Diagnosis on Day One: Inside a PA Student’s Clinical Rotation Experience

During the final year of her education, physician assistant studies student Emily Brenman is putting her knowledge to the test as she treats patients for the first time.

When Emily Brenman arrived on the internal medicine oncology floor at Newton-Wellesley Hospital, it was controlled chaos. A clash of sounds greeted her—patient monitors beeping, footsteps of people running down the hall, someone yelling from one direction, someone laughing from the other.

She was handed a pager, hospital phone, and ID card. Her preceptor turned to her and another student assigned to the unit and said, “Pick a patient, go see them, and we’ll meet back in an hour.”

“I was pacing back and forth, working up the courage to go into my patient’s room, and I see my classmate doing the same thing down the hall,” Brenman remembered. “I finally found the courage to go in the room and saw the patient and her four family members waiting for me.”

The patient went to the emergency room the night before for abdominal pain and nausea. Brenman was the first person from the medical team to see this patient after her admission. She was an older woman, and she was visibly unwell. Brenman checked the patient’s bloodwork, imaging, and reports and noticed several red flags.

“As students, we’re taught the diagnosis is often in a patient’s history,” Brenman said. “This proved true on the first day. After a physical exam, it didn’t take long to connect the dots and suspect the patient had a gastrointestinal bleed.”

Brenman brought her assessment to her preceptor, who agreed. Just a few hours later, the patient was in surgery.

On the very first day of her first clinical rotation as a physician assistant (PA) student, Brenman made a correct diagnosis, all thanks, she said, to many lectures on gastrointestinal bleeds during her studies at Massachusetts College of Pharmacy and Health Sciences (MCPHS). She remembered a professor’s warning about how common these bleeds are. It was one of many clinical concepts Brenman and her classmates were taught to identify and treat as they prepared for their rotations.

“All of the pieces started coming together,” she said. “It was like fireworks. It was intimidating, but incredible.”

Brenman is in the final year of the Master of PA Studies program at MCPHS, applying the knowledge she learned in the classroom to treat real patients in healthcare facilities.

“Walking into your first clinical rotation is nerve-wracking because you have a lot of doubt, questioning whether you studied enough or grasped all the concepts,” she said. “I learned you have to trust your past self, who worked so hard and has come so far, to know that you can keep your patients safe.”

A Texas native, Brenman attended the University of Kansas for her undergraduate degree. She was a business major—until she took a clinical psychology course. She fully committed to her new path, changed her major to psychology, and planned to pursue her doctorate in pediatric clinical psychology.

“While I was working on my undergraduate research, I realized I gravitated toward the clinical aspect of the work more than the research aspect,” she said. “Halfway through my junior year, I declined an offer for a doctoral program and switched to pre-med. It was a whirlwind to complete the requirements prior to graduation, but I had the right people around me to lift me up and help push me toward my goal.”

That support system pulled Brenman to Boston, and less than a year after finishing her degree, she was at MCPHS, training to become a PA.

“You don’t realize just how demanding PA school is until you’re in it,” she said. “The faculty at MCPHS support you through it because they want to mold us into good clinicians. I also relied—and still do—on my classmates, who have become my closest friends. We’re lucky to have each other.”

All the hours spent going to class, lab, simulations, and studying for exams felt worthwhile when Brenman walked into the patient’s room at Newton-Wellesley Hospital. “It was a huge confidence boost to get the diagnosis correct on the first day, but that won’t always be the case because as a student, you will get it wrong. That’s the beauty of learning.”

During her five weeks working in internal medicine, every day looked like the first. Brenman would review patient cases—including new admissions from overnight and those already in her care—and develop a treatment plan before presenting it to her preceptor. Brenman also spent part of her days attending lectures with five fellow PA students and six medical students.

“We were all in a similar boat, feeling excited and overwhelmed. I think most students experience some level of imposter syndrome. The lectures also showed how valuable it is for PAs and doctors to work together as a team.”

Brenman will complete three more clinical rotations at Newton-Wellesley this year in pediatrics, emergency medicine, and interventional radiology. While she’s keeping an open mind and exploring as many specialties as she can, her history of working with children sticks with her.

“The PAs I know are strong advocates for their patients, especially for those who can’t advocate for themselves,” she said. “That’s the part of this work that really inspires me.”

She’s also encouraging more young people to consider becoming PAs. For the second year in a row, she’s helping to lead Project Access, an initiative that introduces students in kindergarten through high school to the profession through hands-on learning experiences. 

“Our goal is to get younger students, especially in underrepresented populations, excited about a career in medicine and show them that anyone can become a PA,” Brenman said. “Last year, 40 people from MCPHS volunteered and visited two schools, and we’re hoping to make it even bigger this year.”

By the end of her MCPHS career, Brenman will have completed nine clinical rotations in various healthcare specialties at Boston’s renowned hospitals. Brenman can feel herself becoming the kind of healthcare provider she always hoped to be.

“I believe compassion and trust are two of the most important qualities in a provider,” she said. “If you don’t take the time to slow down, listen to your patients, and ask the right questions, you might miss something crucial. Sometimes, those small details hold the key to the diagnosis.”