Presented By: Annie Vu, Michigan State University College of Human Medicine
Co-Authors: Bhawana Arora, Michigan State University, College of Human Medicine/Corewell Health
Anuradha Lele Mookerjee, Cooper Medical School of Rowan University
Vijay Rajput, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine
Rakesh Surapaneni, Texas A&M University School of Medicine
Monica van de Riddler, Michigan State University College of Human Medicine

Purpose 
Micromanagement is defined as a supervisory style of "hovering" with the need for excess control, instead of providing space to the trainee to make their own decisions [1]. Micromanagement has been perceived by residents to impede their confidence and autonomy [2,3,4]. There is a dearth of literature on micromanagement in graduate medical education (GME). Micromanagement during clinical supervision is an important, but unaddressed topic. This study explores the perceptions and outlines the possible causes and implications of micromanagement on GME. 

Methods 
A standardized survey was developed and validated in 2022. The residents and fellows at an urban academic medical center completed the survey from June to August 2023. The survey collected data on demographics, educational setting, perceptions of micromanagement, potential factors, and its effects on resident and fellow training. Descriptive statistics were completed. 

Results 
109 residents and fellows (PGY1-7) from eight specialties started the survey, of which 72 completed it. 94% had heard about the concept of micromanagement and 32% of the senior trainees (PGY3-4) perceived micromanagement as being a problem. 38% had experienced some form of micromanaging behavior in the last six months. Patient acuity (93%), patients requiring bedside procedures (54%), patient complexity (89%), and supervisor personality (93%) were perceived factors affecting micromanagement. There were no perceived differences between medical or surgical specialties. The fear of retaliation (33%), patient safety (29%), efficiency of care (25%), and institutional culture (18%) were the justifications perceived by respondents as explanations for micromanagers' behavior. The decline in autonomy (47%), confidence (40%), initiative taking (36%), engagement (33%) and poor supervisor-trainee relationship (25%) were the perceived effects on the trainees. 

Conclusion 
Addressing micromanagement in clinical supervision requires a multifaceted approach, involving both micromanagers and organizational structures. Further research and solutions are needed in addressing micromanagement in the clinical setting.