**Abstract**

This study aims to compare prevalence and determinants of workplace bullying, in interns and residents before and after Tunisian revolution and to assess its influence on their quality of life. It was a two-step-cross-sectional study, carried out in 2009 and in 2016, in547 interns and residents in 2009 and 667 in 2016.The prevalence of workplace bullying decreased significantly (p < 10−3) between 2009 (74%) and 2016 (43.6%). It was related to the professional status, gender, seniority, deliberate choice of medicine, satisfaction, serious family problems and hobbies in 2009 while it was related to professional status, nature of specialty, deliberate choice of medical studies and the satisfaction of the practice of Medicine in 2016. Most common acts were similar between both cohorts. Median mental and physical quality of life scores were below the mean baseline scores in both cohorts with no significant difference. Despite decrease in workplace bullying rate between both cohorts, its perception has not changed. Lawful criminalization, raising public awareness to reduce this phenomenon and prevent its negative effects are preventive measures to apply.

**Keywords:** bullying, quality of life, internship and residency, social changes

#### **1. Introduction**

The socio-cultural changes in the modern world as well as the changes in the mediatization contributed to the emergence of the notion of moral harassment at work (MHW). Research about workplace bullying has continued to grow since Scandinavian investigations about school bullying emerged in the late 70s.

Workplace bullying is "a situation in which one or more persons are systematically and over a long period, targeted by repeated, health-harming mistreatment by one or more perpetrators. Person(s) exposed to the mistreatment has (have) difficulty in defending themselves against this treatment" [1]. This is a complex and dynamic notion that is not the subject of a consensual definition despite the growing scientific interest [1–4].

Insidious violence and hostile actions can be grouped in four categories: isolation and refusal of communication, humiliating attitudes or disqualifying remarks in order to offend human dignity, intimidations aiming at terrorizing the targeted person so that it leads to submission or leave [1].

Health care professionals are highly exposed to MHW and facing the pain and death of patients [5, 6]. Young doctors, interns and residents, are besides obliged to follow a highly demanding apprenticeship. In fact, they live in a state of chronic stress and are subjected to significant mental burden facing the challenge to learn, to work in a team, to become competent, responsible and empathic physicians and at the same time to provide medical services although the hostile atmosphere and in often unfavorable conditions. This kind of heavy occupational atmosphere, promoting the development of MHW, has been highlighted by a previous study conducted in 2009 [7].

Tunisian jasmine revolution, initiated to face critical economic situation, frustration, hopelessness, injustice, corruption and political domination, conducted to a new approach of justice and dignity [8]. It was followed little by little, by the procession of freedom of expression that, sometimes exceeded rights limits.

Otherwise, hospitals' working conditions, within the after revolution, have significantly worsened, due to family patients' violence and lack of equipment, leading to heavy work conditions affecting the medical practice of young doctors and doubly exposing them to harassment at work.

The aims of the study were to:

