Family Nurse Practitioner (FNP) programs often lack structured preclinical competency verification, which delays identification of learning needs and creates patient safety risks. Although registered nurses demonstrate sophisticated clinical judgment within team-based practice, FNP practice demands autonomous diagnostic reasoning, generating differential diagnoses and formulating management plans. This shift requires intentional educational support through formative assessment. At one Western United States public university FNP program, students entered practicum without standardized preclinical evaluation. Faculty observed wide variation in preparedness, from overconfidence to hesitation. This single-cohort, mixed methods pilot educational program evaluation implemented a formative preclinical Objective Structured Clinical Examination for 12 FNP students to evaluate confidence in primary care assessment and diagnostic reasoning while exploring curriculum integration feasibility. Students rated confidence using the Simulation Effectiveness Tool–Modified; faculty used the Lasater Clinical Judgment Rubric. Structured debriefings and surveys captured qualitative data. Two 30-minute standardized patient encounters, an adult and pediatric wellness visits incorporating anemia recognition, followed International Nursing Association for Clinical Simulation and Learning standards. Prebriefing, encounters, documentation, and debriefing integrated Kolb’s experiential learning and Tanner's clinical judgment frameworks. Students reported moderate confidence in primary care assessment (M = 2.32) and diagnostic reasoning (M = 2.26), with lower confidence in clinical decision making (M = 1.70). Faculty ratings paralleled student self-assessments: highest in noticing (M = 2.7), lowest in reflecting (M = 2.0). Students (M = 3.90) and faculty (M = 4.89) rated the Objective Structured Clinical Examination as educationally valuable and appropriate; however, faculty expressed sustainability concerns (M = 2.44). The preclinical Objective Structured Clinical Examination provided structured opportunity for diagnostic reasoning practice and identification of learning needs before practicum entry, demonstrating feasibility within competency-based FNP education.

Alzheimer disease (AD) continues to be underdiagnosed and undertreated in primary care despite the high and growing prevalence. Lack of diagnosis becomes more pressing with the availability of disease-modifying therapies (DMTs) that can slow disease progression during a narrow window of time in the course of the disease. Nurse practitioners (NPs) are central to closing these practice gaps, but persistent deficiencies in knowledge and confidence highlight the need for focused continuing education (CE). A 1.6-hour CE activity was developed on the importance of early AD diagnosis, interpretation of DMT clinical trial data, and strategies to improve DMT access. Outcomes were assessed using pre- and post-activity surveys and a 60-day follow-up survey. A total of 6,541 learners completed the program, the majority of whom were practicing NPs providing direct patient care. Collectively, these providers reported caring for over 35,000 patients at risk for cognitive impairment each week. The CE program led to a remarkable 38% improvement in knowledge, with significant gains across all assessment items (p < .001). The greatest gains were in recognizing the prolonged asymptomatic phase of AD (418% improvement) and identifying risk factors for the primary adverse effect of DMTs (50% improvement). Confidence in key domains improved significantly, with 75%–79% of follow-up respondents who see patients reporting sustained confidence gains. At 60 days, 59% had implemented at least one practice change. This CE program reached a large NP audience and improved knowledge, confidence, and reported practice behaviors related to AD early diagnosis and DMTs.