Kieran Walsh: Medical education—high value but high cost?

Medical education has undergone many reforms over the past thirty years. Medical students of the past spent much time learning things they didn’t need to know—today medical education is curriculum driven. In the past medical education was “one size fits all”—today it is learner centric. In the past students practised on patients—today increasingly they practise in simulations or online. What can be said in defence of medical education of the past? Perhaps there is one thing—it was low cost. Medical education has undergone a process of reform in recent years. I think that most of the reforms have been worthwhile although I know that not everyone would agree with me. However surely most would agree that the reforms have cost money. Small group teaching, high fidelity simulations, high technology e-learning programmes, problem based learning tutorials, train the trainer programmes—they all require funding. So if the direction of travel of medical education has been moving from low cost low value to high cost high value, the obvious question is—where next? I would argue that we must look for models and methods of medical education that are high value, but low cost.

How will we get there? Is technology the way? Technology may offer a route forward, but not in the way that we are currently using it. E-learning is commonly cited as a means to save costs in medical education. Zealots of e-learning will point out the savings that are achievable by this format. Trainer and learner accommodation, travel, and subsistence are not needed—nor are classrooms. However these same zealots ignore the costs of e-learning—which can be sizeable. There are provider costs which include the costs of websites, e-learning content, and hosting. Then there are the costs to the learner—hardware, software, depreciation, internet connections. Then there is the problem of our lack of strategy in e-learning. E-learning programmes should complement face to face education, but all too often they reproduce it. This increases cost, but offers little value. E-learning programmes should also complement each other but all too often they reproduce the wheel. A review of technology enhanced learning in the UK showed that local providers all too often produced their own e-learning programmes without first checking whether the same or similar programmes were available elsewhere. E-learning programmes are certainly more sophisticated than they were. They have been transformed from simple page turners to interactive multimedia presentations. But do we always need this level of technology? Are the bells and whistles for the learners or for the designers?

The short answer is that no one knows how to create or what might constitute value in e-learning or medical education more generally. This is because of the lack of evidence base in this field. However this is also an opportunity to conduct medical education research in a novel area. If you are interested in taking part or finding out more or just putting forward your point of view, then the Higher Education Academy is running a free workshop on this topic at the Royal Free Hospital on 28 Apr 2014. Here is where to find out more.

Competing interests: Kieran Walsh works for BMJ Learning—the medical education division of the BMJ Group. He has written a book on cost and value in medical education published by Radcliffe. He will be involved in running the workshop but will not be paid for this.

Kieran Walsh is clinical director of BMJ Learning—the education service of the BMJ Group. He is responsible for the editorial direction of BMJ Online Learning, BMJ Masterclasses, and BMJ onExamination. He has written two books—the first on cost and value in medical education and the second a dictionary of medical education quotations. He has worked in the past as a hospital doctor – specialising in care of the elderly medicine and neurology.