title: Service or education: in the eye of the beholder.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional, multi-institutional national study conducted through an online survey.
  
  
  METHODS
  General surgical residency programs in the United States.
  
  
  METHODS
  General surgical residents and PDs.
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Southern Illinois University School of Medicine, PO Box 19638, Springfield, IL 62794, USA. hsanfey@siumed.edu
authors.forename: Hilary
authors.initials: H
authors.lastname: Sanfey
authors.forename: Joe
authors.initials: J
authors.lastname: Cofer
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Matthew
authors.initials: M
authors.lastname: Hyser
authors.forename: Colleen
authors.initials: C
authors.lastname: Jakey
authors.forename: Stephen
authors.initials: S
authors.lastname: Markwell
authors.forename: John
authors.initials: J
authors.lastname: Mellinger
authors.forename: Richard
authors.initials: R
authors.lastname: Sidwell
authors.forename: Douglas
authors.initials: D
authors.lastname: Smink
authors.forename: Stephen
authors.initials: S
authors.lastname: Wise
authors.forename: Chris
authors.initials: C
authors.lastname: Wohltman
authors.forename: Gary
authors.initials: G
authors.lastname: Dunnington
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003479:Curriculum; D003625:Data Collection; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D007587:Job Description; D007588:Job Satisfaction; D008297:Male; D008505:Medical Staff, Hospital; D008486:Physician Executives