Dijk Stijntje Willemijn, Essafi Skander, Niehot Christa, Wong John B, Hunink Myriam, Woltman Andrea M
Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, Zuid-Holland, Netherlands.
Radiology, Elisabeth-Tweesteden Ziekenhuis, Tilburg, Netherlands.
BMJ Open. 2025 Mar 13;15(3):e091911. doi: 10.1136/bmjopen-2024-091911.
Medical education profoundly impacts patients, students, educators and public resources. However, the economic dimensions necessary for informed decision-making remain underexplored. This systematic review examines how economic evaluations are conducted and reported in undergraduate medical education (UME) literature and assesses their quality.
Systematic review.
Medline, Embase, Web of Science, Cochrane, ERIC, Google Scholar and the CEVR CEA databases were searched on 13 September 2024.
Eligible studies evaluated interventions within UME and reported (incremental) costs and effects, employing any method such as cost-effectiveness analysis, cost-minimisation analysis or decision-analytic modelling.
Key data, including study characteristics, evaluation type, perspective, intervention details, sensitivity analyses, cost and effect measures, outcomes, expressions of cost-effectiveness and adherence to economic reporting guidelines, were extracted. Quality was assessed using the CHEQUE tool, and the findings were synthesised qualitatively.
Of 6559 studies identified, 21 met the inclusion criteria. Most studies reported costs and effects post-hoc within effectiveness trials, with only one decision-analytic modelling study identified. Evaluated domains included instructional methods, skills training, selection and student health. All but one study adopted a payer (university) perspective, and nearly all focused on short-term outcomes. Sensitivity analyses were rarely performed, and no study achieved full quality scores.
Economic evaluations in UME are scarce and often of limited methodological rigour. A shift towards comprehensive, prospective evaluations is needed to address long-term outcomes, societal perspectives and methodological robustness. Such efforts will enable better resource allocation, enhance the impact of medical education and contribute to a sustainable educational landscape.
CRD42023478907.
医学教育对患者、学生、教育工作者和公共资源有着深远影响。然而，明智决策所需的经济维度仍未得到充分探索。本系统评价考察了本科医学教育（UME）文献中经济评价的开展和报告方式，并评估其质量。
系统评价。
于2024年9月13日检索了Medline、Embase、科学网、Cochrane、教育资源信息中心、谷歌学术以及CEVR成本效果分析数据库。
符合条件的研究评估了UME内的干预措施，并报告了（增量）成本和效果，采用了成本效果分析、成本最小化分析或决策分析模型等任何方法。
提取了关键数据，包括研究特征、评价类型、视角、干预细节、敏感性分析、成本和效果测量指标、结果、成本效果表达以及对经济报告指南的遵循情况。使用CHEQUE工具评估质量，并对结果进行定性综合。
在检索到的6559项研究中，21项符合纳入标准。大多数研究在有效性试验中事后报告成本和效果，仅识别出一项决策分析模型研究。评估领域包括教学方法、技能培训、选拔和学生健康。除一项研究外，所有研究均采用了付费方（大学）视角，且几乎所有研究都关注短期结果。很少进行敏感性分析，没有研究获得满分。
UME中的经济评价很少见，且方法严谨性往往有限。需要转向全面的前瞻性评价，以解决长期结果、社会视角和方法稳健性问题。此类努力将有助于更好地分配资源、增强医学教育的影响，并推动可持续的教育格局发展。
PROSPERO注册号：CRD42023478907。
