Steven Lin

All Publications

• Clinical Documentation and Patient Care Using Artificial Intelligence in Radiation Oncology. Journal of the American College of Radiology : JACR Luh, J. Y., Thompson, R. F., Lin, S. 2019

  Abstract

  Detailed clinical documentation is required in the patient-facing specialty of radiation oncology. The burden of clinical documentation has increased significantly with the introduction of electronic health records and participation in payer-mandated quality initiatives. Artificial intelligence (AI) has the potential to reduce the burden of data entry associated with clinical documentation, provide clinical decision support, improve quality and value, and integrate patient data from multiple sources. The authors discuss key elements of an AI-enhanced clinic and review some emerging technologies in the industry. Challenges regarding data privacy, regulation, and medicolegal liabilities must be addressed for such AI technologies to be successful.

  View details for DOI 10.1016/j.jacr.2019.05.044

  View details for PubMedID 31238022

• One Year of Family Physicians' Observations on Working with Medical Scribes. Journal of the American Board of Family Medicine : JABFM Sattler, A., Rydel, T., Nguyen, C., Lin, S. ; 31 (1): 49–56

  Abstract

  The immense clerical burden felt by physicians is one of the leading causes of burnout. Scribes are increasingly being used to help alleviate this burden, yet few published studies investigate how scribes affect physicians' daily work, attitudes and behaviors, and relationships with patients and the workplace.Using a longitudinal observational design, data were collected, over 1 year, from 4 physicians working with 2 scribes at a single academic family medicine practice. Physician experience was measured by open-ended written reflections requested after each 4-hour clinic session. A data-driven codebook was generated using a constant comparative method with grounded theory approach.A total of 361 physician reflections were completed, yielding 150 distinct excerpts; 289 codes were assigned. The 11 themes that emerged were further categorized under 4 domains. The most frequently recurring domain was clinic operations, which comprised 51.6% of the codes. Joy of practice, quality of care, and patient experience comprised 22.1%, 16.3%, and 10.0% of the codes, respectively.Our study suggests that integrating scribes into a primary care clinic can produce positive outcomes that go beyond reducing clerical burden for physicians. Scribes may benefit patient experience, quality of care, clinic operations, and joy of practice.

  View details for PubMedID 29330239

• Incorporating the Patient Voice Into Practice Improvement: A Role for Medical Trainees. Family medicine Hsu, K. Y., Contreras, V. M., Vollrath, K., Cuan, N., Lin, S. 2019; 51 (4): 348–52

  Abstract

  BACKGROUND AND OBJECTIVES: Many primary care clinics rely on providers and staff to generate quality improvement (QI) ideas without explicitly including patients. However, without understanding patient perspectives, clinics may miss areas for improvement. We identified practice improvement opportunities using a medical student-driven pilot of QI design that incorporates the patient voice and explored provider/staff perceptions of patient perspectives.METHODS: One medical student interviewed eight patients for their perspectives on QI opportunities at a university-based primary care practice. Two trainees independently coded interview transcripts using directed content analysis (final codebook: 11 themes) and determined frequency of mentions for each theme. We surveyed 11 providers/staff by asking them to select 5 of the 11 themes and place them in rank order based on their perceptions of patient concerns; their surveys were aggregated into one ranked list.RESULTS: Patients most frequently identified the following themes as QI opportunities: relationship (ie, feeling of personal connection with providers/staff), specialty care, convenience, sustainability, and goal follow-up. While patients frequently identified relationship (rank=1) and goal follow-up (rank=3) as QI opportunities, the provider/staff top five list did not include relationship (rank=10) or goal follow-up (rank=7).CONCLUSIONS: Our study demonstrates two things: (1) there are areas of discordance between provider/staff perceptions and patient perspectives regarding practice improvement opportunities; and (2) medical students can participate meaningfully in the QI process. By harnessing patient perspectives with the help of medical trainees, clinics may better understand patient concerns and avoid potential QI blind spots.

  View details for PubMedID 30973624

• Ten Ways Artificial Intelligence Will Transform Primary Care. Journal of general internal medicine Lin, S. Y., Mahoney, M. R., Sinsky, C. A. 2019

  Abstract

  Artificial intelligence (AI) is poised as a transformational force in healthcare. This paper presents a current environmental scan, through the eyes of primary care physicians, of the top ten ways AI will impact primary care and its key stakeholders. We discuss ten distinct problem spaces and the most promising AI innovations in each, estimating potential market sizes and the Quadruple Aims that are most likely to be affected. Primary care is where the power, opportunity, and future of AI are most likely to be realized in the broadest and most ambitious scale. We propose how these AI-powered innovations must augment, not subvert, the patient-physician relationship for physicians and patients to accept them. AI implemented poorly risks pushing humanity to the margins; done wisely, AI can free up physicians' cognitive and emotional space for patients, and shift the focus away from transactional tasks to personalized care. The challenge will be for humans to have the wisdom and willingness to discern AI's optimal role in twenty-first century healthcare, and to determine when it strengthens and when it undermines human healing. Ongoing research will determine the impact of AI technologies in achieving better care, better health, lower costs, and improved well-being of the workforce.

