Assessment Of Malpractice Fear and Occupational Anxiety Of Intern Doctors

Abstract

Aim: The internship period is a critical period during which medical candidates experience increased clinical responsibilities and intense professional anxiety and fear of making mistakes. The increased professional responsibilities and concerns about the consequences of decisions made during internships can profoundly impact not only interns' immediate performance but also their long-term professional orientation. Factors such as increased malpractice lawsuits, increased professional responsibilities, and violence in healthcare can negatively impact interns' professional expectations and trigger professional anxiety. Although the number of studies examining professional anxiety and psychological states in medical students has increased in recent years, the current literature is quite limited in assessing the fear of malpractice and professional anxiety levels of interns. This study aimed to assess the levels of fear of malpractice and professional anxiety in interns and to demonstrate the relationship between them. Material and Methods: This is a cross-sectional study conducted on 198 (84.6%) intern physicians studying at Eskişehir Osmangazi University Faculty of Medicine between July and August 2025. Data were collected using a questionnaire form that included sociodemographic characteristics, professional variables that may be associated with malpractice (presence of a physician in the family, personal rights in undergraduate courses, and malpractice training), the Malpractice Fear Scale, and the Professional Anxiety Questionnaire. Chi-square and Spearman correlation tests were used for statistical analyses, with a p≤0.05 level of significance. Results: A high level of fear of malpractice was found in 44.4% of participants. No significant relationship was found between sociodemographic variables and fear of malpractice. However, fear of malpractice was significantly higher among interns who experienced anxiety during patient examinations (p<0.05). 85.9% of participants had moderate to high levels of professional anxiety, with patients requiring emergency intervention being the most common cause of anxiety. A positive and significant correlation was found between fear of malpractice and professional anxiety (r=0.380; p<0.001). Conclusions: Approximately half of intern physicians experience a high level of fear of malpractice, and this is associated with professional anxiety. Findings suggest that fear of malpractice is related to educational conditions and the professional environment rather than individual characteristics. It is recommended that the medical education curriculum be revised in line with the principles of the National Core Education Program (UCEP), that the quantity and quality of clinical practice training be increased, and that structured malpractice awareness training be provided at undergraduate and postgraduate levels.

Keywords

• Internship
• Malpractice
• Anxiety
• Medical students

İntörn Doktorlarda Malpraktis Korkusu ve Mesleki Kaygı Düzeyinin Değerlendirilmesi

