Magali Fassiotto

All Publications

• Untapped Resources: Attaining Equitable Representation for Women in IR. Journal of vascular and interventional radiology : JVIR Perez, M. G., Fassiotto, M., Altamirano, J., Hwang, G. L., Maldonado, Y., Josephs, S., Sze, D. Y., Kothary, N. 2019

  Abstract

  PURPOSE: To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators.MATERIALS AND METHODS: Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012-2017) were statistically compared to that of recurring male faculty.RESULTS: From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P= .722; total publications P= .689; and authorship P= .662).CONCLUSIONS: This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record.

  View details for PubMedID 30772166

• Comparison of Outpatient Satisfaction Survey Scores for Asian Physicians and Non-Hispanic White Physicians. JAMA network open Garcia, L. C., Chung, S., Liao, L., Altamirano, J., Fassiotto, M., Maldonado, B., Heidenreich, P., Palaniappan, L. 2019; 2 (2): e190027

  Abstract

  Patient satisfaction scores are used to inform decisions about physician compensation, and there remains a lack of consensus regarding the need to adjust scores for patient race/ethnicity. Previous research suggests that patients prefer physicians of the same race/ethnicity as themselves and that Asian patients provide lower satisfaction scores than non-Hispanic white patients.To examine whether Asian physicians receive less favorable patient satisfaction scores relative to non-Hispanic white physicians.This population-based survey study used data from Press Ganey Outpatient Medical Practice Surveys collected from December 1, 2010, to November 30, 2014, which included 149 775 patient survey responses for 962 physicians. Every month, 5 patients per physician were randomly selected to complete a satisfaction survey after an outpatient visit. Hierarchical multivariable logistic regression was used to examine the association between Asian race/ethnicity of the physician and racial/ethnic concordance of the patient with the probability of receiving the highest score on the survey item rating the likelihood to recommend the physician. Statistical analysis was performed from April 2 to August 27, 2018.Physician characteristics included race/ethnicity, sex, years in practice, and proportion of Asian patient responders. Patient characteristics included race/ethnicity, sex, age, and language spoken.The highest score (a score of 5 on a 1-5 Likert scale, where 1 indicates very poor and 5 indicates very good) on the survey item rating the likelihood to recommend the physician on the Press Ganey Outpatient Medical Practice Survey.Of the 962 physicians in this study, 515 (53.5%) were women; physicians had a mean (SD) of 19.9 (9.1) years of experience since graduating medical school; 573 (59.6%) were white, and 350 (36.4%) were Asian. In unadjusted analyses, the odds of receiving the highest score on the survey item rating the likelihood to recommend the physician were lower for Asian physicians compared with non-Hispanic white physicians (odds ratio, 0.78; 95% CI, 0.72-0.84; P < .001). This association was not significant after adjusting for patient characteristics, including patient race/ethnicity. However, Asian patients were less likely to give the highest scores relative to non-Hispanic white patients (odds ratio, 0.56; 95% CI, 0.54-0.58; P < .001), regardless of physician race/ethnicity.This study suggests that Asian physicians may be more likely to receive lower patient satisfaction scores because they serve a greater proportion of Asian patients. Patient satisfaction scores should be adjusted for patient race/ethnicity.

  View details for PubMedID 30794297

• What's in a Word? Qualitative and Quantitative Analysis of Leadership Language in Anesthesiology Resident Feedback Journal of Graduate Medical Education Arking, N., Lai, C., Kiwakyou, L. M., Lochbaum, G. M., Shafer, A., Howard, S. K., Mariano, E. R., Fassiotto, M. 2019; 11 (1): 44-52

  View details for DOI 10.4300/JGME-D-18-00377.1

• Resident Perspectives on Work-Life Policies and Implications for Burnout. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry Westercamp, N., Wang, R. S., Fassiotto, M. 2018; 42 (1): 73–77

  Abstract

  As resident burnout increases, there is a need for better awareness, resources, and interventions. Challenges in balancing work and life priorities have been implicated in contributing to physician burnout. Institutional work-life policies (WLPs) are critical tools to meet work-life needs. This study investigates the influence of WLPs on residents' experiences.The authors emailed a SurveyMonkey link to the APA chief resident and Minority Fellow listservs and directly to 94 psychiatry program directors and 52 fellowship directors nationwide to distribute a survey to residents regarding WLP use and barriers, as well as burnout. Estimated response rate was 12-23%. The authors assessed the anonymous responses using SPSS to evaluate for relationships between awareness of WLPs, perceptions/barriers surrounding their usage, and burnout.The authors analyzed 255 responses. Awareness and use of policies ranged from 2 to 33%. A prominent barrier to WLPs is that use results in shifting workload to co-residents (48% agree). Respondents who perceived leadership to view use of WLPs as a sign of weakness (16% agree) were less likely to use WLPs (t (89) = -3.52, p < 0.001, d = 0.61). Residents with burnout (41%) perceived vastly higher barriers to using WLPs as compared to those without burnout.This study supports the need for further investigation of WLPs to mitigate resident burnout and identifies important perceived barriers that affect the use of WLPs including low awareness, potential for shifting workload to co-residents, and negative perceptions of leadership attitudes toward WLPs.