  View details for PubMedID 31090027

• Patient preferences for receiving test results at San Francisco Bay Area free clinics: a multi-site evaluation J Stud Run Clin Gururangan, K., Shin, J., Shi, Y., Ye, P., Vaca, S., Gopisetty, D., Leon, D., Leyden, J., Lin, S. 2019; 5 (1): 1-7
• Identifying Opportunities to Improve Intimate Partner Violence Screening in a Primary Care System. Family medicine Sharples, L., Nguyen, C., Singh, B., Lin, S. 2018; 50 (9): 702–5

  Abstract

  BACKGROUND AND OBJECTIVES: Intimate partner violence (IPV) is a silent epidemic affecting one in three women. The US Preventive Services Task Force recommends routine IPV screening for women of childbearing age, but actual rates of screening in primary care settings are low. Our objectives were to determine how often IPV screening was being done in our system and whether screening initiated by medical assistants or physicians resulted in more screens.METHODS: We conducted a retrospective chart review to investigate IPV screening practices in five primary care clinics within a university-based network in Northern California. We reviewed 100 charts from each clinic for a total of 500 charts. Each chart was reviewed to determine if an IPV screen was documented, and if so, whether it was done by the medical assistant or the physician.RESULTS: The overall frequency of IPV screening was 22% (111/500). We found a wide variation in screening practices among the clinics. Screening initiated by medical assistants resulted in significantly more documented screens than screening delivered by physicians (74% vs 9%, P<0.001).CONCLUSIONS: IPV screening is an important, but underdelivered service. Using medical assistants to deliver IPV screening may be more effective than relying on physicians alone.

  View details for PubMedID 30307590

• Residents' Perspectives on Careers in Academic Medicine: Obstacles and Opportunities. Family medicine Lin, S., Nguyen, C., Walters, E., Gordon, P. 2018; 50 (3): 204–11

  Abstract

  Worsening faculty shortages in medical schools and residency programs are threatening the US medical education infrastructure. Little is known about the factors that influence the decision of family medicine residents to choose or not choose academic careers. Our study objective was to answer the following question among family medicine residents: "What is your greatest concern or fear about pursuing a career in academic family medicine?"Participants were family medicine residents who attended the Faculty for Tomorrow Workshop at the Society of Teachers of Family Medicine Annual Spring Conference in 2016 and 2017. Free responses to the aforementioned prompt were analyzed using a constant comparative method and grounded theory approach.A total of 156 participants registered for the workshops and 95 (61%) answered the free response question. Eight distinct themes emerged from the analysis. The most frequently recurring theme was "lack of readiness or mentorship," which accounted for nearly one-third (31%) of the codes. Other themes included work-life balance and burnout (17%), job availability and logistics (15%), lack of autonomy or flexibility (11%), competing pressures/roles (10%), lower financial rewards (4%), politics and bureaucracy (4%), and research (3%).To our knowledge, this is the first study to identify barriers and disincentives to pursuing a career in academic medicine from the perspective of family medicine residents. There may be at least eight major obstacles, for which we summarize and consider potential interventions. More research is needed to understand why residents choose, or don't choose, academic careers.

  View details for PubMedID 29537463

• A Model Medical Student-Led Interprofessional QI Project on Lab Monitoring PRiMER Kim, C., Lin, S., Sattler, A. 2018

  View details for DOI 10.22454/PRiMER.2018.187050

• Impact of Scribes on Medical Student Education: A Mixed-Methods Pilot Study. Family medicine Hafer, J., Wu, X., Lin, S. 2018; 50 (4): 283–86

  Abstract

  Medical scribes are an increasingly popular strategy for reducing clerical burden, but little is known about their effect on medical student education. We aimed to evaluate the impact of scribes on medical students' self-reported learning experience.We conducted a mixed-methods pilot study. Participants were medical students (third and fourth years) on a family medicine clerkship who worked with an attending physician who practiced with a scribe. Students did not work directly with scribes. Scribes charted for attending physicians during encounters that did not involve a student. Outcomes were three 7-point Likert scale questions about teaching quality and an open-ended written reflection. Qualitative data was analyzed using a constant comparative method and grounded theory approach.A total of 16 medical students returned at least one questionnaire, yielding 28 completed surveys. Students reported high satisfaction with their learning experience and time spent face-to-face with their attending, and found scribes nondisruptive to their learning. Major themes of the open-ended reflections included more time for teaching and feedback, physicians who were less stressed and more attentive, appreciation for a culture of teamwork, and scribes serving as an electronic health records (EHR) resource.To our knowledge, this is the first study evaluating the effect of scribes on medical student education from the students' perspective. Our findings suggest that scribes may allow for greater teaching focus, contribute to a teamwork culture, and serve as an EHR resource. Scribes appear to benefit medical students' learning experience. Larger and more rigorous studies are needed.

