“You can’t always get what you want…”: economic thinking, constrained optimization and health professions education

Abstract

Every choice we make in health professions education has a cost, whether it be financial or otherwise; by choosing one action (e.g., integrating more simulation, studying more for a summative examination) we lose the opportunity to take an alternative action (e.g., freeing up time for other teaching, leisure time). Economics significantly shapes the way we behave and think as educators and learners and so there is increasing interest in using economic ways of thinking and approaches to examine and understand how choices are made, the influence of constraints and boundaries in educational decision making, and how costs are felt. Thus, in this article, we provide a brief historical overview of modern economics, to illustrate how the core concepts of economics—scarcity (and desirability), rationality, and optimization—developed over time. We explain the important concept of bounded rationality, which explains how individual, meso-factors and contextual factors influence decision making. We then consider the opportunities that these concepts afford for health professions education and research. We conclude by proposing that embracing economic thinking opens up new questions and new ways of approaching old questions which can add knowledge about how choice is enacted in contemporary health professions education.

We know but we hope: A qualitative study of the opinions and experiences on the inclusion of management, health economics and research in the medical curriculum

“…There was regret expressed by participants that they did not take advantage of known formal or ad hoc opportunities to engage with these topics. This is balanced by the notion that with staff and curriculum time constraints, there is a bounded rationality that we can only present students with a limited number of opportunities to learn for multiple realities that may or may not occur [52]. However, similar to the health systems science curriculum framework that is presented by Borkan et al (2021) with core and cross-cutting domains, there is a recurring need for the medical curriculum to go beyond the clinical content and prepare future doctors with appropriate skills to better serve populations under their care [13].…”

BMAT's predictive validity for medical school performance: A retrospective cohort study

“…It is not feasible to interview every applicant who has been predicted to obtain the necessary academic requirements 5 . Selection tests represent a relatively cheap and acceptable method (from the selector's perspective) to compare and select applicants for interview, 4,48,54 thus whittling down the numbers of applicants to manageable numbers. This is a reality of the selection process but raises another point for consideration.…”

Whose problem is it anyway? Confronting myths of ‘problems’ in health professions education

“…For instance, practitioners may have a good understanding of what the solution should be, but factors such as logistics, a lack of autonomy, insufficient resources or educational politics may make it impossible to enact. 22 This is reflected in the concept of 'bounded rationality' 23 that involves decision-making under uncertainty, decision-making framed by risk or deviations of people's behaviour from ideals, any or all of which can unravel the assumed translation of evidence to practice. Instead of following the path of evidence, most HPE decision-makers are obliged to compromise between competing drivers, amongst which evidence may have little place.…”