Cost-benefit ratio of modern medical education using micro-costing: a model calculation using the example of an innovative breast brachytherapy workshop.
Cost efficiency
Simulation
Students
Teaching
Training
Journal
Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al]
ISSN: 1439-099X
Titre abrégé: Strahlenther Onkol
Pays: Germany
ID NLM: 8603469
Informations de publication
Date de publication:
28 Feb 2024
28 Feb 2024
Historique:
received:
03
11
2023
accepted:
11
02
2024
medline:
29
2
2024
pubmed:
29
2
2024
entrez:
28
2
2024
Statut:
aheadofprint
Résumé
Radiation oncology is an essential component of therapeutic oncology and necessitates well-trained personnel. Multicatheter brachytherapy (MCBT) is one radiotherapeutic option for early-stage breast cancer treatment. However, specialized hands-on training for MCBT is not currently included in the curriculum for residents. A recently developed hands-on brachytherapy workshop has demonstrated promising results in enhancing knowledge and practical skills. Nevertheless, these simulation-based teaching formats necessitate more time and financial resources. Our analyses include computational models for the implementation and delivery of this workshop and can serve as a basis for similar educational initiatives. This study aimed to assess the cost-effectiveness of a previously developed and evaluated breast brachytherapy simulation workshop. Using a micro-costing approach, we estimated costs at a detailed level by considering supplies, soft- and hardware, and personnel time for each task. This method also allows for a comprehensive evaluation of the costs associated with implementing new medical techniques. The workshop costs were divided into two categories: development and workshop execution. The cost analysis was conducted on a per-participant basis, and the impact on knowledge improvement was measured using a questionnaire. The total workshop costs were determined by considering the initial workshop setup expenses including the development and conceptualization of the course with all involved collaborators, as well as the costs incurred for each individual course. The workshop was found to be financially efficient, with a per-participant cost of € 39, considering the industrial sponsorship provided for brachytherapy equipment. In addition, we assessed the workshop's efficacy by analyzing participant feedback using Likert scale evaluations. The findings indicated a notable enhancement in both theoretical and practical skills among the participants. Moreover, the cost-to-benefit ratio (CBFR) analysis demonstrated a CBFR of € 13.53 for each Likert point increment. The hands-on brachytherapy workshop proved to be a valuable and approximately cost-effective educational program, leading to a significant enhancement in the knowledge and skills of the participants. Without the support of industrial sponsorship, the costs would have been unattainable.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Radiation oncology is an essential component of therapeutic oncology and necessitates well-trained personnel. Multicatheter brachytherapy (MCBT) is one radiotherapeutic option for early-stage breast cancer treatment. However, specialized hands-on training for MCBT is not currently included in the curriculum for residents. A recently developed hands-on brachytherapy workshop has demonstrated promising results in enhancing knowledge and practical skills. Nevertheless, these simulation-based teaching formats necessitate more time and financial resources. Our analyses include computational models for the implementation and delivery of this workshop and can serve as a basis for similar educational initiatives.
METHODS
METHODS
This study aimed to assess the cost-effectiveness of a previously developed and evaluated breast brachytherapy simulation workshop. Using a micro-costing approach, we estimated costs at a detailed level by considering supplies, soft- and hardware, and personnel time for each task. This method also allows for a comprehensive evaluation of the costs associated with implementing new medical techniques. The workshop costs were divided into two categories: development and workshop execution. The cost analysis was conducted on a per-participant basis, and the impact on knowledge improvement was measured using a questionnaire.
RESULTS
RESULTS
The total workshop costs were determined by considering the initial workshop setup expenses including the development and conceptualization of the course with all involved collaborators, as well as the costs incurred for each individual course. The workshop was found to be financially efficient, with a per-participant cost of € 39, considering the industrial sponsorship provided for brachytherapy equipment. In addition, we assessed the workshop's efficacy by analyzing participant feedback using Likert scale evaluations. The findings indicated a notable enhancement in both theoretical and practical skills among the participants. Moreover, the cost-to-benefit ratio (CBFR) analysis demonstrated a CBFR of € 13.53 for each Likert point increment.
CONCLUSION
CONCLUSIONS
The hands-on brachytherapy workshop proved to be a valuable and approximately cost-effective educational program, leading to a significant enhancement in the knowledge and skills of the participants. Without the support of industrial sponsorship, the costs would have been unattainable.