  View details for PubMedID 29669146

• Reimagining Clinical Documentation With Artificial Intelligence. Mayo Clinic proceedings Lin, S. Y., Shanafelt, T. D., Asch, S. M. 2018

  View details for PubMedID 29631808

• RIME and Reason: A Medical Student Perspective of Clinical Training in Student-Run Free Clinics J Stud Run Clin Gururangan, K., Lin, S. 2018; 4 (1): 1-5
• Preparing Residents for Teaching Careers: The Faculty for Tomorrow Resident Workshop FAMILY MEDICINE Lin, S., Gordon, P. 2017; 49 (3): 225-229

  Abstract

  Progress toward growing the primary care workforce is at risk of being derailed by an emerging crisis: a critical shortage of family medicine faculty. In response to the faculty shortage, the Society of Teachers of Family Medicine (STFM) launched a 2-year initiative called "Faculty for Tomorrow" (F4T). The F4T Task Force created a workshop designed to increase residents' interest in, and prepare them for, careers in academic family medicine. We aimed to evaluate the effectiveness of this workshop.Participants were family medicine residents who preregistered for and attended the F4T Resident Workshop at the 2016 STFM Annual Spring Conference. The intervention was a full-day, 9-hour preconference workshop delivered by a multi-institutional faculty team. Participants were asked to complete a questionnaire before and immediately after the workshop. Data collected included demographics, residency program characteristics, future career plans, self-reported confidence in skills, and general knowledge relevant to becoming faculty.A total of 75 participants attended the workshop. The proportion of those who were "extremely likely" to pursue a career in academic family medicine increased from 58% to 72%. Participants reported statistically significant improvements in their confidence in clinical teaching, providing feedback to learners, writing an effective CV, knowledge about the structure of academic family medicine, and knowledge about applying for a faculty position.The STFM F4T Resident Workshop was effective at increasing participants' interest in academic careers, as well as self-reported confidence in skills and knowledge relevant to becoming faculty. The data collected from participants regarding their career plans may inform future interventions.

  View details for Web of Science ID 000397418400010

  View details for PubMedID 28346626

• Rethinking empathy decline: results from an OSCE. The clinical teacher Teng, V. C., Nguyen, C., Hall, K. T., Rydel, T., Sattler, A., Schillinger, E., Weinlander, E., Lin, S. 2017

  Abstract

  The phenomenon of empathy decline among medical students during training is widely accepted, with evidence based largely on studies using self-administered instruments. Recently, researchers have called into question this phenomenon, in light of new findings that suggest a discrepancy between self-administered empathy scores and observed empathic behaviours: for example, during objective structured clinical examinations (OSCEs). Our objective was to compare observed empathy among medical students in different clerkship years using an OSCE.Participants were medical students in their first or second year of clinical clerkships, enrolled in a required family medicine clerkship at Stanford University. Participants completed an OSCE that was directly observed by trained faculty staff, who used the Measure of Patient-Centered Communication (MPCC) instrument to measure empathic behaviours. Statistics were used to determine correlations between observed empathy and the students' year of clerkship, gender, and specialty preference.A total of 129 medical students, evenly divided by gender and clerkship year, participated. There was a possible trend towards higher MPCC scores among students in their second clerkship year compared with students in their first year (p = 0.09), which became more significant when adjusted for outlier effects (p = 0.05). There was no difference in performance by gender. Students interested in a 'people-oriented' specialty scored higher in 'handling the patient's frustration' compared with those who are interested in a 'technology-oriented' specialty.In our study, observed empathic behaviours were not lower in the second compared with the first year of clerkship training. More research is warranted to investigate the apparent discrepancy between self-administered empathy scores and observed empathic behaviours. New findings suggest a discrepancy between self-administered empathy scores and observed empathic behaviours.

