This is the pre-peer reviewed version of the following article Cleland, J., Roberts, R., Kitto, S., Strand, P. and Johnston, P. (2018), Using paradox theory to understand responses to tensions between service and training in general surgery. Med Educ, 52: 288–301. , which has been published in final form at DOI: 10.1111/medu.13475. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.