Dr. Lin is an expert clinician, educator, researcher, and health system leader in the specialty of family medicine. He earned his MD from Stanford University School of Medicine and completed his training at Stanford’s family medicine residency program. Dr. Lin is certified by the American Board of Family Medicine and is an active member of the Society of Teachers of Family Medicine. He has received numerous national awards and was a James Puffer/ABFM fellow with the National Academy of Medicine.

Dr. Lin cares for people of all ages, often for members of the same family. He has a particular interest in preventive cardiology, diabetes, hepatitis B, and mental health. He is proficient in a wide range of primary care procedures – including over 40 different skin, musculoskeletal, and women’s health procedures that are performed in the office. Dr. Lin is fluent in Mandarin Chinese and provides the highest quality, evidence based, culturally competent care for people of all backgrounds at Stanford.

Dr. Lin is the Chief of General Primary Care and the Head of Technology Innovation for the Division of Primary Care and Population Health at Stanford. He is the founder of 3 nationally recognized programs – the O’Connor-Stanford Leaders in Education Residency Program (OSLER), the Stanford Medical Scribe Fellowship (COMET), and the Stanford Healthcare AI Applied Research Team (HEA3RT).

Dr. Lin is the author of over 400 scholarly works and conference presentations. His research covers a broad range of topics. His current focus is artificial intelligence and machine learning in healthcare.

Clinical Focus

  • Family Medicine

Academic Appointments

Administrative Appointments

  • Section Chief, General Primary Care, Division of Primary Care and Population Health (2023 - Present)
  • Service Chief, Family Medicine, Stanford Health Care (2020 - 2023)
  • Founder and Executive Director, Stanford Healthcare AI Applied Research Team (HEA3RT) (2019 - Present)
  • Vice Chief for Technology Innovation, Division of Primary Care and Population Health (2019 - Present)
  • Medical Director, Stanford Family Medicine (2016 - 2021)
  • Associate Chief for Medical Education, Division of Primary Care and Population Health (2016 - 2019)
  • Founder and Executive Director, Stanford Medical Scribe Fellowship (COMET) (2015 - 2021)
  • Founder and Co-Director, Family Medicine Minor Procedure Service (2015 - 2017)
  • Co-Founder and Director of Program Development, Stanford Healthcare Innovations and Experiential Learning Directive (SHIELD) (2014 - 2018)
  • Co-Medical Director, Arbor Free Clinic (2013 - 2016)
  • Associate, Educators-4-CARE (E4C) Program (2011 - 2015)
  • Founder and Director, O'Connor-Stanford Leaders in Education Residency (OSLER) Program (2010 - 2015)

Honors & Awards

  • Department Chair Member, Association of Departments of Family Medicine (2023)
  • Bellue-Holly Distinguished Visiting Professorship, Long School of Medicine, UT Health San Antonio (2023)
  • President's Award, Society of Teachers of Family Medicine (2022)
  • James C. Puffer/American Board of Family Medicine Fellowship at the National Academy of Medicine, National Academy of Medicine (2021-2023)
  • Award for Outstanding Innovation, Vision and Leadership, Stanford Medical Scribe Fellowship, Stanford University School of Medicine (2021)
  • National Innovative Program Award, Society of Teachers of Family Medicine (2021)
  • Award for Outstanding Leadership, Innovation and Service, Division of Primary Care and Population Health, Stanford University School of Medicine (2021)
  • Chair, National Telemedicine Task Force, Society of Teachers of Family Medicine (2020-2022)
  • Innovations in Clinical Care Award, Stanford Health Care (2018)
  • Oral Presentation of Distinction, Teaching and Mentoring Academy, Stanford University School of Medicine (2017)
  • Board of Directors Member at Large, Society of Teachers of Family Medicine (2017-2020)
  • President's Award, Society of Teachers of Family Medicine (2017)
  • Division Teaching Award, Department of Medicine, Stanford University School of Medicine (2017)
  • Clinician Educator Research Award, Division of Primary Care and Population Health, Stanford University School of Medicine (2016)
  • New Faculty Scholar Award, Society of Teachers of Family Medicine (2016)
  • Pisacano Leadership Foundation Alumni Award, American Board of Family Medicine (2015)
  • The Arthur L. Bloomfield Award in Recognition of Excellence in the Teaching of Clinical Medicine, Stanford University School of Medicine (2015)
  • Faculty for Tomorrow Task Force Member, Society of Teachers of Family Medicine (2015-2017)
  • Preceptor of the Year, California Academy of Family Physicians Foundation (2015)
  • Clinician Educator Research Award, Division of General Medical Disciplines, Stanford University School of Medicine (2014)
  • Year of the Family Physician Member Spotlight, California Academy of Family Physicians (2014)
  • Citation in National Hepatitis B Screening Recommendations, U.S. Preventive Services Task Force (2014)
  • National Innovative Program Award, Society of Teachers of Family Medicine (2014)
  • William C. Fowkes, Jr., MD Teaching Award, O'Connor Hospital, Society of Teachers of Family Medicine (2013)
  • Award for Excellence in Graduate Medical Education, American Academy of Family Physicians (2012)
  • Citation in National Viral Hepatitis Action Plan, U.S. Department of Health and Human Services (2011)
  • Citation in National Report on Hepatitis and Liver Cancer, Institute of Medicine (2010)
  • Pisacano Scholar, The Pisacano Leadership Foundation, American Board of Family Medicine (2009)
  • Community Outreach Award, American Academy of Family Physicians (2008)
  • Angels in Medicine Award, Angels in Medicine (2008)
  • Vera Moulton Wall Center Award in Arts, Humanities and Medicine, Stanford Center for Biomedical Ethics (2008)
  • Schweitzer Fellow, The Albert Schweitzer Fellowship (2007)
  • William J. Griffith University Service Award, Duke University (2006)
  • Rainbow of Heroes Award, Pediatric Bone Marrow Transplantation Program, Duke Comprehensive Cancer Center (2005)
  • Serena WuDunn Memorial Scholar, Duke University (2005)
  • Phi Beta Kappa, Duke University (2004)
  • Howard Hughes Research Fellow, Howard Hughes Medical Institute (2004)

Boards, Advisory Committees, Professional Organizations

  • Fellow, National Academy of Medicine (2021 - 2023)
  • Diplomate, American Board of Family Medicine (2013 - Present)
  • Member, American Academy of Family Physicians (2010 - Present)
  • Member, California Academy of Family Physicians (2010 - Present)
  • Member, Society of Teachers of Family Medicine (2010 - Present)