  View details for PubMedID 28842868

• Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology. Women's health issues : official publication of the Jacobs Institute of Women's Health Rogo-Gupta, L. J., Haunschild, C., Altamirano, J., Maldonado, Y. A., Fassiotto, M. 2018; 28 (3): 281–85

  Abstract

  Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.

  View details for PubMedID 29429946

• Female Surgeons as Counter Stereotype: The Impact of Gender Perceptions on Trainee Evaluations of Physician Faculty. Journal of surgical education Fassiotto, M., Li, J., Maldonado, Y., Kothary, N. 2018

  Abstract

  Similar to women in Science, Technology, Engineering and Mathematics disciplines, women in medicine are subject to negative stereotyping when they do not adhere to their sex-role expectations. These biases may vary by specialty, largely dependent on the gender's representation in that specialty. Thus, females in male-dominated surgical specialties are especially at risk of stereotype threat. Herein, we present the role of gender expectations using trainee evaluations of physician faculty at a single academic center, over a 5-year period (2010-2014).Using Graduate Medical Education evaluation data of physician faculty from MedHub, we examined the differences in evaluation scores for male and female physicians within specialties that have traditionally had low female representation (e.g., surgical fields) compared to those with average or high female representation (e.g., pediatrics).Stanford Medicine residents and fellows' MedHub ratings of their physician faculty from 2010 to 2014.A total of 3648 evaluations across 1066 physician faculty.Overall, female physicians received lower median scores than their male counterparts across all specialties. When using regression analyses controlling for race, age, rank, and specialty-specific characteristics, the negative effect persists only for female physicians in specialties with low female representation.This finding suggests that female physicians in traditionally male-dominated specialties may face different criteria based on sex-role expectations when being evaluated by trainees. As trainee evaluations play an important role in career advancement decisions, dictate perceptions of quality within academic medical centers and affect overall job satisfaction, we propose that these differences in evaluations based merely on gender stereotypes could account, in part, for the narrowing pipeline of women promoted to higher ranks in academic medicine.

  View details for PubMedID 29402668

• Pulled in Too Many Directions: The Causes and Consequences of Work-Work Conflict Sociological Perspectives Wynn, A. T., Fassiotto, M., Simard, C., Raymond, J. L., Valantine, H. 2018

  View details for DOI 10.1177/0731121418774568

• A long-term follow-up of a physician leadership program. Journal of health organization and management Fassiotto, M., Maldonado, Y., Hopkins, J. 2018; 32 (1): 56–68

  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.

  View details for PubMedID 29508671

• An Integrated Career Coaching and Time-Banking System Promoting Flexibility, Wellness, and Success: A Pilot Program at Stanford University School of Medicine. Academic medicine : journal of the Association of American Medical Colleges Fassiotto, M., Simard, C., Sandborg, C., Valantine, H., Raymond, J. 2018; 93 (6): 881–87

  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.

  View details for PubMedID 29298183

• Designing a physician leadership development program based on effective models of physician education. Health care management review Hopkins, J., Fassiotto, M., Ku, M. C., Mammo, D., Valantine, H. 2017

  Abstract

  Because of modern challenges in quality, safety, patient centeredness, and cost, health care is evolving to adopt leadership practices of highly effective organizations. Traditional physician training includes little focus on developing leadership skills, which necessitates further training to achieve the potential of collaborative management.The aim of this study was to design a leadership program using established models for continuing medical education and to assess its impact on participants' knowledge, skills, attitudes, and performance.The program, delivered over 9 months, addressed leadership topics and was designed around a framework based on how physicians learn new clinical skills, using multiple experiential learning methods, including a leadership active learning project. The program was evaluated using Kirkpatrick's assessment levels: reaction to the program, learning, changes in behavior, and results. Four cohorts are evaluated (2008-2011).Reaction: The program was rated highly by participants (mean = 4.5 of 5). Learning: Significant improvements were reported in knowledge, skills, and attitudes surrounding leadership competencies. Behavior: The majority (80%-100%) of participants reported plans to use learned leadership skills in their work. Improved team leadership behaviors were shown by increased engagement of project team members.All participants completed a team project during the program, adding value to the institution.Results support the hypothesis that learning approaches known to be effective for other types of physician education are successful when applied to leadership development training. Across all four assessment levels, the program was effective in improving leadership competencies essential to meeting the complex needs of the changing health care system.Developing in-house programs that fit the framework established for continuing medical education can increase physician leadership competencies and add value to health care institutions. Active learning projects provide opportunities to practice leadership skills addressing real word problems.

