Magali Fassiotto, PhD, leads the development, implementation, and administration of programs in Stanford Medicine's Office of Faculty Development and Diversity which are geared toward the advancement, professional development, and diversity of Stanford Medicine faculty. In this role, she manages OFDD's team in advancing Stanford Medicine’s faculty development and diversity initiatives in alignment with diversity and inclusion initiatives across the Stanford Medicine enterprise. Dr. Fassiotto also leads and facilitates workshops for students, trainees, faculty, and staff on unconscious bias, effective mentorship, team building, leading inclusive teams, and building inclusive classrooms. She has published widely in the areas of faculty diversity, unconscious bias, professional development, and organizational identity.
Dr. Fassiotto's academic interests in the functioning of organizations and work teams have led to a career in organizational research and strategic program design. Prior to her role at Stanford Medicine, she worked as a researcher at the National Bureau of Economic Research, examining the impact of federal programs in affecting outcomes for underrepresented and socioeconomically diverse populations. She also worked as a consultant at Ernst & Young and Investor Group Services, where she provided strategic advice to businesses around the country. She completed her undergraduate degree in Economics at Harvard College and her PhD in Organizational Behavior at Stanford Graduate School of Business.
Current Role at Stanford
Stanford Medicine Office of Faculty Development and Diversity
Education & Certifications
PhD, Stanford Graduate School of Business (2013)
AB, Harvard University (2005)
Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study.
JAMA network open
2022; 5 (5): e2213234
Importance: Patient safety reporting systems (PSRSs) are designed to decrease the risk of harm to patients due to medical errors. Owing to the voluntary nature of PSRSs, implicit bias of the reporter may affect the management of safety events reported. Stanford Alert For Events (SAFE) is the PSRS used at Stanford Health Care.Objective: To examine whether variation exists in the content of SAFE reports based on demographic characteristics of physicians who are the subject of the event report.Design, Setting, and Participants: This retrospective qualitative analysis from a single academic medical center evaluated SAFE reports from March 2011 to February 2020. Event reports were coded by theme and categorized by severity (scale of 1 to 3, with 1 being the lowest and 3 the highest). The reports were then analyzed from October 2020 to February 2022 and categorized by physician gender, race and ethnicity, and faculty rank. A total of 501 patient safety events were collected from the adult hospital during the study period, and 100 were excluded owing to incompleteness of information.Main Outcomes and Measures: This qualitative study had no planned outcome.Results: A qualitative analysis was performed on 401 reports representing 187 physicians (138 [73.8%] male and 49 [26.2%] female). In terms of race and ethnicity, 4 physicians (2.1%) were African American, 49 (26.2%) were Asian; 7 (3.7%), Hispanic or Latinx; 108 (57.7%), White; and 19 (10.2%), declined to state. Female physicians had disproportionate representation among reports referencing communication and conversational issues and the lowest severity level. Male physicians had disproportionate representation for ignoring or omitting procedures, process issues, and physical intimidation. African American physicians had disproportionate representation for lack of communication and process issues. Asian physicians had disproportionate representation for lack of communication, process issues, conversational conduct, and the lowest severity level. Latinx physicians had disproportionate representation for conversational conduct. White physicians had disproportionate representation for ignoring or omitting procedures, verbal abuse, physical intimidation, and the highest severity level.Conclusions and Relevance: In this qualitative study, female physicians and physicians who were members of racial and ethnic minority groups were more likely to be reported for low-severity communication issues compared with their male and White counterparts, respectively. These findings suggest that there may be a lower threshold for reporting events when the subject of the report is female and/or a member of a racial or ethnic minority group. Restructuring the reporting and management of patient safety events may be needed to facilitate conflict resolution in a manner that reduces implicit bias and fosters team cohesion.
View details for DOI 10.1001/jamanetworkopen.2022.13234
View details for PubMedID 35594045
The effect of a relationship-centered communication program on patient experience and provider wellness.