Professional Education

  • Board Certification: American Board of Family Medicine, Family Medicine (2013)
  • Residency: Stanford O'Connor Family Medicine Residency (2013) CA
  • Internship: Stanford O'Connor Family Medicine Residency (2011) CA
  • Medical Education: Stanford University School of Medicine (2010) CA
  • Bachelor of Science, Duke University, NC (2006)

Current Research and Scholarly Interests

Artificial intelligence and machine learning in healthcare
Primary care and population health
Value added medical education

2023-24 Courses

All Publications

  • Effectiveness of an Artificial Intelligence-Enabled Intervention for Detecting Clinical Deterioration. JAMA internal medicine Gallo, R. J., Shieh, L., Smith, M., Marafino, B. J., Geldsetzer, P., Asch, S. M., Shum, K., Lin, S., Westphal, J., Hong, G., Li, R. C. 2024


    Inpatient clinical deterioration is associated with substantial morbidity and mortality but may be easily missed by clinicians. Early warning scores have been developed to alert clinicians to patients at high risk of clinical deterioration, but there is limited evidence for their effectiveness.To evaluate the effectiveness of an artificial intelligence deterioration model-enabled intervention to reduce the risk of escalations in care among hospitalized patients using a study design that facilitates stronger causal inference.This cohort study used a regression discontinuity design that controlled for confounding and was based on Epic Deterioration Index (EDI; Epic Systems Corporation) prediction model scores. Compared with other observational research, the regression discontinuity design facilitates causal analysis. Hospitalized adults were included from 4 general internal medicine units in 1 academic hospital from January 17, 2021, through November 16, 2022.An artificial intelligence deterioration model-enabled intervention, consisting of alerts based on an EDI score threshold with an associated collaborative workflow among nurses and physicians.The primary outcome was escalations in care, including rapid response team activation, transfer to the intensive care unit, or cardiopulmonary arrest during hospitalization.During the study, 9938 patients were admitted to 1 of the 4 units, with 963 patients (median [IQR] age, 76.1 [64.2-86.2] years; 498 males [52.3%]) included within the primary regression discontinuity analysis. The median (IQR) Elixhauser Comorbidity Index score in the primary analysis cohort was 10 (0-24). The intervention was associated with a -10.4-percentage point (95% CI, -20.1 to -0.8 percentage points; P = .03) absolute risk reduction in the primary outcome for patients at the EDI score threshold. There was no evidence of a discontinuity in measured confounders at the EDI score threshold.Using a regression discontinuity design, this cohort study found that the implementation of an artificial intelligence deterioration model-enabled intervention was associated with a significantly decreased risk of escalations in care among inpatients. These results provide evidence for the effectiveness of this intervention and support its further expansion and testing in other care settings.

    View details for DOI 10.1001/jamainternmed.2024.0084

    View details for PubMedID 38526472

  • Artificial Intelligence-Generated Draft Replies to Patient Inbox Messages. JAMA network open Garcia, P., Ma, S. P., Shah, S., Smith, M., Jeong, Y., Devon-Sand, A., Tai-Seale, M., Takazawa, K., Clutter, D., Vogt, K., Lugtu, C., Rojo, M., Lin, S., Shanafelt, T., Pfeffer, M. A., Sharp, C. 2024; 7 (3): e243201


    The emergence and promise of generative artificial intelligence (AI) represent a turning point for health care. Rigorous evaluation of generative AI deployment in clinical practice is needed to inform strategic decision-making.To evaluate the implementation of a large language model used to draft responses to patient messages in the electronic inbox.A 5-week, prospective, single-group quality improvement study was conducted from July 10 through August 13, 2023, at a single academic medical center (Stanford Health Care). All attending physicians, advanced practice practitioners, clinic nurses, and clinical pharmacists from the Divisions of Primary Care and Gastroenterology and Hepatology were enrolled in the pilot.Draft replies to patient portal messages generated by a Health Insurance Portability and Accountability Act-compliant electronic health record-integrated large language model.The primary outcome was AI-generated draft reply utilization as a percentage of total patient message replies. Secondary outcomes included changes in time measures and clinician experience as assessed by survey.A total of 197 clinicians were enrolled in the pilot; 35 clinicians who were prepilot beta users, out of office, or not tied to a specific ambulatory clinic were excluded, leaving 162 clinicians included in the analysis. The survey analysis cohort consisted of 73 participants (45.1%) who completed both the presurvey and postsurvey. In gastroenterology and hepatology, there were 58 physicians and APPs and 10 nurses. In primary care, there were 83 physicians and APPs, 4 nurses, and 8 clinical pharmacists. The mean AI-generated draft response utilization rate across clinicians was 20%. There was no change in reply action time, write time, or read time between the prepilot and pilot periods. There were statistically significant reductions in the 4-item physician task load score derivative (mean [SD], 61.31 [17.23] presurvey vs 47.26 [17.11] postsurvey; paired difference, -13.87; 95% CI, -17.38 to -9.50; P < .001) and work exhaustion scores (mean [SD], 1.95 [0.79] presurvey vs 1.62 [0.68] postsurvey; paired difference, -0.33; 95% CI, -0.50 to -0.17; P < .001).In this quality improvement study of an early implementation of generative AI, there was notable adoption, usability, and improvement in assessments of burden and burnout. There was no improvement in time. Further code-to-bedside testing is needed to guide future development and organizational strategy.

    View details for DOI 10.1001/jamanetworkopen.2024.3201

    View details for PubMedID 38506805

  • What Complexity Science Predicts About the Potential of Artificial Intelligence/Machine Learning to Improve Primary Care. Journal of the American Board of Family Medicine : JABFM Young, R. A., Martin, C. M., Sturmberg, J. P., Hall, S., Bazemore, A., Kakadiaris, I. A., Lin, S. 2024; 37 (2): 332-345


    Primary care physicians are likely both excited and apprehensive at the prospects for artificial intelligence (AI) and machine learning (ML). Complexity science may provide insight into which AI/ML applications will most likely affect primary care in the future. AI/ML has successfully diagnosed some diseases from digital images, helped with administrative tasks such as writing notes in the electronic record by converting voice to text, and organized information from multiple sources within a health care system. AI/ML has less successfully recommended treatments for patients with complicated single diseases such as cancer; or improved diagnosing, patient shared decision making, and treating patients with multiple comorbidities and social determinant challenges. AI/ML has magnified disparities in health equity, and almost nothing is known of the effect of AI/ML on primary care physician-patient relationships. An intervention in Victoria, Australia showed promise where an AI/ML tool was used only as an adjunct to complex medical decision making. Putting these findings in a complex adaptive system framework, AI/ML tools will likely work when its tasks are limited in scope, have clean data that are mostly linear and deterministic, and fit well into existing workflows. AI/ML has rarely improved comprehensive care, especially in primary care settings, where data have a significant number of errors and inconsistencies. Primary care should be intimately involved in AI/ML development, and its tools carefully tested before implementation; and unlike electronic health records, not just assumed that AI/ML tools will improve primary care work life, quality, safety, and person-centered clinical decision making.

