N Ascher

University of California, San Francisco, San Francisco, California, United States

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Publications (103)443.56 Total impact

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    ABSTRACT: The purpose of this study was to assess first-year medical students' implicit perceptions of surgeons, focusing on the roles of gender and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). Survey study. Each survey had 1 of 8 possible scenarios; all began with a short description of a surgeon who was described as accomplished and well trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal), and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through 5 questions. These 5 items were averaged to create a composite perception score scaled from 0 to 5. Surveys were administered at the University of California, San Francisco, and the University of California, Los Angeles. We administered surveys to 333 first-year medical students who could read English and voluntarily agreed to participate. A total of 238 students responded (71.5%). They preferred the communal vs agentic surgeon (4.2 ± 0.7 vs 3.9 ± 0.7, p = 0.002) and male medical students perceived surgeons more favorably than female medical students did (4.2 ± 0.6 vs 4.0 ± 0.8, p = 0.036). The preference score did not differ according to surgeon gender (female 4.12 vs male 3.98, p = 0.087). There were no significant interactions between the factors of student gender, surgeon gender, or demeanor. Students who reported an interest in surgery as a career did not perceive surgeons more favorably than the students interested in other fields (4.3 ± 0.7 vs 4.0 ± 0.7 respectively, p = 0.066). Based on our findings, surgeon educators would likely find success in teaching and recruiting medical students by employing a communal demeanor in their interactions with all students, regardless of the students' gender or stated interest in surgery. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Journal of Surgical Education
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    ABSTRACT: Optimizing the surgeon-nurse relationship to improve interprofessional communication is increasingly recognized as an essential component of patient care. The increasing number of women surgeons has altered the surgeon-nurse dynamic, which has traditionally been a male-female relationship. In particular, this shift has raised the issue of whether implicit perceptions regarding gender and demeanor influence the interactions between surgeons and nurses. Therefore, the purpose of this study was to understand nurses' implicit perceptions of surgeons, with a particular focus on gender and gender-normative demeanor. We defined two types of demeanor: communal, which is classically associated with women and includes being supportive and nurturing, and agentic, which is a male-associated trait that includes being direct and assertive. We administered surveys to 1701 nurses at the main campus of our institution. Each survey had one of eight possible scenarios; all began with a short description of a surgeon who was described as accomplished and well-trained, then varied by surgeon gender (male/female), surgeon demeanor (agentic/communal) and type of surgery (breast cancer/lung cancer). Using a 0 to 5 scale, respondents rated their perception of the surgeon through five questions. These five items were averaged to create a composite perception score scaled from 0 to 5. We received 493 surveys. The overall average perception score was 3.8±0.99. Respondents had a statistically significant preference for the communal surgeon (4.1±0.91) versus the agentic surgeon (3.6±1.0, p<0.001). There were no significant main effects of surgeon gender or surgery type. Nurses demonstrated a significant preference for communal surgeons, regardless of surgeon gender. Copyright © 2014. Published by Elsevier Ltd.
    No preview · Article · Dec 2014 · International Journal of Surgery (London, England)
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    ABSTRACT: Background: Perceptions underlie bias and drive behavior. This study assessed female surgeons' implicit perceptions of surgeons, with a focus on the roles of sex and demeanor (communal = supportive, associated with women; agentic = assertive, associated with men). Methods: Electronic surveys were administered via the Association of Women Surgeons e-mail listserve to 550 post-training female surgeons. Each survey had one of the 4 possible scenarios that varied by surgeon sex (male/female) and surgeon demeanor (agentic/communal). Respondents rated their perception of the surgeon through 5 questions regarding preference and 5 questions regarding professional opinion (1 to 5 scale). Results: We received 212 surveys. In both preference and professional scores, female surgeons were rated significantly higher compared with their male counterparts (4.7 vs 4.4 and 4.3 vs 4.0, respectively). Communal surgeons were rated significantly higher versus agentic surgeons in both scores (4.7 vs 4.4 and 4.6 vs 3.7). Conclusions: Female surgeons demonstrated a significant preference for female surgeons and for communal surgeons.
    No preview · Article · Jul 2014 · The American Journal of Surgery
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    ABSTRACT: Background Perceptions underlie bias and drive behavior. This study assessed female surgeons’ implicit perceptions of surgeons, with a focus on the roles of gender and demeanor (communal=supportive, associated with women; agentic=assertive, associated with men). Methods Electronic surveys were administered via the Association of Women Surgeons email list serve to 550 post-training female surgeons. Each survey had one of four possible scenarios that varied by surgeon gender (male/female) and surgeon demeanor (agentic/communal). Respondents rated their perception of the surgeon through five questions regarding preference and five questions regarding professional opinion (1-5 scale). Results We received 212 surveys. In both preference and professional scores, female surgeons were rated significantly higher compared with their male counterparts (4.7 vs. 4.4 and 4.3 vs. 4.0, respectively). Communal surgeons were rated significantly higher versus agentic surgeons in both scores (4.7 vs. 4.4 and 4.6 vs. 3.7). Conclusion Female surgeons demonstrated a significant preference for female surgeons and for communal surgeons.
    No preview · Article · Jan 2014
  • Marie N Dusch · Patricia S O'Sullivan · Nancy L Ascher
