Mitchell Debra, Maloney Stephen, Robinson Luke, Haines Terry, Foo Jonathan
School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia.
Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia.
Med Educ. 2025 Apr;59(4):368-381. doi: 10.1111/medu.15550. Epub 2024 Oct 31.
Student-led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student-led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student-led clinics and report the methods that have been used to measure these costs and benefits.
We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student-led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student-led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies.
Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description-monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits.
Student-led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student-led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student-led clinics in comparison to alternatives. Without the full picture, decision-makers may make decisions that are ill-informed and lead to a loss of benefit for society.
学生主导的诊所为多个利益相关者群体带来一系列益处。学生获得重要的教育机会以推进其培训。获得医疗服务机会有限的患者可能获得有效的医疗服务或更多的有效医疗服务，从而减轻医疗保健系统的负担。由大学运营的学生主导诊所的财务可行性尚不确定，而由于可能涉及的利益相关者成本和收益范围广泛，确定这一点变得复杂。本系统评价旨在综合与学生主导诊所的成本和收益相关的证据，并报告用于衡量这些成本和收益的方法。
我们对MEDLINE All、PsychInfo、CINAHL、A+ Education（Informit）、ERIC（ProQuest）和ProQuest Education数据库进行了系统检索，以查找报告从设立到2023年8月学生主导诊所的成本和/或经济效益的研究。对研究进行资格筛选，并提取数据，包括研究特征、学生主导诊所的描述和经济结果。由于研究的异质性，进行了叙述性综合分析。
在349项潜在符合条件的研究中，纳入了24项。9项研究（38%）采用了结果描述 - 货币化方法；4项采用了部分经济评价（17%）；4项采用了成本描述（17%）；2项采用了成本近似法（8%）；2项采用了成本分析（8%）；1项是全面经济分析（4%）。研究从一系列利益相关者的角度考察了成本或收益，但很少同时考察两者。只有6项研究（25%）确定了其服务的临床有效性。学生诊所给大学带来了提供监督、资本和消耗品方面的成本。收益由患者、学生、大学和更广泛的医疗系统共享，然而，迄今为止的经济评价在很大程度上忽略了这些收益或未对其进行货币化/估值。
学生主导的诊所涉及许多不同的利益相关者，每个利益相关者都可能产生成本并获得收益。这使得我们在试图确定学生主导诊所的经济效率和可行性时变得复杂。需要同时衡量成本和收益，以了解与其他选择相比学生主导诊所的效率。如果没有全面的情况，决策者可能会做出信息不足的决策，导致社会利益受损。