Abstract

Amaç: İntörnlük dönemi, doktor adaylarının klinik sorumluluklarının arttığı, mesleki kaygı ve hata yapma korkusunun yoğun olarak deneyimlendiği kritik bir süreçtir. İntörnlük döneminde artan mesleki sorumluluklar ve alınan kararların sonuçlarına ilişkin kaygılar, intörnlerin yalnızca anlık performanslarını değil; uzun vadeli mesleki yönelimlerini de derinden etkileyebilmektedir. Artan malpraktis davaları, mesleki sorumluluk artışı ve sağlıkta şiddet gibi etmenler intörn doktorların mesleki beklentilerini olumsuz etkileyerek, mesleki kaygının tetiklenmesine neden olabilmektedir. Her ne kadar son yıllarda tıp fakültesi öğrencilerinde mesleki kaygı ve ruhsal durumların incelendiği çalışmalar sayıca artsa da; mevcut literatürde intörn doktorların malpraktis korkusu ve mesleki kaygı düzeylerinin değerlendirilmesine yönelik yapılan çalışmalar oldukça sınırlıdır. Bu çalışma, intörn doktorlarda malpraktis korkusu ve mesleki kaygı düzeylerini değerlendirmek ve aralarındaki ilişkiyi ortaya koymak amacıyla yapılmıştır. Yöntem: Çalışma Temmuz–Ağustos 2025 tarihleri arasında Eskişehir Osmangazi Üniversitesi Tıp Fakültesi’nde öğrenim gören 198 (%84,6) intörn doktor üzerinde yapılan kesitsel tipte bir araştırmadır. Veriler sosyodemografik özellikleri, malpraktis ile ilişkili olabilecek mesleki değişkenleri(ailede hekim varlığı, lisans derslerinde özlük hakları ve malpraktis hakkında eğitim alma durumu) Malpraktis Korku Ölçeği ve Mesleki Kaygı Anketi içeren anket formu ile toplanmıştır. İstatistiksel analizlerde Ki-kare ve Spearman korelasyon testleri kullanılmış, anlamlılık düzeyi p≤0,05 olarak kabul edilmiştir. Bulgular: Katılımcıların %44,4’ünde yüksek düzeyde malpraktis korkusu saptanmıştır. Sosyodemografik değişkenler ile malpraktis korkusu arasında anlamlı ilişki bulunmamıştır. Ancak hasta muayenesi sırasında kaygı hisseden intörnlerde malpraktis korkusu belirgin olarak daha yüksektir (p<0,05). Katılımcıların %85,9’u orta ve yüksek düzeyde mesleki kaygıya sahip olup, en sık kaygı nedeni acil müdahale gerektiren hastalar olmuştur. Malpraktis korkusu ile mesleki kaygı arasında pozitif yönde anlamlı ilişki bulunmuştur (r=0,380; p<0,001). Sonuç: İntörn doktorların yaklaşık yarısı yüksek düzeyde malpraktis korkusu yaşamakta ve bu durum mesleki kaygıyla ilişkilidir. Bulgular, malpraktis korkusunun bireysel özelliklerden çok eğitim-öğretim koşulları ve mesleki ortamla ilişkili olduğunu göstermektedir. Tıp eğitimi müfredatının Ulusal Çekirdek Eğitim Programı (UÇEP) ilkeleri doğrultusunda gözden geçirilmesi, klinik uygulama eğitimlerinin nicelik ve niteliğinin artırılması ile lisans ve lisans sonrası dönemlerde malpraktis farkındalığına yönelik yapılandırılmış eğitimlerin verilmesi önerilmektedir.

Keywords

• İntörnlük
• Malpraktis
• Anksiyete
• Tıp öğrencileri

References

1. 1. Dündar C. Rural obstacles and career anxieties: vocational concerns among medical interns. ESTUDAM Public Health Journal. 2024;9(3):234-44.
2. 2. AlShamlan NA, AlOmar RS, AlShammari MA, AlShamlan RA, AlShamlan AA, Sebiany AM. Anxiety and its association with preparation for future specialty: a cross-sectional study among medical students, Saudi Arabia. Journal of Multidisciplinary Healthcare. 2020;13:581-91.
3. 3. Moczko TR, Bugaj TJ, Herzog W, Nikendei C. Perceived stress at transition to workplace: a qualitative interview study exploring final-year medical students’ needs. Advances in Medical Education and Practice. 2016;7:15-27.
4. 4. Keskınbora KH. What is malpractice? What is complication? What should be known to prevent? Turkiye Klinikleri Forensic Medicine-Special Topics. 2019;5(2):30-44.
5. 5. World Medical Association. World Medical Association statement on medical malpractice [Internet]. Ferney-Voltaire: WMA; 2017 [cited 2025 Sep 4]. Available from: https://www.wma.net/policies-post/world-medical-association-statement-on-medical-malpractice/
6. 6. Renkema E, Broekhuis M, Ahaus K. Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety. BMC Health Services Research. 2014;14(1):38.
7. 7. Pollock JR, Shappell E, Sandefur BJ, Moore ML, Lindor RA. Medical malpractice cases involving medical students. Academic Medicine. 2024;99(10):1108-16.
8. 8. Bourne T, Wynants L, Peters M, Van Audenhove C, Timmerman D, Van Calster B, et al. The impact of complaints procedures on the welfare, health and clinical practice of 7926 doctors in the UK: a cross-sectional survey. BMJ Open. 2015;5(1):e006687.