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    ABSTRACT: As more women become surgeons, knowledge of patient perceptions is necessary to educate this new pool of surgeons on how to maximize patient trust and foster the optimal surgeon-patient relationship. Patients in a general medicine clinic in San Francisco were surveyed. Study respondents read one of the eight short scenarios that differed by surgeon gender, surgery type (lung cancer versus breast cancer), and surgeon demeanor (more masculine-agentic versus more feminine-communal). In all scenarios, the surgeon was described as accomplished and well trained. After reading the short description, respondents rated five items from 0-5, which were averaged to create a measure of preference. Based on the 476 completed surveys, respondents did not have a significant preference for either female or male surgeons (P = 0.76). We found a significant interaction in respondent choice between the surgeon demeanor and the type of surgery (P < 0.05). Respondents preferred an agentic surgeon for lung cancer surgery and a communal surgeon for breast cancer surgery regardless of surgeon or respondent gender. No other interactions or main effects were statistically significant. Our respondents did not overtly prefer a surgeon based on gender, which suggests that patients may not contribute to the traditional gender biases reported by female surgeons. Further work needs to be done to determine if our results can be replicated in different geographic regions and if there is gender stereotyping within the field of surgery.
    No preview · Article · Oct 2013 · Journal of Surgical Research
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    ABSTRACT: Living donor liver transplantation (LDLT), originally used in children with left lateral segment grafts, has been expanded to adults who require larger grafts to support liver function. Most adult LDLT procedures have been performed with right lobe grafts, and this means a significant risk of morbidity for the donors. To minimize the donor risk for adults, there is renewed interest in smaller left lobe grafts. The smaller graft size increases the recipient risk in the form of small-for-size syndrome (SFSS) and essentially transfers the risk from the donor to the recipient. We review the donor and recipient risks of LDLT and pay particular attention to the different types of liver grafts and the use of graft inflow modification to ameliorate the risk of SFSS. Finally, a new metric is proposed for quantifying the recipient benefit in exchange for a specific donor risk. Liver Transpl 19:472–481, 2013. © 2013 AASLD.
    No preview · Article · May 2013 · Liver Transplantation
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    ABSTRACT: Despite the growing need for organ donation among Asian Americans, studies suggest that they are reluctant to donate. To examine the association of attitudes and knowledge about organ donation and transplantation with willingness to donate and willingness to engage in family discussion about organ donation among Asian American adolescents. A cross-sectional study. The Big Island of Hawaii. Self-identified Asian American adolescents (Japanese, Chinese, Filipino, Korean), ages 16 to 17 years old, and each adolescent's parent or guardian. Asian American adolescents provided demographic information and completed the Modified Organ Donation Attitude Survey, the Organ Donation and Transplantation Knowledge Survey, and the Suinn-Lew Asian Self-Identity Acculturation Scale. A parent or guardian also provided demographic information. Linear regression analyses were used to examine the associations with willingness to donate and to engage in family discussion about organ discussion. Willingness to donate was associated with positive knowledge related to general aspects about organ donation and cultural limitations in receiving an organ transplant, a high level of acculturation, and a low level of negative attitudes (R2 = 0.402, F = 18.86, P = .005). Asian American adolescents with approving or positive attitudes were likely to engage in family discussion about organ donation (R2 = 0.195, F = 27.93, P = .005). To reinforce and maintain high levels of knowledge and positive attitudes, organ donation education is most likely needed in high schools.
    Full-text · Article · Mar 2012 · Progress in transplantation (Aliso Viejo, Calif.)
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    ABSTRACT: Despite the importance of preclerkship experiences, surgical education has essentially remained confined to the third-year operating room experience. According to experience-based learning theory, the acquisition of new clinical knowledge is a dynamic process of social enculturation and professional identity development that requires active participation, clinical applicability, and direct interaction with doctors and other members of the medical team. In conjunction with a previously described surgical skills elective, we created a new clinical elective in which preclerkship medical students were assigned a surgical mentor and invited into the operating room to assist in surgeries. The elective paired 36 first-year students with 24 surgeons and instructed students to participate in at least 2 surgeries over the 3-month elective period. Students, surgeons, and operating room nurses filled out questionnaires after each surgery. Although 6 students failed to enter the operating room, 30 students scrubbed and gowned for a total of 62 procedures during the elective period. Although most students reported the operating room to be a comfortable learning environment in which they were actively included, students consistently underrated their performance and contribution to the surgical team compared with the surgeons' and nurses' ratings. With 75% of students who reported using a previously learned surgical skill during each surgery, this elective succeeded in allowing preclerkship medical students the opportunity to participate actively in the operating room. Early surgical exposure is critical for attracting student interest in careers in surgery. We believe that these early clinical experiences, combined with strong mentorship from the surgical faculty, will eventually lead to greater success during clerkships and greater interest in surgery as a career.
    No preview · Article · Jul 2008 · Journal of Surgical Education
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    ABSTRACT: Overall, the liver transplant experience at UCSF has been a highly successful one. The program has made major contributions to the advancement of liver transplantation as a field. The UCSF has pushed the envelope in, at times, including recipients that were thought to have absolute contraindications for liver transplantation. The program is a tribute to the many physicians, surgeons and ancillary personnel, as well as those that preceded them, and participated in their training that these past 20 years has been as rewarding and as productive as they have been.
    No preview · Article · Feb 2008 · Clinical transplants