  View details for DOI 10.1111/tct.12608

  View details for PubMedID 28164429

• An Academic Achievement Calculator for Clinician-Educators in Primary Care. Family medicine Lin, S., Mahoney, M., Singh, B., Schillinger, E. 2017; 49 (8): 640–43

  Abstract

  Academic medical centers need better ways to quantify the diverse academic contributions of primary care clinician-educators. We examined the feasibility and acceptability of an "academic achievement calculator" that quantifies academic activities using a point system.A cohort of 16 clinician-educators at a single academic medical center volunteered to assess the calculator using a questionnaire. Key measures included time needed to complete the calculator, how well it reflected participants' academic activities, whether it increased their awareness of academic opportunities, whether they intend to pursue more academic work, and their overall satisfaction with the calculator.Most participants (69%) completed the calculator in less than 20 minutes. Three-quarters (75%) reported that the calculator reflected the breadth of their academic work either "very well" or "extremely well". The majority (81%) stated that it increased their awareness of opportunities for academic engagement, and that they intend to pursue more academic activities. Overall, three-quarters (75%) were "very satisfied" or "extremely satisfied" with the calculator.To our knowledge, this is the first report of a tool designed to quantify the diverse academic activities of primary care clinician-educators. In this pilot study, we found that the use of an academic achievement calculator may be feasible and acceptable. This tool, if paired with an annual bonus plan, could help incentivize and reward academic contributions among primary care clinician-educators, and assist department leaders with the promotion process.

  View details for PubMedID 28953298

• Impact of Scribes on Physician Satisfaction, Patient Satisfaction, and Charting Efficiency: A Randomized Controlled Trial. Annals of family medicine Gidwani, R., Nguyen, C., Kofoed, A., Carragee, C., Rydel, T., Nelligan, I., Sattler, A., Mahoney, M., Lin, S. 2017; 15 (5): 427–33

  Abstract

  Scribes are increasingly being used in clinical practice despite a lack of high-quality evidence regarding their effects. Our objective was to evaluate the effect of medical scribes on physician satisfaction, patient satisfaction, and charting efficiency.We conducted a randomized controlled trial in which physicians in an academic family medicine clinic were randomized to 1 week with a scribe then 1 week without a scribe for the course of 1 year. Scribes drafted all relevant documentation, which was reviewed by the physician before attestation and signing. In encounters without a scribe, the physician performed all charting duties. Our outcomes were physician satisfaction, measured by a 5-item instrument that included physicians' perceptions of chart quality and chart accuracy; patient satisfaction, measured by a 6-item instrument; and charting efficiency, measured by time to chart close.Scribes improved all aspects of physician satisfaction, including overall satisfaction with clinic (OR = 10.75), having enough face time with patients (OR = 3.71), time spent charting (OR = 86.09), chart quality (OR = 7.25), and chart accuracy (OR = 4.61) (all P values <.001). Scribes had no effect on patient satisfaction. Scribes increased the proportion of charts that were closed within 48 hours (OR =1.18, P =.028).To our knowledge, we have conducted the first randomized controlled trial of scribes. We found that scribes produced significant improvements in overall physician satisfaction, satisfaction with chart quality and accuracy, and charting efficiency without detracting from patient satisfaction. Scribes appear to be a promising strategy to improve health care efficiency and reduce physician burnout.

  View details for PubMedID 28893812

• Creating the medical school of the future through incremental curricular transformation: the Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) EDUCATION FOR PRIMARY CARE Lin, S., Osborn, K., Sattler, A., Nelligan, I., Svec, D., Aaronson, A., Schillinger, E. 2017; 28 (3): 180–84

  View details for DOI 10.1080/14739879.2016.1259965

  View details for Web of Science ID 000441840100011

• Actual and Standardized Patient Evaluations of Medical Students' Skills. Family medicine Sattler, A. L., Merrell, S. B., Lin, S. Y., Schillinger, E. 2017; 49 (7): 548–52

  Abstract

  Physicians must communicate effectively with patients. Actual patients (APs) rarely evaluate medical students' clinical skills; instead, standardized patients (SPs) provide proxy ratings. It is unclear how well SP ratings mirror AP experiences. The aim of this study was to compare AP and SP assessments of medical students' communication skills and professionalism. We hypothesized that their perspectives would be similar, but distinct, and offer insight about how to more reliably include the patient's voice in medical education.Using a mixed methods design, data were gathered from both APs and SPs using a modified SEGUE (Set the stage, Elicit information, Give information, Understand the patient's perspective, End the encounter) framework. Authors analyzed Likert-scale surveys using Spearman's rho (ρ) correlations, and qualitatively analyzed open-ended comments about students' interpersonal skills and professionalism.For APs, the domains of "trusted the student," "discussed treatment," and "reviewed next steps" were positively correlated with whether they would recommend the student to others (ρ.89, ρ.89, ρ.88, respectively, all P<.001). For SPs, feeling like they "trusted the student," "student appeared professionally competent," and "made personal connection" were most highly correlated with recommending the student to others (ρ.86, ρ.86, ρ.76, respectively, all P<.001).Feedback from APs provides unique perspectives, complementing those of SPs, and prompts insights into incorporating patients' voices and values into training. Students may benefit from learning experiences focused on sharing and clarifying information. Providing opportunities for deliberate practice and feedback during both AP and SP encounters may enhance mastery of these skills.

