Evaluation of mobbing experiences among family medicine residents

Abstract

Purpose

This study aimed to examine the prevalence of mobbing experiences among family medicine residents in Turkey.

Methods

A cross-sectional prevalence study was conducted with 406 volunteer physicians undergoing family medicine residency training. Data were collected via an online survey including sociodemographic questions and a modified Mobbing Scale, which assessed mobbing behaviors across five sub-dimensions: lack of communication, boycott and isolation, threats and violence, reduced work commitment, and job and career barriers. Statistical analyses were performed using IBM SPSS Statistics version 25, with statistical significance set at p < 0.05.

Results

The findings revealed that 12.68% of participants experienced mobbing, while an additional 12.70% were uncertain whether they had experienced mobbing. The most frequently reported mobbing experiences occurred in the domains of reduced work commitment (34.69%) and job and career barriers (24.13%). No statistically significant differences were observed based on gender, years of professional experience, or institutional affiliation. However, mobbing related to job and career barriers was more prevalent in Turkish Health Sciences University hospitals. Additionally, a positive correlation was identified between age and job commitment, suggesting that older participants exhibited higher levels of commitment to their work.

Conclusion

The study indicates that mobbing remains a significant issue among family medicine residents, particularly concerning job commitment and career-related obstacles. These findings highlight the need for increased awareness and the implementation of preventive strategies to mitigate mobbing in healthcare environments, especially within large and hierarchical institutions.

Introduction

Mobbing is defined as a series of malicious, intentional, and negative behaviors carried out by one or more individuals against another person or group in the workplace. These behaviors are typically persistent over time and aimed at threatening, intimidating, or dismissing the victim(s). They typically seek to damage the victim’s reputation, social standing, health, or personal well-being [1, 2]. Individuals subjected to prolonged mobbing experience a range of psychological and emotional consequences, including decreased self-esteem, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal tendencies [3].

Research indicates that 583 million people, or 17.9% of the global workforce, experience mobbing in their workplaces [4]. Studies consistently reveal higher rates of mobbing in healthcare settings compared to other professions [5]. Research on mobbing within the healthcare sector, which also addresses the rights violations faced by medical specialty trainees, has significantly raised awareness of the issue [6].

The field of Family Medicine has historically struggled with gaining recognition and acceptance from both society and healthcare stakeholders. Family medicine residents, as members of this often underappreciated discipline, are particularly affected by these challenges. It is hypothesized that the rights violations experienced by family medicine residents, who study within a field that is frequently undervalued, are more prevalent. Consequently, the aim of this study is to investigate whether family medicine residency students experience mobbing.

Methods

This study is a cross-sectional prevalence investigation. Ethical approval was obtained from the Local Ethics Committee (approval date: 13.08.2024, approval number: 2024/08). A minimum sample size of 300, commonly recommended for survey studies, was targeted. The survey questions were administered online via Google Forms after obtaining informed consent. The survey was administered to volunteer family medicine residents. Physicians enrolled in contracted family medicine residency programs were excluded from the study, as they spent half of their training period in non-educational institutions. A total of 406 volunteers participated in the study.

Questionnaire

The survey consisted of sociodemographic questions (age, gender, professional experience, and the type of educational institution where the participant works) and the Mobbing Scale, which consists of 48 items assessing mobbing behaviors. The original Mobbing Scale consists of 48 questions designed to be answered in a seven-point Likert scale format [7]. For this study, the Mobbing Scale was adapted to a three-point Likert scale. The scale’s Turkish validity and reliability study was conducted in 2013, utilizing 38 items instead of the original 48 [8]. Additionally, the Mobbing Scale data were analyzed by dividing it into five sub-factors: lack of communication, boycott and isolation, threats and violence, reduced work commitment, and job and career barriers.

