A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students

Abstract

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.

Piloting a blended-learning concept for integrating evidence-based medicine into the general practice clerkship

“…Maloney et al were able to show that the development and implementation costs of a blended learning unit achieve the break-even point after three years compared to classroom training [14]. …”

Learnings and challenges to deploy an interprofessional and independent medical education programme to a new audience

“…However, in a large but sparsely populated country like Australia, a blended approach to learning is more financially viable and can be as effective as the traditional face-to-face modes. Blended learning has also consistently shown effectiveness in knowledge acquisition compared with no intervention at all [26,27]. It has demonstrated improvements in learning outcomes in graduate studies where curricula are based on adult learning theory [8,9,28,29].…”

Teaching of anatomical sciences: A blended learning approach

“…Adoption of blended learning strategies has resulted in better learning outcomes (Means et al 2009;Kavadella et al 2012;Kazu and Demirkol, 2014;Green and Whitburn, 2016) and improved students' motivation (Guo et al 2002;So and Brush, 2008;Woltering et al 2009). Blended learning is also cost effective (Maloney et al 2015). The lack of student interactions is a limitation, especially with higher online content (Carr-Chellman et al 2000;So and Brush, 2008).…”