Dr. Harman graduated from Case Western Reserve University School of Medicine. She then completed a residency in Internal Medicine at Stanford and a Palliative Care fellowship at the Palo Alto VA/Stanford program before joining the faculty at Stanford. She is the founding medical director of Palliative Care Services for Stanford Health Care and Associate Program Director for Stanford's Internal Medicine Residency Program. Her research and educational interests include communication training in healthcare and bioethics in end-of-life care.

Clinical Focus

  • Palliative Care
  • Internal Medicine
  • Biomedical Ethics

Academic Appointments

Administrative Appointments

  • Ethics Committee, Co-Chair (2013), Stanford University Medical Center (2007 - Present)
  • Professional Practice and Evaluation Committee, Stanford Department of Medicine (2009 - Present)
  • Associate Residency Program Director, Department of Medicine (2011 - Present)
  • Chairperson, Jonathan King Lectureship Committee, Stanford Center for Biomedical Ethics (2011 - Present)
  • Stanford Senior Physicians Disaster Management Committee, Stanford University Medical Center (2011 - Present)
  • Stanford Commitee on Professional Satisfaction and Support, Stanford University Medical Center (2012 - Present)
  • Leadership Council on Clinical Excellence, Stanford Department of Medicine (2014 - Present)

Honors & Awards

  • Isaac Stein Award for Compassionate Care, Stanford Hospital and Clinics Board of Directors (September 23, 2009)
  • Fellow, Stanford Faculty Fellows Program, Stanford University School of Medicine (2013-2014)
  • Arnold P. Gold Professorship, Arnold P. Gold Foundation (2011-2014)

Boards, Advisory Committees, Professional Organizations

  • Member, American Academy of Hospice and Palliative Medicine (2007 - Present)
  • Member, American Academy on Communication in Healthcare (2011 - Present)
  • Associate Editor, PC-FACS (publication of the AAHPM) (2013 - Present)
  • Leader, Palliative Medicine Interest Group, Society of General Internal Medicine (2013 - Present)
  • Ethics Committee Member, Society of General Internal Medicine (2015 - Present)

Professional Education

  • Residency:Stanford University Hospital -Clinical Excellence Research Center (2006) CA
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2006)
  • Board Certification: Hospice and Palliative Medicine, American Board of Internal Medicine (2008)
  • Fellowship:Palo Alto VA Healthcare System (2007) CA
  • Medical Education:Case Western Reserve University School of Medicine (2003) OH

Research & Scholarship

Clinical Trials

  • A ProspectiveTrial Using Video Images in Advance Care Planning in Hospitalized Seriously Ill Patients With Advanced Cancer Not Recruiting

    The purpose of this study is to compare the decision making of hospitalized subjects with advanced cancer having a verbal discussion about CPR compared to subjects using a video.

    Stanford is currently not accepting patients for this trial. For more information, please contact Ryan Oden, (650) 725 - 5417.

    View full details


2016-17 Courses

Graduate and Fellowship Programs


All Publications

  • The State of Medical Student Performance Evaluations: Improved Transparency or Continued Obfuscation? Academic medicine Hom, J., Richman, I., Hall, P., Ahuja, N., Harman, S., Harrington, R., Witteles, R. 2016; 91 (11): 1534-1539


    The medical student performance evaluation (MSPE), a letter summarizing academic performance, is included in each medical student's residency application. The extent to which medical schools follow Association of American Medical Colleges (AAMC) recommendations for comparative and transparent data is not known. This study's purpose was to describe the content, interpretability, and transparency of MSPEs.This cross-sectional study examined one randomly selected MSPE from every Liaison Committee on Medical Education-accredited U.S. medical school from which at least one student applied to the Stanford University internal medical residency program during the 2013-2014 application cycle. The authors described the number, distribution, and range of key words and clerkship grades used in the MSPEs and the proportions of schools with missing or incomplete data.The sample included MSPEs from 117 (89%) of 131 medical schools. Sixty schools (51%) provided complete information about clerkship grade and key word distributions. Ninety-six (82%) provided comparative data for clerkship grades, and 71 (61%) provided complete key word data. Key words describing overall performance were extremely heterogeneous, with a total of 72 used and great variation in the assignment of the top designation (median: 24% of students; range: 1%-60%). There was also great variation in the proportion of students awarded the top internal medicine clerkship grade (median: 29%; range: 2%-90%).The MSPE is a critical component of residency applications, yet data contained within MSPEs are incomplete and variable. Approximately half of U.S. medical schools do not follow AAMC guidelines for MSPEs.

