Mookerjee Anuradha, Li Becky, Arora Bhawana, Surapaneni Rakesh, Rajput Vijay, Van de Ridder Monica
Internal Medicine, Cooper Medical School of Rowan University, Camden, USA.
School of Medicine, Nova Southeastern University Dr. Kiran C Patel College of Allopathic Medicine, Fort Lauderdale, USA.
Cureus. 2022 Mar 26;14(3):e23523. doi: 10.7759/cureus.23523. eCollection 2022 Mar.
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.
学习者自主性是毕业后医学教育中的一项宝贵财富，能让实习生为未来的职业环境中独立面对挑战做好准备。教育机构面临着在学习者自主性和监督之间取得平衡的艰巨任务。在毕业后医学教育中，实习生通常希望得到的监督比他们的主治医生给予的更少。这种增加的监督是以学习者自主性为代价的，并且在患者治疗结果或安全性方面并未显示出改善。当主治医生对细节进行控制时，实习生可能会将他们视为“微观管理者”。微观管理者的主要特征包括过度要求进展情况汇报、坚持任务要按他们的方式完成以及仔细审查每一个细节。这种微观管理行为不利于学习环境，甚至可能导致带教老师倦怠。商业文献揭示了关于这个话题的一场辩论。不幸的是，在毕业后医学教育中仍然缺乏关于微观管理的文献。虽然一系列内部因素可能导致学术医疗机构中的过度监督，但我们推测微观管理的存在是由于三个驱动因素之间的复杂动态关系：问责制、信任和自主性。当实习生被问责时，他们学会为自己的行为负责，这会导致信任的建立，进而促进积极性和自主性的获得。理想情况下，带教主治医生应该能够根据他们的信任以及实习生的能力、问责制和自主性，舒适地调整他们的监督水平。微观管理的医生做不到这一点，这可能会对学习者产生不利影响。微观管理在实习生早期融入过程中可能被一些人视为有益的组成部分，理由是能带来更好的患者治疗结果和安全性。然而，从长远来看，它会威胁学习环境，并侵蚀问责制、信任和自主性之间的复杂关系。我们建议在三个层面——微观管理者、被微观管理的人以及组织结构——采取行动计划来减轻微观管理，并希望这些解决方案能改善实习生和带教老师的学习环境。
