Dr. Srinivasan is a Clinical Professor of Medicine at Stanford University, Associate Director at the Stanford Center for Asian Healthcare Research and Education (Stanford CARE), Fellow at the Stanford Center for Innovation in Global Health (CIGH), board member at the Stanford Clinical Teaching Seminar Series, and member of the Stanford Teaching and Mentoring Academy (TMA). She is co-Director of the One Health Teaching Scholars Faculty Development Program, an international program focusing on faculty development for health professions education around the world. She is a contributor to CBS-KPIX “Medical Mondays”. Dr. Srinivasan brings her skills as an educator, physician, health services researcher, and entrepreneur to considering how scalable technologies can improve health care. Her work in Virtual Health/telemedicine and new patient engagement models has been published in the NEJM Catalyst – a leading healthcare innovation journal.
Previously, Dr. Srinivasan was a Master Clinical Educator and Professor of Clinical Medicine at the University of California, Davis School of Medicine. She was the Senior Associate Editor and Editorial Fellowship Director for the Journal of General Internal Medicine, and was the Kimitaka Kaga Visiting Professor at the University of Tokyo at the International Research Center for Medical Education. At UC Davis, Dr. Srinivasan was the Director of Practice Based Learning and Improvement and Medical Director of the Clinical Performance Examination for a decade. She is former President of the California-Hawaii Society of General Internal Medicine, and ex-officio National Council Member for SGIM. She was a RWJ Foundation Generalist Physician Faculty Scholar and US Health and Human Service Public Policy Fellow. Dr. Srinivasan has been awarded the California SGIM Educator of the Year Award, and was recognized by her university with the Dean’s Award for Excellence in Education. Her research has focused on improving physician competency around clinical decision-making, through Virtual Health, technology-aided education and reflective practice.
- Internal Medicine
- Clinical Decision-Making
- Scalable technologies for healthcare
- Precision Medicine
Clinical Professor, Medicine - Primary Care and Population Health
Residency: University of Iowa Hospitals and Clinics (1998) IA
Board Certification: American Board of Internal Medicine, Internal Medicine (2011)
Medical Education: Northwestern University Feinberg School of Medicine (1995) IL
Fellowship: The Regenstrief Institute - Indiana Univ SOM (2001) IN
Disaggregated Mortality from Gastrointestinal Cancers in Asian Americans: Analysis of United States Death Records.
International journal of cancer
Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003-2017, we report age-standardized mortality rates, standardized mortality ratios, and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver, and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention. This article is protected by copyright. All rights reserved.
View details for DOI 10.1002/ijc.33490
View details for PubMedID 33527405
Transforming Interprofessional Roles During Virtual Health Care: The Evolving Role of the Medical Assistant, in Relationship to National Health Profession Competency Standards.
Journal of primary care & community health
2021; 12: 21501327211004285
INTRODUCTION: Medical assistants (MAs) were once limited to obtaining vital signs and office work. Now, MAs are foundational to team-based care, interacting with patients, systems, and teams in many ways. The transition to Virtual Health during the COVID-19 pandemic resulted in a further rapid and unique shift of MA roles and responsibilities. We sought to understand the impact of this shift and to place their new roles in the context of national professional competency standards.METHODS: In this qualitative, grounded theory study we conducted semi-structured interviews with 24 MAs at 10 primary care sites at a major academic medical center on their experiences during the shift from in-person to virtual care. MAs were selected by convenience sample. Coding was done in Dedoose version 8.335. Consensus-based inductive and deductive approaches were used for interview analysis. Identified MA roles were compared to national MA, Institute of Medicine, physician, and nursing professional competency domains.RESULTS: Three main themes emerged: Role Apprehension, Role Expansion, and Adaptability/Professionalism. Nine key roles emerged in the context of virtual visits: direct patient care (pre-visit and physical care), panel management, health systems ambassador, care coordination, patient flow coordination, scribing, quality improvement, and technology support. While some prior MA roles were limited by the virtual care shift, the majority translated directly or expanded in virtual care. Identified roles aligned better with Institute of Medicine, physician, and nursing professional competencies, than current national MA curricula.CONCLUSIONS: The transition to Virtual Health decreased MA's direct clinical work and expanded other roles within interprofessional care, notably quality improvement and technology support. Comparison of the current MA roles with national training program competencies identified new leadership and teamwork competencies which could be expanded during MA training to better support MA roles on inter-professional teams.
