About

Katrina A Fletcher, MD, is an Assistant Professor of Clinical Psychiatry at the Perelman School of Medicine at the University of Pennsylvania. She holds multiple roles at the Children’s Hospital of Philadelphia, including Attending Psychiatrist in the Outpatient Pediatric Health and Behavior Clinic, and on Pennsylvania’s Telephonic Psychiatric Consultation Service Program. Dr. Fletcher is also the Associate Director of Behavioral Health Education in the Pediatric Residency Program, Co-Director of Pediatric Advanced Skills in Behavioral Health, Medical Director of the Telephonic Psychiatric Consultation Service Program (TiPS), and Program Director of the Post Pediatric Portal Program. Her work focuses on pediatric mental health, behavioral health education, and clinical pathways for anxiety and obsessive-compulsive disorder in outpatient settings. She has contributed to research and educational initiatives aimed at improving mental health care for children and adolescents, including simulation-based education for pediatric residents and community partnerships for public health advocacy.

Research topics

• Medicine
• Family medicine
• Medical education
• Psychology
• Nursing

Selected publications

• The Prevalence and Characteristics of Difficult Patient Encounters

  Annals of Internal Medicine · 2026-01-12 · 3 citations

  articleSenior author

  BACKGROUND: Patients are sometimes experienced as difficult by their providers. PURPOSE: To estimate the prevalence of difficult patient encounters among adults being seen in nonpsychiatric settings. Secondary goals were to assess patient and provider characteristics associated with difficulty as well as patient outcomes. DATA SOURCES: MEDLINE, Web of Science, SciELO, ProQuest, Theses, Scopus, PsycInfo, Cochrane Central Register of Controlled Trials, Global Index Medicus, and EMBASE (inception through 7 July 2025). STUDY SELECTION: In duplicate and independently. DATA EXTRACTION: Prevalence, patient characteristics (sex, mental health diagnosis, somatization, personality disorders, and chronic pain), provider characteristics (type of provider, encounter setting, burnout, years of experience, and sex), and encounter outcomes (patient unmet expectations and satisfaction) were extracted in duplicate. DATA SYNTHESIS: The prevalence of difficult encounters among clinic patients was 0.17 (95% CI, 0.15 to 0.19). Patient characteristics that increased difficulty included personality disorders (relative risk [RR], 2.2 [CI, 1.5 to 3.1]), depression (RR, 1.9 [CI, 1.7 to 2.2]), anxiety (RR, 2.1 [CI, 1.7 to 2.6]), and chronic pain (RR, 1.9 [CI, 1.5 to 2.4]). Providers with less experience (weighted mean difference, -3.5 years [CI, -5.0 to -1.9 years]) rated more encounters as difficult. Patients perceived as difficult were more likely to have unmet visit expectations (RR, 1.9 [CI, 1.4 to 2.5]) and lower satisfaction (RR, 0.76 [CI, 0.65 to 0.88]). LIMITATION: Limited data and heterogeneity for many secondary analyses. CONCLUSION: Providers perceived 17% of clinic patients as difficult. Patients perceived as difficult were more likely to have depression, anxiety, a greater number of symptoms, personality disorders, or chronic pain. Less experienced providers were more likely to judge patients as difficult. Patients from difficult encounters had more unmet visit expectations and less satisfaction. PRIMARY FUNDING SOURCE: None. (PROSPERO: CRD42024583715).

  PublisherDOI

• Recovering From a Leadership Misstep

  Journal of Graduate Medical Education · 2026-04-01

  articleOpen accessSenior author
  PublisherOA PDFDOI

• An Internal Medicine Resident Continuity Clinic at a Federally Qualified Health Center: Structure, Feasibility, and Early Outcomes

  Journal of General Internal Medicine · 2025-02-21 · 1 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• The difficult inpatient, prevalence and characteristics

  Patient Education and Counseling · 2025-04-25 · 5 citations

  articleSenior author
  PublisherDOI

• A Visual Arts Activity to Support Residents as They Care for “Difficult Patients”

  Journal of Graduate Medical Education · 2025-02-01 · 1 citations

  articleOpen access

  Background Certain patients significantly challenge the care team, increasing the risk of burnout as clinicians struggle to perform their best work while meeting the needs of their patients. Imagining another’s perspective, a clinical empathy skill, can increase compassion and lower distress when interacting with these patients. Objective To evaluate the effectiveness of an art-based perspective-taking activity on clinicians’ feelings of discomfort when anticipating encounters with challenging patients. Methods This museum-based session was conducted from 2017 to 2022 (virtual sessions in 2020) by faculty trained in using arts-based methods to teach. Residents (n=142) in a university-based internal medicine residency program along with health professionals, trainees, and faculty (n=12) attending an international conference were invited to participate. Participants recalled a challenging patient, chose a piece of art that might be meaningful to this person, and discussed their choice and insights gained. Participants completed pre-post ratings of anticipated discomfort. Inaugural participants submitted written reflections on these ratings. Data were analyzed using paired t tests and content analysis. Results Five 90-minute sessions were conducted with 65 internal medicine residents and 12 faculty; 75 of 77 total participants completed pre-post discomfort ratings (response rate 97.4%). Anticipated discomfort decreased after sessions (mean pre=5.38; post=4.13; P <.01). Open-ended responses aligned with a transition from self to other focus in perspective-taking. Costs were minimized by using art from a campus museum, paper and pencil surveys, and faculty academic time. Conclusions This innovative visual arts–based activity to increase empathy for challenging patients is simple, feasible, self-contained, and cost-effective.

