Costs and assessment in medical education: a strategic view

Van der Vleuten and Heeneman have added another important piece to the emerging jigsaw that will eventually show us the full picture of cost in healthcare professional education [1]. Their idea of redistributing the resources of assessment in a curriculum is an attractive one. Their suggestion that we concentrate more on progress testing could make a real difference in how we allocate funding to different forms of assessment. Perhaps more importantly it could also make a real difference to the outcomes that we can achieve by means of assessment for a given cost. Inevitably there are gaps in their approach. Their estimates of costs are in their own words ‘rough’ and there is also limited data. However, the main strength of their approach is that they bring much needed radical thinking to the area of cost in assessment. In this short commentary I will try to articulate some more radical thinking in this field. The issue of cost and value in healthcare professional education generally and assessment in healthcare professional education specifically has been largely neglected until relatively recently. There has been little research and few systematic reviews. Academic endeavours in this field have not always been of high quality. Terms like cost-effectiveness are used loosely and sometimes lazily: interventions are described as cost-effective without a thorough analysis of their costs or their effectiveness or a comparison with other interventions of differing cost-effectiveness [2; 3]. Put simply, no intervention can be cost-effective in and of itself – it can only be considered to be cost-effective in comparison to an alternative. In the absence of such comparisons conclusions are merely rhetoric.