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Guerin A, Lee J, Floyd B, Yemane L, Fassiotto M, Griffith E, Blankenburg R, Hilgenberg SL, Dali S, De Araujo M, Jones K, Kuo K, Rassbach CE. Building an Antiracist Department Through an Experiential Department-Wide Antiracism Curriculum. Acad Pediatr 2023; 23:1505-1506. [PMID: 37422256 DOI: 10.1016/j.acap.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Allison Guerin
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - July Lee
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Baraka Floyd
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Lahia Yemane
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Magali Fassiotto
- Office of Faculty Development & Diversity (M Fassiotto), Stanford School of Medicine, Stanford, Calif.
| | - Emmett Griffith
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Rebecca Blankenburg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Sarah L Hilgenberg
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Salma Dali
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Monique De Araujo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kamaal Jones
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Kevin Kuo
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
| | - Caroline E Rassbach
- Department of Pediatrics (A Guerin, J Lee, B Floyd, L Yemane, E Griffith, R Blankenburg, SL Hilgenberg, S Dali, M De Araujo, K Jones, K Kuo, CE Rassbach), Stanford School of Medicine, Palo Alto, Calif.
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Abstract
Objective: Gender parity lags in academic medicine. We applied the Rank Equity Index (REI) to compare the longitudinal progress of women's academic medicine careers. We hypothesized that women have different rank parity in promotion by specialty based on the proportion of women in the specialty. Materials and Methods: Aggregate data by sex for medical students, residents, assistant professors, associate professors, and professors in nine specialties were obtained from the Association of American Medical Colleges for 2019-2020. Specialties were clustered into terciles based on the proportion of women in the field: upper (obstetrics and gynecology, pediatrics, psychiatry), middle (internal medicine, emergency medicine, anesthesia), and lower (surgery, urology, and orthopedic surgery). We calculated the percentage representation by sex by specialty and rank to calculate REI. Specialty-specific REI comparisons between each rank were performed to assess parity in advancement. Results: Only specialties in the upper tercile recruited proportionally more women medical students to residency training. All specialties advanced women for the resident-to-assistant professor with psychiatry, internal medicine, emergency medicine, anesthesia, urology, and orthopedic surgery that promoted women faculty at rates above parity. No specialty demonstrated parity in advancement based on sex for the assistant professor-to-associate professor or associate professor-to-professor transitions. Conclusion: Gender inequity in advancement is evident in academic medicine starting at the assistant professor-to-associate professor stage, regardless of overall proportion of women in the specialty. This suggests a common set of barriers to career advancement of women faculty in academic medicine that must be addressed starting at the early career stage.
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Affiliation(s)
- Moon O Lee
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California, USA
| | - Cherri Hobgood
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Rogo-Gupta LJ, Altamirano J, Homewood LN, Donnellan NM, Miles S, Stuparich M, Salinaro J, Lum D, Fassiotto M. Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care. Am J Obstet Gynecol 2023; 229:304.e1-304.e9. [PMID: 37330126 DOI: 10.1016/j.ajog.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.
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Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Laura N Homewood
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA
| | - Nicole M Donnellan
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Shana Miles
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Julia Salinaro
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Deirdre Lum
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
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Rogo T, Holland S, Fassiotto M, Maldonado Y, Joseph T, Ramilo O, Byrd K, Delair S. Strategies to Increase Workforce Diversity in Pediatric Infectious Diseases. J Pediatric Infect Dis Soc 2022; 11:S148-S154. [PMID: 36477593 DOI: 10.1093/jpids/piac094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The number of physicians who are underrepresented in medicine within the pediatric infectious diseases workforce remains disproportionate compared to the US population. Physician workforce diversity plays an important role in reducing health care disparities. Pathways to careers in pediatric infectious diseases require that a diverse pool of students enter medicine and subsequently choose pediatric residency followed by subspecialty training. Efforts must be made to expose learners to pediatric infectious diseases earlier in the education timeline. Along with recruitment and creation of pathways, cultures of inclusivity must be created and fostered within institutions of learning along the entire spectrum of medical training.
