This is the peer reviewed version of the following article: Cleland, J. and Durning, S. J. (2019), Education and service: how theories can help in understanding tensions. Med Educ, 53: 42-55., which has been published in final form at https://doi.org/10.1111/medu.13738. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.