Identifiants
pubmed: 38418653
doi: 10.1007/s00066-024-02218-6
pii: 10.1007/s00066-024-02218-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Deutsche Forschungsgemeinschaft
ID : 413668513
Informations de copyright
© 2024. The Author(s).
Références
Vorwerk H, Engenhart-Cabillic R (2022) Students’ learning behavior in digital education for radiation oncology. Strahlenther Onkol 198(1):12–24
doi: 10.1007/s00066-021-01858-2
pubmed: 34842943
Maurer, M. A., I. Maurer, and M. A. Kamp, Can neuro-oncology teaching contribute to educate medical doctors better? A reflection on the value of neuro-oncology for student teaching. Chin Neurosurg J, 2022. 8(1): p. 23.
Polgar C, Fodor J, Major T, Sulyok Z, Kasler M (2013) Breast-conserving therapy with partial or whole breast irradiation: ten-year results of the Budapest randomized trial. Radiother Oncol 108(2):197–202
doi: 10.1016/j.radonc.2013.05.008
pubmed: 23742961
Strnad V, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H, Major T et al (2016) 5‑year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 387(10015):229–238
doi: 10.1016/S0140-6736(15)00471-7
pubmed: 26494415
Baglan KL, Sharpe MB, Jaffray D, Frazier RC, Fayad J, Kestin LL et al (2003) Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 55(2):302–311
doi: 10.1016/S0360-3016(02)03811-7
pubmed: 12527042
Landis DM, Luo W, Song J, Bellon JR, Punglia RS, Wong JS et al (2007) Variability among breast radiation oncologists in delineation of the postsurgical lumpectomy cavity. Int J Radiat Oncol Biol Phys 67(5):1299–1308
doi: 10.1016/j.ijrobp.2006.11.026
pubmed: 17275202
Strnad V, Polgar C, Ott OJ, Hildebrandt G, Kauer-Dorner D, Knauerhase H et al (2023) Accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy compared with whole-breast irradiation with boost for early breast cancer: 10-year results of a GEC-ESTRO randomised, phase 3, non-inferiority trial. Lancet Oncol 24(3):262–272
doi: 10.1016/S1470-2045(23)00018-9
pubmed: 36738756
Lettmaier S, Kreppner S, Lotter M, Walser M, Ott OJ, Fietkau R, Strnad V (2011) Radiation exposure of the heart, lung and skin by radiation therapy for breast cancer: a dosimetric comparison between partial breast irradiation using multicatheter brachytherapy and whole breast teletherapy. Radiother Oncol 100(2):189–194
doi: 10.1016/j.radonc.2010.07.011
pubmed: 20673690
Knippen S, Schonherr S, Schwedas M, Teichmann T, Howitz S, Maurer M et al (2023) Low doses to the heart in daily practice for treating left-sided breast cancer using accelerated partial-breast irradiation by multicatheter brachytherapy and deep-inspiration breath-hold using a SIB. Strahlenther Onkol 199(4):389–395
doi: 10.1007/s00066-023-02047-z
pubmed: 36826517
pmcid: 10033472
Schafer R, Strnad V, Polgar C, Uter W, Hildebrandt G, Ott OJ et al (2018) Quality-of-life results for accelerated partial breast irradiation with interstitial brachytherapy versus whole-breast irradiation in early breast cancer after breast-conserving surgery (GEC-ESTRO): 5‑year results of a randomised, phase 3 trial. Lancet Oncol 19(6):834–844
doi: 10.1016/S1470-2045(18)30195-5
pubmed: 29695348
Marcrom SR, Kahn JM, Colbert LE, Freese CM, Doke KN, Yang JC et al (2019) Brachytherapy Training Survey of Radiation Oncology Residents. Int J Radiat Oncol Biol Phys 103(3):557–560
doi: 10.1016/j.ijrobp.2018.10.023
pubmed: 30612963
Sturdza AE, Stephanides M, Jurgenliemk-Schulz I, Eriksen JG, Benstead K, Hoskin P et al (2022) Brachytherapy training survey among radiation oncology residents in Europe. Radiother Oncol 177:172–178
doi: 10.1016/j.radonc.2022.10.030
pubmed: 36328092
Cook, D.A., R. Hatala, R. Brydges, B. Zendejas, J.H. Szostek, A.T. Wang, et al., Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA, 2011. 306(9): p. 978–88.
