their
PCP.
• The postgraduate trainees will see the patient and report the plan
back to the provider, the postgraduate trainees should be
documenting everything in the electronic health record but provider is
billing for the visit.
• The provider will agree/disagree with patient plan, and see the patient
before they leave the office, the provider closes the note.
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41. Mentored Clinic (continued)
• As the postgraduate trainees become more independent, they will be able to schedule
extra follow-ups of their own patients during this time (this responds to the feedback
that more openings for simple follow up are needed).
• CHCI providers prefer to have the postgraduate trainees complete, bill, and lock the
progress notes and then have the provider place a brief addendum.
• Other organizations may structure the feedback and notes differently.
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42. Other Program Faculty
Roles and Responsibilities
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43. Other Program Faculty
• Specialty Rotation Faculty
• Didactic Faculty
• Supervisors
• Hands on Procedures Faculty
• EMR Super Users
• Program Alumni
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44. Questions?
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45. Wrap-Up
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46. To download the digital version of "Training
the Next Generation: Residency and
Fellowship Programs for Nurse Practitioners
in Community Health Centers"
https://www.weitzmaninstitute.org/
NPResidencyBook
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47. NTTAP Learning Collaborative Opportunities!
• NTTAP Learning Collaborative Opportunities offered in:
– Comprehensive and Team-Based Care (October 2022 to June 2023)
– Postgraduate NP Residency (October 2022 to March 23)
– Health Professions Student Training (January to June 2023)
– HIV Prevention (January to June 2023)
• For more information, please reach out to Meaghan Angers
(angersm@chc1.com)
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48. Contact Information
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For information on future webinars, activity
sessions, and learning collaboratives:
please reach out to nca@chc1.com or visit
https://www.chc1.com/nca