In the present study, the original seven-point Likert structure of the Mobbing Scale was adapted to a three-point response format (“agree,” “undecided,” and “disagree”). This modification was implemented to improve response clarity, reduce cognitive burden, and facilitate completion in an online survey setting, particularly given physicians’ time constraints. Collapsing response categories has been suggested in the literature to enhance response reliability when distinctions between adjacent categories may not be meaningful for respondents. However, it is acknowledged that such modifications may influence the psychometric properties of the scale [9].

Statistical Analysis

All statistical analyses were performed using IBM SPSS Statistics version 25 (IBM, Armonk, NY, USA). Statistical methods were selected in accordance with the study objectives, which aimed to (i) describe the prevalence of mobbing, (ii) compare mobbing levels across demographic groups, and (iii) examine relationships between continuous variables. The distribution of continuous variables was assessed using skewness and kurtosis values. Descriptive statistics (mean, standard deviation, and percentages) were used to summarize the data. Group comparisons were conducted to evaluate whether mobbing levels differed according to gender, professional experience, and institutional type. For comparisons between two groups, independent samples t-tests were used when normality assumptions were met; otherwise, non-parametric alternatives were considered. For comparisons involving more than two groups, one-way ANOVA was applied, followed by Bonferroni post hoc tests to identify the source of significant differences. Pearson correlation analysis was performed to examine the relationship between age and mobbing sub-dimensions, as both variables were continuous and approximately normally distributed. The internal consistency of the scale was assessed using Cronbach’s alpha coefficient to ensure reliability of the modified measurement tool. A p-value of < 0.05 was considered statistically significant.

Results

Reliability Analysis

The internal consistency of the modified Mobbing Scale was evaluated using Cronbach’s alpha coefficient. The overall Cronbach’s alpha value was 0.838, indicating good internal consistency. This indicates that the modified scale demonstrates good internal consistency and reliably measure the underlying construct of mobbing, despite the reduction in response categories.

A total of 406 volunteers participated in the study, including 266 females and 140 males. Forty participants (9.9%) worked at universities jointly operated with the Ministry of Health, 147 participants (36.2%) were employed at Turkish Health Sciences University (SBU), and 219 participants (53.9%) worked at other university clinics. Based on the overall scale scores, a 12.68% prevalence of mobbing was found. The proportion of undecided responses was 12.70% (Table 1).

Table 1.

Distribution of mobbing scale and sub-factor data variables

Mobbing (n = 406)
	Agree	Undecided	Disagree
	Mean ± SD; (%)
Total	6.08 ± 4.94; (12.68)	6.09 ± 4.57; (12.70)	35.77 ± 7.07 (74.52)
Lack of communication	0.25 ± 0.67; (4.18)	0.65 ± 1.05; (10.91)	05.09 ± 1.33 (84.97)
Boycott and isolation	0.88 ± 1.99; (6.29)	1.36 ± 1.88; (9.78)	11.75 ± 3.14 (83.93)
Threats and violence	0.24 ± 0.70; (2.07)	0.46 ± 0.89; (3.89)	11.24 ± 1.30 (93.73)
Reduced work commitment	2.77 ± 2.13; (34.69)	2.27 ± 1.75; (28.44)	2.93 ± 1.88 (36.73)
Job and career barriers	1.93 ± 2.05; (24.13)	1.32 ± 1.47; (16.59)	4.73 ± 2.44 (59.20)

SD Standard Deviation

According to the sub-factor analysis, the intensity of mobbing was observed as follows: lack of communication (4.18%), boycott and isolation (6.29%), threats and violence (2.07%), reduced work commitment (34.69%), and job and career barriers (24.13%) (Table 1).

No significant differences were found in the scale evaluation scores based on gender, years of professional experience, or the institution in which the participants worked. However, mobbing was significantly more prevalent in the Job and Career Barriers sub-factor in SBU hospitals (Table 2).

Table 2.

