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A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

Maloney S, Nicklen P, Rivers G, Foo J, Ooi YY, Reeves S, Walsh K, Ilic D - J. Med. Internet Res. (2015)

Bottom Line: However, the cost-effectiveness of delivering blended learning is unclear.The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness.Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model.

View Article: PubMed Central - HTML - PubMed

Affiliation: Monash University, Frankston, Australia. stephen.maloney@monash.edu.

ABSTRACT

Background: Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.

Objective: This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.

Methods: The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.

Results: The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.

Conclusions: Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

No MeSH data available.


Equation for the calculation of the incremental cost for each quality-adjusted student educated (ICER).
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figure1: Equation for the calculation of the incremental cost for each quality-adjusted student educated (ICER).

Mentions: The following analysis was applied from the perspective of Monash University, measuring the cost of training student clinicians against their self-reported level of EBM competence. The primary outcome was student competency in EBM, measured 1 month after the teaching activities, using the validated Berlin Questionnaire. We calculated the cost-effectiveness for each course delivery method by first determining the quality of students’ education with each method, known as quality-adjusted students educated (QASE), using the formula QASE = number of students educated x the group’s average rating on the Berlin Questionnaire. In this approach, the reported average rating was used as a surrogate for measuring the improved ability of the total cohort of 497 students for each teaching approach. QASE is the measurement of effect in the incremental cost-effectiveness analysis. Cost-effectiveness was calculated using the incremental cost-effectiveness ratio (ICER), which measures cost per QASE (Figure 1). The ICER is reflective of the ongoing operational costs and does not include the initial transition cost in its calculation. Thus, the results represent the cost-effectiveness of the second iteration and onwards only.


A Cost-Effectiveness Analysis of Blended Versus Face-to-Face Delivery of Evidence-Based Medicine to Medical Students.

Maloney S, Nicklen P, Rivers G, Foo J, Ooi YY, Reeves S, Walsh K, Ilic D - J. Med. Internet Res. (2015)

Equation for the calculation of the incremental cost for each quality-adjusted student educated (ICER).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4527010&req=5

figure1: Equation for the calculation of the incremental cost for each quality-adjusted student educated (ICER).
Mentions: The following analysis was applied from the perspective of Monash University, measuring the cost of training student clinicians against their self-reported level of EBM competence. The primary outcome was student competency in EBM, measured 1 month after the teaching activities, using the validated Berlin Questionnaire. We calculated the cost-effectiveness for each course delivery method by first determining the quality of students’ education with each method, known as quality-adjusted students educated (QASE), using the formula QASE = number of students educated x the group’s average rating on the Berlin Questionnaire. In this approach, the reported average rating was used as a surrogate for measuring the improved ability of the total cohort of 497 students for each teaching approach. QASE is the measurement of effect in the incremental cost-effectiveness analysis. Cost-effectiveness was calculated using the incremental cost-effectiveness ratio (ICER), which measures cost per QASE (Figure 1). The ICER is reflective of the ongoing operational costs and does not include the initial transition cost in its calculation. Thus, the results represent the cost-effectiveness of the second iteration and onwards only.

Bottom Line: However, the cost-effectiveness of delivering blended learning is unclear.The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness.Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model.

View Article: PubMed Central - HTML - PubMed

Affiliation: Monash University, Frankston, Australia. stephen.maloney@monash.edu.

ABSTRACT

Background: Blended learning describes a combination of teaching methods, often utilizing digital technologies. Research suggests that learner outcomes can be improved through some blended learning formats. However, the cost-effectiveness of delivering blended learning is unclear.

Objective: This study aimed to determine the cost-effectiveness of a face-to-face learning and blended learning approach for evidence-based medicine training within a medical program.

Methods: The economic evaluation was conducted as part of a randomized controlled trial (RCT) comparing the evidence-based medicine (EBM) competency of medical students who participated in two different modes of education delivery. In the traditional face-to-face method, students received ten 2-hour classes. In the blended learning approach, students received the same total face-to-face hours but with different activities and additional online and mobile learning. Online activities utilized YouTube and a library guide indexing electronic databases, guides, and books. Mobile learning involved self-directed interactions with patients in their regular clinical placements. The attribution and differentiation of costs between the interventions within the RCT was measured in conjunction with measured outcomes of effectiveness. An incremental cost-effectiveness ratio was calculated comparing the ongoing operation costs of each method with the level of EBM proficiency achieved. Present value analysis was used to calculate the break-even point considering the transition cost and the difference in ongoing operation cost.

Results: The incremental cost-effectiveness ratio indicated that it costs 24% less to educate a student to the same level of EBM competency via the blended learning approach used in the study, when excluding transition costs. The sunk cost of approximately AUD $40,000 to transition to the blended model exceeds any savings from using the approach within the first year of its implementation; however, a break-even point is achieved within its third iteration and relative savings in the subsequent years. The sensitivity analysis indicates that approaches with higher transition costs, or staffing requirements over that of a traditional method, are likely to result in negative value propositions.

Conclusions: Under the study conditions, a blended learning approach was more cost-effective to operate and resulted in improved value for the institution after the third year iteration, when compared to the traditional face-to-face model. The wider applicability of the findings are dependent on the type of blended learning utilized, staffing expertise, and educational context.

No MeSH data available.