title: Cost: the missing outcome in simulation-based medical education research: a systematic review.
abstract: BACKGROUND
  The costs involved with technology-enhanced simulation remain unknown. Appraising the value of simulation-based medical education (SBME) requires complete accounting and reporting of cost. We sought to summarize the quantity and quality of studies that contain an economic analysis of SBME for the training of health professions learners.
  
  
  METHODS
  We performed a systematic search of MEDLINE, EMBASE, CINAHL, ERIC, PsychINFO, Scopus, key journals, and previous review bibliographies through May 2011. Articles reporting original research in any language evaluating the cost of simulation, in comparison with nonstimulation instruction or another simulation intervention, for training practicing and student physicians, nurses, and other health professionals were selected. Reviewers working in duplicate evaluated study quality and abstracted information on learners, instructional design, cost elements, and outcomes.
  
  
  RESULTS
  From a pool of 10,903 articles we identified 967 comparative studies. Of these, 59 studies (6.1%) reported any cost elements and 15 (1.6%) provided information on cost compared with another instructional approach. We identified 11 cost components reported, most often the cost of the simulator (n = 42 studies; 71%) and training materials (n = 21; 36%). Ten potential cost components were never reported. The median number of cost components reported per study was 2 (range, 1-9). Only 12 studies (20%) reported cost in the Results section; most reported it in the Discussion (n = 34; 58%).
  
  
  CONCLUSIONS
  Cost reporting in SBME research is infrequent and incomplete. We propose a comprehensive model for accounting and reporting costs in SBME.
authors.affiliation: Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. zendejas.benjamin@mayo.edu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zendejas
authors.forename: Amy T
authors.initials: AT
authors.lastname: Wang
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Hamstra
authors.forename: David A
authors.initials: DA
authors.lastname: Cook
mesh_terms: D003198:Computer Simulation / Q000191:economics*; D003362:Cost-Benefit Analysis; D004501:Education, Medical / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D012106:Research / Q000191:economics*; D013663:Teaching / Q000191:economics