Power Dynamics and Hierarchy: Lived Experiences of Medical Interns and Residents in the Maternity Ward at Zewditu Memorial Hospital, Ethiopia: An Interpretive Phenomenological Study

The influence of hierarchical structures in maternity wards on supervision, learner autonomy, and professional development has been recognized, yet its impact on medical trainees in low-resource teaching hospitals remains poorly understood. This study explored how medical interns and residents perceive and navigate power relations in the maternity ward of Zewditu Memorial Hospital, a tertiary teaching hospital in Addis Ababa, Ethiopia. Using an interpretive phenomenological approach, we conducted in-depth interviews with 20 participants between November 2022 and February 2023, including medical interns, residents, and general practitioners involved in maternity care. We analyzed the data thematically to capture participants' lived experiences of hierarchy, supervision, and clinical responsibility. Findings revealed three interrelated subthemes-status-role interactions, activity-transferring, and blame shifting-which together illuminate how hierarchical relations structure clinical learning, professional identity, and emotional well-being. Participants described a supervisory environment dominated by OB/GYN specialists whose authority was enacted through evaluative control and largely non-negotiable decision-making. This hierarchical arrangement constrained trainees' autonomy, limited opportunities for critical engagement, and positioned interns and residents as responsible for patient care without corresponding decision-making power. Activity-transferring frequently placed trainees in situations that exceeded their experience and formal roles, generating fear of errors and ethical tension. Blame-shifting further intensified trainees' vulnerability, undermining confidence, psychological safety, and their willingness to speak up. The findings reveal that hierarchy in the maternity ward functioned as a double-edged structure for clinical education. While it supported supervision and accountability, it also constrained learning, ethical agency, and open communication. Rather than reflecting a negotiated learning environment, clinical training was largely obedience-based, with authority concentrated among senior physicians and risk distributed to trainees. Educational strategies that promote guided autonomy, respectful supervision, and psychological safety are essential to enhance learning and support professional development in maternity care training contexts.