Patient education and counseling
OBJECTIVES: Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness.METHODS: 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019.RESULTS: 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTRCP significantly increased and persisted more than 7 months following program completion.CONCLUSIONS: The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience.PRACTICE IMPLICATIONS: Implementing a RCC course for providers may improve patient experience and provider wellness.
View details for DOI 10.1016/j.pec.2021.10.025
View details for PubMedID 34772532
The Need to Mitigate Unconscious Bias to Improve Sponsorship Opportunities for Underrepresented Faculty in Academic Radiology.
AJR. American journal of roentgenology
Women physicians and those from racial and ethnic groups underrepresented in medicine face unique barriers to career advancement in academic medicine, especially in specialties that lack diversity such as radiology. One such barrier is the effect of unconscious bias on the ability of faculty from these groups to find effective sponsors. Given the central role of sponsorship in career advancement, departments are called upon to implement formal sponsorship programs to address inequities stemming from bias.
View details for DOI 10.2214/AJR.21.26481
View details for PubMedID 34467782
Using the Rank Equity Index to Measure Emergency Medicine Faculty Rank Progression.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
BACKGROUND: Faculty diversity is a high-priority goal for academic emergency medicine. Most administrators currently monitor faculty diversity using aggregate data, which may obscure underrepresentation by rank. We apply the Rank Equity Index (REI), to EM faculty data to assess rank progression.METHODS: We calculated the REI (% faculty cohort higher rank / % faculty cohort lower rank) for EM faculty. We performed REI analyses by faculty gender (women, men) and race/ethnicity (white, Black, Hispanic/Latinx, Asian). We compared: Professor/ Assistant Professor, Professor/ Associate Professor, and Associate Professor/ Assistant Professor to establish rank parity for gender and race/ethnicity. Parity is an REI of 1.0.RESULTS: REI analysis by gender demonstrates that women faculty did not achieve parity at any rank comparison in any study year. REI analysis by race/ethnicity demonstrates that all faculty of color are below parity at the assistant to associate professor promotion. Latinx faculty are at parity for associate professor to professor, but Asian and Black faculty do not achieve parity in any comparison. Intersecting gender and race/ethnicity in the REI analysis demonstrates that Asian women have the lowest REIs among all faculty ranks and races/ethnicities. Men of all races/ethnicities achieved parity in two of three rank comparisons, except for Black men, who did not achieve parity in any comparison.CONCLUSIONS: REI analysis demonstrates EM women faculty and faculty of color are not achieving rank parity and are disadvantaged at the first tier of promotion. A preliminary longitudinal trend analysis suggests little progress. Asian women and Black men experience the most rank inequity. REI analysis identifies a need for focused faculty development to enhance our most vulnerable faculty's rank progression, suggesting that targeted recruitment and retention efforts of women faculty of all races/ethnicities and faculty of color, in particular, will improve diversity at every tier of faculty rank.
View details for DOI 10.1111/acem.14268
View details for PubMedID 33909327
Effects of surgeon sociodemographics on patient-reported satisfaction.
BACKGROUND: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.METHODS: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. chi2 tests and generalized estimating equation regression models were run to assess correlation.RESULTS: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making.CONCLUSION: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
View details for DOI 10.1016/j.surg.2020.12.006
View details for PubMedID 33531133
Effect of Surgeon Sociodemographics on Patient-Reported Satisfaction
ELSEVIER SCIENCE INC. 2020: S138
View details for Web of Science ID 000582792300243
Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine.
