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Year : 2016  |  Volume : 41  |  Issue : 1  |  Page : 72-73

It costs in medical education

BMJ Learning, BMJ Group, London, England, United Kingdom

Date of Web Publication8-Dec-2015

Correspondence Address:
Kieran Walsh
BMJ Learning, BMJ Group, London, England
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-0218.170997

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How to cite this article:
Walsh K. It costs in medical education . Indian J Community Med 2016;41:72-3

How to cite this URL:
Walsh K. It costs in medical education . Indian J Community Med [serial online] 2016 [cited 2022 May 17];41:72-3. Available from: https://www.ijcm.org.in/text.asp?2016/41/1/72/170997


Medical education is expensive. [1] Some of the most recent advances in medical education have added to that expense. For example medical schools can pay hundreds of thousands of pounds on simulation equipment. However the price that the medical school pays may not represent the total cost. If a piece of simulation equipment for example costs ͳ20 000 to buy, then other costs will need to be added to this. These might include everything from the costs of technicians to run the equipment to the cost of maintenance and repair. Depending on the equipment being bought these costs may approach or even exceed the purchase cost. When these costs are added to the purchase costs, the result is the total cost of ownership. [2],[3] When making purchasing decisions in medical education, it is important to consider the total cost of ownership as it will have a significant effect on overall budget. [4],[5] This paper outlines the components that typically make up total cost of ownership, and suggests methods by which the costs of these components can be controlled.

Components that make up the total cost of ownership include the purchasing price, set up costs, operative costs and long term costs. Set up costs include the costs of planning, purchase (from researching what to buy through to contracting), installation and integration with existing systems or equipment, insurance, and migration from the old system to the new. Operative costs are the costs of running the new product or service that has been purchased. These include the costs of faculty or personnel, training the trainers, and consumables. Long term costs include the costs of maintenance and repairs, renewal, depreciation, upgrades, scaling up, decommissioning, and replacement or disposal.

These components must all be considered when making purchasing decisions. Sometimes different components will have different values and so will need to be balanced against each other and against the purchasing costs. In terms of set up costs, the ideal purchase in medical education would be one that is low cost; that is inexpensive, easy and quick to buy; that can be installed quickly, and seamlessly integrated with existing materials; that requires low or no insurance; and where users can be easily migrated from the old system to the new. In terms of operative costs, the ideal purchase would be one that requires inexpensive input from faculty; where faculty already know how to use it; and which requires little or no consumables to be run. In terms of long term costs, an ideal purchase would be durable with low maintenance and repair and renewal costs; would be slow to depreciate in value; would be easy to upgrade without being replaced; and would be easy to be replaced or disposed of. This list should be comprehensive - however not all the components listed will be relevant to all purchasing decisions.

If all this seems a bit too technical or theoretical, then it probably appropriate to look at some practical examples. Simulation is likely to be one such example. [6] Let's say a medical school decides to buy a laparoscopic simulator. The purchase price is reasonable. Set up costs are also reasonable. There is little planning to be done in terms of how best to use the equipment - largely because faculty have been waiting for it for a while and already have a plan in place. The cost of purchase was also low - no market research was needed as the faculty knew exactly what they wanted to buy. The purchased simulator was a stand-alone one - it did not require integration with existing systems or equipment. There was no old version of this equipment and therefore migration from the old system to the new was not needed. Insurance for the new simulator was captured within the envelope of the simulation centre's insurance. Operative costs are also low. The simulator needs no consumables and is a single user part task trainer. Learners do not therefore need much supervision when using the simulator. The cost of faculty is thus minimal. However the long term costs are significant. The simulator breaks down twice in its second year of usage. Repair is expensive and slow and so the cost of having unused equipment needs to be added to the costs of repair. Two years after purchase, the software on which the simulator operates needs to be upgraded - this is expensive and requires considerable input from the technology team. After four years the simulator needs to be replaced - however there is no exact substitute and new and similar pieces of equipment and now considerably more expensive. This scenario will not be unfamiliar to readers who work with technology. It can be difficult to predict all hidden costs. This example also shows the importance of budgeting cycles within medical education. In year one, this appears a great investment; in year two, less so; and by year four, questions might be asked regarding the long term wisdom of the investment.

Purchase of e-learning resources may throw up a different set of issues. [7],[8] Once again, purchase, set up, and running costs might be low. However in the second year, the medical school might wish to scale up the use of the resource - in order to drive outcomes. [9] The school might have bought a license originally for 200 users. This license was low cost - however the license for scaling up to 400 users is prohibitively expensive. Nonetheless more learners now need and want the resource. The medical school is thus left in a difficult position.

These problems are not unique to simulation or e-learning. [10],[11] They can affect decisions regarding the purchase of assessment item banks, evaluation tools, or even space. There will not always be a straightforward way out of these dilemmas - most often the best workable solution is to balance a number of different priorities. However it is always wise to be aware of these hidden costs and to ensure that they don't turn up as an unexpected and unwanted surprise.

   References Top

Walsh K, Jaye P. Cost and value in medical education. Educ Prim Care 2013;24:391-3.  Back to cited text no. 1
Ellram LM, Siferd SP. Total cost of ownership: A key concept in strategic cost management decisions. JBL 1998;19:55-84.  Back to cited text no. 2
Ellram LM. Total cost of ownership: An analysis approach for purchasing. Int J Phys Distrib Logist Manag 1995;25:4-23.  Back to cited text no. 3
Degraeve Z, Roodhooft F. Effectively selecting suppliers using total cost of ownership. JSCM 1999;35:5-10.  Back to cited text no. 4
Roodhooft F, Degraeve Z, Labro E. An evaluation of vendor selection models from a total cost of ownership perspective. Eur J Oper Res 2000;125:34-58.  Back to cited text no. 5
Ker J, Hogg G, Maran N. Cost effective simulation. In: Walsh K, editor. Cost Effectiveness in Medical Education. Abingdon: Radcliffe; 2010. p. 61-71.  Back to cited text no. 6
Sandars J. Cost-effective e-learning in medical education. In: Walsh K, editor. Cost Effectiveness in Medical Education. Abingdon: Radcliffe; 2010. p. 40-7.  Back to cited text no. 7
Sandars J, Walsh K. A consumer guide to the world of e-learning. BMJ Career Focus 2005;330:96-7.   Back to cited text no. 8
Walsh K, Rutherford A, Richardson J, Moore P. NICE medical education modules: An analysis of cost-effectiveness. Educ Prim Care 2010;21:396-8.  Back to cited text no. 9
Cowan DF. Total cost of ownership. In: Cowan D, editor. Informatics for the Clinical Laboratory: A Practical Guide. New York: Springer; 2005. p. 87-97.  Back to cited text no. 10
West R, Daigle SL. Total cost of ownership: A strategic tool for ERP planning and implementation. ECAR 2006;2004:1-14.  Back to cited text no. 11


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