9. 9. Kerr A, Thompson C. Medical students’ reactions to uncertainty during clinical rotations. Familiy Medicine. 2022;54(4):285-9.
10. 10. Yeniçeri N, Mevsim V, Özçakar N, Özan S, Güldal D, Başak O. Comparison of final-year medical students’ anxiety about future professional life and their trait anxiety. EPGRN Congress. 2007;21(1):19-24.
11. 11. Yasin YK, Öztürk S, Dereboy Ç, Okyay P. A qualitative study on professional concerns of final-year medical students, Aydın. Med Educ World. 2018;17(52):35-49.
12. 12. Uğrak U, Işık O. Assessment of relationship between physicians' malpractice experience and fear of malpractice: cross-sectional research. Turk Klin J Health Sci. 2022;7(1).
13. 13. Katz DA, Williams GC, Brown RL, Aufderheide TP, Bogner M, Rahko PS, et al. Emergency physicians' fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med. 2005;46(6):525-33. doi: 10.1016/j.annemergmed.2005.04.016. Epub 2005 Jul 14. PMID: 16308068; PMCID: PMC7539660.
14. 14. Uğrak U, Işık O. Turkish validity and reliability study of the Malpractice Fear Scale. Hacettepe J Health Adm. 2020;23(2):261-72.
15. 15. Johnston WF, Rodriguez RM, Suarez D, Fortman J. Study of medical students' malpractice fear and defensive medicine: a “hidden curriculum?”. West J Emerg Med. 2013;15(3):293-9.
16. 16. Dörtyol BG. Opinions, career choices and influencing factors of final-year medical students regarding postgraduate period. 2017;16(50):12-21.
17. 17. Göksu MM, Taslidere B. Factors affecting final-year medical students’ preferences in specialty exam and attitudes towards emergency medicine. Anatolian J Emerg Med. 2021;4(1):6-11.
18. 18. Castel ES, Ginsburg LR, Zaheer S, Tamim H. Understanding nurses’ and physicians’ fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors? BMC Health Serv Res. 2015;15:326.
19. 19. Can, R., Işık, M. T., Aslan, A., Ayaz, M. (2024). Factors affecting physician fear of malpractice and defensive medicine practices: A cross-sectional study. JAREM, 14(2),77-83. doi.org/10.4274/jarem.galenos.2024.52386
20. 20. Goetz K, Oldenburg D, Strobel CJ, Steinhäuser J. Influence of fears of perceived legal consequences on general practitioners’ practice in relation to defensive medicine: a cross-sectional survey in Germany. BMC Prim Care. 2024;25(1):23.
21. 21. Sarikaya O, Civaner M, Kalaca S. The anxieties of medical students related to clinical training. Int J Clin Pract. 2006;60(11):1414-8.
22. 22. Kaygusuz TÖ, Erensoy A. Opinions and professional expectations of final-year medical students regarding medical education by gender. Fırat Univ J Med Sci. 2019;33(3):127-35.
23. 23. Ergin A, Uzun SU, Topaloğlu S. Trait and professional anxiety levels of Pamukkale University medical faculty 5th- and 6th-year students and influencing factors. Mugla Sitki Kocman Univ Med J. 2016;3(3):16-21.
24. 24. Ekmen E, Keklik B. A study on the examination of medical faculty students levels of Professional anxiety and career expectations. Med Educ World. 2025;24(73):38-47.
25. 25. O'Leary KJ, Choi J, Watson K, Williams MV. Medical students' and residents' clinical and educational experiences with defensive medicine. Acad Med. 2012;87(2):142-8.
26. 26. Atılgan SBÇ, Temizayak F, Çağıran T, Tarı OE, Gürler G, Müderrisoğlu MC, et al. The views of senior medical students about medical skills training at Hacettepe University Faculty of Medicine. Med Educ World. 2020;19(57):5-25.
27. 27. Köse C. Self-assessment of some basic professional knowledge and skills of a medical faculty interns. STED. 2018;27(3):176-89.
28. 28. Yalçınoğlu N, Kayı İ, Işık Ş, Aydın T, Zengin Ş, Karabey S. Opinions of final-year students of Istanbul University Faculty of Medicine on medical education. Ist Tıp Fak Derg. 2013;75(3):41-5.