Comparison of the sub-factor “Job and career barriers” data according to the institution worked in

Mobbing	Institution		Mean difference	p
Agree	Common use	SBU	-0.214	1.000
		Others	0.406	0.728
	SBU	Others	0.621*	0.014*
Undecided	Common use	SBU	0.258	0.962
		Others	0.169	1.000
	SBU	Others	-0.089	1.000
Disagree	Common use	SBU	-0.023	1.000
		Others	-0.580	0.487
	SBU	Others	-0.557	0.099

SBU: Türkiye Health Sciences University; ANOVA test < 0.05 was accepted as significant

A positive correlation was found between age and reduced work commitment, indicating that job commitment increases with age (Table 3).

Table 3.

Comparison of the sub-factor data of “reduced work commitment” according to age

Reduced work commitment	Age (n; r; p)
Agree	406; -0.153; 0.002*
Undecided	406; -0.069; 0.167
Disagree	406; 0.242; <0.0021*

r: Pearson Correlation; Correlation test < 0.05 was accepted as significant

Discussion

According to the findings of our study, 12.68% of the participants reported experiencing mobbing, while 12.70% were undecided. The literature indicates that mobbing is a global issue, with rates varying across different sectors and countries. It is estimated that approximately 3% to 30% of employees worldwide are exposed to mobbing in the workplace [10].

The 12.68% prevalence found in our study aligns with the global average, but it is somewhat lower compared to studies conducted in Turkey that highlight higher rates of mobbing in the workplace. For instance, a study conducted in Turkey found that 42% of the 1,246 participants reported experiencing mobbing, with the most common behaviors targeting performance disruption. In addition, vertical mobbing, from superior to subordinate, was reported at a rate of 27%. This indicates that mobbing remains relatively common in the general business world, and sectoral differences can have a significant impact on its prevalence [11].

Numerous studies indicate that mobbing is particularly prevalent in the healthcare sector. While the majority of these studies focus on nurses, there are relatively few studies addressing doctors [12]. In a study conducted on physicians undergoing medical specialization training in our country, the Leyman Psychological Terror Inventory Scale was used to assess burnout and mobbing perception. The perception of mobbing was found to be low, with a score of 1.87 on a five-point Likert scale. Our study makes a significant contribution to the literature by focusing on family medicine residents, offering an original perspective in this field.

The healthcare sector is known to be one of the workplaces where mobbing occurs frequently, due to factors such as workload, stress, and long working hours. Research emphasizes that healthcare professionals are particularly vulnerable to mobbing, which has serious psychological and physical effects on employees. These effects lead to issues such as reduced work motivation, burnout, depression, and an increased desire to leave the profession. These consequences not only jeopardize the quality of healthcare delivery but also result in additional costs, including higher absenteeism rates and the need for enhanced security measures in the workplace [13]. Furthermore, Kocaman et al. (2017) found that perceived mobbing has a positive impact on anger expression in a study conducted on 379 physicians at Süleyman Demirel University [14].

The findings of our study show that mobbing experiences occur at varying intensities across different sub-categories, and these experiences are independent of factors such as work experience or gender.

The categories in which mobbing is most intensely experienced were found to be reduced work commitment (34.69%) and obstacles related to work and career (24.13%). These findings suggest that mobbing is not only a psychological threat to individuals but also creates significant barriers to professional development and career progression. Leymann defined mobbing as psychological terror in the workplace and emphasized the detrimental effects of such obstacles on the workforce [15]. In line with these findings, it can be concluded that mobbing is a factor that hinders individuals career development, potentially leading to long-term negative effects on employees.

The positive correlation between age and reduced work commitment indicates that as age increases, the level of job commitment also increases. The literature suggests that more experienced employees tend to be more committed to their jobs [16]. This finding implies that older, more experienced individuals may be more resistant to negative factors such as mobbing. Additionally, individuals who have become more established in the workplace with age may have developed stronger defense mechanisms against mobbing.

In our study, we found that mobbing was more prevalent in the work and career-related obstacles sub-factor in SBU hospitals. Previous studies have shown that mobbing is more common in the healthcare sector, particularly in large and complex organizations [17]. This finding in SBU hospitals suggests that high competition and workload may be contributing factors that increase the risk of mobbing. Furthermore, job and career barriers may be more prominent in large organizations due to their complex structures and hierarchical systems. Yıldız and Altun, in their investigation of mobbing prevalence in the healthcare sector, also highlighted that high competition in large and complex organizations increases the risk of mobbing [17].

