The Grey Anatomy of Workplace Mistreatment

Workplace mistreatment in graduate medical education is typically measured using instruments with validity evidence, yet these tools may inadequately capture context-dependent experiences that vary by frequency, source, and setting.

To examine response frequency distributions from 2 mistreatment instruments used with residents and fellows whereby ambiguous ("grey") experiences appeared distinct from explicit mistreatment, and to assess the differential associations of each with resident well-being and burnout.

Using data collected in 2024 from the Workplace Psychologically Violent Behaviors scale (WPVB; 12 items) and Negative Acts Questionnaire (6 items) on 266 of 675 residents and fellows (39.4% response rate) at a large Northeast sponsoring institution, we conducted an exploratory factor analysis to examine the underlying structure of WPVB responses. Grey items were defined as those whose interpretation depends heavily on frequency, source, and context; explicit items represented overt behaviors regardless of context. We compared well-being and burnout across residents grouped by grey item frequency, using a modified Medical Student Well-Being Index and a single-item burnout measure.

Two factors emerged from the exploratory factor analysis, accounting for 55.2% of the variance: 9 grey items (eg, having your performance evaluated negatively) in the first factor and 3 explicit items (eg, been humiliated or ridiculed) in the second. Grey item frequency was associated with well-being (r=0.59; 95% CI, 0.48-0.68) and burnout (r=0.54; 95% CI, 0.42-0.64).

Grey mistreatment experiences-ambiguous in isolation but potentially harmful when repeated frequently-were more strongly associated with resident well-being and burnout than explicit mistreatment.