  View details for DOI 10.1097/HMR.0000000000000146

  View details for PubMedID 28157830

• Reasons for faculty departures from an academic medical center: a survey and comparison across faculty lines BMC MEDICAL EDUCATION Girod, S. C., Fassiotto, M., Menorca, R., Etzkowitz, H., Wren, S. M. 2017; 17

  Abstract

  Faculty departure can present significant intellectual costs to an institution. The authors sought to identify the reasons for clinical and non-clinical faculty departures at one academic medical center (AMC).In May and June 2010, the authors surveyed 137 faculty members who left a west coast School of Medicine (SOM) between 1999 and 2009. In May and June 2015, the same survey was sent to 40 faculty members who left the SOM between 2010-2014, for a total sample size of 177 former faculty members. The survey probed work history and experience, reasons for departure, and satisfaction at the SOM versus their current workplace. Statistical analyses included Pearson's chi-square test of independence and independent sample t-tests to understand quantitative differences between clinical and non-clinical respondents, as well as coding of qualitative open-ended responses.Eighty-eight faculty members responded (50%), including three who had since returned to the SOM. Overall, professional and advancement opportunities, salary concerns, and personal/family reasons were the three most cited factors for leaving. The average length of time at this SOM was shorter for faculty in clinical roles, who expressed lower workplace satisfaction and were more likely to perceive incongruence and inaccuracy in institutional expectations for their success than those in non-clinical roles. Clinical faculty respondents noted difficulty in balancing competing demands and navigating institutional expectations for advancement as reasons for leaving.AMCs may not be meeting faculty needs, especially those in clinical roles who balance multiple missions as clinicians, researchers, and educators. Institutions should address the challenges these faculty face in order to best recruit, retain, and advance faculty.

  View details for DOI 10.1186/s12909-016-0830-y

  View details for PubMedID 28073345

• Training and Professionalism Year Book of Pediatrics Fassiotto, M., Maldonado, Y., Sandborg, C. edited by Cabana, M. D., Goldstein, A. M., De Gialluly, P. S., Schroeder, A. R. Elsevier, Inc.. 2017: 499–501
• Loud and Clear: The Effect of Protest Signals on Congressional Attention Mobilization: An International Quarterly Fassiotto, M., Soule, S. A. 2017; 22 (1): 17-38

  View details for DOI 10.17813/1086-671X-22-1-17

• Reducing Implicit Gender Leadership Bias in Academic Medicine With an Educational Intervention. Academic medicine Girod, S., Fassiotto, M., Grewal, D., Ku, M. C., Sriram, N., Nosek, B. A., Valantine, H. 2016; 91 (8): 1143-1150

  Abstract

  One challenge academic health centers face is to advance female faculty to leadership positions and retain them there in numbers equal to men, especially given the equal representation of women and men among graduates of medicine and biological sciences over the last 10 years. The purpose of this study is to investigate the explicit and implicit biases favoring men as leaders, among both men and women faculty, and to assess whether these attitudes change following an educational intervention.The authors used a standardized, 20-minute educational intervention to educate faculty about implicit biases and strategies for overcoming them. Next, they assessed the effect of this intervention. From March 2012 through April 2013, 281 faculty members participated in the intervention across 13 of 18 clinical departments.The study assessed faculty members' perceptions of bias as well as their explicit and implicit attitudes toward gender and leadership. Results indicated that the intervention significantly changed all faculty members' perceptions of bias (P < .05 across all eight measures). Although, as expected, explicit biases did not change following the intervention, the intervention did have a small but significant positive effect on the implicit biases surrounding women and leadership of all participants regardless of age or gender (P = .008).These results suggest that providing education on bias and strategies for reducing it can serve as an important step toward reducing gender bias in academic medicine and, ultimately, promoting institutional change, specifically the promoting of women to higher ranks.

