Medical Intern

Brief Description Psychiatric Mental Health Nurse Practitioner (PMHNP) Student — Medication Clinic Rotation PMHNP Clinical Rotation — Medication Clinic Location: Agency Wide (RiverBridge primary) Terms Unpaid clinical rotation — not a CRS employee Preceptor Designated per rotation — named in writing before start (MD, DO, NP, or PA-C) Length Per program (typically 6–12 weeks) About The Rotation Counseling & Recovery Services of Oklahoma (CRSOK) is a Section 223 Certified Community Behavioral Health Clinic (CCBHC) serving approximately 1,600 active clients across four sites. The Medical Clinic delivers integrated psychiatric medication management, medication-assisted treatment (MAT), and physical health monitoring to adults and youth with serious mental illness, substance use disorders, and co-occurring presentations. This rotation offers PMHNP students an intensive, real-world clinical experience in a publicly funded, high-acuity behavioral health setting.

Students gain direct exposure to the full scope of PMHNP practice: SMI and SED evaluation and treatment, medication management, MOUD prescribing, integrated physical health monitoring, trauma-informed care, and care coordination across complex social systems. Because CRSOK hosts students at varying academic levels, learning objectives and supervision intensity are tiered to the individual student. Rotation Goals By the end of the rotation, the PMHNP student will demonstrate progressive competency in the following domains, calibrated to academic level: Psychiatric diagnosis and differential reasoning across SMI, SED, SUD, and co-occurring presentations using DSM-5-TR Psychopharmacology — selection, dosing, monitoring, and patient education across antipsychotics, mood stabilizers, antidepressants, anxiolytics, and MOUD MAT/MOUD competency — buprenorphine and naltrexone induction, maintenance, and SAMHSA/DEA compliance Physical health integration — metabolic monitoring, abnormal result escalation, and primary care linkage Documentation and regulatory compliance — E&M documentation, 42 CFR Part 2, PDMP navigation, and structured EHR field use Trauma-informed practice — Sanctuary Model application across complex, high-acuity populations Care coordination — closing care loops with case managers, counselors, PCPs, pharmacies, and community partners Population Students should expect a high-acuity, diagnostically complex population: Adults and youth with schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, and treatment-resistant presentations Patients in active MAT for opioid and alcohol use disorder — dual diagnosis with SMI is the norm, not the exception Patients with significant social-determinant complexity: housing instability, justice involvement, insurance gaps, transportation barriers Pediatric and adolescent patients at YES Tulsa and CALM Center sites — by assignment Patients on high-risk regimens (clozapine, LAIs, complex polypharmacy) — observed and discussed, not independently managed CRSOK operates under the Sanctuary Model.

Students engage patients in a trauma-informed, recovery-oriented, nonjudgmental manner consistent with Sanctuary principles. Tiered Competency Framework Competencies are organized into three tiers. The preceptor assigns a tier at rotation start based on the student’s program year, prior clinical hours, and demonstrated baseline.

Students do not self-select their tier. Advancement within a rotation is possible with preceptor approval. Domain Tier 1 (Early MSN) Tier 2 (Late MSN / Capstone) Tier 3 (Post-Master’s Cert.) Psychiatric Evaluation Observes; documents HPI with supervision Conducts supervised evaluation; differential with guidance Near-independent evaluation; presents differential and plan for review Psychopharmacology Identifies classes and indications via chart review Discusses selection rationale; reviews monitoring Proposes plan with rationale; anticipates monitoring and education MAT / MOUD Observes visits; reviews protocol Reviews PDMP with preceptor; joins induction discussions Active participation; drafts MOUD plan under supervision Physical Health Observes metabolic monitoring and lab review Flags abnormals; joins patient education Interprets panels; proposes escalation; documents under supervision Documentation / EHR Observes E&M note; reviews field requirements Drafts progress note for review and co-signature Produces near-complete note; preceptor edits and co-signs 42 CFR Part 2 / PDMP Reviews consent workflow; observes PDMP check Understands Part 2 disclosure; joins PDMP-informed discussions Applies Part 2 in documentation; conducts PDMP review with preceptor Trauma-Informed Care Completes Sanctuary orientation; observes interactions Applies Sanctuary language in supervised interactions; debriefs Consistent trauma-informed communication; self-identifies growth Care Coordination Observes documentation and case-manager communication Joins warm handoffs; reviews coordination notes Initiates coordination with supervision; documents loop closure Weekly Learning Objectives The schedule below assumes a 12-week rotation.

Shorter rotations compress Phases 1–3 accordingly, with the preceptor setting depth at each phase. All timelines are adjusted at preceptor discretion based on tier and pacing. Phase 1 — Orientation & Foundation (Weeks 1–2) Week Learning Objectives Clinical Activities 1 Understand CRSOK structure, the CCBHC model, and Medication Clinic workflow.

Complete onboarding. Understand how 42 CFR Part 2 differs from standard HIPAA. Site orientation with Medical Clinic Manager.

Onboarding: HIPAA, 42 CFR Part 2, Sanctuary Model, EHR view-only walkthrough. Shadow a full clinic day across appointment types. 2 Identify the diagnostic distribution of the population. Understand MAT protocol structure and PDMP requirements.

Review metabolic monitoring intervals by psychotropic class. Chart review of 5–10 active charts across categories. Observe a MAT session.

Review Procedure 9.00.01 and the metabolic monitoring protocol. First HPI observation with debriefing. Phase 2 — Supervised Participation (Weeks 3–6) Week Learning Objectives Clinical Activities 3 Conduct supervised history and MSE.

Apply DSM-5-TR criteria to assigned cases. Understand CRS E&M documentation structure. First supervised evaluation under direct observation.

