Structural and Role-Based Workplace Mistreatment in Clinical Training: A Cross-Sectional Study of Intern and Resident Physicians

Background Workplace mistreatment in medical education has been widely reported; however, structural and role-based forms of mistreatment embedded within routine clinical practice remain underexplored. Intern physicians, who occupy a transitional position between student and physician roles, may be particularly vulnerable. This study aimed to assess the prevalence and patterns of workplace mistreatment in a clinical training environment, examine differences according to professional role, identify the most frequently reported behaviors, and explore reported sources of mistreatment. Methods 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. 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 operationalized 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. Results Using the primary operational definition, 69.7% of participants met criteria for persistent mistreatment. Intern physicians had significantly higher odds of exposure compared with research assistants (OR = 5.58, 95% CI: 2.87–10.84, p < 0.001). Disparities were most pronounced in workload- and role-related behaviors, including inappropriate task assignment and excessive non-educational workload. Severe forms of mistreatment, such as physical violence and sexual or identity-based harassment, were less frequent but reported across training levels. Reported sources of mistreatment included both physicians and non-physician staff. Conclusions Workplace mistreatment in the clinical learning environment is common and disproportionately affects intern physicians. The concentration of disparities in role- and workload-related domains suggests that harmful practices may be embedded within routine clinical structures rather than limited to isolated interpersonal incidents. Effective responses should consider structural workload dynamics, transitional vulnerability during internship, and the multidirectional nature of clinical hierarchies.