Jonathan Foo, Margaret Hay, Stephen Maloney

Cost and value are so pervasive in our day to day decision-making, that it often slips by unnoticed. The December #HMIChat brought the concepts of cost and value in medical education out of the dark and kicked it around like an old wallet – yielding an insightful and passionate discussion touching upon the themes of understanding value in the context of contemporary teaching and learning practices, applying cost and value deliberately with appropriate measurement, and developing a common language for cost and value.

Reflecting on the discussion, we felt three strong themes emerge:

The first, and arguably the most important theme to arise, was around WHAT value actually is. The term value can be used in many ways and in many contexts. The meaning of value is flavoured by perspective and objective. Whose value are we considering? And why are we considering value? We discussed patient level outcomes, but also acknowledged the limitations of this in many aspects of Med Ed where cause and effect are difficult to discern, and also in situations where the objective is to provide value to the learner, not the patient.

The second key concept was around HOW to measure and/or implement cost and value. There appeared to be unanimous agreement that deliberate design, incorporating cost and value, is the way forward. Both quantitative and qualitative measures are useful and play different roles in informing decision-making.

An interesting tangent arose around the application of cost and value to students (or educational interventions) that fail. Deliberate design for early-intervention was a recurring suggestion, including cost-effective selection processes and learning to fail fast – and to learn from failing.

The third theme revolved around understanding and communicating WHY cost and value is important. To do so, there needs to be a baseline competency on the language and tools used in cost and value. The paradigm then shifts from implicit to explicit, and equips innovators to communicate the value of their practice.

(Above: facilitators @s_maloney75 and @JonFromAus limbering up for December #HMIChat)

The playing field of medical education is constantly changing, and we need to be limbered up and ready adapt to change. Can you afford to not think about cost and value?



Jonathan Foo, B.Physiotherapy is a physiotherapist and PhD Candidate at Monash University, Australia. His thesis is on the application of economic evaluations to HPE. Jon is the secretary for the Society for Cost and Value in Health Professions Education.


Margaret Hay, PhD is the Director of the Monash Institute for Health and Clinical Education at Monash and Director of Admissions for the Faculty of Medicine, Nursing, and Health Science, Monash University, Australia. She is a regular member of faculty at several Harvard Macy Institute courses in Boston, Singapore, and Australia.


Stephen Maloney, PhD is the Director of Education for the School of Primary and Allied Health Care at Monash University, Australia; and chair of the Society for Cost and Value in Health Professions Education.



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