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Balancing Education and Service in Graduate Medical Education: Data From Pediatric Trainees and Program Directors

Kesselheim, Jennifer C. MD, MEd; Sun, Pengling MS; Woolf, Alan D. MD, MPH; London, Wendy B. PhD; Boyer, Debra MD

doi: 10.1097/ACM.0000000000000174
Research Reports

Purpose: To measure pediatric program directors’ (PDs’) and trainees’ perceptions of and expectations for the balance of service and education in their training programs.

Method: In fall 2011, an electronic survey was sent to PDs and trainees at Boston Children’s Hospital. Respondents described perceptions and expectations for service and education and rated the education and service inherent to 12 vignettes. Wilcoxon rank sum tests measured the agreement between PD and trainee perceptions and ratings of service and education assigned to each vignette.

Results: Responses were received from 28/39 PDs (78%) and 223/430 trainees (52%). Seventy-five (34%) trainees responded that their education had been compromised by excessive service obligations; only 1 (4%) PD agreed (P < .0001). Although 132 (59%) trainees reported that service obligations usually/sometimes predominated over clinical education, only 3 (11%) PDs agreed (P < .0001). One hundred trainees (45%) thought rotations never/rarely/sometimes provided a balance between education and clinical demands compared with 2 PDs (7%) (P < .0001). Both groups agreed that service can, without formal teaching, be considered educational. Trainees scored 6 vignettes as having greater educational value (P ≤ .01) and 10 as having lower service content (P ≤ .04) than PDs did.

Conclusions: Trainees and medical educators hold mismatched impressions of their training programs’ balance of service and education. Trainees are more likely to report an overabundance of service. These data may impact the interpretation of Accreditation Council for Graduate Medical Education survey results and should be incorporated into dialogue about future curricular design initiatives.

Dr. Kesselheim is assistant professor of pediatrics, Department of Pediatric Oncology, Dana-Farber/Children’s Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.

Ms. Sun is statistician, formerly with the Department of Pediatric Oncology, Dana-Farber/Children’s Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.

Dr. Woolf is associate professor of pediatrics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

Dr. London is statistician, Department of Pediatric Oncology, Dana-Farber/Children’s Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.

Dr. Boyer is assistant professor of pediatrics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.

Funding/Support: The study was funded by the Academy for Teaching and Learning at Boston Children’s Hospital.

Other disclosures: None reported.

Ethical approval: The study was deemed exempt from institutional review board review.

Previous presentations: These data were previously presented as a poster at the Pediatric Academic Societies annual meeting, Boston, Massachusetts; April 30, 2012.

Correspondence should be addressed to Dr. Kesselheim, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; telephone: (617) 632-2423; fax: (617) 632-2270; e-mail: Jennifer_kesselheim@dfci.harvard.edu.

© 2014 by the Association of American Medical Colleges