Weinberg E, O'Sullivan P, Boll A G, Nelson T R
Division of Academic Affairs, Baystate Health Systems, Springfield, Mass.
JAMA. 1994 Sep 7;272(9):669-73.
Large nonuniversity teaching hospitals are major providers of the clinical training component of undergraduate medical education, yet little information is available to policymakers, participating hospitals, or sponsoring medical schools on the institutional costs of this service.
To determine the costs associated with teaching students in required third-year clerkships for a group of large nonuniversity teaching hospitals.
SETTING/PARTICIPANTS: A total of 201 medical students from nine large nonuniversity teaching hospitals affiliated with nine medical schools that participate in required third-year clerkships.
During a typical week, students completed 24-hour time and activity logs that classified each activity, instructor, and audience. From these logs, the number of teaching hours by full-time faculty and others were estimated and costs were calculated.
Full-time faculty provided a mean of 0.242 h/d of formal teaching, 0.326 h/d of informal teaching, and 0.581 h/d of supervised patient care training per student, an estimated direct faculty cost of $412 per week per student. The cost of direct and indirect departmental and academic administration, as well as other direct out-of-pocket medical education costs, added $250 per week per student. The average annual clinical program cost of third-year clerkships to nonuniversity hospitals and their full-time faculties was $31,776 per student. This figure does not include the substantial contributions of teaching by other than paid faculty (eg, volunteer physicians and residents), which was important in terms of activity and service provided.
Direct and indirect costs of third-year medical student education for most hospitals in this study was more than $1 million per year, well in excess of the average support provided by sponsoring medical schools.
大型非大学教学医院是本科医学教育临床培训部分的主要提供者，但政策制定者、参与的医院或主办医学院校几乎没有关于这项服务的机构成本的信息。
确定一组大型非大学教学医院在三年级必修临床实习中教授学生的相关成本。
地点/参与者：来自九所医学院附属的九家大型非大学教学医院的201名医学生，这些医院参与三年级必修临床实习。
在一个典型的星期内，学生完成24小时的时间和活动日志，对每项活动、指导教师和受众进行分类。根据这些日志，估算全职教师和其他人员的教学小时数并计算成本。
全职教师平均每天为每名学生提供0.242小时的正式教学、0.326小时的非正式教学以及0.581小时的监督患者护理培训，估计每位学生每周的直接教师成本为412美元。直接和间接的部门及学术管理成本，以及其他直接的自付医疗教育成本，每名学生每周增加250美元。非大学医院及其全职教师三年级临床实习项目的平均年度成本为每名学生31,776美元。这个数字不包括非带薪教师（如志愿医生和住院医师）教学的巨大贡献，这在活动和提供的服务方面很重要。
本研究中大多数医院三年级医学生教育的直接和间接成本每年超过100万美元，远远超过主办医学院校提供的平均支持。