Academic medicine : journal of the Association of American Medical Colleges
As educators, researchers, clinicians, and administrators, faculty serve pivotal roles in academic medical centers (AMCs). Thus, the quality of faculty members' experiences is inseparable from an AMC's success. In seeking new methods to assess equity in advancement in academic medicine, the authors developed the Rank Equity Index (REI)-adapted from the Executive Parity Index, a scale previously implemented within the business sector-to examine national data on gender and racial/ethnic equity across faculty ranks. The REI was employed on self-reported demographic data, collected by the Association of American Medical Colleges, from U.S. medical school faculty in 2017, to make pairwise rank comparisons of the professoriate by demographic characteristics and department. Overall results indicated that women did not attain parity at any pairwise rank comparison, while men were above parity at all ranks. Similar results were observed across all departments surveyed: women in the basic sciences had REIs closest to parity, women in pediatrics had the highest representation but had REIs that were further from parity than the REIs in the basic sciences, and women in surgery demonstrated the lowest REIs. Nationally, REIs were below 1.00 for all racial/ethnic group rank comparisons except for White and, in one case, multiple race non-Hispanic/Latinx. Across all analyzed departments, Black/African American, Asian, Hispanic/Latinx, and multiple race Hispanic/Latinx faculty had REIs below parity at all ranks except in two cases. In a comparison of 2017 and 2007 data, REIs across both race/ethnicity and gender were lower in 2007 for nearly all groups. REI analyses can highlight inequities in faculty rank that may be masked when using aggregate faculty proportions, which do not account for rank. The REI provides AMCs with a new tool to better analyze institutional data to inform efforts to increase parity across all faculty ranks.
View details for DOI 10.1097/ACM.0000000000003720
View details for PubMedID 32889948
The Long "Race" to Diversity in Otolaryngology.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
The number of health disparities disproportionately affecting minority communities continue to rise. Thus, it is imperative to assess whether equity within medical school enrollment and along the academic pipeline has mirrored this growth, especially among elite surgical specialties such as otolaryngology. Census and educational data from 2010 and 2018 were used to assess the current otolaryngology, surgery, and internal medicine physician and faculty workforce diversity across each stage of the academic medicine trajectory by race and ethnicity. We found that disparities exist in medical school enrollment for minority students such that Hispanic/Latinx representation was only 30% and Black representation only 50% of their respective proportions in the US population in 2018. Disparities in achieving full professorship were also observed across all 3 specialties but most prominently in otolaryngology, with 1% Black representation among otolaryngology professors in 2018. A collective strategy toward diversifying the otolaryngology workforce should be explored.
View details for DOI 10.1177/0194599820951132
View details for PubMedID 32838654
The association between Asian patient race/ethnicity and lower satisfaction scores.
BMC health services research
2020; 20 (1): 678
BACKGROUND: Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings.METHODS: Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N=216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex.RESULTS: Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking.CONCLUSIONS: Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.
View details for DOI 10.1186/s12913-020-05534-6
View details for PubMedID 32698825
Everyday Heroism: Maintaining Organizational Cultures of Wellness and Inclusive Excellence Amid Simultaneous Pandemics.
Academic medicine : journal of the Association of American Medical Colleges
2020; Publish Ahead of Print
Health care professionals and the institutions in which they work are being stretched to their limits amidst the current COVID-19 pandemic. At the same time, a second longstanding pandemic has been brought to the fore: the entrenched system of racial injustice and oppression. The first pandemic is new and to date substantial resources have been allocated to urgently addressing its mitigation; the second has a long history with inconsistent attention and resources but has recently been spotlighted more intensely than at any time in the nation's recent past. The authors of this article contend that these 2 simultaneous pandemics have brought forth the need for institutions in the United States to make a renewed commitment to respect, wellness, diversity, and inclusion. While investment and leadership in these domains have always been essential, these have largely been viewed as a "nice-to-have" option. The events of much of 2020 (most notably) have illustrated that committing to and investing in policies, programs, centers, and leadership to drive change in these domains are essential and a "need-to-have" measure. The authors outline the necessity of investing in the promotion of cultures of inclusive excellence at both individual and organizational levels to coordinate a united response to the simultaneous pandemics. It is in the interests of health care systems to consider the wellness of the workforce to overcome the longer term economic, systemic, and social trauma that will likely occur for years to come at both the individual and institutional levels. Maintaining or augmenting investment is necessary despite the economic challenges the nation faces. Now is the time to cultivate resilience and wellness through a renewed commitment to cultures of respect, diversity, and inclusion. This commitment is urgently needed to support and sustain the health care workforce and maintain outstanding health care systems for future generations.