  View details for PubMedID 28724153

• Providing Specialty Care for the Poor and Underserved at Student-Run Free Clinics in the San Francisco Bay Area. Journal of health care for the poor and underserved Liu, M. B., Xiong, G., Boggiano, V. L., Ye, P. P., Lin, S. 2017; 28 (4): 1276–85

  Abstract

  This report describes the model of specialty clinics implemented at Stanford University's two student-run free clinics, Arbor Free Clinic and Pacific Free Clinic, in the San Francisco Bay Area. We describe our patient demographic characteristics and the specialty services provided. We discuss challenges in implementing specialty care at student-run free clinics.

  View details for DOI 10.1353/hpu.2017.0113

  View details for PubMedID 29176094

• Impact of a scholarly track on quality of residency program applicants. Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors Celebi, J. M., Nguyen, C. T., Sattler, A. L., Stevens, M. B., Lin, S. Y. 2016; 27 (6): 478-481

  Abstract

  It is generally believed that residency programs offering scholarly tracks attract higher quality applicants, although there is little evidence of this in the literature. We explored the impact of a clinician-educator track on the quality of applicants to our residency program by comparing the volume and characteristics of applicants before (2008-2011) and after (2012-2015) the track was introduced.The total number of applications received was compared between the pre-track and post-track years. Among interviewees, data on United States Medical Licensing Examination (USMLE) Step 1 scores, Step 2 Clinical Knowledge (CK) scores, Medical Student Performance Evaluation (MSPE) scores, and proportion of candidates with an advanced degree (e.g. MPH, PhD) were compared. An online survey was administered to all interviewees in 2014-2015 to measure interest in the track.The total number of applications to the residency program increased significantly from the pre-track to the post-track years. Compared to the pre-track years, interviewees during the post-track years had statistically higher USMLE Step 1 and Step 2 CK scores, better MSPE scores, and were more likely to have an advanced degree. Two-thirds of survey respondents reported that the track increased their interest in the residency program.A residency clinician-educator track may be associated with increased overall interest from applicants, higher application volume, and better measures of applicant quality based on USMLE scores, MSPE scores, and proportion of candidates with an advanced degree. Residency programs may consider a potential increase in the quality of their applicants as an added benefit of offering a scholarly track.

  View details for DOI 10.1080/14739879.2016.1197049

  View details for PubMedID 27312956

• Qualities of Resident Teachers Valued by Medical Students FAMILY MEDICINE Montacute, T., Teng, V. C., Yu, G. C., Schillinger, E., Lin, S. 2016; 48 (5): 381-384

  Abstract

  Medical students often see residents as the most important teachers on the wards. However, there is a relative lack of data on the qualities that medical students value in their resident teachers. We conducted a qualitative study to determine the teaching behaviors that medical students value in their resident teachers.Over a 1-year period, 28 medical students completed 115 open-ended written reflections about their educational experiences with residents at a single, university-affiliated, community-based family medicine residency program in San Jose, CA. Qualitative data were analyzed using the constant comparative method associated with grounded theory. Ten recurring themes were identified after triangulation with published literature.When given the opportunity to make open-ended written reflections about the teaching abilities of their resident teachers, medical students most often commented on topics relevant to a "safe learning environment." More than one in four reflections were associated with this theme, and all were characterized as positive, suggesting that the ability to set a safe learning environment is a quality that medical students value in their resident teachers. In contrast, the least frequently occurring theme was "knowledge," suggesting that residents' fund of knowledge may not be as important as other qualities in the eyes of medical students.Our study adds to a growing body of literature suggesting that, from the medical students' perspective, a resident's fund of medical knowledge may not be as important as his/her ability to establish a supportive, safe, and nonthreatening environment to learn and practice medicine.