    View details for DOI 10.3122/jabfm.2023.230219R1

    View details for PubMedID 38740483

  • Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19. Journal of medical Internet research Jeong, Y., Crowell, T., Devon-Sand, A., Sakata, T., Sattler, A., Shah, S., Tsai, T., Lin, S. 2024; 26: e47667


    On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a "postpandemic" landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic. First, clinical workflows must support both in-person and internet-based care delivery. Second, the integration of asynchronous care delivery is critical. Third, planning for the future means planning for everyone, including those with potentially limited access to health care due to barriers in technology and communication. While these lessons are neither unique to primary care settings nor all-encompassing, they establish a grounded foundation on which to construct higher-quality, more resilient, and more equitable health systems.

    View details for DOI 10.2196/47667

    View details for PubMedID 38393776

  • Artificial Intelligence in Health, Health Care, and Biomedical Science: An AI Code of Conduct Principles and Commitments Discussion Draft NAM Perspectives Adams, L., Fontaine, E., Lin, S., Crowell, T., Chung, V., Gonzalez, A. 2024

    View details for DOI 10.31478/202403a

  • Reimagining Primary Care With AI: A Future Within Reach Shah, S., Tsai, T., Sattler, A., Lee, J., Yang, B., Smith, M., Lin, S. Practice Update / Elsevier. 2024
  • Differences Between Patient and Clinician-Taken Images: Implications for Virtual Care of Skin Conditions Mayo Clinic Proceedings: Digital Health Rikhye, R. V., Hong, G. E., Singh, P., Smith, M. A., Loh, A., Muralidharan, V., Wong, D., Sayres, R., Phung, M., Betancourt, N., Fong, B., Sahasrabudhe, R., Nasim, K., Eschholz, A., Matias, Y., Corrado, G. S., Chou, K., Webster, D. R., Bui, P., Liu, Y., Liu, Y., Ko, J., Lin, S. 2024; 2 (1): 107-118
  • Storylines of family medicine VIII: clinical approaches Family Medicine and Community Health Ventres, W. B., Stone, L. A., Gibson-Oliver, L. E., Meehan, E. K., Ricker, M. A., Loxterkamp, D., Ogbeide, S. A., deGruy, F. V., Mahoney, M. R., Lin, S., MacRae, C., Mercer, S. W. 2024

    View details for DOI 10.1136/fmch-2024-002795

  • Trends in Pediatric Primary Care Visits During the COVID-19 Pandemic: Opportunity to Address Adolescent Behavioral Health Through Telemedicine. Family medicine Hong, G., Less, J., Masoudian, B., Cruz, A., Sifuentes, S., Vue, J., Yanamandra, A., Sattler, A., Lin, S. 2023


    The COVID-19 pandemic impacted the volume and nature of pediatric primary care visits nationwide. This study aimed to identify trends in pediatric visits at our institution during the pandemic to reveal opportunities to improve care of children and adolescents.We performed a retrospective chart review of all pediatric visits conducted at a single family medicine clinic within a large academic medical center in Northern California from January 1, 2019, through September 30, 2021. Data collected for each visit included age, sex, type of visit (preventive or problem-focused), reason for visit (if problem-focused), and mode of visit (in-person or telehealth). We analyzed data using descriptive statistics and χ2 tests.A total of 4,844 pediatric visits occurred during the study period. Visit volume dropped 9% from 2019 to 2020 and recovered to prepandemic levels in 2021. During the study period from 2019 to 2021, the percentage of problem-focused visits increased from 30% to 37% (P=.008) among adolescents, driven largely by an increase in the percentage of behavioral health visits from 14% to 29% (P<.001). We found no significant changes in the age or sex of patients seen. Telemedicine visit volume decreased from 2020 to 2021 in all age categories except for adolescents, which remained stable at 43% of all visits.A sharp increase in behavioral health concerns among adolescents stands out as the most notable impact of COVID-19 on pediatric care at our institution. Our findings raise questions about how behavioral health care can be optimized for adolescents in the postpandemic era.

    View details for DOI 10.22454/FamMed.2023.755040

    View details for PubMedID 37540534

  • Telemedicine Competencies in Family Medicine Clerkships: A CERA Study. Family medicine Bajra, R., Lin, S., Theobald, M., Antoun, J. 2023; 55 (6): 405-410


    While the Association of American Medical Colleges (AAMC) designated cross-disciplinary telemedicine competencies, curricular implementation is at disparate stages across medical schools and with significant curricular gaps. We investigated factors associated with the presence of telemedicine curriculum in family medicine clerkships.Data were evaluated as part of the 2022 CERA survey of family medicine clerkship directors (CD). Participants answered questions about telemedicine curriculum in their clerkship, including whether it was required or optional, whether telemedicine competencies were assessed, the availability of faculty expertise, volume of visits, student autonomy in visits, CD's attitude about the importance of telemedicine education, and awareness of the Society of Teachers of Family Medicine's (STFM) Telemedicine Curriculum.Ninety-four of 159 CDs (59.1%) responded to the survey. Over one-third of FM clerkships (38, 41.3%) did not teach telemedicine and most CDs (59, 62.8%) did not assess competencies. The presence of telemedicine curriculum was positively associated with CDs' awareness of STFM's Telemedicine Curriculum (P=.032), attitude of CDs toward importance of telemedicine teaching (P=.007), higher level of learner autonomy in telemedicine visits (P=.035), and private medical schools (P=.020).Almost two-thirds of clerkships (62.8%) did not assess telemedicine competencies, and fewer than one-third of CDs (28.6%) considered telemedicine education as important as other clerkship topics. CDs' attitudes were a significant determinant of whether teaching of telemedicine skills occurred. Awareness of telemedicine education resources and higher learner autonomy in telemedicine encounters may promote integration into clerkship curriculum.

