Education and service: how theories can help in understanding tensions

Abstract

Objectives This paper reviews why tensions between service and education persist and highlights that this is an area of medical education research (MER) that, to date, lacks a robust body of theory‐driven research. After carrying out a review of the literature on service–education tensions in medical education and training, we turn to consider how theory can help provide new insights into service–education tensions. Methods We conducted a search of the literature on service–education tensions since 1998 to examine the use of theory in studies on this topic. Results We identified 44 out of 603 relevant papers. Their focus fell into four broad categories: time residents spent on ‘service’ and ‘education’; perceptions of the balance between service and education; considerations of how best to define service and education, and the impact of structural and systems changes on education/training. Of the papers reporting primary research, the dominant methodology was the bespoke survey. Rarely were the precise natures of tensions or how different factors interact to cause tensions examined in detail. Discussion Through discussion and reflection, we then agreed on the applicability of four sociocultural theories for illuminating some examples of service–education tensions. We present four sociocultural theories: Holland's figured worlds, Kemmis et al.'s practice architectures, Lave and Wenger's situated learning and Engeström's cultural‐historical activity theory (CHAT or AT). We describe each and then briefly illustrate how each theory can support new ways of thinking and potential directions for research focusing on education–service tensions. Conclusions The use of theory in research studies will not resolve service–education tensions. However, what theory can do is illuminate and magnify different aspects of service–education tensions, to generate new insight and knowledge that can then be used to inform future research and changes in practice.

Factors that Contribute to Resident Teaching Effectiveness

“…Our findings suggest that medical students perceived those residents who can manage flow in the emergency department (SBP2) and demonstrate compassion, integrity, and respect for others (PROF1) as having the greatest teaching effectiveness. While the reason for the association between SBP2 and teaching effectiveness is not clear, there is well-documented tension between education and service missions in medical education [13]. One possibility is that residents who can manage flow in two busy academic emergency departments have organizational and time management skills that allowed them to balance these missions and be available to guide medical students in patient management while providing quality teaching.…”

How theory and design-based research can mature PBL practice and research

“…Communities of practice (CoP) introduced by Lave and Wenger (1991), is another relevant theory. The principle behind this theory is that learning involves interacting with others in a specific place and time; learning is a matter of participation in a community of members with mutual goals and interests (Cleland and Durning 2019). A community of practice contains members who learn through their participation and interactions with one another on a regular basis, during which they share practices, mutually engage, and develop around things that matter to them (Wenger 1998).…”

Living comfortably in liminal spaces: Trickster and the medical educator

“…Three papers in this issue, although they vary in subject matter and approach, exemplify the challenges of medical education, positioned as it is at the intersection of so many boundaries. One paper addresses the tension between clinical specialties, 1 a second discusses the age-old conflict between education and service, 2 and a third focuses on how individual teachers navigate the territory between vulnerability and credibility in their day-to-day contact with students. 3 Fault lines, gaps and tensions characterise the working lives of medical educators.…”

“…Considering how we might deal with tensions, organisation science alerts us to four general human responses: Avoid, Ask, Accept and Change. 2 The first two are fairly straightforward responses that illustrate ways in which we might simply ignore a tension by avoiding it or passing the challenge to someone else. The latter two deserve elaboration as we try to understand how to actually manage tensions in our assessment practices.…”