The case drops
You get the chart the way you'd get it in real life: a chief complaint, a med list with a problem buried in it, and history that doesn't quite add up. No script, no multiple choice.
Mafia Pearl · Membership
Clinical Simulations
Rehearse the patient before the patient is real.
Podcasts teach you the “why.” Simulations make you prove it out loud. Mafia Pearl members meet live on Zoom for mock-patient simulations: NP Z plays the patient, and you run the encounter. He challenges the three things that decide real practice — your diagnostic reasoning, your medication selection, and the way you interview — with incomplete information, competing differentials, and a plan you have to defend, in a group small enough that everyone gets pressed and everyone gets feedback.
Run by NP Z, Duke-trained Psychiatric Nurse Practitioner · Live on Zoom
$100Per month
2Live simulations / month
8Members max per group
Your Instructor: NP Z
You are not rehearsing with a tutor. You are rehearsing with a clinician.NP Z, PMHNP-BC, is a Duke-trained psychiatric nurse practitioner who has spent his career where psychiatry gets real: evaluations, medication decisions, and patients whose charts never tell the whole story.
He built Pearls and Prep into 127 episodes of case-based psychiatric teaching — listened to by thousands of PMHNP students and clinicians every month — because he believes the gap in NP education is not knowledge. It is reps. Mafia Pearl is where those reps happen: live, out loud, with a clinician who will press your reasoning the way your first attending will.
When you defend a plan in a simulation, you are learning from someone who has defended those same plans in practice — and who knows exactly which mistakes new PMHNPs make in their first year, because he trains them for a living.
Credentials
- PMHNP-BC — ANCC board-certified Psychiatric-Mental Health Nurse Practitioner
- Duke University — Psychiatric-Mental Health Nurse Practitioner
- Master's, Chemical Dependency Counseling — Grand Canyon University
- Podcaster — host of Pearls and Prep, 127 episodes of psychiatric case studies
What a Session Looks Like
Ninety minutes, one case, nowhere to hide — in the best wayYou work it out loud
You interview NP Z in character as the patient, build the differential, and commit to a treatment plan — while he presses the way a good attending does: why that diagnosis, why that drug, why that dose, what are you watching for?
Feedback & pearls
Every session closes with direct feedback: what landed, what would have hurt the patient, and the clinical pearls worth carrying into your own practice — the same pearls the podcast is built on.
Who It's For
Built for the stretch between “boards passed” and “first patient”PMHNP students
You're in clinicals, you know the material, and you want reps applying it under pressure — before a preceptor is grading the attempt.
New grads
Your first real panel is coming — or already here. Simulations close the gap between the exam answer and the decision you'd defend in the room.
Early-career clinicians
You want a small, trusted group to stress-test your reasoning on hard cases — psychopharm choices, differentials, the calls that keep you up later.
Walk In Ready
What changes after a few months of reps- Run a full psychiatric evaluation — interview, mental status exam, and a formulation you can say out loud without freezing
- Defend every medication choice — why this drug, why this dose, what you are monitoring, and what would make you switch
- Catch the dangerous differential — the medical mimics and buried interactions hiding in the med list
- Survive the hard questions — the attending's “why?” stops being a threat and starts being a routine
Start rehearsing
$100 / month
Two live simulations a month, office hours, and the full clinical library. Cancel anytime.
Join Mafia Pearl — $100/moSecure checkout by Stripe. Groups capped at 8 — when a cohort fills, the next one opens.
Membership
What's included
- Two live simulation sessions every month — case-based, on Zoom, run by NP Z
- Groups capped at 8 members — never more, so every member presents and gets feedback
- Open office hours — extra time with NP Z when you feel like you aren't getting what you need
- Full clinical library unlocked — Boss Pearl level on Patreon: study guides, psychopharm deep dives, practice questions
- Direct feedback on your reasoning — not a recording, not a webinar: a working session
Mafia Pearl
$100 / month
Simulations, office hours, and the full clinical library — one membership.
Join Mafia Pearl — $100/moWhen a group fills at 8, the next cohort opens — your seat is in the group you're placed in, not a crowd. Questions first? [email protected]
Why only 8?
Because feedback doesn't scale. In a group of eight, NP Z hears every member's reasoning on every case — and can correct it in the moment. The cap is the product: when a cohort fills, the next one opens, and no group ever runs bigger than eight.
Mafia Pearl · $100/mo · 2 live simulations · groups capped at 8
Join now