    View details for DOI 10.22454/FamMed.2023.242006

    View details for PubMedID 37307393

  • Impact of a Medical Scribe Program on the Educational Trajectory of Prehealth and Underrepresented in Medicine Students. Family medicine Less, J., Nguyen, C., Teng, V., Lin, S. 2023; 55 (6): 389-393


    Sparse research exists on evaluating the effects of medical scribing programs on the educational trajectory of prehealth students. This study assesses the impact of the Stanford Medical Scribe Fellowship (COMET) on its prehealth participants' educational goals, preparation for graduate training, and acceptance into health professional schools.We distributed a 31-question survey with both closed- and open-ended questions to 96 alumni. The survey collected participant demographics, self-reported underrepresented in medicine (URM) status, pre-COMET clinical experiences and educational goals, application to and acceptance at health professional schools, and perceived impact of COMET on their educational trajectory. SPSS was used to complete the analyses.The survey had a 97% (93/96) completion rate. Among all respondents, 69% (64/93) applied to a health professional school and 70% (45/64) were accepted. Among URM respondents, 68% (23/34) applied to a health professional school and 70% (16/23) were accepted. Overall acceptance rates for MD/DO and PA/NP programs were 51% (24/47) and 61% (11/18), respectively. URM acceptance rates for MD/DO and PA/NP programs were 43% (3/7) and 58% (7/12), respectively. For current or recently graduated health professional school respondents, 97% (37/38) "strongly agreed" or "agreed" that COMET helped them succeed in their training.COMET is associated with a positive impact on the educational trajectory of its prehealth participants and a higher acceptance rate into health professional schools than the national rates for both overall and URM applicants. Scribing programs may serve as pipeline development and help increase the diversity of the future health care workforce.

    View details for DOI 10.22454/FamMed.2023.416490

    View details for PubMedID 37307390

  • Feasibility and Acceptability of a US National Telemedicine Curriculum for Medical Students and Residents: Multi-institutional Cross-sectional Study. JMIR medical education Bajra, R., Frazier, W., Graves, L., Jacobson, K., Rodriguez, A., Theobald, M., Lin, S. 2023; 9: e43190


    Telemedicine use increased as a response to health care delivery changes necessitated by the COVID-19 pandemic. However, lack of standardized curricular content creates gaps and inconsistencies in effectively integrating telemedicine training at both the undergraduate medical education and graduate medical education levels.This study evaluated the feasibility and acceptability of a web-based national telemedicine curriculum developed by the Society of Teachers of Family Medicine for medical students and family medicine (FM) residents. Based on the Association of American Medical Colleges telehealth competencies, the asynchronous curriculum featured 5 self-paced modules; covered topics include evidence-based telehealth uses, best practices in communication and remote physical examinations, technology requirements and documentation, access and equity in telehealth delivery, and the promise and potential perils of emerging technologies.A total of 17 medical schools and 17 FM residency programs implemented the curriculum between September 1 and December 31, 2021. Participating sites represented 25 states in all 4 US census regions with balanced urban, suburban, and rural settings. A total of 1203 learners, including 844 (70%) medical students and 359 (30%) FM residents, participated. Outcomes were measured through self-reported 5-point Likert scale responses.A total of 92% (1101/1203) of learners completed the entire curriculum. Across the modules, 78% (SD 3%) of participants agreed or strongly agreed that they gained new knowledge, skills, or attitudes that will help them in their training or career; 87% (SD 4%) reported that the information presented was at the right level for them; 80% (SD 2%) reported that the structure of the modules was effective; and 78% (SD 3%) agreed or strongly agreed that they were satisfied. Overall experience using the national telemedicine curriculum did not differ significantly between medical students and FM residents on binary analysis. No consistent statistically significant relationships were found between participants' responses and their institution's geographic region, setting, or previous experience with a telemedicine curriculum.Both undergraduate medical education and graduate medical education learners, represented by diverse geographic regions and institutions, indicated that the curriculum was broadly acceptable and effective.

    View details for DOI 10.2196/43190

    View details for PubMedID 37155241

  • Voice assistants' responses to questions about the COVID-19 vaccine: a national cross-sectional study. JMIR formative research Sossenheimer, P., Hong, G., Devon-Sand, A., Lin, S. 2023


    BACKGROUND: Artificial intelligence (AI)-powered voice assistants (VAs) - like Apple Siri, Google Assistant, and Amazon Alexa - interact with users in natural language and are capable of responding to simple commands, searching the internet, and answering questions. Despite being an increasingly popular way for the public to access health information, VAs could be a source of ambiguous or potentially biased information.OBJECTIVE: In response to the ongoing prevalence of vaccine misinformation and disinformation, this study aims to evaluate how smartphone VAs respond to information- and recommendation-seeking inquiries regarding the COVID-19 vaccine.METHODS: A national cross-sectional survey of English-speaking adults who owned a smartphone with a VA installed, conducted online from April 22-28, 2021. The primary outcomes were the VAs' responses to two questions: "Should I get the COVID vaccine?" and "Is the COVID vaccine safe?". Directed content analysis was used to assign a negative, neutral, or positive connotation to each response and website title provided by the VAs. Statistical significance was assessed using the t test (parametric) or Mann-Whitney U (nonparametric) test for continuous variables and the chi2 or Fisher exact test for categorical variables.RESULTS: Of the 466 survey respondents included in the final analysis, 404 (86.7%) used Apple Siri, 53 (11.4%) used Google Assistant, and 9 (1.9%) used Amazon Alexa. In response to the question "Is the COVID vaccine safe?" 89.9% of users received a direct response, of which 97.3% had a positive connotation encouraging users to get vaccinated. Of the websites presented, only 5.3% had a positive connotation and 94.7% had a neutral connotation. In response to the question "Should I get the COVID vaccine?" 93.1% of users received a list of websites, of which 91.5% had a neutral connotation. For both COVID-19 vaccine-related questions, there was no association between the connotation of a response and the age, gender, zip code, race/ethnicity, or education level of the respondent.CONCLUSIONS: Our study found that VAs were much more likely to respond directly with positive connotations to the question, "Is the COVID vaccine safe?" but not respond directly and provide a list of websites with neutral connotations to the question, "Should I get the COVID vaccine?" To our knowledge, this is the first study to evaluate how VAs respond to both information- and recommendation-seeking inquiries regarding the COVID-19 vaccine. These findings add to our growing understanding of both the opportunities and pitfalls of VAs in supporting public health information dissemination.CLINICALTRIAL:

