Resident perceptions of service versus clinical education

Abstract

Background: The Accreditation Council for Graduate Medical Education states that education needs to have priority over service. There is a potential for residents to have a negative perception of activities termed service.

Objective: To understand how residents of one obstetrics and gynecology program conceptualize service and clinical education in their daily training experiences.

Methods: We conducted a qualitative survey using semistructured interviews with 9 residents in obstetrics and gynecology. Verbatim transcripts underwent phenomenologic analysis for themes and statements exemplifying the essence and nuances of residents' experiences.

Results: The conceptualization of service and clinical education encompassed 6 categories, with some overlap between terms. The category education encompassed (1) tasks and situations with some educational value termed indirect patient care; (2) tasks and situations with high educational values subdivided into direct patient care and teacher-learner interactions; and (3) traditional educational activities, including reflection. Service denoted: (1) tasks and situations with little to no educational value subdivided into indirect and direct patient care categories; (2) tasks and situations with some educational value described as direct patient care; and (3) community service to patients and communities.

Conclusions: Definitions and the relative educational value of service and clinical education experiences overlapped considerably, but they varied by systematic, environmental, and personal factors. Service was used interchangeably to connote negative experiences that interfered with educational goals and positive experiences at the core of the profession's higher calling, the raison d'être of many physicians. The community needs to agree on the definitions of these terms and clarify the meaning of an appropriate balance.

FIGURE 1

Clinical Education Themes

FIGURE 2

Service Themes