Zaorsky NG, Shaikh T, Handorf E, Eastwick G, Hesney A, Scher ED et al (2016) What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey. Int J Radiat Oncol Biol Phys 94(2):235–242
doi: 10.1016/j.ijrobp.2015.10.008
pubmed: 26684409
Loewen SK, Ruan Y, Wu CHD, Arifin A, Kim M, Bashir B et al (2023) Supply and Demand for Radiation Oncologists in Canada: Workforce Planning Projections From 2020 to 2040. Int J Radiat Oncol Biol Phys
Maurer I, Drescher R, Hammersen J, Dieckmann N, Gremme Y, Sturm MJ et al (2023) Development and implementation of a student tumor board as a teaching format for medical students. J Cancer Res Clin Oncol 149(17):16087–16096
doi: 10.1007/s00432-023-05336-3
pubmed: 37698680
pmcid: 10620267
Knoth J, Konrad S, Lossl K, Motisi L, Maurer M, Linde P et al (2023) Survey on brachytherapy training among radiation oncology residents in the German-speaking regions of Europe. Strahlenther Onkol 199(9):798–805
doi: 10.1007/s00066-023-02108-3
pubmed: 37462693
pmcid: 10450005
Laurence CO, Black LE, Karnon J, Briggs NE (2010) To teach or not to teach? A cost-benefit analysis of teaching in private general practice. Med J Aust 193(10):608–613
doi: 10.5694/j.1326-5377.2010.tb04072.x
pubmed: 21077819
Maurer MA, Drozdz S, Ehrenpfordt J, Schwedas M, Friedlein M, Hille N et al (2023) Development, implementation, and results of a simulation-based hands-on brachytherapy workshop for medical students. Strahlenther Onkol 199(4):370–378
doi: 10.1007/s00066-023-02058-w
pubmed: 36881115
pmcid: 9990013
MacKenzie TA, Willan AR, Cox MA, Green A (1991) Indirect costs of teaching in Canadian hospitals. Cmaj 144(2):149–152
pubmed: 1898870
pmcid: 1453017
Bundesjustizministerium. KHG Krankenhausfinanzierungsgesetz; § 17a Finanzierung von Ausbildungskosten. 18.06.2023; Available from: https://www.gesetze-im-internet.de/khg/__17a.html .
Nousiainen MT, McQueen SA, Ferguson P, Alman B, Kraemer W, Safir O et al (2016) Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs? Clin Orthop Relat Res 474(4):935–944
doi: 10.1007/s11999-015-4512-6
pubmed: 26335344
Potter S, Davies C, Davies G, Rice C, Hollingworth W (2020) The use of micro-costing in economic analyses of surgical interventions: a systematic review. Health Econ Rev 10(1):3
doi: 10.1186/s13561-020-0260-8
pubmed: 31997021
pmcid: 6990532
Ismail I, Wolff S, Gronfier A, Mutter D, Swanstrom LL (2015) A cost evaluation methodology for surgical technologies. Surg Endosc 29(8):2423–2432
doi: 10.1007/s00464-014-3929-4
pubmed: 25318371
Bund, T.d.L.M. Tarifvertrag für Ärztinnen und Ärzte an Universitätskliniken (TV-Ärzte) vom 30. Oktober 2006 in der Fassung des Änderungstarifvertrages Nr. 8 vom 25. August 2022. 2022; Available from: https://www.tdl-online.de/fileadmin/downloads/rechte_Navigation/C._Aerzte/01_TV-Aerzte/TV-%C3%84rzte__i.d.F._des_%C3%84TV_Nr._8_VT.pdf .
Länder, T.d. Tarifvertrag für den öffentlichen Dienst der Länder (TV-L) vom 12. Oktober 2006 in der Fassung des Änderungstarifvertrages Nr. 12 vom 29. November 2021. 2021; Available from: https://www.tdl-online.de/fileadmin/downloads/rechte_Navigation/A._TV-L__2011_/01_Tarifvertrag/TV-L__i.d.F._des_%C3%84TV_Nr._12_VT.pdf .