    View details for DOI 10.2196/43007

    View details for PubMedID 36719815

  • Toward Equitable Innovation in Health and Medicine: A Framework Wailoo, K., Yamamoto, K., Abernethy, A., Asch, D., Carrasquillo, O., Chandra, A., Charo, A., El-Samad, H., Goodwin, M., Hatch, A., Hu, J., Iezzoni, L., London, A., Mathews, D., Parthasarathy, S., Persons, T., Rai, A., Rajan, K., Tsosie, K., Gonzalez, A., Lin, S., Bremer, A., Bowman, K. The National Academies Press. 2023

    View details for DOI 10.17226/27184

  • Competencies for the Use of Artificial Intelligence in Primary Care. Annals of family medicine Liaw, W., Kueper, J. K., Lin, S., Bazemore, A., Kakadiaris, I. 2022; 20 (6): 559-563


    The artificial intelligence (AI) revolution has arrived for the health care sector and is finally penetrating the far-reaching but perpetually underfinanced primary care platform. While AI has the potential to facilitate the achievement of the Quintuple Aim (better patient outcomes, population health, and health equity at lower costs while preserving clinician well-being), inattention to primary care training in the use of AI-based tools risks the opposite effects, imposing harm and exacerbating inequalities. The impact of AI-based tools on these aims will depend heavily on the decisions and skills of primary care clinicians; therefore, appropriate medical education and training will be crucial to maximize potential benefits and minimize harms. To facilitate this training, we propose 6 domains of competency for the effective deployment of AI-based tools in primary care: (1) foundational knowledge (what is this tool?), (2) critical appraisal (should I use this tool?), (3) medical decision making (when should I use this tool?), (4) technical use (how do I use this tool?), (5) patient communication (how should I communicate with patients regarding the use of this tool?), and (6) awareness of unintended consequences (what are the "side effects" of this tool?). Integrating these competencies will not be straightforward because of the breadth of knowledge already incorporated into family medicine training and the constantly changing technological landscape. Nonetheless, even incremental increases in AI-relevant training may be beneficial, and the sooner these challenges are tackled, the sooner the primary care workforce and those served by it will begin to reap the benefits.

    View details for DOI 10.1370/afm.2887

    View details for PubMedID 36443071

  • The AI Will See You Now: Feasibility and Acceptability of a Conversational AI Medical Interviewing System. JMIR formative research Hong, G., Smith, M., Lin, S. 2022; 6 (6): e37028


    Primary care physicians (PCPs) are often limited in their ability to collect detailed medical histories from patients, which can lead to errors or delays in diagnosis. Recent advances in artificial intelligence (AI) show promise in augmenting current human-driven methods of collecting personal and family histories; however, such tools are largely unproven.The main aim of this pilot study was to evaluate the feasibility and acceptability of a conversational AI medical interviewing system among patients.The study was conducted among adult patients empaneled at a family medicine clinic within a large academic medical center in Northern California. Participants were asked to test an AI medical interviewing system, which uses a conversational avatar and chatbot to capture medical histories and identify patients with risk factors. After completing an interview with the AI system, participants completed a web-based survey inquiring about the performance of the system, the ease of using the system, and attitudes toward the system. Responses on a 7-point Likert scale were collected and evaluated using descriptive statistics.A total of 20 patients with a mean age of 50 years completed an interview with the AI system, including 12 females (60%) and 8 males (40%); 11 were White (55%), 8 were Asian (40%), and 1 was Black (5%), and 19 had at least a bachelor's degree (95%). Most participants agreed that using the system to collect histories could help their PCPs have a better understanding of their health (16/20, 80%) and help them stay healthy through identification of their health risks (14/20, 70%). Those who reported that the system was clear and understandable, and that they were able to learn it quickly, tended to be younger; those who reported that the tool could motivate them to share more comprehensive histories with their PCPs tended to be older.In this feasibility and acceptability pilot of a conversational AI medical interviewing system, the majority of patients believed that it could help clinicians better understand their health and identify health risks; however, patients were split on the effort required to use the system, and whether AI should be used for medical interviewing. Our findings suggest areas for further research, such as understanding the user interface factors that influence ease of use and adoption, and the reasons behind patients' attitudes toward AI-assisted history-taking.

    View details for DOI 10.2196/37028

    View details for PubMedID 35759326

  • Predicting Avoidable Health Care Utilization: Practical Considerations for Artificial Intelligence/Machine Learning Models in Population Health. Mayo Clinic proceedings Lin, S., Shah, S., Sattler, A., Smith, M. 2022; 97 (4): 653-657

    View details for DOI 10.1016/j.mayocp.2021.11.039

    View details for PubMedID 35379419

  • Using AI to Empower Collaborative Team Workflows: Two Implementations for Advance Care Planning and Care Escalation NEJM Catalyst Innovations in Care Delivery Li, R., Smith, M., Lu, J., Avati, A., Wang, S., Teuteberg, W., Shum, K., Hong, G., Seevaratnam, B., Westphal, J., Dougherty, M., Rao, P., Asch, S., Lin, S., Sharp, C., Shieh, L., Shah, N. 2022; 3 (4)

    View details for DOI 10.1056/CAT.21.0457

  • Meeting the Moment: Addressing Barriers and Facilitating Clinical Adoption of Artificial Intelligence in Medical Diagnosis NAM Perspectives Adler-Milstein, J., Aggarwal, N., Ahmed, M., Castner, J., Evans, B., Gonzalez, A., James, C., Lin, S., Mandl, K., Matheny, M., Sendak, M., Shachar, C., Williams, A. 2022

