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Let’s avoid educational inflation


Weighing the Cost of Educational Inflation in Undergraduate Medical Education. Cusano R, et al. Adv in Health Sci Educ 2016; published online.  http://dx.doi.org/10.1007/s10459-016-9708-3

Reviewed by Rebecca Tenney-Soeiro, MD, MSEd

Tags: pre-clerkship, teaching, program evaluation, opinion piece

Editor’s Note: This is a review of a “Reflection” piece rather than a study and so we will forego the usual review format.

As the authors point out, the length of medical school training has remained constant while the expectations of graduating medical students (and the schools that train them) continue to increase. The resulting “educational inflation,” while well-intentioned, can have adverse effects on the actual medical education as well as the emotional, psychological, and financial well-being of students. The authors discuss a cost-effectiveness framework for educating students and advocate for prioritization of interventions that improve learning outcomes and do so with no additional costs.  If improved learning and/or cost savings cannot be accomplished, they advocate resisting the urge to change.

Recent innovations like virtual patients, simulation, and inter-professional education have the potential to improve learning and clinical outcomes.  However, educators are not very good at taking anything away from the curriculum.  The authors discuss existence bias (the tendency to consider the mere existence of something in the existing curriculum as evidence of its value), the psychological effect of loss (the fear that removing content will reduce learning outcomes), and the endowment effect (the tendency to inflate the value of something that we own or created) as causes of our reluctance to reduce content and expectations. 

As educators we frequently incorporate educational content into practice on the assumption that learning outcomes are better, even with limited data.  Educational researchers also tend to perform studies that demonstrate the effectiveness of innovations rather than redundancy in the existing curriculum and innovative studies demonstrating a positive impact on learning outcomes are more likely to be published. 

Adding curriculum may anticipate the future needs of society and further developments in healthcare, but are core knowledge and clinical skills being adversely affected?  Is student well-being being monitored?

We should prioritize interventions that improve learning outcomes with no additional costs to programs or students and also interventions that are cost saving without adversely affecting learning outcomes. We should resist change if there is no proof of improved learning outcomes or cost savings. 

Editor’s note: This is a very important article for anyone involved in medical education. As a physician educator named William Welch once wrote: “The time has gone by when one mind can encompass all which has been ascertained in the medical sciences.” That was in 1886. As a former dean at my institution was fond of saying, “The medical school curriculum is the only known organism without an excretory system.” (A similar quote can be found in the medical education classic Time to Heal by Kenneth Ludmerer). As this essay points out, overloading the medical school curriculum without adequate thought can have negative unforeseen consequences. In many instances it probably already has. (RR)

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