Abstract Purpose The perceived tension between service and education is the subject of frequent debate in medicine. On the basis of an apprenticeship model, residency programs are expected to balance the two, yet definitions of service and education remain elusive, and resident perspectives on this issue are not well understood in internal medicine (IM). This study aimed to explore how IM residents conceptualize service in relation to their education. Method From August 2023 to January 2024, semistructured, one-on-one interviews were conducted with 16 IM residents at the University of Toronto. Consistent with a constructivist grounded theory approach, data collection and data analysis were completed in parallel until theoretical sufficiency. Using constant comparison and investigator triangulation, a conceptual framework was developed to describe how residents perceive the interplay between service and education. Results Three key themes were identified. First, service in everyday conversation was often a catchall for negative experiences, yet most residents recognized that many tasks attributed to service are necessary for patient care. Second, education was believed to encompass a range of activities and responsibilities that can promote learning, provided they are accompanied by opportunities for autonomy and feedback commensurate to a resident’s level and experience. Third, service and education were frequently acknowledged to overlap but to varying degrees, depending on attendings’ practices and residents’ individual perspectives. Ultimately, the perceived delineation between service and education appears to be fluid and flexible. Conclusions The conceptualization of service appears to be dynamic, and the perceived interplay between service and education may be both situation dependent and resident dependent. Tension between service and education may be driven by high clinical volumes and administrative burdens, but opportunities with graduated responsibility and meaningful feedback may help reinforce the learning inherent in the service of providing patient care.
Kim et al. (Wed,) studied this question.