    View details for PubMedID 26703411

  • A resident-created hospitalist curriculum for internal medicine housestaff. Journal of hospital medicine Kumar, A., Smeraglio, A., Witteles, R., Harman, S., Nallamshetty, S., Rogers, A., Harrington, R., Ahuja, N. 2016; 11 (9): 646-649


    The growth of hospital medicine has led to new challenges, and recent graduates may feel unprepared to meet the expanding clinical duties expected of hospitalists. At our institution, we created a resident-inspired hospitalist curriculum to address the training needs for the next generation of hospitalists. Our program provided 3 tiers of training: (1) clinical excellence through improved training in underemphasized areas of hospital medicine, (2) academic development through required research, quality improvement, and medical student teaching, and (3) career mentorship. In this article, we describe the genesis of our program, our final product, and the challenges of creating a curriculum while being internal medicine residents. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine.

    View details for DOI 10.1002/jhm.2590

    View details for PubMedID 27079160

  • Curricular Innovations for Medical Students in Palliative and End-of-Life Care: A Systematic Review and Assessment of Study Quality JOURNAL OF PALLIATIVE MEDICINE DeCoste-Lopez, J., Madhok, J., Harman, S. 2015; 18 (4): 338-349
  • Curricular innovations for medical students in palliative and end-of-life care: a systematic review and assessment of study quality. Journal of palliative medicine Decoste-Lopez, J., Madhok, J., Harman, S. 2015; 18 (4): 338-349


    Recent focus on palliative and end-of-life care has led medical schools worldwide to enhance their palliative care curricula.The objective of the study was to describe recent curricular innovations in palliative care for medical students, evaluate the quality of studies in the field, and inform future research and curricular design.The authors searched Medline, Scopus, and Educational Resource Information Center (ERIC) for English-language articles published between 2007 and 2013 describing a palliative care curriculum for medical students. Characteristics of the curricula were extracted, and methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).The sample described 48 curricula in 12 countries. Faculty were usually interdisciplinary. Palliative care topics included patient assessment, communication, pain and symptom management, psychosocial and spiritual needs, bioethics and the law, role in the health care system, interdisciplinary teamwork, and self-care. Thirty-nine articles included quantitative evaluation, with a mean MERSQI score of 9.9 (on a scale of 5 to 18). The domain most likely to receive a high score was data analysis (mean 2.51 out of 3), while the domains most likely to receive low scores were validity of instrument (mean 1.05) and outcomes (mean 1.31).Recent innovations in palliative care education for medical students represent varied settings, learner levels, instructors, educational modalities, and palliative care topics. Future curricula should continue to incorporate interdisciplinary faculty. Studies could be improved by integrating longitudinal curricula and longer-term outcomes; collaborating across institutions; using validated measures; and assessing higher-level outcomes including skills, behaviors, and impact on patient care.

    View details for DOI 10.1089/jpm.2014.0270

    View details for PubMedID 25549065

  • Patients Who Lack Capacity and Lack Surrogates: Can They Enroll in Hospice? JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Effiong, A., Harman, S. 2014; 48 (4): 745-U277
  • Patients who lack capacity and lack surrogates: can they enroll in hospice? Journal of pain and symptom management Effiong, A., Harman, S. 2014; 48 (4): 745-50 e1


    Patients who lack capacity and lack surrogates are among the most vulnerable patients we care for in palliative care. In the case we present here, we have considered how to make end-of-life decisions for a patient who lacks both capacity and surrogates, who has a terminal illness, and who is not a candidate for disease-modifying treatments. We first define and characterize this population of patients through a review of the literature and then explore some decision-making quandaries that are encountered at the end of life. Finally, we make recommendations on how best to proceed with decision making for this vulnerable population.