View details for DOI 10.1097/ACM.0000000000003905
View details for PubMedID 33369903
Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity.
JAMA network open
2020; 3 (8): e2012762
Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood.To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians.In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration.Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status.Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively.Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity.Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.
View details for DOI 10.1001/jamanetworkopen.2020.12762
View details for PubMedID 32766802
Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations.
Journal of women's health (2002)
Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.
View details for DOI 10.1089/jwh.2019.8233
View details for PubMedID 32857642
Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators.
Journal of vascular and interventional radiology : JVIR
PURPOSE: To examine the impact of targeted efforts to increase the number of female speakers at the Society of Interventional Radiology (SIR) Annual Scientific Meeting (ASM) by reporting gender trends for invited faculty in 2017/2018 vs2016.MATERIALS AND METHODS: Faculty rosters for the 2016, 2017, and 2018 SIR ASMs were stratified by gender to quantify female representation at plenary sessions, categorical courses, symposia, self-assessment modules, and "meet-the-expert" sessions. Keynote events, scientific abstract presentations, and award ceremonies were excluded. In 2017, the SIR Annual Meeting Committee issued requirements for coordinators to invite selected women as speakers. Session coordinators are responsible for issuing speaker invitations, and invited speakers have the option to decline.RESULTS: Years 2017 and 2018 showed increases in female speaker representation, with women delivering 13% (89 of 687) and 14% (85 of 605) of all assigned presentations, compared with 9% in 2016 (46 of 514; P= .03 and P= .01, respectively). Gender diversity correlated with the gender of the session coordinator(s). When averaged over a 3-year period, female speakers constituted 7% of the speaker roster (112 of 1,504 presentations) for sessions led by an all-male coordinator team, compared with 36% (108 of 302) for sessions led by at least 1 female coordinator (P < .0001). Results of the linear regression model confirmed the effect of coordinator team gender composition (P < .0001).CONCLUSIONS: Having a woman as a session coordinator increased female speaker participation, which suggests that the inclusion of more women as coordinators is one mechanism for achieving gender balance at scientific meetings.
View details for DOI 10.1016/j.jvir.2019.07.006
View details for PubMedID 31587951
- Characteristics of Academic Physicians Associated With Patient Satisfaction AMERICAN JOURNAL OF MEDICAL QUALITY 2019: 1062860619876344
- Drs. Kothary et al respond. Journal of vascular and interventional radiology : JVIR 2019
Untapped Resources: Attaining Equitable Representation for Women in IR.
Journal of vascular and interventional radiology : JVIR
PURPOSE: To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators.MATERIALS AND METHODS: Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012-2017) were statistically compared to that of recurring male faculty.RESULTS: From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P= .722; total publications P= .689; and authorship P= .662).CONCLUSIONS: This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.
View details for PubMedID 30772166
Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians.
JAMA network open
2019; 2 (2): e190027
Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients.To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians.This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018.Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken.The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey.Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity.This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.
View details for PubMedID 30794297
What's in a Word? Qualitative and Quantitative Analysis of Leadership Language in Anesthesiology Resident Feedback
Journal of Graduate Medical Education
2019; 11 (1): 44-52
View details for DOI 10.4300/JGME-D-18-00377.1
An Integrated Career Coaching and Time-Banking System Promoting Flexibility, Wellness, and Success: A Pilot Program at Stanford University School of Medicine.
