Quality Learning Experiences: A Clinical Pipeline for Work Force Development

Darcy Wikoff is a Family Nurse Practitioner who has worked in community-based primary care in Sacramento, California, for nearly a decade. She completed the Entry Level Master of Science in Nursing (ELMSN) program in 2016 and earned her Doctor of Nursing Practice (DNP) in 2025 from Samuel Merritt University and currently serves as Clinical Director of Graduate Education and directs the APP postgraduate fellowship program at WellSpace Health. Since July 2022, she has also served as an Assistant Professor in the FNP program at Samuel Merritt University, integrating her clinical practice experience caring for complex patients into the faculty practice model.

Quality matters. When we speak on practice readiness for new health care clinicians, what are we measuring? Is it medical knowledge? Is it confidence? Is it competence and preparedness? I surmise it is all of those things. How do we train this? Quality education is upstream and down.

The clinician you ultimately become is often determined by the mentorship and training you experienced in school and the first year after graduation. When textbooks and patient-based learning models are no longer theoretical and when patient outcomes are directly influenced by clinical judgment, this transition is where healthcare education succeeds or where it reveals its gaps.

As a nurse practitioner actively practicing in primary care, a faculty member educating future clinicians, and a preceptor for first-year APP fellows, I see the same truth from two perspectives. Experiential clinician training is the single most important factor in determining whether a new clinician enters practice as confident, competent, and prepared to provide safe, comprehensive, high-quality care. And also, that structured clinical practicums and postgraduate fellowships, which are often viewed as enhancements to education, are foundational components of clinician formation.

Advanced Practice Provider (NP/PA) education is academically rigorous. Students spend years mastering pathophysiology, pharmacology, and diagnostic reasoning. However, medicine is ultimately a practiced art. Clinical competence is developed through repeated, mentored exposure to real patient care situations where complexity, uncertainty, and time constraints coalesce and coexist.

Research consistently demonstrates that high-quality precepted patient experiences strongly influence readiness for independent practice. In fact, studies show that precepted experiences account for nearly all variance in students’ transition-to-practice readiness and a significant majority of their confidence in practical clinical skills. These findings are not surprising to those of us who teach and practice simultaneously. We see daily how live, guided or supervised clinical experiences build decision-making skills where classroom scenarios may fail.

Students who work alongside engaged, skilled clinician faculty develop stronger clinical reasoning, improve their ability to prioritize complex patient presentations, and gain confidence in performing and managing competing clinical demands in real time. From an educational standpoint, faculty practice (Clinical Practicum) allows me to bring authentic case-based learning into a live classroom, in the form of a clinic. Students are not learning hypothetical medicine; they are learning medicine that reflects the complexity of modern primary care. In the postgraduate fellowship, the precepted, structured slow ramp-up of patient care allows for well-reasoned clinical decision-making anchored in the support of a mentor and preceptor. This allows for practice development, something we are not taught in school, but something we learn (or suffer through) in the grind of daily medicine.

Primary care is no longer the runny nose and cough of old, but chronic and advanced disease management, navigating barriers to care in the form of social determinants of health, and population-based health care, which challenges our medical abilities and access to care like never before.

When true experiential training is absent or insufficient, the consequences extend beyond individual clinician stress. New graduates experience increased burnout, decreased job satisfaction, and higher turnover rates. Healthcare systems face longer orientation periods and increased training costs to retain their workforce. They also face the real loss of recruitment and onboarding costs when providers leave after less than a year due to burnout.

Investing in strong clinical training models like clinical practicums and postgraduate fellowships is ultimately an investment in patient safety and healthcare workforce sustainability.

If we are serious about preparing the next generation of Advanced Practice Providers, we must prioritize comprehensive experiential learning across the entire educational continuum. This includes:

• Expanding clinical practice models in our clinics with faculty who can help students integrate real-world clinical experience into their academic training.

• Supporting postgraduate fellowships that provide structured transition-to-practice support.

Healthcare education must evolve alongside healthcare delivery. The complexity of modern medicine and primary care demands clinicians who are not only knowledgeable but adaptable, realistic, confident, and prepared for independent decision-making on their first day of practice.

The type of clinician a health care provider develops into is influenced not only by what they study, but by how they are trained, mentored, and supported during their transition into practice. Clinical practicums and fellowships represent a continuum of experiential learning that transforms students into safe, effective, and resilient clinicians.

Clinical pipelines for workforce development are on the rise with a “grow-your-own” mentality. This strategy encourages collaboration with university partners to expand clinical education programs. The American Hospital Association (AHA) encouraged these agencies to “partner productively” to strengthen the healthcare workforce pipeline and ensure clinicians are job-ready when they graduate.

According to HRSA and AAMC, the United States faces a severe and worsening primary care provider shortage, with projections estimating deficits of over 124k physicians next year and 187k in a decade from now, with primary care disciplines (and patients) most severely affected. The Association of American Medical Colleges projects a shortage of 20-40,000 primary care physicians by 2036. Although advanced practice providers like Physician Associates and Nurse Practitioners cannot fill that void completely, training them to do the work by educating upstream through clinical practicums and in their first year of practice within a fellowship is an invaluable and overlooked resource that will help bridge the gap for primary care in the decades to come.