  • No preview · Article · Feb 2008 · Journal of Surgical Research
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    ABSTRACT: Early introduction to surgical skills may serve several valuable purposes; medical students will acquire skills that will reduce their anxiety in approaching clerkships and improve the quality of patient care, and they will possibly become interested in surgery as a career. We designed an elective called "OR assist" for first and second year medical students based on needs identified from the literature and third year students. The elective comprised three sessions for a total of 6 hours and included instruction in surgical skills and operating room etiquette. We surveyed the students before and after the experience and also surveyed a group of control students. We assessed confidence in surgical skills and OR etiquette and concerns about surgical lifestyle, environment, and enthusiasm. Eight-six students participated and generally had some operating room experience. The 75 students with pre/post match data reported significant improvement in confidence in suturing, knots, and instrumentation (P < 0.001; effect sizes >1.0) and less concern about issues related to enthusiasm for surgery (P < 0.001; effect size = 0.5). The participants and controls did not differ at baseline except for identification of surgical instruments, which was higher for participants. After the experience, the participants were significantly more confident and had less concern about enthusiasm in surgery than the controls. An elective can be effective in improving students' confidence and reducing their concerns about surgery as a career. This is a unique opportunity for early exposure to surgical role models.
    No preview · Article · Nov 2007 · Journal of Surgical Research
  • Article: P30
    P. Derish · J. Maa · N. Ascher · H. Harris

    No preview · Article · Feb 2007 · Journal of Surgical Research
  • Article: P29

    No preview · Article · Feb 2007 · Journal of Surgical Research

  • No preview · Article · Jul 2004 · Transplantation

  • No preview · Article · Jul 2004 · Transplantation

  • No preview · Article · Nov 2001 · Transplantation Proceedings
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    ABSTRACT: The natural history and predictors of HCV-related disease severity post-transplantation are uncertain. The aims of this study were to define the natural history of post-transplantation HCV infection by assessing the rate of fibrosis progression, to determine if the post-transplantation natural history differs from that observed pre-transplantation, and to identify predictors of post-transplantation disease progression. Post-transplantation biopsies (mean: 3+/-1.6/patient) from 284 patients were scored according to histologic stage, using the method of Desmet et al. Change in fibrosis score (fibrosis progression/year) post-transplantation was used as the primary outcome. Predictors analyzed included viral factors (genotype and viral load at transplantation), patient demographics, year of transplantation, country of transplantation, pre-transplantation fibrosis progression, immunosuppression and laboratory data. There was a linear association between change in fibrosis score and time from transplantation, with a median rate of fibrosis progression per year of 0.3 (0.004-2.19/year). Using parametric time-to-event analysis, the expected median duration to cirrhosis was 10 years. The rate of post-transplantation fibrosis progression was significantly higher than pre-transplantation (0.2/year (0.09-0.8) p<0.0001), and higher in Spanish than US centers (0.48 (0.01-2.19) vs 0.28 (0.004-2.08); p=0.09) despite similar progression rates prior to transplantation. Variables independently associated with post-transplantation progression included year of transplantation (p=0.0001), race (p=0.02), number of methyl-prednisolone boluses (p=0.03), and HCV RNA levels at transplantation (p=0.01). HCV-related disease progression is accelerated in immunocompromised compared to immunocompetent patients, with a progressive increase in patients who have recently undergone liver transplantation. Changes in patient management post-transplantation over time and between transplant centers may account for the increase in fibrosis progression observed in recent years.
    No preview · Article · May 2000 · Journal of Hepatology

  • No preview · Article · Apr 1999 · Transplantation

  • No preview · Article · May 1998 · Transplantation

  • No preview · Article · Apr 1998 · Gastroenterology

Publication Stats

3k Citations
443.56 Total Impact Points

Institutions

  • 1992-2015
    • University of California, San Francisco
      • • Department of Surgery
      • • Division of Hospital Medicine
      San Francisco, California, United States
  • 2000
    • Hospital Universitari i Politècnic la Fe
      Valenza, Valencia, Spain
  • 1997
    • San Francisco VA Medical Center
      San Francisco, California, United States
  • 1979-1988
    • University of Minnesota Duluth
      • Laboratory Medicine and Pathology
      Duluth, Minnesota, United States
  • 1987
    • Children's Hospitals and Clinics of Minnesota
      Minneapolis, Minnesota, United States
  • 1984
    • University of Minnesota Medical Center, Fairview
      Minneapolis, Minnesota, United States