Context High‐quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. Methods We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5‐year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. Results A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n = 43). The profession most commonly referred to was that of the physician (n = 46). The mean ± standard deviation (SD) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost‐related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. Conclusions The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time.

BackgroundBlended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.ObjectiveThis study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.MethodsThe economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.ResultsThe incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.ConclusionsUnder the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

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Healthcare and health professions education share many of the same problems in decision making. In both cases, there is a finite amount of resources, and so choices need to be made between alternatives. To navigate the options available requires effective decision making. Choosing one option requires consideration of its opportunity cost -the benefit forgone of the other competing options.The purpose of this guide is to introduce educational decision-makers to the economic concept of cost, and how to read studies about educational costs to inform effective cost-conscious decision-making.This guide leads with a brief review of study designs commonly utilised in this field of research, followed by an overview of how study findings are commonly presented. The tutorial will then offer a four-step model for appraising and considering the results of an economic evaluation. It asks the questions: 1) Can I trust the results? 2) What are the results telling me? 3) Could the results be transferred to my context? 4) Should I change my practice?Educational decision-makers are uniquely positioned to create change in teaching and learning practices. Data published from economic evaluations can be a powerful decision-making aide. As the number of studies that examine the cost and value of health professions education grows, education decision-makers will require increasing skill in understanding, appraising, and considering the study findings, to ensure that educational activities achieve optimal value for a given spend. PRACTICE POINTS1. The main reason to consider cost and value in health professions education is to ensure that teaching and assessment deliver optional educational value for a given spend.5. Appraising a study's reporting of costs can be assisted by asking 1) How were the interventions cost-items identified? 2) how were the cost items measured? And 3) how were the cost items priced?6. Uncertainty around point estimates of cost and value is evaluated through the sensitivity analysis, which considers the impact of varying assumptions and conditions. Decision-makers should consider the sensitivity scenario which best aligns with their own context, to better interpret study transferability.7. Value is highly context dependent, and decisions concerning the uptake or rejection of an educational innovation are ultimately affected by factors and forces beyond effectiveness and costs.

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Strong economic links for multiple stakeholders as a result of failure by students in clinical education have been identified. The cost burden is skewed in the direction of students. Any generalisation of these results should be made with consideration for the unique clinical education context in which each health professional education programme operates.

ContextThe design of selection methods must balance, amongst a range of factors, the desire to select the best possible future doctors with the reality of our resource‐constrained environment. Examining the cost of selection processes enables us to identify areas in which efficiencies may be gained.MethodsA cost description study was conducted based on selection for 2018 entry into medical school directly from secondary school. The perspectives of applicants, volunteer interviewers and the admitting institution were considered. Costs were modelled based on the Monash University (Australia) selection process, which uses a combination of secondary school matriculation score, aptitude test score (Undergraduate Medicine and Health Sciences Admission Test) and multiple mini‐interview score. A variety of data sources were utilised, including bespoke surveys, audit data and existing literature. All costs are expressed in 2018 Australian dollars (AU$). Applicant behaviours in preparing for selection tests were also evaluated.ResultsA total of 381 of 383 applicants returned the survey. Over 70% of applicants had utilised commercial preparation materials. The median total cost to applicants was AU$2586 (interquartile range [IQR] AU$1574‐3999), including costs to both prepare for and attend selection tests. Of 217 volunteer interviewers, 108 returned the survey. These were primarily health professional clinicians at a mid‐career stage. The median total cost to interviewers was AU$452 (IQR AU$252‐715) for participation in a half‐day interview session, largely due to the loss of income. The cost to the admitting institution was AU$269 per applicant, accounted for by the costs of equipment and consumables (52%), personnel (34%) and facilities (14%).ConclusionsThe costs of student selection for medical school are substantial. Understanding costs facilitates achievement of the objective of selecting the desired future medical workforce within the constraints of the resources available. Opportunities for change may arise from changes in applicant preparation behaviours, opportunities for economies of scale, and efficiencies driven by technological solutions.