Ethics of cost analyses in medical education

Abstract

Cost analyses in medical education are rarely straightforward, and rarely lead to clear-cut conclusions. Occasionally they do lead to clear conclusions but even when that happens, some stakeholders will ask difficult but valid questions about what to do following cost analyses–specifically about distributive justice in the allocation of resources. At present there are few or no debates about these issues and rationing decisions that are taken in medical education are largely made subconsciously. Distributive justice ‘concerns the nature of a socially just allocation of goods in a society’. Inevitably there is a large degree of subjectivity in the judgment as to whether an allocation is seen as socially just or ethical. There are different principles by which we can view distributive justice and which therefore affect the prism of subjectivity through which we see certain problems. For example, we might say that distributive justice at a certain institution or in a certain medical education system operates according to the principle that resources must be divided equally amongst learners. Another system may say that resources should be distributed according to the needs of learners or even of patients. No ethical system or model is inherently right or wrong, they depend on the context in which the educator is working.

You can't put a value on that… Or can you? Economic evaluation in simulation-based medical education

“…There is a noted lack of methodological rigour and consistency in such analyses in health professions education. [7][8][9][10] With the need (why) for economic evaluation in SBME established, we join Lin et al in focusing on the detail (how) and consider the value of SBME as our departure point for discussion.…”

“…Cost and value analyses have the potential to determine the feasibility and sustainability of SBME. There is a noted lack of methodological rigour and consistency in such analyses in health professions education . With the need (why) for economic evaluation in SBME established, we join Lin et al.…”