We thank Maloney and colleagues for their comments on our Innovation Report outlining the use of multimodal simulation as an adjunctive pedagogy in an anatomy curriculum. We agree that the inclusion of cost comparisons alongside educational innovations can aid decision makers and administrators in selecting technologies and pedagogical approaches to use in their institutions. While it may at times be feasible to make this comparison with traditional tutoring methodologies or other interventions through crossover-type study designs, we also feel it is important to point out that all stakeholders, including trainees, educators, and administrators, must enter comparative processes with equipoise regarding presumption of learning outcomes. In many educational institutions, this is becoming increasingly difficult in simulation-based education because of the abundant evidence supporting its benefit to learners. In many cases, randomized controlled trials comparing benefits of pedagogic strategies are not feasible because of the sensitive nature of providing an educational intervention to one group of students to the exclusion of another group.
At our institution, the ability to estimate de novo costs of simulation in a course is complicated by the previous large existing commitment to simulation resources. For example, incorporating simulation into our anatomy course did not require the purchase of new mannequins or task trainers; the medical school already owned these, and in fact, they were by then used in many other school of medicine and hospital courses. Thus, the larger issue in regard to cost related to the incremental costs of human resources (i.e., supported academic time for faculty instructors with simulation expertise). In addition, for our specific curriculum, comparison with cadaveric modalities in the anatomy course was not feasible. Cadavers were not accessible in the cultural context of the country of our study (Malaysia)—a reality that prompted our use of the simulation-based curriculum from the outset.
However, we fully agree that the Prato Statement’s dual emphasis on sustainability and optimization of educational value1 should remain at the forefront of decision making for educators and administrators alike, and we advocate for training in health professions education to include instruction in economic evaluations and cost/value analyses. As Maloney and colleagues point out, it is only with this cultural change that educators can demonstrate the worth of emerging educational technologies to administrators and balance the competing priorities of financial sustainability and the highest-quality educational programming.
Nicole A. Shilkofski, MD, MEd
Associate professor, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; ORCID: https://orcid.org/0000-0003-0000-0871; e-mail: firstname.lastname@example.org; Twitter: @HopkinsKids.
Julianne S. Perretta, MSEd, RRT-NPS
Instructor, Department of Anesthesiology and Critical Care Medicine and the Johns Hopkins Medicine Simulation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Elizabeth A. Hunt, MD, MPH, PhD
Associate professor, Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Health Informatics and the Johns Hopkins Medicine Simulation Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
1. Maloney S, Reeves S, Rivers G, Ilic D, Foo J, Walsh K. The Prato Statement on cost and value in professional and interprofessional education. J Interprof Care. 2017;31:1–4.