Statistics USBOL (2022) Occupational Employment and Wage Statistics. Available from: https://www.bls.gov/oes
Bundesfinanzministerium. AfA-Tabelle Gesundheitswesen. 1995; Available from: https://www.bundesfinanzministerium.de/Content/DE/Standardartikel/Themen/Steuern/Weitere_Steuerthemen/Betriebspruefung/AfA-Tabellen/AfA-Tabelle_Gesundheitswesen.pdf?__blob=publicationFile&v=3 .
Bundesfinanzministerium. AfA-Tabelle Gesundheitswesen. 1995. Available from: https://www.bundesfinanzministerium.de/Content/DE/Standardartikel/Themen/Steuern/Weitere_Steuerthemen/Betriebspruefung/AfA-Tabellen/AfA-Tabelle_Gesundheitswesen.pdf?__blob=publicationFile&v=3 .
Fleßa S (2022) Systemisches Krankenhausmanagement. De Gruyter
doi: 10.1515/9783110753103
Wenderlein, J.M., Klimaschutz: Auch klinische Kompetenz spart. Dtsch Arztebl 2020; 117(17): A‑893 / B‑749, 2020.
de statista (2022) Strompreise für Industrie und Gewerbe seit 2003. 2023 04.02.2023; Available from: https://de.statista.com/statistik/daten/studie/154902/umfrage/strompreise-fuer-industrie-und-gewerbe-seit-2006/chland bis. Statista
Phillips JJ (2003) Return on Investment in Training and Performance Improvement Programs. Butterworth-Heinemann
McDavid JC (2006) Program Evaluation and Performance. Measurement (Sage Publications)
Roscoe SN (1980) W.B., Measurement of transfer of training. Aviat Psychol p. pp:18293
Fletcher, J.D. and A.P. Wind, Cost considerations in using simulations for medical training. Mil Med, 2013. 178(10 Suppl): p. 37–46.
Orlansky J (1984) K.M., String J, Operating Costs of Aircraft and Flight Simulators. IDA Paper P, vol 1733. Institute for Defense Analyses
Patel VL, Yoskowitz NA, Arocha JF (2009) Towards effective evaluation and reform in medical education: a cognitive and learning sciences perspective. Adv Health Sci Educ Theory Pract 14(5):791–812
doi: 10.1007/s10459-007-9091-1
pubmed: 18214707
Dubois N, Diep AN, Ghuysen A, Declaye J, Donneau AF, Vogin G et al (2022) Training of radiotherapy professionals: status, content, satisfaction and improvement suggestions in the Greater Region. BMC Med Educ 22(1):485
doi: 10.1186/s12909-022-03567-5
pubmed: 35733149
pmcid: 9217112
Zevin B, Aggarwal R, Grantcharov TP (2014) Surgical simulation in 2013: why is it still not the standard in surgical training? J Am Coll Surg 218(2):294–301
doi: 10.1016/j.jamcollsurg.2013.09.016
pubmed: 24211055
Zendejas B, Wang AT, Brydges R, Hamstra SJ, Cook Cost DA (2013) the missing outcome in simulation-based medical education research: a systematic review. Surgery 153(2):160–176
doi: 10.1016/j.surg.2012.06.025
pubmed: 22884087
Mechanic, R., K. Coleman, and A. Dobson, Teaching hospital costs: implications for academic missions in a competitive market. JAMA, 1998. 280(11): p. 1015–9.
Schreyogg, J., A micro-costing approach to estimating hospital costs for appendectomy in a cross-European context. Health Econ, 2008. 17(1 Suppl): p. S59–69.
stifterverband.org. Fellowships für Innovationen in der digitalen Hochschullehre Thüringen. 2023 18.06.2023; Available from: https://www.stifterverband.org/digital-lehrfellows-thueringen .
Goksel O, Sapchuk K, Morris WJ, Salcudean SE (2013) Prostate brachytherapy training with simulated ultrasound and fluoroscopy images. IEEE Trans Biomed Eng 60(4):1002–1012
doi: 10.1109/TBME.2012.2222642
pubmed: 23047861
AlQhtani A, AlSwedan N, Almulhim A, Aladwan R, Alessa Y, AlQhtani K et al (2021) Online versus classroom teaching for medical students during COVID-19: measuring effectiveness and satisfaction. BMC Med Educ 21(1):452
doi: 10.1186/s12909-021-02888-1
pubmed: 34454493
pmcid: 8397601