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Affiliation(s)
- Tanya Rogo
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sabina Holland
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Magali Fassiotto
- Office of Faculty Development & Diversity, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yvonne Maldonado
- Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tuhina Joseph
- Division of Pediatric Infectious Diseases, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Octavio Ramilo
- Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Katrina Byrd
- Division of Pediatric Infectious Diseases, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shirley Delair
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Haverfield MC, Victor R, Flores B, Altamirano J, Fassiotto M, Kline M, Weimer-Elder B. Qualitatively exploring the impact of a relationship-centered communication skills training program in improving patient perceptions of care. PEC Innov 2022; 1:100069. [PMID: 37213728 PMCID: PMC10194165 DOI: 10.1016/j.pecinn.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/07/2022] [Accepted: 07/23/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore qualitative patient experience comments before and after a relationship-centered communication skills training to understand patient experience, program impact, and opportunities for improvement. Methods Qualitative patient experience evaluation data was captured from January 2016 to December 2018 for 483 health care clinicians who participated in the skills training. A random sampling of available open-ended patient comments (N = 33,223) were selected pre-training (n = 668) and post-training (n = 566). Comments were coded for valence (negative/neutral/positive), generality versus specificity, and based on 12 communication behaviors reflective of training objectives. Results No significant difference was found in the valence of comments, or generality versus specificity of comments before and after the training. A significant decrease was present in perceived clinician concern. "Confidence in care provider" was the communication skill most frequently identified in comments both pre- and post-training. Conclusion Perceptions of interactions largely remained the same following training. Key relationship-centered communication skills require further attention in future training efforts. Measurements of patient satisfaction and engagement may not adequately represent patient experience. Innovation This study identified areas for improvement in the training program and offers a model for utilizing patient experience qualitative data in understanding communication training impact.
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Affiliation(s)
- Marie C. Haverfield
- Department of Communication Studies, San Jose State University, San Jose, CA, USA
- Corresponding author at: 220 E. San Fernando Street, San Jose, CA 95112, USA.
| | - Robert Victor
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford Medicine, Stanford, CA, USA
| | - Merisa Kline
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
| | - Barbette Weimer-Elder
- Physician Partnership Program Patient Experience, Stanford Health Care, Stanford, CA, USA
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Jerome B, Fassiotto M, Altamirano J, Sutha K, Maldonado Y, Poullos P. Disability Identity Among Diverse Learners and Employees at an Academic Medical Center. JAMA Netw Open 2022; 5:e2241948. [PMID: 36355375 PMCID: PMC9650606 DOI: 10.1001/jamanetworkopen.2022.41948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This survey study evaluates representation of persons with disabilities across demographic characteristics at an academic medical center.
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Affiliation(s)
- Barbara Jerome
- Stanford University School of Medicine, Stanford, California
| | | | | | - Ken Sutha
- Stanford University School of Medicine, Stanford, California
| | | | - Peter Poullos
- Stanford University School of Medicine, Stanford, California
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7
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Altamirano J, Kline M, Schwartz R, Fassiotto M, Maldonado Y, Weimer-Elder B. The effect of a relationship-centered communication program on patient experience and provider wellness. Patient Educ Couns 2022; 105:1988-1995. [PMID: 34772532 DOI: 10.1016/j.pec.2021.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
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-LTR CP 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.
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Affiliation(s)
- Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Merisa Kline
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Rachel Schwartz
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
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Burton É, Flores B, Jerome B, Baiocchi M, Min Y, Maldonado YA, Fassiotto M. Assessment of Bias in Patient Safety Reporting Systems Categorized by Physician Gender, Race and Ethnicity, and Faculty Rank: A Qualitative Study. JAMA Netw Open 2022; 5:e2213234. [PMID: 35594045 PMCID: PMC9123495 DOI: 10.1001/jamanetworkopen.2022.13234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Élan Burton
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Brenda Flores
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Barbara Jerome
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Michael Baiocchi
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Yan Min
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California
| | - Yvonne A. Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Palo Alto, California
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Fassiotto M, Valantine H, Shanafelt T, Maldonado Y. Everyday Heroism: Maintaining Organizational Cultures of Wellness and Inclusive Excellence Amid Simultaneous Pandemics. Acad Med 2021; 96:1389-1392. [PMID: 33369903 PMCID: PMC8475642 DOI: 10.1097/acm.0000000000003905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
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 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.
