title: Weighing the cost of educational inflation in undergraduate medical education.
abstract: Despite the fact that the length of medical school training has remained stable for many years, the expectations of graduating medical students (and the schools that train them) continue to increase. In this Reflection, the authors discuss motives for educational inflation and suggest that these are likely innocent, well-intentioned, and subconscious-and include both a propensity to increase expectations of ourselves and others over time, and a reluctance to reduce training content and expectations. They then discuss potential risks of educational inflation, including reduced emphasis on core knowledge and clinical skills, and adverse effects on the emotional, psychological, and financial wellbeing of students. While acknowledging the need to change curricula to improve learning and clinical outcomes, the authors proffer that it is naïve to assume that we can inflate educational expectations at no additional cost. They suggest that before implementing and/or mandating change, we should consider of all the costs that medical schools and students might incur, including opportunity costs and the impact on the emotional and financial wellbeing of students. They propose a cost-effectiveness framework for medical education and advocate prioritization of interventions that improve learning outcomes with no additional costs or are cost-saving without adversely impacting learning outcomes. When there is an additional cost for improved learning outcomes or a decline in learning outcomes as a result of cost saving interventions, they suggest careful consideration and justification of this trade-off. And when there are neither improved learning outcomes nor cost savings they recommend resisting the urge to change.
authors.affiliation: Office of Student Affairs, University of Calgary, Calgary, AB, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Cusano
authors.affiliation: Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Busche
authors.affiliation: Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Coderre
authors.affiliation: Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Wayne
authors.initials: W
authors.lastname: Woloschuk
authors.affiliation: Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Chadbolt
authors.affiliation: Office of Undergraduate Medical Education, Health Sciences Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. kmclaugh@ucalgary.ca.
authors.forename: Kevin
authors.identifier: http://orcid.org/0000-0002-3092-5325
authors.initials: K
authors.lastname: McLaughlin
mesh_terms: D003362:Cost-Benefit Analysis; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000191:economics* / Q000639:trends*; D004521:Educational Measurement; D006801:Humans; D009937:Organizational Objectives; D012577:Schools, Medical / Q000191:economics* / Q000639:trends*
keywords: Cost-effectiveness; Credentialism; Educational inflation