  View details for Web of Science ID 000376224100009

  View details for PubMedID 27159098

• Training Future Clinician-Educators: A Track for Family Medicine Residents. Family medicine Lin, S., Sattler, A., Chen Yu, G., Basaviah, P., Schillinger, E. 2016; 48 (3): 212-216

  Abstract

  Despite a growing demand for skilled clinician-educators, residents today rarely receive formal training in clinical teaching, curriculum development, administration, leadership, or educational scholarship. The authors describe the development, implementation, and preliminary evaluation of the O'Connor Stanford Leaders in Education Residency (OSLER) track, a novel clinician-educator track within the family medicine residency program affiliated with Stanford University School of Medicine.In 2010, the OSLER track was introduced at O'Connor Hospital, a community hospital that houses an 8-8-8 family medicine residency program. Residents who are in good standing can apply to the track at the midpoint of their first postgraduate year. Residents are immersed in a flexible, experience-based, 2.5-year-long curriculum with hands-on teaching activities at its core. To foster skills in educational scholarship, track residents are required to design and complete a scholarly project.A comprehensive evaluation plan is currently in progress. Preliminary data indicates high levels of satisfaction with the track's overall value, impact on core teaching skills, and effect on career trajectory. Residents gained more confidence in core teaching skills as they progressed through the track. Scholarly work output by residents has increased significantly since the track was implemented. The residency program has seen an increased interest from applicants since the track was started, with data suggesting that applicant quality has increased from the pre-track to post-track years.More research is needed to assess the effectiveness and reproducibility of this clinician-educator track. If proven, this model may be replicated at other academic medical centers.

  View details for PubMedID 26950910

• Next big thing: integrating medical scribes into academic medical centres BMJ STEL Lin, S., Khoo, J., Schillinger, E. 2016; 2: 27-29

  View details for DOI 10.1136/bmjstel-2015-000054

• Codes and Pheos. Journal of general internal medicine Lin, S. 2016

  View details for PubMedID 26941043

• Hepatitis B Screening in Asian and Pacific Islanders: New Guidelines, Old Barriers JOURNAL OF IMMIGRANT AND MINORITY HEALTH Nguyen, C. T., Lin, S. Y. 2015; 17 (5): 1585-1587

  Abstract

  Chronic hepatitis B virus (HBV) infection is a serious liver disease that disproportionately affects Asian and Pacific Islander immigrants. In May 2014, the U.S. Preventive Services Task Force released new HBV screening guidelines that expanded screening to non-pregnant adolescents and adults who were born in Asia and the Pacific Islands, and U.S.-born persons not vaccinated as infants whose parents were born in Central or Southeast Asia. Although the guidelines empower health care providers and community health workers to expand their screening efforts, old barriers to screening remain deeply rooted in this population. These barriers include cultural beliefs about wellness, myths and misconceptions about HBV, and lack of access to appropriate, culturally sensitive care. Through a combination of strategies-retooling the current health care workforce to be more culturally sensitive providers, involving oriental medicine practitioners in patient education, and engaging grassroots organizations-we can overcome barriers and take full advantage of the new HBV screening guidelines.

  View details for DOI 10.1007/s10903-014-0123-7

  View details for Web of Science ID 000360911300036

  View details for PubMedID 25354568

• Value-added medical education: engaging future doctors to transform health care delivery today. Journal of general internal medicine Lin, S. Y., Schillinger, E., Irby, D. M. 2015; 30 (2): 150-151

  View details for DOI 10.1007/s11606-014-3018-3

  View details for PubMedID 25217209

• Documentation and treatment of hypertension: quality of care and missed opportunities in a family medicine resident clinic. Postgraduate medical journal So, P., Lin, S. Y. 2015; 91 (1071): 30-34

  Abstract

  In the USA, uncontrolled hypertension contributes to 1000 deaths a day. However, little is known about the quality of hypertension management in family medicine resident clinics.To examine rates of documentation and treatment of elevated blood pressure, and to identify missed opportunities to address hypertension. Study design A cross-sectional chart review of 1011 adult patient visits between 2 January and 4 February 2013 was performed in a resident-run federally qualified health centre. For patients with elevated blood pressure at time of visit, we noted whether or not the residents had documented a diagnosis or discussion of hypertension and the presence or absence of a treatment plan. We compared these rates with those from a national sample of primary care physicians.262/1011 (26%) of adult patients had elevated blood pressure at time of visit. Of those, 115/262 (44%) had documentation and a plan for treatment, 79/262 (30%) had documentation but no plan, and 68/262 (26%) had neither documentation nor plan. Nationally, 45% of patients are diagnosed and treated compared with 44% of study visits with documentation and treatment.Fewer than half of visits of patients with elevated blood pressure resulted in both documentation and a treatment plan. Nevertheless, these rates are comparable to national providers. Elevated blood pressure was more likely to be missed during acute visits and in patients with less elevated blood pressure.