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Affiliation(s)
- Magali Fassiotto
- M. Fassiotto is associate dean, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Hannah Valantine
- H. Valantine is professor, Department of Medicine, Stanford University School of Medicine, Stanford, California, and former chief officer for scientific workforce diversity, National Institutes of Health, Bethesda, Maryland
| | - Tait Shanafelt
- T. Shanafelt is Jeanie and Stewart Ritchie Professor of Medicine, chief wellness officer, Stanford Medicine, director, Stanford WellMD Center, and associate dean, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Y. Maldonado is Taube Professor, global health and infectious diseases, and senior associate dean, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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10
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Hobgood C, Fassiotto M. Using the Rank Equity Index to measure emergency medicine faculty rank progression. Acad Emerg Med 2021; 28:966-973. [PMID: 33909327 DOI: 10.1111/acem.14268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/05/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Faculty diversity is a high-priority goal for academic emergency medicine (EM). 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.
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Affiliation(s)
- Cherri Hobgood
- Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity Stanford University School of Medicine Stanford California USA
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11
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Nuyen B, Altamirano J, Fassiotto M, Alyono J. Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery 2021; 169:1441-1445. [PMID: 33531133 DOI: 10.1016/j.surg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
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. χ2 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.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
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Fassiotto M, Flores B, Victor R, Altamirano J, Garcia LC, Kotadia S, Maldonado Y. Rank Equity Index: Measuring Parity in the Advancement of Underrepresented Populations in Academic Medicine. Acad Med 2020; 95:1844-1852. [PMID: 32889948 DOI: 10.1097/acm.0000000000003720] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
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 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 2 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.
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Affiliation(s)
- Magali Fassiotto
- M. Fassiotto is associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Brenda Flores
- B. Flores is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Robert Victor
- R. Victor is research and program officer, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Jonathan Altamirano
- J. Altamirano is senior research analyst, Office of Faculty Development and Diversity and Global Child Health Program, Stanford University School of Medicine, Stanford, California
| | - Luis C Garcia
- L.C. Garcia is a medical student and research assistant, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Shaila Kotadia
- S. Kotadia is director of culture and inclusion, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Yvonne Maldonado
- Y. Maldonado is professor of pediatrics and of epidemiology and population health, and senior associate dean for faculty development and diversity, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Lee MO, Altamirano J, Garcia LC, Gisondi MA, Wang NE, Lippert S, Maldonado Y, Gharahbaghian L, Ribeira R, Fassiotto M. Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. West J Emerg Med 2020; 21:117-124. [PMID: 33207156 PMCID: PMC7673899 DOI: 10.5811/westjem.2020.8.47277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the “topbox” score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). Methods We looked at PG surveys from January 2015–December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: “Likelihood of your recommending our ED to others”; and “Courtesy of the doctor.” We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. Results We analyzed a total of 3,038 surveys. For “Likelihood of your recommending our ED to others,” topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70–0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60–0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54–0.93) and vertical areas (OR 0.71; 95% CI 0.53–0.95) compared to fast track. For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06–1.14); less likely among Asian (OR 0.70; 95% CI, 0.58–0.84), Black (OR 0.66; 95% CI, 0.45–0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55–0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50–0.95) compared to fast track. Conclusion Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.
