Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.
Med Educ. 2017 Jul;51(7):740-754. doi: 10.1111/medu.13266. Epub 2017 Mar 21.
Failure by students in health professional clinical education intertwines the health and education sectors, with actions in one having potential downstream effects on the other. It is unknown what economic costs are associated with failure, how these costs are distributed, and the impacts these have on students, clinicians and workplace productivity. An understanding of cost drivers and cost boundaries will enable evidence-based targeting of strategic investments into clinical education, including where they should be made and by whom.
This study was designed to determine the additional economic costs associated with failure by students in health professional clinical education.
A cost analysis study involving cost identification, measurement, valuation and the calculation of total cost was conducted. Costs were considered from the perspective of the student, the education institution, the clinical educator, the health service placement provider organisation and the government. Data were based on a 5-week clinical education programme at Monash University, Australia. Data were collected using quantitative surveys and interviews conducted with health professional students, clinical educators and education institute staff. Reference group representation was also sought at various education institution and health service organisation levels. A transferable model with sensitivity analysis was developed.
There is a total additional cost of US$9371 per student failing in clinical education from the perspective of all stakeholders considered. Students bear the majority of this burden, incurring 49% of costs, followed by the government (22%), the education institution (18%), the health service organisation (10%) and the clinical educator (1%).
Strong economic links for multiple stakeholders as a result of failure by students in clinical education have been identified. The cost burden is skewed in the direction of students. Any generalisation of these results should be made with consideration for the unique clinical education context in which each health professional education programme operates.
学生在健康专业临床教育中的失败交织了卫生和教育部门，一个部门的行动对另一个部门可能产生下游影响。目前尚不清楚与失败相关的经济成本是多少，这些成本如何分配，以及这些成本对学生、临床医生和工作场所生产力的影响。了解成本驱动因素和成本边界将使对临床教育的战略投资进行基于证据的定位成为可能，包括应该在哪里进行投资以及由谁进行投资。
本研究旨在确定健康专业临床教育中学生失败所带来的额外经济成本。
进行了一项成本分析研究，包括成本识别、衡量、估值和总成本计算。从学生、教育机构、临床教育者、卫生服务提供者组织和政府的角度考虑了成本。数据基于澳大利亚莫纳什大学为期 5 周的临床教育计划。使用定量调查和对健康专业学生、临床教育者和教育机构工作人员进行的访谈收集数据。还在各种教育机构和卫生服务组织层面寻求了参考群体的代表性。开发了一个具有敏感性分析的可转移模型。
从所有考虑的利益相关者的角度来看，学生在临床教育中失败的总成本为每位学生 9371 美元。学生承担了大部分负担，占 49%，其次是政府（22%）、教育机构（18%）、卫生服务组织（10%）和临床教育者（1%）。
已经确定了由于学生在临床教育中的失败，多个利益相关者之间存在强烈的经济联系。成本负担偏向学生。在对每个健康专业教育计划运作的独特临床教育环境进行任何概括时，都应考虑这些结果。
