Rees Charlotte E, Foo Jonathan, Nguyen Van N B, Edouard Vicki, Maloney Stephen, Ottrey Ella, Palermo Claire
School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.
Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
Med Educ. 2022 Apr;56(4):407-417. doi: 10.1111/medu.14701. Epub 2021 Dec 19.
Cost studies are increasingly popular given resource constraints. While scholars stress the context-dependent nature of cost, and the importance of theory, cost studies remain context-blind and atheoretical. However, realist economic evaluation (REE) privileges context and the testing/refinement of economic programme theory. This preliminary REE serves to test and refine economic programme theory for supervision training programmes of different durations to better inform future programme design/implementation.
Our preliminary REE unpacked how short (half-day) and extended (12 week) supervision training programmes in Victoria, Australia, produced costs and outcomes. We employed mixed methods: qualitative realist and quantitative cost methods. Economically optimised programme models were developed guided by identified cost-sensitive mechanisms and contexts.
As part of identified context-mechanism-outcome configurations (CMOCs) for both training programmes, we found a wider diversity of positive outcomes but greater costs for the extended programme (11 outcomes; AU$3069/learner) compared with the short programme (7 outcomes; $385/learner). We identified four shared cost-sensitive mechanisms for both programmes (training duration, learner protected time, learner engagement, and facilitator competence) and one shared cost-sensitive context (learners' supervisory experience). We developed two economically optimised programme models: (1) short programme for experienced supervisors facilitated by senior educators ($406/learner); and (2) extended programme for inexperienced supervisors facilitated by junior educators ($2104/learner).
Our initial economic programme theory was somewhat supported, refuted and refined. Results were partly consistent with previous research, but also extended it through unpacking cost-sensitive mechanisms and contexts. Although our preliminary REE fills a pressing gap in the methodology literature, conducting REE was challenging given our desire to integrate economic and realist analyses fully, and remain faithful to realist principles. Attention to training duration and experience levels of the facilitator-learner dyad may help to balance the cost and outcomes of training programmes.
鉴于资源限制，成本研究越来越受欢迎。虽然学者们强调成本的情境依赖性以及理论的重要性，但成本研究仍然缺乏情境考量且缺乏理论依据。然而，现实主义经济评估（REE）重视情境以及经济项目理论的检验/完善。这项初步的REE旨在检验和完善不同时长的监督培训项目的经济项目理论，以便为未来的项目设计/实施提供更好的参考。
我们的初步REE剖析了澳大利亚维多利亚州的短期（半天）和长期（12周）监督培训项目是如何产生成本和结果的。我们采用了混合方法：定性现实主义和定量成本方法。在确定的成本敏感机制和情境的指导下，开发了经济优化的项目模型。
作为两个培训项目确定的情境-机制-结果配置（CMOCs）的一部分，我们发现长期项目（11个结果；每位学习者3069澳元）与短期项目（7个结果；每位学习者385澳元）相比，积极结果的多样性更大，但成本更高。我们确定了两个项目共有的四个成本敏感机制（培训时长、学习者受保护时间、学习者参与度和促进者能力）和一个共有的成本敏感情境（学习者的监督经验）。我们开发了两个经济优化的项目模型：（1）由资深教育工作者为经验丰富的监督者提供的短期项目（每位学习者406澳元）；（2）由初级教育工作者为经验不足的监督者提供的长期项目（每位学习者2104澳元）。
我们最初的经济项目理论在一定程度上得到了支持、反驳和完善。结果部分与先前的研究一致，但也通过剖析成本敏感机制和情境对其进行了扩展。虽然我们的初步REE填补了方法论文献中的一个紧迫空白，但鉴于我们希望充分整合经济分析和现实主义分析，并忠实于现实主义原则，进行REE具有挑战性。关注培训时长以及促进者-学习者二元组的经验水平可能有助于平衡培训项目的成本和结果。