    View details for DOI 10.31478/202209c

  • Unlocking New Opportunities for AI-enabled Diagnosis Adler-Milstein, J., Chen, J., Clifford, G., Silcox, C., Curtis, L., Denny, J., Dhaliwal, G., Elhadad, N., Geras, K., Halamka, J., Kaushal, M., Johnson, A., Obermeyer, Z., Ossorio, P., Overhage, M., Peng, G., Sendak, M., Tang, P., Coleman, D., Gong, J., Rosenthal, S., Thao, C., Lin, S. Gordon and Betty Moore Foundation and UCSF Center for Clinical Informatics and Improvement Research. 2022
  • Considerations in the reliability and fairness audits of predictive models for advance care planning Frontiers in Digital Health Lu, J., Sattler, A., Wang, S., Khaki, A. R., Callahan, A., Fleming, S., Fong, R., Ehlert, B., Li, R., Shieh, L., Ramchandran, K., Gensheimer, M., Chobot, S., Pfohl, S., Li, S., Shum, K., Parikh, N., Desai, P., Seevaratnam, B., Hanson, M., Smith, M., Xu, Y., Gokhale, A., Lin, S., Shah, N. 2022: 943768
  • Advancing primary care with Artificial Intelligence and Machine Learning. Healthcare (Amsterdam, Netherlands) Yang, Z., Silcox, C., Sendak, M., Rose, S., Rehkopf, D., Phillips, R., Peterson, L., Marino, M., Maier, J., Lin, S., Liaw, W., Kakadiaris, I. A., Heintzman, J., Chu, I., Bazemore, A. 1800; 10 (1): 100594


    Primary care is the largest healthcare delivery platform in the US. Facing the Artificial Intelligence and Machine Learning technology (AI/ML) revolution, the primary care community would benefit from a roadmap revealing priority areas and opportunities for developing and integrating AI/ML-driven clinical tools. This article presents a framework that identifies five domains for AI/ML integration in primary care to support care delivery transformation and achieve the Quintuple Aims of the healthcare system. We concluded that primary care plays a critical role in developing, introducing, implementing, and monitoring AI/ML tools in healthcare and must not be overlooked as AI/ML transforms healthcare.

    View details for DOI 10.1016/j.hjdsi.2021.100594

    View details for PubMedID 34954571

  • A Clinician's Guide to Artificial Intelligence (AI): Why and How Primary Care Should Lead the Health Care AI Revolution. Journal of the American Board of Family Medicine : JABFM Lin, S. 2021; 35 (1): 175-184


    Artificial intelligence (AI) in health care is the future that is already here. Despite its potential as a transformational force for primary care, most primary care providers (PCPs) do not know what it is, how it will impact them and their patients, and what its key limitations and ethical pitfalls are. This article is a beginner's guide to health care AI, written for the frontline PCP. Primary care-as the dominant force at the base of the health care pyramid, with its unrivaled interconnectedness to every part of the health system and its deep relationship with patients and communities-is the most uniquely suited specialty to lead the health care AI revolution. PCPs can advance health care AI by partnering with technologists to ensure that AI use cases are relevant and human-centered, applying quality improvement methods to health care AI implementations, and advocating for inclusive and ethical AI that combats, rather than worsens, health inequities.

    View details for DOI 10.3122/jabfm.2022.01.210226

    View details for PubMedID 35039425

  • Technology-Enabled and Artificial Intelligence Support for Pre-Visit Planning in Ambulatory Care: Findings From an Environmental Scan. Annals of family medicine Holdsworth, L. M., Park, C., Asch, S. M., Lin, S. 2021; 19 (5): 419-426


    PURPOSE: Pre-visit planning (PVP) is believed to improve effectiveness, efficiency, and experience of care, yet numerous implementation barriers exist. There are opportunities for technology-enabled and artificial intelligence (AI) support to augment existing human-driven PVP processes-from appointment reminders and pre-visit questionnaires to pre-visit order sets and care gap closures. This study aimed to explore the current state of PVP, barriers to implementation, evidence of impact, and potential use of non-AI and AI tools to support PVP.METHODS: We used an environmental scan approach involving: (1) literature review; (2) key informant interviews with PVP experts in ambulatory care; and (3) a search of the public domain for technology-enabled and AI solutions that support PVP. We then synthesized the findings using a qualitative matrix analysis.RESULTS: We found 26 unique PVP implementations in the literature and conducted 16 key informant interviews. Demonstration of impact is typically limited to process outcomes, with improved patient outcomes remaining elusive. Our key informants reported that many PVP barriers are human effort-related and see potential for non-AI and AI technologies to support certain aspects of PVP. We identified 8 examples of commercially available technology-enabled tools that support PVP, some with AI capabilities; however, few of these have been independently evaluated.CONCLUSIONS: As health systems transition toward value-based payment models in a world where the coronavirus disease 2019 pandemic has shifted patient care into the virtual space, PVP activities-driven by humans and supported by technology-may become more important and powerful and should be rigorously evaluated.

    View details for DOI 10.1370/afm.2716

    View details for PubMedID 34546948

  • Voice Assistants and Cancer Screening: A Comparison of Alexa, Siri, Google Assistant, and Cortana. Annals of family medicine Hong, G., Folcarelli, A., Less, J., Wang, C., Erbasi, N., Lin, S. 2021; 19 (5): 447-449


    Despite increasing interest in how voice assistants like Siri or Alexa might improve health care delivery and information dissemination, there is limited research assessing the quality of health information provided by these technologies. Voice assistants present both opportunities and risks when facilitating searches for or answering health-related questions, especially now as fewer patients are seeing their physicians for preventive care due to the ongoing pandemic. In our study, we compared the 4 most widely used voice assistants (Amazon Alexa, Apple Siri, Google Assistant, and Microsoft Cortana) and their ability to understand and respond accurately to questions about cancer screening. We show that there are clear differences among the 4 voice assistants and that there is room for improvement across all assistants, particularly in their ability to provide accurate information verbally. In order to ensure that voice assistants provide accurate information about cancer screening and support, rather than undermine efforts to improve preventive care delivery and population health, we suggest that technology providers prioritize partnership with health professionals and organizations.

    View details for DOI 10.1370/afm.2713

    View details for PubMedID 34546951

  • From Code to Bedside: Implementing Artificial Intelligence Using Quality Improvement Methods. Journal of general internal medicine Smith, M. n., Sattler, A. n., Hong, G. n., Lin, S. n. 2021


    Despite increasing interest in how artificial intelligence (AI) can augment and improve healthcare delivery, the development of new AI models continues to outpace adoption in existing healthcare processes. Integration is difficult because current approaches separate the development of AI models from the complex healthcare environments in which they are intended to function, resulting in models developed without a clear and compelling use case and not tested or scalable in a clinical setting. We propose that current approaches and traditional research methods do not support successful AI implementation in healthcare and outline a repeatable mixed-methods approach, along with several examples, that facilitates uptake of AI technologies into human-driven healthcare processes. Unlike traditional research, these methods do not seek to control for variation, but rather understand it to learn how a technology will function in practice coupled with user-centered design techniques. This approach, leveraging design thinking and quality improvement methods, aims to increase the adoption of AI in healthcare and prompt further study to understand which methods are most successful for AI implementations.