The rate of undecided responses in the study was found to be 12.70%. This may indicate that participants had difficulty forming a clear opinion about their mobbing experiences or struggled to define and recognize mobbing. Research suggests that the definition of mobbing and the accurate perception of such experiences by employees can be a significant challenge [8]. Since mobbing is sometimes experienced indirectly, employees may not always be aware of it. Moreover, personal perceptions and cultural differences can introduce ambiguity in defining mobbing. Many employees may perceive negative behaviors they encounter as part of general workplace competition or stress, and therefore may not recognize them as mobbing. This can lead to a considerable number of ambiguous responses. Some researchers have suggested that employees’ difficulty in recognizing psychological harassment, due to the ambiguity in mobbing definitions and subjective perceptions, may contribute to underreporting of mobbing prevalence [11].

In the international literature, mobbing is reported with varying prevalences in different countries and sectors. Multicenter studies, particularly in European countries, show that approximately 10–20% of employees are exposed to systematic psychological harassment at least once during their working lives. Research conducted in Scandinavian countries emphasizes that healthcare workers are at higher risk of mobbing, and that the main reasons for this include hierarchical structure, heavy workload, and problems with team communication [18]. These findings support the fact that the results obtained in our study are consistent with the international literature and that mobbing is a universal problem, especially in the healthcare sector.

Considering the mobbing rate of 12.68% and the rate of undecided responses of 12.70% in our study, these findings suggest that mobbing rates in Turkey are close to the global average. However, it is important to acknowledge that mobbing experiences may vary across sectors, organizational structures, and cultural contexts. Mobbing is not only an individual psychological issue but also a phenomenon that arises from organizational structures and management policies. Therefore, raising awareness and implementing more effective measures against psychological harassment in workplaces are crucial.

These findings have important societal implications, as mobbing among family medicine residents may negatively affect not only physicians’ well-being but also the quality and safety of patient care. Addressing workplace bullying can contribute to a more sustainable healthcare system by improving job satisfaction, reducing burnout, and preventing workforce attrition. Furthermore, increasing awareness and implementing preventive strategies may foster healthier organizational cultures, ultimately benefiting both healthcare professionals and society at large.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to establish causal relationships between variables. Second, the use of voluntary participation and online data collection may have introduced selection bias, as individuals with stronger opinions or experiences related to mobbing may have been more likely to participate. Third, the data were based on self-reports, which may be subject to response, recall, and social desirability bias. In addition, the modification of the original seven-point Likert scale to a three-point format may have affected the scale’s psychometric properties. Although the internal consistency of the modified scale was good, the validity of this adapted version was not independently re-evaluated.

Conclusion

The overall intensity of mobbing experienced by family medicine residents was found to be 12.68%, with higher rates in the areas of “job and career obstacles” and “reduced work commitment.” The lowest intensity of mobbing was observed in the category of “threats and harassment.” These results underscore that mobbing experiences among family medicine residents are significant, highlighting the need for increased awareness and further efforts to address this issue within the field.

Authors’ contributions

The concept and design of the study: Y.S. and A.K.K.; Data acquisition: Y.S., A.K.K., S.Ç., Y.Ç.E., Z.K., and S.K.; Statistical analysis: Y.S.; Analyzed the data and drafted the manuscript: Y.S., A.K.K., S.Ç., Y.Ç.E., Z.K., and S.K. All authors read and approved the final version of the manuscript.

Funding

None.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All necessary approvals were obtained from the Health Sciences University, Trabzon Faculty of Medicine Clinical Research Ethics Committee (approval date: 13.08.2024, decision no: 2024/08). Data were collected through an online survey created using Google Forms. The survey was administered to volunteer family medicine residents. As online informed consent was obtained all volunters with prior notification that there was no obligation to indicate names while completing the survey.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.