The economic cost of failure in clinical education: a multi-perspective analysis.
BACKGROUND
Failure by students in health professional clinical education intertwines the health and education sectors, with actions in one having potential downstream effects on the other. It is unknown what economic costs are associated with failure, how these costs are distributed, and the impacts these have on students, clinicians and workplace productivity. An understanding of cost drivers and cost boundaries will enable evidence-based targeting of strategic investments into clinical education, including where they should be made and by whom.


OBJECTIVE
This study was designed to determine the additional economic costs associated with failure by students in health professional clinical education.


METHODS
A cost analysis study involving cost identification, measurement, valuation and the calculation of total cost was conducted. Costs were considered from the perspective of the student, the education institution, the clinical educator, the health service placement provider organisation and the government. Data were based on a 5-week clinical education programme at Monash University, Australia. Data were collected using quantitative surveys and interviews conducted with health professional students, clinical educators and education institute staff. Reference group representation was also sought at various education institution and health service organisation levels. A transferable model with sensitivity analysis was developed.


RESULTS
There is a total additional cost of US$9371 per student failing in clinical education from the perspective of all stakeholders considered. Students bear the majority of this burden, incurring 49% of costs, followed by the government (22%), the education institution (18%), the health service organisation (10%) and the clinical educator (1%).


CONCLUSIONS
Strong economic links for multiple stakeholders as a result of failure by students in clinical education have been identified. The cost burden is skewed in the direction of students. Any generalisation of these results should be made with consideration for the unique clinical education context in which each health professional education programme operates.
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.|Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.
Jonathan
J
Foo
Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.|Department of Economics, Faculty of Business and Economics, Monash University, Melbourne, Victoria, Australia.
George
G
Rivers
Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.|Medical Education Research and Quality Unit, Monash University, Melbourne, Victoria, Australia.
Dragan
D
Ilic
Office of Learning and Teaching, Monash University, Melbourne, Victoria, Australia.
Darrell J R
DJR
Evans
Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.|BMJ Learning, BMJ Publishing Group, London, UK.
Kieran
K
Walsh
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.|Allied Health Research Unit, Monash Health, Melbourne, Victoria, Australia.
Terrence
T
Haines
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
Sophie
S
Paynter
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.
Prue
P
Morgan
Department of Physiotherapy, Monash Health, Melbourne, Victoria, Australia.
Karl
K
Lincke
Department of Physiotherapy, Peninsula Health, Melbourne, Victoria, Australia.
Haria
H
Lambrou
Allied Health & Community Services Planning, Innovation, Research and Education (ASPIRE) Unit, Western Health, Melbourne, Victoria, Australia.
Anna
A
Nethercote
Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia.|Society for Cost and Value in Health Professions Education, Monash University, Melbourne, Victoria, Australia.|Medical Education Research and Quality Unit, Monash University, Melbourne, Victoria, Australia.
Stephen
S
Maloney
D001315:Australia; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D004504:Education, Medical, Undergraduate / Q000191:economics*; D006801:Humans; D013334:Students; D017132:Workplace