Micromanagement During Clinical Supervision: Solutions to the Challenges

Abstract

Learner autonomy is an invaluable asset in graduate medical education, preparing the trainee to independently face challenges in the future professional settings. Educational institutions face the difficult task of providing a balance between learner autonomy and supervision. In graduate medical education, trainees often prefer less supervision than what is imparted by their attending physician. This increased supervision comes at the cost of learner autonomy and has not exhibited improvement in patient outcomes or safety. When attendings exhibit control over details, the trainees may label them as “micromanagers”. Cardinal features of a micromanager include excessively requesting updates, insisting that the task be done their way, and scrutinizing every detail. This micromanaging behavior is non-conducive to the learning environment and may even contribute to supervisor burnout. The business literature reveals a debate about this very topic. Unfortunately, there is still a lack of literature on micromanagement in graduate medical education. Although a conglomerate of internal factors may lead to excessive supervision in an academic medical institution, we surmise that micromanagement exists because of a complex dynamic between three drivers: accountability, trust, and autonomy. When trainees are held accountable, they learn to take ownership for their actions which leads to establishment of trust which further enables motivation and gaining of autonomy. Supervising attendings should ideally be able to comfortably adjust their level of supervision based on their trust and the trainee’s competence, accountability, and autonomy. The micromanaging physician is unable to do so, and this can have a detrimental effect on the learner. Micromanagement can be perceived by some as a beneficial component during the early immersion of the trainee with the rationalization for better patient outcomes and safety. However, in the long term, it threatens the learning environment and erodes the complex relationship between accountability, trust, and autonomy. We recommend an action plan to mitigate micromanagement at three levels-the micromanager, the micromanaged, and the organizational structure-and hope that these solutions enhance the learning environment for both the trainee and supervisor.

Micromanagement in clinical supervision: a scoping review

“…Conversely, alternatives to micromanagement were essentially positive, including entrustment or granting autonomy, coaching for trainees’ independent practice, and effective supervision and leadership. Nonetheless, supervisory practices associated with micromanagement mostly engender negative perceptions and, as such, the field of medicine seems more tolerant of this approach to clinical training than fields outside medicine, such as organizational management, public administration, and political science [ 27 ]. In the field of organizational management, Peter Drucker’s 1946 work on democracy in management (decentralizing and delegating more authority to employees) and Douglas McGregor’s 1960 Theory X manager (a manager who is poor at proper delegating), criticize micromanagement as a strong disrupter of organizational life and an organizational pathology [ 28 ].…”

“…Given the greater tolerance for supervisory micromanagement in medical fields [ 27 ], it is reasonable to ask, what exactly is the problem with scrutinizing, i.e., monitoring every last detail or a detail-oriented faculty? Some aspects of performance by health professionals are crucially important— such as those linked to patient safety, performance and professional expertise—and may be seen as justifying ‘over-management’.…”

Nurse managers’ managerial innovation and it’s relation to proactivity behavior and locus of control among intensive care nurses

“…On the other hand, an external locus of control can undermine empowerment and encourage passivity [ 80 ]. To counteract this, Nurse Managers should foster personal accountability and steer clear of excessive supervision or micromanagement that might inhibit nurse empowerment [ 81 ]. Implementing shared governance models that provide nurses with autonomy commensurate with their skills can facilitate this equilibrium [ 82 ].…”