View details for DOI 10.1177/21501327211004285
View details for PubMedID 33764223
Qualitative Assessment of Rapid System Transformation to Primary Care Video Visits at an Academic Medical Center.
Annals of internal medicine
The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits.To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits.Semistructured qualitative interviews.6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019.Fifty-three program participants (overlapping roles as medical providers [n = 20], medical assistants [n = 16], nurses [n = 4], technologists [n = 4], and administrators [n = 13]) were interviewed about video visit transition and challenges.In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method.Nine faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used.The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization.Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability.After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being.Stanford Department of Medicine and Stanford Health Care.
View details for DOI 10.7326/M20-1814
View details for PubMedID 32628536
Assessing 3rd year medical students' interprofessional collaborative practice behaviors during a standardized patient encounter: A multi-institutional, cross-sectional study.
2015; 37 (10): 915-925
To understand how third-year medical student interprofessional collaborative practice (IPCP) is affected by self-efficacy and interprofessional experiences (extracurricular experiences and formal curricula).The authors measured learner IPCP using an objective structured clinical examination (OSCE) with a standardized nurse (SN) and standardized patient (SP) during a statewide clinical performance examination. At four California medical schools from April to August 2012, SPs and SNs rated learner IPCP (10 items, range 0-100) and patient-centered communication (10 items, range 0-100). Post-OSCE, students reported their interprofessional self-efficacy (16 items, 2 factors, range 1-10) and prior extracurricular interprofessional experiences (3 items). School representatives shared their interprofessional curricula during guided interviews.Four hundred sixty-four of 530 eligible medical students (88%) participated. Mean IPCP performance was 79.6 ± 14.1 and mean self-efficacy scores were 7.9 (interprofessional teamwork) and 7.1 (interprofessional feedback and evaluation). Seventy percent of students reported prior extracurricular interprofessional experiences; all schools offered formal interprofessional curricula. IPCP was associated with self-efficacy for interprofessional teamwork (β = 1.6, 95% CI [0.1, 3.1], p = 0.04) and patient-centered communication (β = 12.5, 95% CI [2.7, 22.3], p = 0.01).Medical student IPCP performance was associated with self-efficacy for interprofessional teamwork and patient-centered communication. Increasing interprofessional opportunities that influence medical students' self-efficacy may increase engagement in IPCP.
View details for DOI 10.3109/0142159X.2014.970628
View details for PubMedID 25313933
Measuring Knowledge Structure: Reliability of Concept Mapping Assessment in Medical Education
2008; 83 (12): 1196-1203
To test the reliability of concept map assessment, which can be used to assess an individual's "knowledge structure," in a medical education setting.In 2004, 52 senior residents (pediatrics and internal medicine) and fourth-year medical students at the University of California-Davis School of Medicine created separate concept maps about two different subject domains (asthma and diabetes) on two separate occasions each (four total maps). Maps were rated using four different scoring systems: structural (S; counting propositions), quality (Q; rating the quality of propositions), importance/quality (I/Q; rating importance and quality of propositions), and a hybrid system (H; combining elements of S with I/Q). The authors used generalizability theory to determine reliability.Learners (universe score) contributed 40% to 44% to total score variation for the Q, I/Q, and H scoring systems, but only 10% for the S scoring system. There was a large learner-occasion-domain interaction effect (19%-23%). Subsequent analysis of each subject domain separately demonstrated a large learner-occasion interaction effect (31%-37%) and determined that administration on four to five occasions was necessary to achieve adequate reliability. Rater variation was uniformly low.The Q, I/Q, and H scoring systems demonstrated similar reliability and were all more reliable than the S system. The findings suggest that training and practice are required to perform the assessment task, and, as administered in this study, four to five testing occasions are required to achieve adequate reliability. Further research should focus on whether alterations in the concept mapping task could allow it to be administered over fewer occasions while maintaining adequate reliability.
View details for Web of Science ID 000267654800030
View details for PubMedID 19202500