  PublisherOA PDFDOI

• The “Difficult” Inpatient, a Qualitative Study of Physician Perspectives

  Journal of General Internal Medicine · 2024-05-20 · 4 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

• Writing a Medical Education Grant Budget

  Journal of Graduate Medical Education · 2024-10-01 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Effect of Implementing a Commercial Electronic Early Warning System on Outcomes of Hospitalized Patients

  American Journal of Medical Quality · 2023-09-01 · 2 citations

  article

  Despite the widespread adoption of early warning systems (EWSs), it is uncertain if their implementation improves patient outcomes. The authors report a pre-post quasi-experimental evaluation of a commercially available EWS on patient outcomes at a 700-bed academic medical center. The EWS risk scores were visible in the electronic medical record by bedside clinicians. The EWS risk scores were also monitored remotely 24/7 by critical care trained nurses who actively contacted bedside nurses when a patient's risk levels increased. The primary outcome was inpatient mortality. Secondary outcomes were rapid response team calls and activation of cardiopulmonary arrest (code-4) response teams. The study team conducted a regression discontinuity analysis adjusting for age, gender, insurance, severity of illness, risk of mortality, and hospital occupancy at admission. The analysis included 53,229 hospitalizations. Adjusted analysis showed no significant change in inpatient mortality, rapid response team call, or code-4 activations after implementing the EWS. This study confirms the continued uncertainty in the effectiveness of EWSs and the need for further rigorous examinations of EWSs.

  PublisherDOI

• Multicenter Study of Optional In-Person Visits to Residency Programs After Virtual Interviews

  Journal of Graduate Medical Education · 2023-12-01 · 9 citations

  articleOpen access

  Background Compared to in-person recruitment, virtual interviewing reduces costs and promotes equity. However, many residency applicants believe that visiting programs helps inform their rank decisions. Objective We assessed the feasibility of and stakeholder opinions about optional in-person visits after virtual interviewing and program rank list finalization. Methods Six internal medicine residency programs conducted virtual recruitment in 2022-2023 and finalized their rank lists 4 weeks before the deadline. Applicants were invited for optional in-person visits after program rank list finalization. Interviewed applicants, program directors, and program administrators were given surveys that included 7-17 questions and employed “skip logic,” discrete answers (eg, “yes/no/unsure” or multiple choice), and open-ended questions. Survey questions assessed stakeholders’ opinions about the value, equity, and potential downsides of this recruitment process. Results Participating programs interviewed an average of 379 applicants (range 205-534) with 39 (10.3% [39 of 379], range 7.9%-12.8% [33 of 420-51 of 397]) applicants completing in-person visits. Of 1808 interviewed applicants, 464 responded to the survey (26%); 88% (407 of 464) believe a similar optional in-person visit should be offered next year, 75% (347 of 464) found this process equitable, but only 56% (258 of 464) trusted programs not to change their rank lists. Nearly all who attended an in-person visit (96.5%, 109 of 113) found it valuable. All program directors liked the optional in-person visit and believe future applicants should be offered similar in-person visits. Conclusions A large majority of participating applicants and program directors believe that in-person visits should be offered after program rank list finalization. The majority of respondents felt this recruitment process was equitable.

  PublisherOA PDFDOI

• Influence of the COVID-19 Pandemic on Health-Care Career Interests Among High School Students

  Journal of Adolescent Health · 2023-12-09 · 3 citations

  articleOpen accessSenior author
  PublisherOA PDFDOI

Frequent coauthors

• Marilyn M. Schapira

  University of Pennsylvania

  154 shared

• Pamela Ganschow

  University of Illinois System

  74 shared

• Elizabeth A. Jacobs

  The University of Texas at Austin

  74 shared

• Cindy M. Walker

  73 shared

• Jeff Whittle

  70 shared

• Sanjay Saint

  National Patient Safety Foundation

  55 shared

• Siddhartha Singh

  National Institute of Technology Durgapur

  52 shared

• Brian Kwan

  University of California, San Diego

  51 shared

Labs

• Katrina A Fletcher's LabPI

Education

• IM residency

  University of Chicago Department of Medicine

  1999

• MD

  University of Chicago Pritzker School of Medicine

  1996

• BA

  DePauw University

  1992