Isaranuwatchai Wanrudee, Brydges Ryan, Carnahan Heather, Backstein David, Dubrowski Adam
Centre for Excellence in Economic Analysis Research, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Adv Health Sci Educ Theory Pract. 2014 May;19(2):219-32. doi: 10.1007/s10459-013-9464-6. Epub 2013 Jun 1.
While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).
虽然模拟训练的最终目标是促进学习，但成本效益是一个关键因素。比较模拟训练在教育和成本效益方面的研究将有助于做出更明智的课程决策。我们利用先前发表的数据对三个基于模拟的项目进行了成本效益分析。医学生（每组15人）在三个2小时的静脉导管插入技能训练项目之一中进行练习：低保真度（虚拟现实）、高保真度（人体模型）或渐进式（包括虚拟现实、任务训练器和人体模型模拟器）。一周后，所有人都在混合模拟（标准化病人与任务训练器）上进行了迁移测试。我们使用净效益回归模型通过配对比较来确定最具成本效益的训练项目。我们还创建了成本效益可接受性曲线，以直观地表示在各种“支付意愿”值下，一个项目与其比较对象相比更具成本效益的概率。我们对实施成本和总成本进行了单独分析。结果表明，渐进式项目的总成本最高（p < 0.001），而高保真度项目的实施成本最高（p < 0.001）。虽然最具成本效益的项目取决于决策者的支付意愿值，但渐进式训练项目总体上在教育和成本效益方面最为突出。我们的分析表明，一种战略性地结合模拟模式的渐进式项目提供了一种具有成本效益的解决方案。更一般地说，我们介绍了如何将成本效益分析应用于模拟训练；这是医学教育工作者可用于投资决策（例如，购买具有成本效益且教育效果良好的模拟器）的一种方法。