Academic medicine : journal of the Association of American Medical Colleges
2018; 93 (6): 881-887
Faculty in academic medicine experience multiple demands on their time at work and home, which can become a source of stress and dissatisfaction, compromising success. A taskforce convened to diagnose the state of work-life flexibility at Stanford University School of Medicine uncovered two major sources of conflict: work-life conflict, caused by juggling demands of career and home; and work-work conflict, caused by competing priorities of the research, teaching, and clinical missions combined with service and administrative tasks. Using human-centered design research principles, the 2013-2014 Academic Biomedical Career Customization (ABCC) pilot program incorporated two elements to mitigate work-life and work-work conflict: integrated career-life planning, coaching to create a customized plan to meet both career and life goals; and a time-banking system, recognizing behaviors that promote team success with benefits that mitigate work-life and work-work conflicts. A matched-sample pre-post evaluation survey found the two-part program increased perceptions of a culture of flexibility (P = .020), wellness (P = .013), understanding of professional development opportunities (P = .036), and institutional satisfaction (P = .020) among participants. In addition, analysis of research productivity indicated that over the two-year program, ABCC participants received 1.3 more awards, on average, compared with a matched set of nonparticipants, a funding difference of approximately $1.1 million per person. These results suggest it is possible to mitigate the effects of extreme time pressure on academic medicine faculty, even within existing institutional structures.
View details for DOI 10.1097/ACM.0000000000002121
View details for PubMedID 29298183
View details for PubMedCentralID PMC5976513
A long-term follow-up of a physician leadership program.
Journal of health organization and management
2018; 32 (1): 56-68
Purpose Physician leadership programs serve to develop individual capabilities and to affect organizational outcomes. Evaluations of such programs often focus solely on short-term increases in individual capabilities. The purpose of this paper is to assess long-term individual and organizational outcomes of the Stanford Leadership Development Program. Design/methodology/approach There are three data sources for this mixed-methods study: a follow-up survey in 2013-2014 of program participants ( n=131) and matched (control) non-participants ( n=82) from the 2006 to 2011 program years; promotion and retention data; and qualitative in-person interview data. The authors analyzed survey data across leadership knowledge, skills, and attitudes as well as leadership titles held, following program participation using Pearson's χ2 test of independence. Using logistic regression, the authors analyzed promotion and retention among participants and non-participants. Finally, the authors applied both a grounded theory approach and qualitative content analysis to analyze interview data. Findings Program participants rated higher than non-participants across 25 of 30 items measuring leadership knowledge, skills, and attitudes, and were more likely to hold regional/national leadership titles and to have gained in leadership since program participation. Asian program participants were significantly more likely than Asian non-participants to have been promoted, and women participants were less likely to have left the institution than non-participants. Finally, qualitative interviews revealed the long-term impact of leadership learning and networking, as well as the enduring, sustained impact on the organization of projects undertaken during the program. Originality/value This study is unique in its long-term and comprehensive mixed-methods nature of evaluation to assess individual and organizational impact of a physician leadership program.
View details for DOI 10.1108/JHOM-08-2017-0208
View details for PubMedID 29508671
Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology.
Women's health issues : official publication of the Jacobs Institute of Women's Health
2018; 28 (3): 281-285
Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.
View details for DOI 10.1016/j.whi.2018.01.001
View details for PubMedID 29429946
Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty.
Journal of surgical education
Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014).Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics).Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014.A total of 3648 evaluations across 1066 physician faculty.Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation.This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine.
View details for DOI 10.1016/j.jsurg.2018.01.011
View details for PubMedID 29402668
Resident Perspectives on Work-Life Policies and Implications for Burnout.
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
2018; 42 (1): 73-77
As resident burnout increases, there is a need for better awareness, resources, and interventions. Challenges in balancing work and life priorities have been implicated in contributing to physician burnout. Institutional work-life policies (WLPs) are critical tools to meet work-life needs. This study investigates the influence of WLPs on residents' experiences.The authors emailed a SurveyMonkey link to the APA chief resident and Minority Fellow listservs and directly to 94 psychiatry program directors and 52 fellowship directors nationwide to distribute a survey to residents regarding WLP use and barriers, as well as burnout. Estimated response rate was 12-23%. The authors assessed the anonymous responses using SPSS to evaluate for relationships between awareness of WLPs, perceptions/barriers surrounding their usage, and burnout.The authors analyzed 255 responses. Awareness and use of policies ranged from 2 to 33%. A prominent barrier to WLPs is that use results in shifting workload to co-residents (48% agree). Respondents who perceived leadership to view use of WLPs as a sign of weakness (16% agree) were less likely to use WLPs (t (89) = -3.52, p < 0.001, d = 0.61). Residents with burnout (41%) perceived vastly higher barriers to using WLPs as compared to those without burnout.This study supports the need for further investigation of WLPs to mitigate resident burnout and identifies important perceived barriers that affect the use of WLPs including low awareness, potential for shifting workload to co-residents, and negative perceptions of leadership attitudes toward WLPs.
