Education vs Service

I was recently part of a very interesting conversation about the balance between education and service in a residency program. The question was whether clinic hours are considered education or service. Is clinic always educational, because there is potentially something to learn from each patient? Is it always service, because there is only so much to learn from doing yet another annual exam? Or it is some sort of continuum, where a small amount of clinic time is educational, but if you are spending too many hours there, it becomes service? Does it depend on what else the residents could be doing with that time? For example, does clinic become service when you are being pulled out of a case in the operating room to cover the clinic?

For example, I was recently pulled off the OR schedule in order to cover my colleague’s clinic schedule because she was sick. I missed two hysteroscopies, one D&C, and a laparoscopic tubal ligation. All three are “intern cases” in my program – cases for which I would have been expected to be the primary surgeon. I missed out on operating experience in order to cover the OB clinic. So is that education, or service? Some folks consider it education because it was clinical work, as opposed to “non-physician tasks” such as filling out paperwork or faxing records release forms. Another person that I spoke with said that being pulled from the OR (experience which is often harder to get than clinic) in order to cover for a sick colleague is definitely service.

So, what do you think?

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