The idea didn’t come to me during a feedback session or a faculty meeting. It came on the drive home, post-call. I turned on a podcast I had queued for weeks, something about leadership and managing up. I didn’t expect it to resonate. I expected background noise for my commute.
But then the host said something simple: “Managing up is not about control; it’s about clarity.”
I had first encountered the term during my time as a primary care physician and clinician educator, before returning to fellowship. At the time, it struck me as a corporate strategy: understand your boss’s needs, communicate clearly, and try not to get in the way. But as I listened, it resonated differently now. The host spoke about managing up as a form of leadership; a method of influencing systems even when you’re not the final decision-maker, advocating for alignment between values and action, and navigating hierarchies with intention.
Somewhere between the highway signs and the host’s closing points, I realized: this is what trainees do or try to do every day. And yet, we rarely name it.
Returning to fellowship after time as an attending was disorienting. I came in with a sense of professional identity and communication skills honed through years of teaching and leadership. But I found myself questioning whether that assertiveness translated well in a training environment. Was I overstepping by speaking up in meetings? Was I too forward in asking questions? Did I come across as difficult when I asked for transparency around certain decisions?
The line between being appropriately proactive and “too assertive” often felt unclear. I wasn’t trying to disrupt the system, I simply couldn’t stop seeing opportunities for clarity, equity, and improvement.
That’s when I started thinking about managing up not just as a skill from a prior life, but as something deeply relevant to medical training.
Managing Up in Medical Education
Medical education is built on hierarchy. While that structure can support learning and patient safety, it can also make it difficult for trainees to speak up, especially when advocating for themselves. But leadership doesn’t begin after training ends. The ability to communicate with clarity, offer feedback upward, and raise systemic concerns respectfully is something we should be encouraging from day one.
Managing up is not about circumventing authority; it’s about strengthening it through dialogue. It allows trainees to act as collaborators in their education rather than passive participants. And when done well, it can enhance institutional function, improve team culture, and contribute to learner well-being.
Strategies for Managing Up as a Trainee
1) Communicate Early and Clearly
Often, trainees hesitate to bring up concerns until they’ve reached a breaking point. But early communication, whether about schedule clarity, conference time, or role expectations, can prevent small issues from becoming larger ones.
2) Frame Issues Around Shared Goals
When raising concerns, it’s helpful to frame them in terms of mutual benefit. For example, requesting time to attend a conference is not just a personal ask, it’s an opportunity to represent the program, foster professional growth, and bring knowledge back to the institution.
3) Propose Solutions
Supervisors are more likely to respond positively when trainees come with suggestions, not just problems. Whether proposing a different call structure or a process improvement, thinking like a leader and proposing viable solutions that benefit the group signals that you are invested in the success of the team, not just your own experience.
4) Seek Transparency and Equity
If something doesn’t make sense, such as how CME days are allocated or how opportunities are distributed, ask. These questions are not about challenging authority, but about building systems that are fair and sustainable.
5) Reframe Self-Advocacy as Responsibility
Advocating for oneself is often misinterpreted as arrogance, especially for certain groups, and those who don’t fit expected norms. But self-advocacy is also about setting an example, making space for others, and holding systems accountable. It is not a disruption, it is a responsibility.
Medical education can benefit from normalizing the concept of managing up, not as a rebellion, but as a partnership. We should talk about it in didactics, model it during supervision, and give it language during feedback.
Because somewhere, another trainee is driving home after call, wondering if they asked for too much. And maybe all they need is a quiet moment and the right words to realize that what they’re doing is learning how to lead from exactly where they are.
What is your experience with managing up in medicine? Share in the comments!
Dr. Sobrina Mohammed is a second-year endocrinology fellow with a prior career as a clinician educator, returning to training with a unique perspective on clinical education, mentorship, and patient care.
Illustration by Diana Connolly