  View details for DOI 10.1097/ACM.0000000000001099

  View details for PubMedID 26826068

• Occupational Radiation Exposure during Pregnancy: A Survey of Attitudes and Practices among Interventional Radiologists JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Ghatan, C. E., Fassiotto, M., Jacobsen, J. P., Sze, D. Y., Kothary, N. 2016; 27 (7): 1013-1020

  Abstract

  To assess attitudes of interventional radiologists toward occupational ionizing radiation exposure in pregnancy and to survey practice patterns and outcomes.A 34-question anonymous online survey on attitudes and work practices toward interventional radiologists who worked during pregnancy was sent to active SIR members, including 582 women.There were 534 (10%) respondents, including 142 women and 363 men. Among respondents, men were statistically older than women (P < .001) and had practiced interventional radiology (IR) longer (P < .001). Of female interventional radiologists, 55% had worked during pregnancy and reported no specific mutagenic events in their offspring. Spontaneous abortions (11%) and use of reproductive technology (17%) matched that of women with similar age and socioeconomic background. Although more women changed their work practice because of concerns of occupational exposure than men (23% vs 13%), this change was largely limited to the duration of a pregnancy. Among pregnant interventional radiologists, 4 (6%) completely abstained from performing fluoroscopically guided interventions (FGIs), whereas 31 (46%) continued to spend > 80% of their work week doing FGIs with additional protection. Perceptions of impact of pregnancy on daytime work redistribution varied significantly with gender (P < .001); however, perceptions regarding impact of pregnancy on on-call hours, distribution of complex cases, and need to hire for temporary coverage were similar between the genders.Most pregnant interventional radiologists continue to practice IR while pregnant. Pregnancy and fetal outcomes parallel that of the general population when matched for demographics. However, perceptions of impact of pregnancy on work lives of colleagues vary notably.

  View details for DOI 10.1016/j.jvir.2016.03.040

  View details for PubMedID 27236211

• Women in Academic Medicine: Measuring Stereotype Threat Among Junior Faculty JOURNAL OF WOMENS HEALTH Fassiotto, M., Hamel, E. O., Ku, M., Correll, S., Grewal, D., Lavori, P., Periyakoil, V. J., Reiss, A., Sandborg, C., Walton, G., Winkleby, M., Valantine, H. 2016; 25 (3): 292-298

  Abstract

  Gender stereotypes in science impede supportive environments for women. Research suggests that women's perceptions of these environments are influenced by stereotype threat (ST): anxiety faced in situations where one may be evaluated using negative stereotypes. This study developed and tested ST metrics for first time use with junior faculty in academic medicine.Under a 2012 National Institutes of Health Pathfinder Award, Stanford School of Medicine's Office of Diversity and Leadership, working with experienced clinicians, social scientists, and epidemiologists, developed and administered ST measures to a representative group of junior faculty.174 School of Medicine junior faculty were recruited (62% women, 38% men; 75% assistant professors, 25% instructors; 50% white, 40% Asian, 10% underrepresented minority). Women reported greater susceptibility to ST than did men across all items including ST vulnerability (p < 0.001); rejection sensitivity (p = 0.001); gender identification (p < 0.001); perceptions of relative potential (p = 0.048); and, sense of belonging (p = 0.049). Results of career-related consequences of ST were more nuanced. Compared with men, women reported lower beliefs in advancement (p = 0.021); however, they had similar career interest and identification, felt just as connected to colleagues, and were equally likely to pursue careers outside academia (all p > 0.42).Innovative ST metrics can provide a more complete picture of academic medical center environments. While junior women faculty are susceptible to ST, they may not yet experience all of its consequences in their early careers. As such, ST metrics offer a tool for evaluating institutional initiatives to increase supportive environments for women in academic medicine.

  View details for DOI 10.1089/jwh.2015.5380

  View details for Web of Science ID 000372173200014

• Initial Conditions Palgrave Encyclopedia of Strategic Management Carroll, G., Fassiotto, M. A. edited by Augier, M., Teece, D. J. 2016

  View details for DOI 10.1057/978-1-349-94848-2_786-1

• Category Signaling and Reputation ORGANIZATION SCIENCE Negro, G., Hannan, M. T., Fassiotto, M. 2015; 26 (2): 584-600

  View details for DOI 10.1287/orsc.2014.0935

  View details for Web of Science ID 000355095100017

• Organizations as Fonts of Entrepreneurship ORGANIZATION SCIENCE Sorensen, J. B., Fassiotto, M. A. 2011; 22 (5): 1322-1331

  View details for DOI 10.1287/orsc.1100.0622

  View details for Web of Science ID 000295027600019