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Is Dyad Practice in Simulation Really Cost-Effective?

Walsh, Kieran FRCPI, FHEA

doi: 10.1097/ACM.0000000000000666
Letters to the Editor

Clinical director of BMJ Learning, the medical education service of the BMJ Group, London, United Kingdom;

Disclosures: None reported.

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To the Editor:

Räder and colleagues1 have made a worthy contribution to the evidence base with regard to dyad practice and simulation. They found that dyad practice was as effective as individual practice in learning a challenging skill. Their statistical analysis of the quantitative data was unimpeachable, and their qualitative analysis was equally if not more robust. However, their conclusion regarding the cost-effectiveness of their approach is a matter for debate.

The authors mention cost on a number of occasions—including in the abstract and in the conclusion—however, at no stage do they explicitly state the actual cost of either approach in their report. They write that “this type of directed self-guided training is cost-effective, as both groups learned the … skills in the absence of an instructor,”1 yet there was no direct comparison of the effectiveness or cost-effectiveness of their approaches with instructor-led approaches as one would expect.2 Räder and colleagues1 draw their conclusions about the cost-effectiveness of dyad practice on the assumption that dyad “practice is more efficient because pairs of students learn the same skill in less practice time.”

This may be a reasonable assumption, but close examination suggests that it may contain some errors of logic. Even though there will be savings in practice time, management time will be taken up in organizing the dyads and twinning learners with their peers. This can be done in the context of a research study as in this case; however, it would require extra management input for it to be rolled out on a continuous basis and to make dyad practice the standard in student learning. Even if there are savings in practice time, it is worth considering whether such savings in time will be converted into savings in cost. Medical students are not paid, so their time cannot be converted into cost. There is the time of setting up and running the simulation session—which might be shorter with dyads—but much of the effort will be spent on setting up in the initial phase. Lastly, the construct of the learning being considered assumes that the simulation is a structured curriculum-driven activity. What if the learners simply wanted to use the simulator on their own and in their own time, as is done in some open-access simulation units? Surely the cost of that would be even lower.

All this is not to say that the authors’ idea wasn’t excellent—it was, and it produced excellent outcomes. Probably it would be worth pursuing even if its cost were the same as individual practice. Statements about its cost-effectiveness, however, are at present largely speculative.

Kieran Walsh, FRCPI, FHEA

Clinical director of BMJ Learning, the medical education service of the BMJ Group, London, United Kingdom;

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1. Räder SB, Henriksen AH, Butrymovich V, et al. A study of the effect of dyad practice versus that of individual practice on simulation-based complex skills learning and of students’ perceptions of how and why dyad practice contributes to learning. Acad Med. 2014;89:1–8
2. Walsh K, Levin H, Jaye P, Gazzard J. Cost analyses approaches in medical education: There are no simple solutions. Med Educ. 2013;47:962–968
© 2015 by the Association of American Medical Colleges