View details for DOI 10.1007/s40596-017-0757-6
View details for PubMedID 28842868
Pulled in Too Many Directions: The Causes and Consequences of Work-Work Conflict
View details for DOI 10.1177/0731121418774568
Designing a physician leadership development program based on effective models of physician education.
Health care management review
Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance.The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011).Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members.All participants completed a team project during the program, adding value to the institution.Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system.Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care institutions. Active learning projects provide opportunities to practice leadership skills addressing real word problems.
View details for DOI 10.1097/HMR.0000000000000146
View details for PubMedID 28157830
Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines
BMC MEDICAL EDUCATION
Faculty departure can present significant intellectual costs to an institution. The authors sought to identify the reasons for clinical and non-clinical faculty departures at one academic medical center (AMC).In May and June 2010, the authors surveyed 137 faculty members who left a west coast School of Medicine (SOM) between 1999 and 2009. In May and June 2015, the same survey was sent to 40 faculty members who left the SOM between 2010-2014, for a total sample size of 177 former faculty members. The survey probed work history and experience, reasons for departure, and satisfaction at the SOM versus their current workplace. Statistical analyses included Pearson's chi-square test of independence and independent sample t-tests to understand quantitative differences between clinical and non-clinical respondents, as well as coding of qualitative open-ended responses.Eighty-eight faculty members responded (50%), including three who had since returned to the SOM. Overall, professional and advancement opportunities, salary concerns, and personal/family reasons were the three most cited factors for leaving. The average length of time at this SOM was shorter for faculty in clinical roles, who expressed lower workplace satisfaction and were more likely to perceive incongruence and inaccuracy in institutional expectations for their success than those in non-clinical roles. Clinical faculty respondents noted difficulty in balancing competing demands and navigating institutional expectations for advancement as reasons for leaving.AMCs may not be meeting faculty needs, especially those in clinical roles who balance multiple missions as clinicians, researchers, and educators. Institutions should address the challenges these faculty face in order to best recruit, retain, and advance faculty.
View details for DOI 10.1186/s12909-016-0830-y
View details for PubMedID 28073345
- Training and Professionalism Year Book of Pediatrics edited by Cabana, M. D., Goldstein, A. M., De Gialluly, P. S., Schroeder, A. R. Elsevier, Inc.. 2017: 499–501
Loud and Clear: The Effect of Protest Signals on Congressional Attention
Mobilization: An International Quarterly
2017; 22 (1): 17-38
View details for DOI 10.17813/1086-671X-22-1-17
Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention.
2016; 91 (8): 1143-1150
One challenge academic health centers face is to advance female faculty to leadership positions and retain them there in numbers equal to men, especially given the equal representation of women and men among graduates of medicine and biological sciences over the last 10 years. The purpose of this study is to investigate the explicit and implicit biases favoring men as leaders, among both men and women faculty, and to assess whether these attitudes change following an educational intervention.The authors used a standardized, 20-minute educational intervention to educate faculty about implicit biases and strategies for overcoming them. Next, they assessed the effect of this intervention. From March 2012 through April 2013, 281 faculty members participated in the intervention across 13 of 18 clinical departments.The study assessed faculty members' perceptions of bias as well as their explicit and implicit attitudes toward gender and leadership. Results indicated that the intervention significantly changed all faculty members' perceptions of bias (P < .05 across all eight measures). Although, as expected, explicit biases did not change following the intervention, the intervention did have a small but significant positive effect on the implicit biases surrounding women and leadership of all participants regardless of age or gender (P = .008).These results suggest that providing education on bias and strategies for reducing it can serve as an important step toward reducing gender bias in academic medicine and, ultimately, promoting institutional change, specifically the promoting of women to higher ranks.