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Affiliation(s)
- Moon O Lee
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Jonathan Altamirano
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Luis C Garcia
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Michael A Gisondi
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - N Ewen Wang
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Suzanne Lippert
- Kaiser-Permanente East Bay, Department of Emergency Medicine, Oakland, California
| | - Yvonne Maldonado
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Laleh Gharahbaghian
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Ryan Ribeira
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Magali Fassiotto
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
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Chen H, Pierson E, Schmer-Galunder S, Altamirano J, Jurafsky D, Leskovec J, Fassiotto M, Kothary N. Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations. J Womens Health (Larchmt) 2020; 30:551-556. [PMID: 32857642 DOI: 10.1089/jwh.2019.8233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Heidi Chen
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Emma Pierson
- Department of Computer Science, Stanford University, Stanford, California, USA
| | | | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Dan Jurafsky
- Department of Computer Science, Stanford University, Stanford, California, USA.,Department of Linguistics, Stanford University, Stanford, California, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Nishita Kothary
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
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Abstract
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.
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Affiliation(s)
- Mahbuba Tusty
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Brenda Flores
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Robert Victor
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, School of Medicine, Stanford University, Stanford, California, USA
| | - Javier Howard
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
| | - Tulio A Valdez
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, California, USA
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Garcia LC, Shanafelt TD, West CP, Sinsky CA, Trockel MT, Nedelec L, Maldonado YA, Tutty M, Dyrbye LN, Fassiotto M. Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity. JAMA Netw Open 2020; 3:e2012762. [PMID: 32766802 PMCID: PMC7414389 DOI: 10.1001/jamanetworkopen.2020.12762] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE 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. OBJECTIVE To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status. MAIN OUTCOMES AND MEASURES 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. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.
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Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Colin P. West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Mickey T. Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Laurence Nedelec
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Yvonne A. Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Liao L, Chung S, Altamirano J, Garcia L, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. The association between Asian patient race/ethnicity and lower satisfaction scores. BMC Health Serv Res 2020; 20:678. [PMID: 32698825 PMCID: PMC7374891 DOI: 10.1186/s12913-020-05534-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/13/2020] [Indexed: 02/04/2023] Open
Abstract
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.
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Affiliation(s)
- Lillian Liao
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Columbia University Vagelos College of Physicians and Surgeons, 50 Haven Avenue Box #B-26, New York, NY10032 USA
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Luis Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
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Ghatan CE, Altamirano J, Fassiotto M, Perez MG, Maldonado Y, Josephs S, Sze DY, Kothary N. Achieving Speaker Gender Equity at the SIR Annual Scientific Meeting: The Effect of Female Session Coordinators. J Vasc Interv Radiol 2019; 30:1870-1875. [DOI: 10.1016/j.jvir.2019.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/28/2019] [Accepted: 07/08/2019] [Indexed: 11/26/2022] Open
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Heidenreich P, Shieh L, Fassiotto M, Kahn J, Weinacker A, Smith R, Trockel MT, Shanafelt T, Palaniappan L. Letter to the Editor: Characteristics of Academic Physicians Associated With Patient Satisfaction. Am J Med Qual 2019; 35:357-358. [PMID: 31529975 DOI: 10.1177/1062860619876344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hopkins J, Fassiotto M, Ku MC, Mammo D, Valantine H. Designing a physician leadership development program based on effective models of physician education. Health Care Manage Rev 2019; 43:293-302. [PMID: 28157830 PMCID: PMC5540850 DOI: 10.1097/hmr.0000000000000146] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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. PURPOSE 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. METHODOLOGY/APPROACH 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). RESULTS 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. RESULTS All participants completed a team project during the program, adding value to the institution. CONCLUSION 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. PRACTICE IMPLICATIONS 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.
