Micromanagement in clinical supervision: a scoping review

Abstract

Micromanagement in clinical supervision in health professions education generally refers to supervision characterized by unproductive excessive control and attention to detail. It can affect autonomy, competence, well-being of learners, teamwork, and ultimately patient care. Despite its potential negative impact on learners and patients, no comprehensive review of this phenomenon has been conducted. This scoping review aims to explore the breadth of extant literature concerning micromanagement in clinical supervision in health professions education and map the body of research on the topic. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Review (PRISMA-ScR). We searched eight databases, and the final review and analysis comprised 12 articles that examined micromanagement in clinical supervision across health professions education. Micromanagement was conceptualized as ineffective supervisory practices such as undue scrutiny, excessive control, domination, and ineffectual leadership. Conversely, alternatives to micromanagement included entrusting or granting autonomy, coaching for independent practice, and providing effective supervision and leadership. Overall, micromanagement was attributed to individual behavioral and personality factors, such as distrust, perfectionism, self-conviction, and low self-esteem. The consequences of micromanagement included inadequacies in professional development and well-being of trainees and patient care, and organizational dysfunction. Suggested solutions included entrusting or empowering trainees with encouragement and clear communication, open communication efforts by trainees, organizational management for quality supervision, and facultys valuing both clinical and educational goals. Current literature on micromanagement—in the context of clinical supervision in health professions education—was found to be sparse, implying a need for more rigorous research and discourse on this understudied area. The findings can be used to recognize, solve, and prevent the prevalent, and often unrecognized, phenomena of micromanagement, which may improve clinical supervision, the professional development of trainees and faculty, organizational management, and ultimately patient care.