    View details for DOI 10.1016/j.jpainsymman.2013.12.244

    View details for PubMedID 24709366

  • Late referral to palliative care consultation service: length of stay and in-hospital mortality outcomes. The Journal of community and supportive oncology Humphreys, J., Harman, S. 2014; 12 (4): 129-136


    Palliative care services in the United States are increasing in their prevalence but continue to vary in their implementation, with different referral policies and timing of patient access to services.To better define a late referral and to understand the association of late referrals to palliative care with patient health outcomes, including postreferral length of hospital stay and in-hospital mortality.We performed a retrospective study using multiple linear and logistic regressions on 1,225 patients with pre-existing oncologic diagnoses who received a referral to Stanford Hospital's palliative care service.Those oncologic patients who were referred to palliative care in the first week following admission had significantly shorter lengths of stay after referral, as well as lower in-hospital mortality, compared with patients who were referred later than 1 week following admission. Regression analyses, adjusted for demographic variables, DNR status, and sickness, revealed that waiting 1 week or longer to refer a patient was associated with an overall increased length of stay of 2.70 days (P < .001). This increased to 3.40 days (P < .001) when patients who died in the hospital were removed from the data, suggesting that in-hospital mortality was not solely responsible for the trend. Waiting 1 week to refer was associated with increased odds of a patient's dying in the hospital vs being discharged alive by a factor of 3.04 (P < .001).This study was limited to analyzing inpatient palliative care consultation services with a emphasis on patients with metastatic solid tumors. We used a proxy for patient sickness burden but did not analyze outcomes specific to cancer stage or individual oncologic diagnosis separately.Our study suggests that late referrals may have a marked negative impact on health outcomes, which argues for the design and implementation of hospital policies that encourage early referral to palliative care for advanced cancer patients.

    View details for PubMedID 24971422

  • Update in Palliative Care-2011 JOURNAL OF GENERAL INTERNAL MEDICINE Harris, P. F., Arnold, R. M., Braun, U. K., Fromme, E., Ghermay, R., Harman, S., Jayes, R. L., Walling, A. M. 2012; 27 (5): 582-587


    The aim of this update is to summarize scientifically rigorous articles published in 2010 that serve to advance the field of palliative medicine and have an impact on clinical practice.We conducted two separate literature searches for articles published between January 1, 2010 and December 31, 2010. We reviewed title pages from the Annals of Internal Medicine, British Medical Journal, Journal of the American Geriatrics Society, JAMA, Journal of Clinical Oncology, JGIM, Journal of Pain and Symptom Management, Journal of Palliative Medicine, Lancet, New England Journal of Medicine, PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care). We also conducted a Medline search with the key words "palliative," "hospice," and "terminal" care. Each author presented approximately 20 abstracts to the group. All authors reviewed these abstracts, and when needed, full text publications. We focused on articles relevant to general internists. We rated the articles individually, eliminating by consensus those that were not deemed of highest priority, and discussed the final choices as a group.We first identified 126 articles with potential relevance. We presented 20 at the annual SGIM update session, and discuss 11 in this paper.

    View details for DOI 10.1007/s11606-011-1929-9

    View details for Web of Science ID 000302869300019

    View details for PubMedID 22127796

  • Palliative Care Rounds: Toward Evidence-Based Practice JOURNAL OF PAIN AND SYMPTOM MANAGEMENT Dy, S. M., Harman, S. M., Braun, U. K., Howie, L. J., Harris, P. F., Jayes, R. L. 2012; 43 (4): 795-801