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Affiliation(s)
- Joseph Hopkins
- Joseph Hopkins, MD, MMM, is Clinical Professor of Medicine, Stanford University School of Medicine, California; and Director Stanford Leadership Development Program, Associate Chief Medical Officer, and Senior Medical Director for Quality, Stanford Hospital and Clinics, California. E-mail: . Magali Fassiotto, PhD, is Assistant Dean in the Office of Faculty Development and Diversity, Stanford University School of Medicine, California. Manwai Candy Ku, MA, PhD, is Research Scientist, Apple, Inc., Cupertino, California (formerly Research Scientist in the Office of Faculty Development and Diversity, Stanford University School of Medicine, California). Dagem Mammo, BS, is Medical Student, Stanford University School of Medicine, California. Hannah Valantine, MD, MRCP, FACC, is Chief Officer for Scientific Workforce Diversity at the National Institutes of Health in Bethesda, Maryland; and Professor of Medicine and co-Director of the Stanford Leadership Development Program, Stanford University School of Medicine, California (formerly co-Director of the Stanford Leadership Development Program and Senior Associate Dean for Diversity and Leadership, Stanford University School of Medicine, California)
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Perez MG, Fassiotto M, Altamirano J, Hwang GL, Maldonado Y, Josephs S, Sze DY, Kothary N. Untapped Resources: Attaining Equitable Representation for Women in IR. J Vasc Interv Radiol 2019; 30:579-583. [DOI: 10.1016/j.jvir.2018.10.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022] Open
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Garcia LC, Chung S, Liao L, Altamirano J, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians. JAMA Netw Open 2019; 2:e190027. [PMID: 30794297 PMCID: PMC6484609 DOI: 10.1001/jamanetworkopen.2019.0027] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE 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. OBJECTIVE To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians. DESIGN, SETTING, AND PARTICIPANTS 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. EXPOSURES 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. MAIN OUTCOMES AND MEASURES 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. RESULTS 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. CONCLUSIONS AND RELEVANCE 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.
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Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Lily Liao
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, California
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Fassiotto M, Li J, Maldonado Y, Kothary N. Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty. J Surg Educ 2018; 75:1140-1148. [PMID: 29402668 DOI: 10.1016/j.jsurg.2018.01.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/13/2017] [Accepted: 01/13/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE 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). DESIGN 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). SETTING Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014. PARTICIPANTS A total of 3648 evaluations across 1066 physician faculty. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California.
| | - Jie Li
- Office of Graduate Medical Education, Stanford University Medical Center, Stanford, California
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, California
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Fassiotto M, Simard C, Sandborg C, Valantine H, Raymond J. An Integrated Career Coaching and Time-Banking System Promoting Flexibility, Wellness, and Success: A Pilot Program at Stanford University School of Medicine. Acad Med 2018; 93:881-887. [PMID: 29298183 PMCID: PMC5976513 DOI: 10.1097/acm.0000000000002121] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
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.
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Affiliation(s)
- Magali Fassiotto
- M. Fassiotto is assistant dean, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California. C. Simard is senior director of research, Clayman Institute for Gender Research, Stanford University, Stanford, California. C. Sandborg is professor, Department of Pediatrics, Stanford University School of Medicine, and vice president of medical affairs, Lucile Packard Children's Hospital at Stanford, Stanford, California. H. Valantine is chief officer for scientific workforce diversity, National Institutes of Health, Bethesda, Maryland. J. Raymond is professor, Department of Neurobiology, Stanford University School of Medicine, Stanford, California
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Koran M, Fassiotto M, Hwang G, Maldonado Y, Kothary N. 3:27 PM Abstract No. 295 Effect of gender on trainee evaluations of faculty. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Rogo-Gupta LJ, Haunschild C, Altamirano J, Maldonado YA, Fassiotto M. Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology. Womens Health Issues 2018; 28:281-285. [PMID: 29429946 DOI: 10.1016/j.whi.2018.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND 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. OBJECTIVE 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. STUDY DESIGN 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). RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Carolyn Haunschild
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Yvonne A Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Westercamp N, Wang RS, Fassiotto M. Resident Perspectives on Work-Life Policies and Implications for Burnout. Acad Psychiatry 2018; 42:73-77. [PMID: 28842868 DOI: 10.1007/s40596-017-0757-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 06/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nicole Westercamp
- San Mateo County Behavioral Health and Recovery Services, San Mateo, CA, USA.
| | - Raziya S Wang
- San Mateo County Behavioral Health and Recovery Services, San Mateo, CA, USA
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Abstract
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.
