An Approach to Economic Evaluation in Undergraduate Anatomy Education

Abstract

Medical education research is becoming increasingly concerned with the value (defined as "educational outcomes per dollar spent") of different teaching approaches. However, the financial costs of various approaches to teaching anatomy are under-researched, making evidence-based comparisons of the value of different teaching approaches impossible. Therefore, the aims of this study were to report the cost of six popular anatomy teaching methods through a specific, yet generalizable approach, and to demonstrate a process in which these results can be used in conjunction with existing effectiveness data to undertake an economic evaluation. A cost analysis was conducted to report the direct and indirect costs of six anatomy teaching methods, using an established approach to cost-reporting. The financial information was then combined with previously published information about the effectiveness of these six teaching methods in increasing anatomy knowledge, thereby demonstrating how estimations of value can be made. Dissection was reported as the most expensive teaching approach and computer aided instruction/learning (CAI/L) was the least, based on an estimation of total cost per student per year and assuming a student cohort size of just over 1,000 (the United Kingdom average). The demonstrated approach to economic evaluation suggested computer aided instruction/learning as the approach that provided the most value, in terms of education outcomes per dollar spent. The study concludes by suggesting that future medical education research should incorporate substantially greater consideration of cost, in order to draw important conclusions about value for learners. Anat Sci Educ 0: 1-13.

Spending Wisely: The Role of Cost and Value Research in the Pursuit of Advancing Anatomical Sciences Education

“…Anatomical sciences education, with human donor dissection, encapsulates several core elements that contribute to medical education expenses (McLachlan et al, 2004; Chumbley et al, 2021). This approach features high fixed costs (costs that occur regardless of the number of students) due to required specialized infrastructure, sourcing of carefully controlled materials, skilled technical expertise, and bespoke maintenance and curation (Cornwall and Stringer, 2009).…”

“…This approach features high fixed costs (costs that occur regardless of the number of students) due to required specialized infrastructure, sourcing of carefully controlled materials, skilled technical expertise, and bespoke maintenance and curation (Cornwall and Stringer, 2009). For example, using the data from Chumbley et al (2021), the upfront costs for human donor dissection were calculated as being over 77,000 GBP (using Great British Pounds [GBP/£] as the currency) compared to 30,000 GBP for the plastic model modality, and 3,000 GBP for the computer‐assisted learning approach. Human donor dissection also includes high variable costs (costs that change with the number of learners), due to its requirement of small group learning and its impact on academic workload.…”

“…Healthcare students' engagement with donor dissection pedagogy seems to positively impact a wide array of psychosocial skills including: Professionalism (Escobar‐Poni and Poni, 2006; Sbayeh et al, 2016; Ghosh, 2017; Ghosh and Kumar, 2019; Goss et al, 2019) teamwork (O'Connell and Pascoe, 2004; Nieder et al, 2005; Vasan et al, 2008; Lerner et al, 2009; Hafferty et al, 2013; Krupat et al, 2016; Laakkonen and Muukkonen, 2019), communication (Evans, 2013), medical ethics (Hildebrandt, 2016; Sbayeh et al, 2016; Stephens et al, 2019), clinical and spatial reasoning (Elizondo‐Omaña et al, 2008; Elizondo‐Omaña et al, 2010; Evans et al, 2018; Langlois et al, 2020) and tolerance of uncertainty (Stephens et al, 2020). While Chumbley et al (2021) elegantly illustrate that computer‐aided instruction, plastic models, and virtual dissection tables are projected to be the least costly, these anatomy education teaching modalities are rarely (if ever) tied to the development of these “other” skills. While students may gain these psychosocial skills through other non‐anatomy disciplines or units of study, these courses may not have the same student investment or provide as early an exposure.…”

“…More commonly, however, educational choices are a trade‐off between spending more for a greater effect (north‐east) or accepting a lesser effect to save money (south‐west). A case of the latter is provided by Chumbley et al (2021). Herein the authors demonstrate that compared to simulation, using plastic models are less costly and less effective.…”

“…Anatomy education is a unique medical science discipline for exploring cost‐effectiveness analysis, given its foundational and historical place in medical education (Davis et al, 2014), the array of pedagogical approaches available (Chan and Pawlina, 2015), the increasing plethora of digital anatomy resources (Chan and Pawlina, 2015; Erolin, 2019; Bork et al, 2019; Birbara et al, 2020; Birbara and Pather, 2021), and the ongoing debate around the role of human donor dissection (Azer et al, 2007; Sugand et al, 2010; Pather, 2015; Fernandes et al, 2015; McMenamin et al, 2018; Bogomolova et al, 2020; Jones, 2020). Adding to this age‐old discussion is the decision‐making power and relevance of the cost‐effectiveness analysis found in the article by Chumbley et al (2021).…”