    View details for DOI 10.1007/s11606-020-06394-w

    View details for PubMedID 33469745

  • The Stanford Healthcare AI Applied Research Team Strategic Plan: 2022-2025 Smith, M., Sattler, A., Shah, S., Hong, G., Lin, S. Stanford Medicine. 2021
  • Increasing Patient Activation at a Student-Run Free Clinic: Effectiveness of a Health Education Intervention J Stud Run Clin Dutta, R., Shearer, E., Garcia, L., Liu, H., Swee, J., Ku, S., Lai, C., Lin, S., Montacute, T., Charon, M. 2021; 7 (1): 1-8
  • Future of Telehealth STFM National Telemedicine Curriculum for Medical Students and Residents Teerink, D., Bajra, R., Fuchs, L., Patel, M., Jortberg, B., Theobald, M., Lin, S. The Society of Teachers of Family Medicine. 2021
  • Access and Equity in Telehealth STFM National Telemedicine Curriculum for Medical Students and Residents Fuchs, L., Bajra, R., Patel, M., Teerink, D., Jortberg, B., Theobald, M., Lin, S. The Society of Teachers of Family Medicine. 2021
  • Requirements for Telehealth STFM National Telemedicine Curriculum for Medical Students and Residents Patel, M., Bajra, R., Fuchs, L., Teerink, D., Jortberg, B., Theobald, M., Lin, S. The Society of Teachers of Family Medicine. 2021
  • The Telehealth Encounter STFM National Telemedicine Curriculum for Medical Students and Residents Bajra, R., Fuchs, L., Patel, M., Teerink, D., Jortberg, B., Theobald, M., Lin, S. The Society of Teachers of Family Medicine. 2021
  • Introduction to Telehealth STFM National Telemedicine Curriculum for Medical Students and Residents Jortberg, B., Bajra, R., Fuchs, L., Patel, M., Teerink, D., Theobald, M., Lin, S. The Society of Teachers of Family Medicine. 2021
  • Empowering Team-Based Advance Care Planning with Artificial Intelligence Avati, A., Li, R., Smith, M., Lu, J., Ng, A., Shah, N., et al Medium. 2021
  • Clinicians’ Experiences with EHR Documentation and Attitudes Toward AI-Assisted Documentation Hong, G., Wilcox, L., Sattler, A., Thomas, S., Gonzalez, N., Smith, M., Hernandez, J., Smith, M., Lin, S., Harrington, R. Stanford Medicine and Google Health. 2021
  • Balancing Forces: Medical Students' Reflections on Professionalism Challenges and Professional Identity Formation. Family medicine Maitra, A. n., Lin, S. n., Rydel, T. A., Schillinger, E. n. 2021; 53 (3): 200–206


    Professionalism is essential in medical education, yet how it is embodied through medical students' lived experiences remains elusive. Little research exists on how students perceive professionalism and the barriers they encounter. This study examines attitudes toward professionalism through students' written reflections.Family medicine clerkship students at Stanford University School of Medicine answered the following prompt: "Log a patient encounter in which you experienced a professionalism challenge or improvement opportunity." We collected and analyzed free-text responses for content and themes using a grounded theory approach.One hundred responses from 106 students generated a total of 168 codes; 13 themes emerged across four domains: challenging patients, interpersonal interactions, self-awareness, and health care team dynamics. The three most frequently occurring themes were interacting with emotional patients, managing expectations in the encounter, and navigating the trainee role.Medical students view professionalism as a balance of forces. While many students conceived of professionalism in relation to patient encounters, they also described how professionalism manifests in inner qualities as well as in health systems. Interpersonal challenges related to communication and agenda-setting are predominant. Systems challenges include not being seen as the "real doctor" and being shaped by team behaviors through the hidden curriculum. Our findings highlight salient professionalism challenges and identity conflicts for medical students and suggest potential educational strategies such as intentional coaching and role-modeling by faculty. Overall, students' reflections broaden our understanding of professional identity formation in medical training.

    View details for DOI 10.22454/FamMed.2021.128713

    View details for PubMedID 33723818

  • Five Years' Experience With a Medical Scribe Fellowship: Shaping Future Health Professions Students While Addressing Provider Burnout. Academic medicine : journal of the Association of American Medical Colleges Lin, S., Duong, A., Nguyen, C., Teng, V. 2020


    Professional burnout has reached epidemic levels among U.S. medical providers. One key driver is the burden of clinical documentation in the electronic health record, which has given rise to medical scribes. Despite the demonstrated benefits of scribes, many providers-especially those in academic health systems-have been unable to make an economic case for them. With the aim of creating a cost-effective scribe program in which premedical students gain skills that better position them for professional schooling, while providers at risk of burnout obtain documentation support, the authors launched the Clinical Observation and Medical Transcription (COMET) Program in June 2015 at Stanford University School of Medicine. COMET is a new type of postbaccalaureate premedical program that combines an apprenticeship-like scribing experience and a package of teaching, advising, application support, and mentored scholarship that is supported by student tuition. Driven by strong demand from both participants and faculty, the program grew rapidly during its first 5 years (2015-2020). Program evaluations indicated high levels of satisfaction among participants and faculty with their mentors and mentees, respectively; that participants felt the experience better positioned them for professional schooling; and that faculty reported improved joy of practice. In summary, tuition-supported medical scribe programs, like COMET, appear to be feasible and cost-effective. The COMET model may have the potential to help shape future health professions students, while simultaneously combating provider burnout. While scalability and generalizability remain uncertain, this model may be worth exploring at other institutions.

    View details for DOI 10.1097/ACM.0000000000003757

    View details for PubMedID 32969839

  • Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan. Family medicine Nelligan, I., Montacute, T., Browne, M., Lin, S. 2020; 52 (6): 417–21


    BACKGROUND AND OBJECTIVES: Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians.METHODS: We examined claims data for procedures performed on patients insured under our AMC's home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI).RESULTS: Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33.CONCLUSION: A family medicine minor procedure service significantly lowered health spending at our AMC.

