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The Right Path

Erika Bramlette, PA, MBA, always knew she wanted to work in health care. At a young age, she was witness to the diseases that can ravage a family: hypertension, diabetes, substance abuse, and cancer. "I knew that there was a way to make an impact on preventing and managing medical illnesses, particularly with proper patient education,” she recalled. “I knew that [being a physician assistant (PA)] was going to be the right path for me, ultimately.” That path took Bramlette to Rikers Island Correctional Facility in Elmhurst, New York, where she treated both male and female inmates, and to Planned Parenthood of Nassau County, where she’s provided care for more than 20 years. Eventually, that path diverged to the world of academics, through Cornell and the University of Maryland Eastern Shore, and now to the GW School of Medicine and Health Sciences (SMHS), where she serves as assistant professor of physician assistant studies. The New York native, who specializes in women’s health, shares her journey here.

Can you tell me about the start of your career as a PA?

I’ve mainly done primary care and women’s health. I used to work at Rikers Island Correctional Facility. I worked there for over three years, treating both males and females inmates.

What was that like?

It was probably the most incredible job I’ve had, not just because it’s a unique situation in that you’re practicing medicine in a locked facility, under certain constraints; sometimes I couldn’t come home if the inmate count was off.  It was a population of patients that, for the most part, I would say were forgotten, particularly the women. Most of the female inmates were substance abusers who were incarcerated for crimes related to drug use. It was really eye-opening.

During that time, I [also] worked with a lot of HIV patients. I was assigned to the Communicable Disease Unit, which is where they sent inmates who may have had signs of infections, such as tuberculosis (TB) or chicken pox, and required immediate isolation. I worked in the isolation unit for over two years; I became an HIV specialist and was very familiar with TB treatment protocols. It was a great experience, actually. I think it’s where I learned the most, and it’s good that I did it right out of school.

Rikers Island Correctional Facility provided a great basis for primary care, some infectious disease, and pulmonology.

What did your time at Rikers Island teach you about the PA profession?

I think this profession tends to draw a certain type of person. I think PAs want to spend more face time with patients.  Our training is based in primary care and family medicine. I believe this profession tends to draw people who are truly compassionate and interested in impacting patient care from that basic level. Having the opportunity to really bond with your patients and mentor them when needed is an honor. I think that’s where it started — with patients — and now I get to do the same thing with students.

How did you get involved in education?

I started [in] education at Cornell University in 2011 as a clinical coordinator; I worked with the students in their second year of training, when they were completing their clerkships. That is when I first started teaching, and it’s been great ever since.

How did you make your way to GW?

I worked at Cornell for about three-and-a-half years. When my mentor left, and I started to feel like I wanted to expand my role in education and to have more flexibility in structuring the clinical year.  So, I thought it would be a great time to leave New York and seek a promotional opportunity.

I interviewed at University of Maryland Eastern Shore, which is a state school. It is an HBCU (Historically Black College and University), and I thought that would be a great opportunity to work with a different student population. The program was on probation, and I saw it as an opportunity to put my mark on it, change it, put all the things I learned to work. Unfortunately, I started there in September, and three weeks later, they informed us that they lost accreditation.

When I went to the PAEA (Physician Assistant Education Association) conference, I saw Karen Wright, Ph.D., interim chair of Physician Assistant Studies and program director for the Physician Assistant Program at SMHS. She said, ‘We have a position, you should apply.’ So I did. It’s a different path than I planned, but I think it worked out the way it was supposed to.

What role will you play in education at SMHS?

At Cornell, I didn’t teach a whole course; I taught lectures in a course. I’m going to do the same here, but this will be my first time course directing. I will be course director for Reproductive Medicine; I will teach some lectures in the course, but I’ll also be scheduling outside lecturers, organizing team-based learning activities, and analyzing the exam results. Overseeing the entire course should be a great learning experience.

It seems like your transition into education has come as a natural evolution.

Exactly. Education is an integral part of women’s health and family planning; if you’re not exposed to the various family planning options, you’re not going to know enough to educate a patient about these options.  OB/GYN has typically been plagued with high litigation; the learning opportunities are limited. The lack of exposure may affect a provider’s comfort level when educating a patient on family planning options. If they haven’t been exposed to certain methods of birth control, they’re probably not going to offer it, which is a disservice to the patient. 

Can you tell me about your experience with Planned Parenthood?

It was my first job out of school. I started part-time, then per diem pretty much throughout my whole career. I went there initially, and I was very impressed with the care I received from the nurse practitioner. I remember going to PA school and saying, ‘I’m going to come back and work here.’ And that’s what I did.

I [was drawn to their] genuine dedication to patient education and inclusiveness, and they’ve been doing it for years. Planned Parenthood provides non-judgmental, compassionate care — it’s ingrained in their culture. I really have enjoyed the experience. That’s the main reason I stay; I’m not there for the money. I’m there for the mission. I really believe in their mission.

You’re also interested in research; can you discuss your current research interests?

There was a time at Cornell when I had the opportunity to start looking at our student evaluations; I realized that all of our students were getting these high perfect scores on their evaluations from being on rotation, and it didn’t seem to align with their academic performance. For my capstone project for the Leadership in Academic Medicine Program at Cornell, I proposed implementing an evaluation tool based on entrustable professional activities, or EPAs. They’re basically competency-based measures based on the question, ‘When can you perform this task without being supervised?’ EPAs are currently used in residency training.  My theory is that [they] will result in a less subjective evaluation of the student.  Hopefully EPAs will help preceptors consider  ‘What do you want this student to know by the time they leave this rotation?’ when evaluating PA students.

I will be continuing that here [at GW]. There’s very little information in the literature for PA students, but I think it’s something we could look into for PA student evaluations as well.

Another interest is leadership, particularly in the PA profession.  It would be interesting to see if the dependent nature of the profession impacts progression into leadership roles.