View details for DOI 10.1097/ACM.0000000000001099
View details for PubMedID 26826068
Occupational Radiation Exposure during Pregnancy: A Survey of Attitudes and Practices among Interventional Radiologists
JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY
2016; 27 (7): 1013-1020
To assess attitudes of interventional radiologists toward occupational ionizing radiation exposure in pregnancy and to survey practice patterns and outcomes.A 34-question anonymous online survey on attitudes and work practices toward interventional radiologists who worked during pregnancy was sent to active SIR members, including 582 women.There were 534 (10%) respondents, including 142 women and 363 men. Among respondents, men were statistically older than women (P < .001) and had practiced interventional radiology (IR) longer (P < .001). Of female interventional radiologists, 55% had worked during pregnancy and reported no specific mutagenic events in their offspring. Spontaneous abortions (11%) and use of reproductive technology (17%) matched that of women with similar age and socioeconomic background. Although more women changed their work practice because of concerns of occupational exposure than men (23% vs 13%), this change was largely limited to the duration of a pregnancy. Among pregnant interventional radiologists, 4 (6%) completely abstained from performing fluoroscopically guided interventions (FGIs), whereas 31 (46%) continued to spend > 80% of their work week doing FGIs with additional protection. Perceptions of impact of pregnancy on daytime work redistribution varied significantly with gender (P < .001); however, perceptions regarding impact of pregnancy on on-call hours, distribution of complex cases, and need to hire for temporary coverage were similar between the genders.Most pregnant interventional radiologists continue to practice IR while pregnant. Pregnancy and fetal outcomes parallel that of the general population when matched for demographics. However, perceptions of impact of pregnancy on work lives of colleagues vary notably.
View details for DOI 10.1016/j.jvir.2016.03.040
View details for PubMedID 27236211
Women in Academic Medicine: Measuring Stereotype Threat Among Junior Faculty
JOURNAL OF WOMENS HEALTH
2016; 25 (3): 292-298
Gender stereotypes in science impede supportive environments for women. Research suggests that women's perceptions of these environments are influenced by stereotype threat (ST): anxiety faced in situations where one may be evaluated using negative stereotypes. This study developed and tested ST metrics for first time use with junior faculty in academic medicine.Under a 2012 National Institutes of Health Pathfinder Award, Stanford School of Medicine's Office of Diversity and Leadership, working with experienced clinicians, social scientists, and epidemiologists, developed and administered ST measures to a representative group of junior faculty.174 School of Medicine junior faculty were recruited (62% women, 38% men; 75% assistant professors, 25% instructors; 50% white, 40% Asian, 10% underrepresented minority). Women reported greater susceptibility to ST than did men across all items including ST vulnerability (p < 0.001); rejection sensitivity (p = 0.001); gender identification (p < 0.001); perceptions of relative potential (p = 0.048); and, sense of belonging (p = 0.049). Results of career-related consequences of ST were more nuanced. Compared with men, women reported lower beliefs in advancement (p = 0.021); however, they had similar career interest and identification, felt just as connected to colleagues, and were equally likely to pursue careers outside academia (all p > 0.42).Innovative ST metrics can provide a more complete picture of academic medical center environments. While junior women faculty are susceptible to ST, they may not yet experience all of its consequences in their early careers. As such, ST metrics offer a tool for evaluating institutional initiatives to increase supportive environments for women in academic medicine.
View details for DOI 10.1089/jwh.2015.5380
View details for Web of Science ID 000372173200014
Palgrave Encyclopedia of Strategic Management
edited by Augier, M., Teece, D. J.
View details for DOI 10.1057/978-1-349-94848-2_786-1
- Category Signaling and Reputation ORGANIZATION SCIENCE 2015; 26 (2): 584-600
- Organizations as Fonts of Entrepreneurship ORGANIZATION SCIENCE 2011; 22 (5): 1322-1331