Present assessment and differential. Compare against preceptor’s note. Draft a practice note (not submitted). 4 Apply psychopharmacology to real cases: current meds, monitoring, interactions.

Understand LAI administration workflow. Participate in medication visits: gather history, present to preceptor, observe plan discussion. Observe LAI administration.

Review one complex polypharmacy case. 5 Apply MAT competencies: induction vs. maintenance. Participate in PDMP review. Understand controlled-substance documentation.

Active MAT participation under direct supervision. First supervised PDMP review. Read assigned sections of SAMHSA TIP 63. 6 Integrate physical health monitoring.

Identify abnormal metabolic results and escalation steps. Understand PCP linkage in a CCBHC. Review flagged abnormals with preceptor.

Review the no-PCP list with the Nurse Care Manager. Draft a metabolic-risk patient education note for review. Phase 3 — Expanding Independence (Weeks 7–10) Week Learning Objectives Clinical Activities 7–8 Conduct evaluations with decreasing direct observation.

Produce draft E&M notes at required complexity. Demonstrate reasoning across at least three diagnostic categories. Evaluations under proximate supervision; preceptor reviews and debriefs afterward.

Draft full E&M notes for co-signature. Present two formal cases. 9–10 Demonstrate MOUD competency appropriate to tier. Apply trauma-informed communication independently.

Initiate at least one documented care coordination action. Active MAT participation by tier. Debrief a challenging interaction using Sanctuary language.

Complete one care coordination loop with documentation reviewed by preceptor. Phase 4 — Integration & Wrap-Up (Weeks 11–12) Week Learning Objectives Clinical Activities 11 Synthesize the experience: three areas of growth, two for continued development. Demonstrate documentation competency at program level.

Preceptor review meeting. Self-assessment against the tier framework. Complete pending program evaluation forms. 12 Demonstrate readiness for the next clinical stage.

Complete all program documentation. Provide structured feedback to CRSOK. Final case presentations.

Program competency evaluation completed. Student exit survey submitted. Preceptor evaluation sent to program coordinator.

Students May (with preceptor present or immediately available) Conduct psychiatric history and mental status examination Present assessment and formulate a differential for preceptor review Propose a medication plan or adjustment for review — the preceptor makes the final prescribing decision Draft E&M progress notes for preceptor co-signature — student notes are never submitted without co-signature Review the PDMP with the preceptor present Participate in MAT visits at the level consistent with academic tier Review lab results and propose escalation steps for review Provide structured patient education as directed Participate in care coordination and document actions under review Students Do Not Independently prescribe, modify, or discontinue any medication Independently access or act on PDMP findings without preceptor review Administer medications without explicit authorization and documented training through CRS nursing staff Submit, sign, or finalize any EHR documentation without preceptor co-signature Communicate clinical plans or results to patients without preceptor involvement Have independent patient contact outside scheduled, supervised sessions Access patient records beyond what is necessary for assigned supervised cases Student Expectations Professionalism & Conduct Arrive on time. Notify the Medical Clinic Manager and preceptor at least two hours before any absence; unexcused absences are reported to the program coordinator. Maintain professional conduct consistent with CRS dress code and the Sanctuary Model Engage patients in a trauma-informed, recovery-oriented, nonjudgmental manner at all times Do not discuss patient information outside the clinical setting. 42 CFR Part 2 applies to all SUD information encountered.

Clinical Preparation Review assigned charts before sessions when advance access is granted Complete assigned readings (9.00.01, SAMHSA TIPs, metabolic monitoring protocol) by the indicated week Prepare structured case presentations as assigned Documentation & Reporting Complete all program learning logs and competency documentation on schedule Flag any patient safety concern, suspected medication error, or scope uncertainty to the preceptor immediately — never manage independently Report any adverse event or near-miss to the preceptor and Medical Clinic Manager CRS Provides A named preceptor designated in writing before the start date and communicated to the student and program coordinator Site orientation: clinic workflow, EHR scope, emergency procedures, Sanctuary Model, and 42 CFR Part 2 Structured mid-rotation and end-of-rotation feedback using the program’s evaluation instrument Schedule coordination, onboarding documentation, and site access through the Medical Clinic Manager A valid Affiliation Agreement with the academic program before the first clinical day Compliance with Oklahoma Board of Nursing regulations governing PMHNP student supervised practice An exit survey at the end of each rotation, routed to the preceptor and clinic leadership for quality improvement Evaluation Evaluation occurs at two formal points, supplemented by ongoing informal feedback. Mid-Rotation (midpoint) Preceptor and student meet for 30 minutes. Preceptor completes the program midpoint form; student completes a self-assessment against the tier framework; goals are adjusted for Phase 3.

Final (last week) Preceptor completes the program final competency evaluation. Student completes the CRS exit survey. Both submitted to the program coordinator within five business days.

Ongoing Brief verbal feedback after each supervised encounter. Performance or conduct concerns are communicated to the program coordinator promptly, not held until formal evaluation. Applicable Policies 42 CFR Part 2 (Confidentiality of SUD Patient Records) — oriented in Week 1; confidentiality acknowledgment signed Oklahoma Board of Nursing — PMHNP student supervised-practice regulations Oklahoma CPA requirements — if an APRN preceptor supervises, collaborative practice agreement requirements are observed CRS Medication Management Procedure 9.00.01 — assigned sections reviewed by Week 2 CCBHC Certification Criteria — documentation and care coordination requirements oriented at onboarding DEA / PDMP requirements — students observe and participate in discussions but do not independently access the PDMP SAMHSA TIP 63 (MAT for Opioid Use Disorder) — assigned reading, Weeks 4–5 Summary Unpaid Internship.