GME Online: A CostEffective Method for Presenting a Core Curriculum to Medical Residents

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GME Online A Cost-Effective Method for
Presenting a Core Curriculum to Medical Residents

• Joseph W. York, PhD
• Gerald R. Stapleton, MS
• Leslie J. Sandlow, MD
• Department of Medical Education
• University of Illinois at Chicago
• College of Medicine

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The UIC Department of Medical Education goes
online
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Costs and benefits of online programs

• To date, few reports are available that compare
  costs of online programs to their on-ground
  counterparts.

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Justification for an online course can be based
on

• Lower costs per student
• More students for same cost
• Ability to reach new student populations (in a
  cost-effective manner)

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Cost Behavior of Technology
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Identification of Cost Categories

• Development
• Presentation
• Technical Overhead

(Per Rumble-JALN Sept 2001)
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Dimensions of the UIC Online GME Core Curriculum

• Meet the ACGME requirement for a regular review
  of ethical, socio- economic, medical/ legal, and
  cost-containment issues that affect GME and
  medical practice aka the Core Curriculum

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continued . . .

• Provide instruction to 1,000 medical and dental
  residents in 60 programs rotating among 15
  institutions
• Identify a cost-effective method for delivering
  the core curriculum
• Document participation and achievement

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Key features

• 13 topics to be presented in discrete modules
• Each module takes from 3-5 hours to complete
• Use content experts across campus to develop
  materials
• Some form of assessment and evaluation

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Project Time Line
o
o
o
o
o
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Alternative delivery modes for the core curriculum

• Face-to-face conferences using College of
  Medicine faculty and small group discussions
• Online readings with asynchronous discussion
  groups
• Others

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Development Costs
Course preparation time per contact hour (per J.
Boettcher, 1999) F2F Lecture 2-10
hours Online material 5-23 hours

• Factors
• Familiarity with materials
• Skill in developing web pages
• Course management systems
• Technical support

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Development costs, continued

• Infrastructure
• Equipment and software
• Tech support

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Assumptions used

• Faculty hourly costs 50 (with benefits)
• Online preparation time 2X face-to-face use
  midpoints (6 hrs F2F 12 hrs online)
• 13 modules X 5 hours 65 contact hours

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Development Costs
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Presentation Costs
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Summing up so far

• Online costs 20 lower than F2F
• But there are other issues

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Add increment of new residents (1,000)
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Expressed graphically,
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Overhead Costs

• Institution provides support through an
  Instructional Technology Lab, as well as
  bandwidth, PCs.
• Few guidelines in the literature regarding
  allocating overhead to online courses.
• Note that University of Illinois sponsors 29
  programs including GME online.

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Two viewpoints to resolving overhead cost issue

• Investment view Enterprise-sustaining costs are
  not allocated on the margin. The addition of one
  program to 28 already existing will not consume
  significant amounts of resources.

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The other viewpoint

• All costs must be considered (Bates, 2000).
  Using sensitivity analysis, consider the total
  cost difference at 1,000 and 2,000 participants
  (60,000 and 240,000). Do these describe the
  outside limits of overhead that would be
  allocated to this program?

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Other items for discussion

• Scalability Identifying competent faculty for
  F2F presentations when numbers increase.
• Geographic independence Online course is not
  bound by reasonable travel limits.
• Facility costs
• Resident travel time

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Continued

• Documentation Small group discussions are
  archived and available for analysis and
  performance assessment.
• Program may not be representative of higher-ed
  online courses.
• Participants are certainly not comparable to
  undergraduate students full-time employees with
  salaries and generally high competency in
  technology.

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Summary

• Online educational programs can be cost-effective
  for large numbers of participants.
• Online program costs behave in the same manner as
  other technology investments.
• While overhead costs are difficult to determine
  and allocate, sensitivity analysis allows
  estimation of allowable allocations for
  break-even analysis.

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Acknowledgements to UI Onlinewww.online.uillinois
.edu
The GME Core Curriculum can be viewed
at www.gme-core.org