Structural and role-based workplace mistreatment in clinical training: a cross-sectional study of intern and resident physicians

Workplace mistreatment is common in medical training, but some forms may be embedded in routine clinical roles and workloads rather than occurring only as isolated interpersonal incidents. Intern physicians, who occupy a transitional position between student and physician roles, may be particularly vulnerable. This study examined the prevalence and patterns of workplace mistreatment in a clinical training environment, compared intern physicians with resident physicians (referred to as “research assistants” in the Turkish medical training system), and identified commonly reported behaviors and sources of mistreatment. This cross-sectional descriptive study was conducted at a tertiary teaching hospital in Turkey between January and February 2020. The study population comprised 200 research assistants and 124 intern physicians, of whom 221 (68.2%) participated voluntarily. Workplace mistreatment was assessed using a 56-item, theory-informed, behavior-based questionnaire grounded in Leymann’s framework of repeated negative acts. Persistent mistreatment was defined as exposure to at least two distinct behaviors occurring often or always. Logistic regression analyses examined associations between professional role and mistreatment, adjusting for gender and psychiatric history. Overall, 69.7% of participants met the study definition of persistent mistreatment. Intern physicians had significantly higher odds of exposure than resident physicians (OR = 5.58, 95% CI: 2.87–10.84, p < 0.001). The largest role-based differences were observed in workload- and role-related behaviors, particularly inappropriate task assignment and excessive non-educational workload. Severe behaviors, such as physical violence and sexual or identity-based harassment, were less frequent but reported in both groups. Among intern physicians, reported sources of mistreatment included both physicians and non-physician staff. In this study, workplace mistreatment in the clinical learning environment was common and disproportionately affected intern physicians. The concentration of differences in workload- and role-related behaviors suggests that mistreatment may be linked not only to individual interactions but also to routine clinical structures and role expectations. Efforts to address mistreatment should therefore consider workload organization, the vulnerability of interns’ transitional role, and the multiple sources from which mistreatment may arise within clinical training settings.