Bureaucrapathologies: Galloping Regulosis, Assessment Degradosis, and Other Unintended Organizational Maladies in Post-Graduate Medical Education

Abstract

As decadelong observers of evolving administrative regulations governing academic medicine, the authors have identified several organizational disorders they define as "bureaucrapathologies," pathological conditions caused by dysfunctional bureaucratic processes that generate excesses of wasted time, effort, and other resources. Appearing wherever bureaucratic organizations exist, they have become particularly egregious in health care, research, and education. In past decades, graduate medical education has been beset by proliferating assessment requirements accompanied by corresponding documentation requirements imposed by academic educational regulatory agencies (specifically the Accreditation Council on Graduate Medical). Although originating from the best of intentions, these largely untested, unvalidated, and unfunded mandates generate burdensome personnel, time, and resource requirements. As they trickle down organizational levels, the intentions of the originators are inevitably degraded. As motivations and incentives of lower level administrators and faculty differ considerably from those at higher levels, we inevitably encounter debatable assessment practices yielding results of dubious reliability and validity. These processes invariably lead to proliferating reports and paperwork. All of this raises serious questions about the benefits vs. harms of these enterprises. In our view, these pathogenic processes can be recognized as diagnosable subtypes of bureaucrapathology. Here the authors briefly describe two, Galloping Regulosis and Assessment Degradosis, which reflect on their pathogenesis and offer preliminary thoughts for potential remedies. Several other recently identified bureaucrapathological syndromes awaiting future delineation are noted.

Efeitos da burocracia na educação inclusiva: As perceções dos diretores portugueses

“…Poder-se-ia pôr a hipótese de que este aumento dos procedimentos burocráticos resulte de uma má aplicação dos modelos pelos decisores portugueses, mas a incapacidade de superar o modelo weberiano, apesar do aumento da autonomia e flexibilidade, foi igualmente sentida a nível internacional (Medeiros, 2006;Torres, 2008). Podem ser encontrados vários estudos (Anzures, 2020;Farrel & Morris, 2003;Osipov, 2020;Yager & Katzman, 2015), onde se percebe que os procedimentos burocráticos têm aumentado e algumas formas e práticas educativas que podem ser relacionadas com a pós-burocracia, não substituíram as práticas características da burocracia, enquanto modelo tradicional de organização racional-legal. Ao invés, somaram-se e coexistem com elas (Afonso & Mendes, 2018).…”