  View details for DOI 10.1136/postgradmedj-2013-132520

  View details for PubMedID 25583737

• Always Learning: Why I Build Smartphone Apps California Family Physician Lin, S. 2015; 66 (2): 24,26
• Effectiveness of a smartphone app for guiding antidepressant drug selection. Family medicine Man, C., Nguyen, C., Lin, S. 2014; 46 (8): 626-630

  Abstract

  Major depression is a prevalent chronic disease in the United States. However, many physicians lack access to decision support tools at point of care to help choose antidepressants in a rational, evidence-based manner. A patient-centered treatment model that uses a symptom-based approach to selecting antidepressants was developed into a smartphone application to provide instant, evidence-based recommendations and drug monographs. The purpose of this study was to assess the impact of this mobile application on the confidence level of family physicians in treating depression.The smartphone application was provided to 14 family medicine residents and attending physicians from the O'Connor Family Medicine Residency Program in San Jose, CA. Participants were asked to use the software as drug reference and clinical decision support during patient care activities. Three surveys were administered over a 12-week period to assess provider characteristics, outcome measures (ie, confidence in managing depression and choosing an initial antidepressant based on patient symptoms, medical comorbidities, potential side effects, and drug interactions), and fund of antidepressant knowledge.The average confidence levels in managing depression, starting an antidepressant on a patient with depression, and choosing an initial antidepressant based on patient symptoms increased significantly within the period of smartphone application usage. The average scores on the antidepressant knowledge tests also improved.The smartphone application was an effective tool for both increasing confidence in depression treatment and educating physicians. Future studies to evaluate the effectiveness and impact of smartphone applications on medical education and postgraduate training are warranted.

  View details for PubMedID 25163042

• The Symptom Cluster-Based Approach to Individualize Patient-Centered Treatment for Major Depression JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE Lin, S. Y., Stevens, M. B. 2014; 27 (1): 151-159

  Abstract

  Unipolar major depressive disorder is a common, disabling, and costly disease that is the leading cause of ill health, early death, and suicide in the United States. Primary care doctors, in particular family physicians, are the first responders in this silent epidemic. Although more than a dozen different antidepressants in 7 distinct classes are widely used to treat depression in primary care, there is no evidence that one drug is superior to another. Comparative effectiveness studies have produced mixed results, and no specialty organization has published recommendations on how to choose antidepressants in a rational, evidence-based manner. In this article we present the theory and evidence for an individualized, patient-centered treatment model for major depression designed around a targeted symptom cluster-based approach to antidepressant selection. When using this model for healthy adults with major depressive disorder, the choice of antidepressants should be guided by the presence of 1 of 4 common symptom clusters: anxiety, fatigue, insomnia, and pain. This model was built to foster future research, provide a logical framework for teaching residents how to select antidepressants, and equip primary care doctors with a structured treatment strategy to deliver optimal patient-centered care in the management of a debilitating disease: major depressive disorder.

  View details for DOI 10.3122/jabfm.2014.01.130145

  View details for Web of Science ID 000329292000021

  View details for PubMedID 24390897

• Renewing US medical students' interest in primary care: bridging the role model gap POSTGRADUATE MEDICAL JOURNAL Teng, V. C., Lin, S. Y. 2014; 90 (1059): 1-2

  View details for DOI 10.1136/postgradmedj-2013-131802

  View details for Web of Science ID 000328246900001

  View details for PubMedID 24336309

• Stopping a Silent Killer in the Underserved Asian and Pacific Islander Community: A Chronic Hepatitis B and Liver Cancer Prevention Clinic by Medical Students ASIAN PACIFIC JOURNAL OF CANCER PREVENTION Lin, S. Y., Chang, E. T., So, S. K. 2009; 10 (3): 383-386

  Abstract

  To assess and alleviate the burden of chronic hepatitis B virus (HBV) infection among low-income, uninsured Asian and Pacific Islanders (APIs) in San Jose, California.From 2007 to 2008, we provided free HBV testing and follow-up to 510 patients, 74% of whom were foreign-born Vietnamese. Patients were tested for hepatitis B surface antigen and surface antibody. Chronically infected patients who elected to undergo follow-up monitoring were evaluated for liver damage (ALT), liver cancer (AFP), and HBV replication (HBV DNA).Overall, 17% were chronically infected; 33% of these were unaware that they were infected. Of those who underwent follow-up monitoring, 100% had elevated ALT, 9% had elevated AFP, and 24% had HBV DNA levels that exceeded the threshold for treatment. Patients who were candidates for antiviral therapy were enrolled in drug assistance programs, and those with elevated AFP levels were referred for CT scans. Uninfected patients lacking protective antibodies were provided free HBV vaccinations.More liver cancer prevention in the medically underserved API community is needed, including universal screening for HBV and follow-up for those chronically infected.

