Service or education: In the eye of the beholder

Hilary Sanfey, Joe Cofer, Jonathan R. Hiatt, Matthew Hyser, Colleen Jakey, Stephen Markwell, John Mellinger, Richard Sidwell, Douglas Smink, Stephen Wise, Chris Wohltman, Gary Dunnington

Research output: Contribution to journalArticle

20 Scopus citations


Objectives: To elicit and compare surgical resident and program director (PD) perspectives on service and education in surgical training and the conditions that influence these opinions. Design: Cross-sectional, multi-institutional national study conducted through an online survey. Setting: General surgical residency programs in the United States. Participants: General surgical residents and PDs. Main Outcome Measures: Resident and PD perspectives on the circumstances, conditions, and context in which activities are perceived as service vs education. Results: Respondents scored 24 resident activities on 5-point Likert scales and commented on conditions that influenced these scores. From 17 residency programs, 105 of 218 PDs (48.4%) responded, and 407 of 645 residents (63.1%) responded. Compared with residents, PDs rated 21 of 24 activities (87.5%) as more educational than service (P ≤ .05). In more than half these activities, notable minorities (≥25%) of residents stated that these activities were service and educational, depending on factors that included the particular attending physician, case complexity, and experience with the activity. Postgraduate year seniority correlated with service and educational perceptions in 12 activities (P < .05). Attending physician teaching and learning environment correlated positively (P < .05) with perception as educational in 8 and 5 activities, respectively. Conclusions: This study demonstrated significant differences in service and education definitions for PDs and residents. The implication that these activities are mutually exclusive may devalue residents' perceptions of the importance of patient care as an essential component of surgical competency. In an era of diminished work hours and continuity of care, educators must teach residents to appreciate the educational value in providing care for all patients and develop a sense of patient ownership in both faculty and residents.

Original languageEnglish (US)
Pages (from-to)1389-1395
Number of pages7
JournalArchives of Surgery
Issue number12
StatePublished - Dec 1 2011
Externally publishedYes

ASJC Scopus subject areas

  • Surgery

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    Sanfey, H., Cofer, J., Hiatt, J. R., Hyser, M., Jakey, C., Markwell, S., Mellinger, J., Sidwell, R., Smink, D., Wise, S., Wohltman, C., & Dunnington, G. (2011). Service or education: In the eye of the beholder. Archives of Surgery, 146(12), 1389-1395.