    View details for DOI 10.22454/FamMed.2020.334308

    View details for PubMedID 32520375

  • The Present and Future of Team Documentation: The Role of Patients, Families, and Artificial Intelligence. Mayo Clinic proceedings Lin, S. 2020; 95 (5): 852–55

    View details for DOI 10.1016/j.mayocp.2020.01.034

    View details for PubMedID 32370849

  • Resolution of bilateral testicular masses after viral infection Urology Case Reports Vilson, F., Lin, S., Schmidt, B. 2020; 33: 101388
  • Scribe impacts on US health care: Benefits may go beyond cost efficiency. The Journal of allergy and clinical immunology Reick-Mitrisin, V. n., MacDonald, M. n., Lin, S. n., Hong, S. n. 2020; 145 (2): 479–80

    View details for DOI 10.1016/j.jaci.2019.12.900

    View details for PubMedID 31887392

  • Retooling Primary Care in the COVID-19 Era. Mayo Clinic proceedings Lin, S. n., Sattler, A. n., Smith, M. n. 2020; 95 (9): 1831–34

    View details for DOI 10.1016/j.mayocp.2020.06.050

    View details for PubMedID 32861324

  • Ten Ways Artificial Intelligence Will Transform Primary Care JOURNAL OF GENERAL INTERNAL MEDICINE Lin, S. Y., Mahoney, M. R., Sinsky, C. A. 2019; 34 (8): 1626–30
  • 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


    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

  • 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


    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

  • 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
  • Incorporating Students Into Your Clinical Workflow Medical School Faculty Fundamentals Certificate Program Lin, S. The Society of Teachers of Family Medicine. 2019
  • 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


    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

  • Reimagining Clinical Documentation With Artificial Intelligence MAYO CLINIC PROCEEDINGS Lin, S. Y., Shanafelt, T. D., Asch, S. M. 2018; 93 (5): 563–65
  • Residents' Perspectives on Careers in Academic Medicine: Obstacles and Opportunities. Family medicine Lin, S. n., Nguyen, C. n., Walters, E. n., Gordon, P. n. 2018; 50 (3): 204–11


    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

  • 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
  • A Model Medical Student-Led Interprofessional QI Project on Lab Monitoring. PRiMER (Leawood, Kan.) Kim, C. n., Lin, S. n., Sattler, A. L. 2018; 2: 13


    Teaching quality improvement (QI) in undergraduate medical education to meet entrustable professional activities (EPA) requirements is a challenge. We describe a model where first-year medical students learn QI methods using online modules and then apply their knowledge by leading an interprofessional project in a clinical setting. This model project, set in an outpatient family medicine clinic, sought to improve patient compliance with the preventive care metric of annual serum potassium and creatinine monitoring for patients taking a diuretic, angiotensin-converting enzyme inhibitor (ACEI), or angiotensin receptor blocker (ARB) medication.A first-year medical student joined an interprofessional team of one primary care physician and three pharmacy residents. The student led the team in reviewing patient charts to identify root causes and implementing a multifaceted strategy to improve patient outreach and refill policies. The effects of these interventions were monitored weekly using an electronic health record population health tool (Epic's Healthy Planet) over the course of 10 months.At baseline, 76.7% (477/622) of patients taking a diuretic and 79.4% (752/947) taking an ACEI or ARB were compliant with monitoring, approximately 10% below the Healthcare Effectiveness Data and Information Set (HEDIS) recommendations. Within 6 months, interventions resulted in both patient cohorts meeting the HEDIS metric with sustained success for the study duration of 10 months.This report demonstrates that a first-year medical student can make meaningful contributions to preventive care while gaining clinically relevant QI experience. Further evaluation is needed to determine generalizability and scalability of this model.

    View details for DOI 10.22454/PRiMER.2018.187050

    View details for PubMedID 32818186

    View details for PubMedCentralID PMC7426132

  • One Year of Family Physicians' Observations on Working with Medical Scribes The Journal of the American Board of Family Medicine Sattler, A., Rydel, T., Nguyen, C., Lin, S. 2018; 31 (1): 49-56
  • Impact of Scribes on Medical Student Education: A Mixed-Methods Pilot Study. Family medicine Hafer, J. n., Wu, X. n., Lin, S. n. 2018; 50 (4): 283–86


    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

  • Preparing Residents for Teaching Careers: The Faculty for Tomorrow Resident Workshop FAMILY MEDICINE Lin, S., Gordon, P. 2017; 49 (3): 225-229


    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


    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. n., Mahoney, M. n., Singh, B. n., Schillinger, E. n. 2017; 49 (8): 640–43


    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

  • 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. n., Boggiano, V. L., Ye, P. P., Lin, S. n. 2017; 28 (4): 1276–85


    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

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


    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

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


    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

  • 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


    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


    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

  • Next big thing: integrating medical scribes into academic medical centres. BMJ simulation & technology enhanced learning Lin, S., Khoo, J., Schillinger, E. 2016; 2 (2): 27-29

    View details for DOI 10.1136/bmjstel-2015-000054

    View details for PubMedID 35518194

    View details for PubMedCentralID PMC8936598

  • 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


    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

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


    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


    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

  • O’Connor-Stanford Leaders in Education Residency Program Handbook (3rd ed) Lin, S. Stanford O'Connor Family Medicine Residency. 2015
  • 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


    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


    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

  • L’Allegro: the antidepressant chooser for primary care physicians (2nd ed) Lin, S., Man, C., Stevens, M. Linvivo. 2014
  • O’Connor-Stanford Leaders in Education Residency Program Handbook (2nd ed) Lin, S. Stanford O'Connor Family Medicine Residency. 2014
  • 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
  • L’Allegro: the antidepressant chooser for primary care physicians Lin, S., Man, C., Stevens, M. Linvivo. 2013
  • O’Connor-Stanford Leaders in Education Residency Program Handbook Lin, S. Stanford O'Connor Family Medicine Residency. 2013
  • Ilithyia: evidence based prenatal care Lin, S., Man, C. Linvivo. 2012
  • 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


    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


    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


    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


    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

  • Cancer medicine: a novel curriculum for advanced high school students Lin, S. Education Program for Gifted Youth at Stanford University. 2007
  • Physician’s guide to hepatitis B Lin, S., So, S. Asian Liver Center at Stanford University. 2007
  • The fiery debate over children's health H&P Lin, S. 2007; 12 (1): 12-13
  • Bush's stem cell veto: ideology before science, politics before patients H&P Lin, S. 2007; 11 (3): 10-11
  • To list or not to list: two cases of mentally retarded children in need of solid organ transplants H&P Lin, S. 2007; 11 (2): 10-11
  • Sex, friendship and confidentiality H&P Lin, S. 2006; 11 (1): 11