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Affiliation(s)
- Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine , Stanford, California, USA
| | - Yvonne Maldonado
- Department of Pediatrics, Stanford University School of Medicine , Stanford, California, USA
| | - Joseph Hopkins
- Department of Medicine, Stanford University School of Medicine , Stanford, California, USA
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Girod SC, Fassiotto M, Menorca R, Etzkowitz H, Wren SM. Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines. BMC Med Educ 2017; 17:8. [PMID: 28073345 PMCID: PMC5223325 DOI: 10.1186/s12909-016-0830-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/24/2016] [Indexed: 05/03/2023]
Abstract
BACKGROUND 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). METHOD 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Sabine C Girod
- Department of Surgery, Stanford University School of Medicine, 94305, Stanford, CA, USA.
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, 94305, Stanford, CA, USA
| | - Roseanne Menorca
- Department of Surgery, Stanford University School of Medicine, 94305, Stanford, CA, USA
| | - Henry Etzkowitz
- Science and Technology Society Program, Stanford University and International Triple Helix Institute, Palo Alto, CA, USA
| | - Sherry M Wren
- Department of Surgery, Stanford University School of Medicine, 94305, Stanford, CA, USA
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Girod S, Fassiotto M, Grewal D, Ku MC, Sriram N, Nosek BA, Valantine H. Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention. Acad Med 2016; 91:1143-50. [PMID: 26826068 DOI: 10.1097/acm.0000000000001099] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE 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. METHOD 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Sabine Girod
- S. Girod is associate professor, Department of Surgery and, by courtesy, Department of Otolaryngology, Stanford University School of Medicine, Stanford, California. M. Fassiotto is director of programs and research, Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California. D. Grewal is assessment and program evaluation analyst, Office of the Vice Provost for Undergraduate Education, Stanford University, Stanford, California. M.C. Ku is research program manager, Apple Inc., Cupertino, California. N. Sriram is founder of Implisci, Charlottesville, Virginia. B.A. Nosek is professor, Department of Psychology, University of Virginia, and executive director, Center for Open Science, Charlottesville, Virginia. H. Valantine is chief officer for scientific workforce diversity, National Institutes of Health, Bethesda, Maryland. This work was conducted while H. Valantine was at Stanford University, Stanford, California
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Fassiotto M, Hamel EO, Ku M, Correll S, Grewal D, Lavori P, Periyakoil VJ, Reiss A, Sandborg C, Walton G, Winkleby M, Valantine H. Women in Academic Medicine: Measuring Stereotype Threat Among Junior Faculty. J Womens Health (Larchmt) 2015; 25:292-8. [PMID: 26555562 DOI: 10.1089/jwh.2015.5380] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Magali Fassiotto
- 1 Office of Faculty Development and Diversity, Stanford University School of Medicine , Stanford, California
| | | | - Manwai Ku
- 3 Apple, Inc. , Cupertino, California
| | - Shelley Correll
- 4 Department of Sociology, Stanford University , Stanford, California
| | - Daisy Grewal
- 5 Office of the Vice Provost for Undergraduate Education, Stanford University , Stanford, California
| | - Philip Lavori
- 6 Department of Health Research and Policy, Stanford University School of Medicine , Stanford, California
| | - V J Periyakoil
- 7 Department of Medicine, Stanford University School of Medicine , Stanford, California
| | - Allan Reiss
- 8 Department of Psychiatry and Behavioral Medicine, Stanford University School of Medicine , Stanford, California
| | - Christy Sandborg
- 9 Department of Pediatrics, Stanford University School of Medicine , Stanford, California
| | - Gregory Walton
- 10 Department of Psychology, Stanford University , Stanford, California
| | - Marilyn Winkleby
- 7 Department of Medicine, Stanford University School of Medicine , Stanford, California
| | - Hannah Valantine
- 7 Department of Medicine, Stanford University School of Medicine , Stanford, California.,11 National Institutes of Health , Bethesda, Maryland
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