  View details for Web of Science ID 000270750100011

  View details for PubMedID 19640178

• Building partnerships with Traditional Chinese Medicine Practitioners to increase hepatitis B awareness and prevention JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Chang, E. T., Lin, S. Y., Sue, E., Bergin, M., Su, J., So, S. K. 2007; 13 (10): 1125-1127

  Abstract

  The annual Hepatitis B Prevention and Education Symposium aims to develop partnerships between non-Western and Western health care providers to prevent chronic hepatitis B virus (HBV) infection and death from liver cancer among Asians and Pacific Islanders (APIs).Each year from 2004 through 2007, we partnered with professional, academic, and community-based organizations to organize an educational symposium for Traditional Chinese Medicine practitioners and acupuncturists in California. Participants completed pre- and postsymposium surveys assessing knowledge about HBV and liver cancer.The symposia were held in San Francisco, Los Angeles, and Stanford, California.Over 1000 participants attended the four symposia combined; most were born in Asia.Symposium activities included educational lectures and games, presentation of a physician's guide to HBV management, and case studies.Chi-square tests were used to compare the proportion of correct responses to each knowledge-based question, as well as the total number of correct responses, before and after the symposium.Knowledge about HBV and liver cancer was low prior to the symposium. The proportion of correct responses to the most commonly mistaken questions increased significantly at the conclusion of each symposium. The total number of correct responses rose from below 60% to above 75% each year.Similar educational symposia targeting health care providers who serve API patients can improve HBV and liver cancer awareness and prevention throughout the API community.

  View details for DOI 10.1089/acm.2007.0655

  View details for Web of Science ID 000252247200014

  View details for PubMedID 18166125

• Why we should routinely screen Asian American adults for hepatitis B: A cross-sectional study of Asians in California HEPATOLOGY Lin, S. Y., Chang, E. T., So, S. K. 2007; 46 (4): 1034-1040

  Abstract

  Chronic hepatitis B virus (HBV) infection is a serious liver disease that, if left undiagnosed or without appropriate medical management, is associated with a 25% chance of death from cirrhosis or liver cancer. To study the demographics and prevalence of chronic HBV infection and HBV vaccination in the Asian American population, we provided free HBV serological screening and administered a survey to 3163 Asian American adult volunteers in the San Francisco Bay Area between 2001 and 2006. Of those screened, 8.9% were chronically infected with HBV. Notably, one-half to two-thirds (65.4%) of the chronically infected adults were unaware that they were infected. Of those who were not chronically infected, 44.8% lacked protective antibodies against HBV and were likely susceptible to future infection. Men were twice as likely as women to be chronically infected (12.1% versus 6.4%). Asian Americans born in East Asia, Southeast Asia, or the Pacific Islands were 19.4 times more likely to be chronically infected than those born in the United States. Self-reporting of prior vaccination was unreliable to assess protection against HBV. Among the 12% who reported having been vaccinated, 5.2% were chronically infected, and 20.3% lacked protective antibodies.Given the high prevalence of unrecognized chronic HBV infection in the Asian American population, we call for healthcare providers to routinely screen Asian adults for HBV, regardless of their vaccination status. Those who test positive should be provided with culturally appropriate information to prevent disease transmission and proper medical management to reduce their risk of liver disease.

  View details for DOI 10.1002/hep.21784

  View details for Web of Science ID 000249910500013

  View details for PubMedID 17654490

• Hepatitis B and liver cancer knowledge and preventive practices among Asian Americans in the San Francisco Bay Area, California ASIAN PACIFIC JOURNAL OF CANCER PREVENTION Wu, C. A., Lin, S. Y., So, S. K., Chang, E. T. 2007; 8 (1): 127-134

  Abstract

  Chronic hepatitis B virus (HBV) infection causes liver cancer and disproportionately affects the Asian community in the U.S. In order to advance HBV and liver cancer awareness and prevention, it is important to identify existing gaps in knowledge and preventive practices among Asian Americans. Therefore, the authors administered a written questionnaire to 199 adults in the Asian-American community of the San Francisco Bay Area, California. Although the majority of adults had at least a college education, knowledge regarding HBV transmission, prevention, symptoms, risks, and occurrence was low. Fewer than 60% reported having been tested for HBV, only 31% reported having been vaccinated against HBV, and only 44% reported having had their children vaccinated. Asians, especially those born in China or Southeast Asia, had significantly poorer knowledge regarding HBV and liver cancer than non-Asians. Those with higher knowledge levels were significantly more likely to have been tested for HBV and to have had their children vaccinated. Younger adults, women, Caucasians, more highly educated individuals, those not born in China or Hong Kong, and those with a personal or family history of liver disease were more likely to have taken preventive action against HBV. Our results suggest that HBV and liver cancer knowledge among Asian Americans, especially Chinese Americans, is poor, and that better knowledge is associated with increased preventive practices. Thus, there is a need for increased HBV education and improved community-based interventions to prevent HBV-related liver disease in the high-risk Asian-American community.

  View details for Web of Science ID 000253887000026

  View details for PubMedID 17477787

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