Working to learn or learning to work: resident perceptions of service and education in internal medicine
Bibliographic record
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".