Discussion Paper: Commissioning of medical education in the post-registration arena
Medical education is expensive. In some circumstances, this expense has led to new models of funding post-registration education. One such approach is commissioned or tendered education. This model is based on a purchaser–provider split, where centrally funded authorities commission or seek tenders for post-registration medical education from education providers. Despite the growth of commissioning of medical education, there has been little public debate on its advantages or disadvantages. There are a number of advantages of a commissioning model. It can act as an incentive to quality improvement, and it drives competition between providers. In addition, commissioning decisions can be devolved so that local purchasers can decide what forms of medical education they wish to pay for. It also acts as a means of increasing choice. There are also disadvantages to the commissioning model. The process of commissioning is in itself expensive. In addition, competition might act as a barrier to integration and induce destabilisation in the system of medical education. This model may also suggest that there is a price for everything and that all components of medical education must be reduced to their lowest common denominator of cost. It would work best if pure market forces were unleashed, but the truth is that medical education is rarely a pure market.
Australian and New Zealand Association for Health Professional Educators (ANZAHPE) (2014). Gold Coast declaration on learning through practice in the health professions. Retrieved from http://media.wix.com/ugd/363deb_ acff357111d84498b177b7bb32dc8e03.pdf
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., . . . Zurayk,
H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet, 376(9756), 1923– 1958. doi:10.1016/S0140-6736(10)61854-5
Hafferty, F. W. (1998). Beyond curriculum reform: Confronting medicine's hidden curriculum. Academic Medicine, 73(4), 403–407.
Murray, E., Gruppen, L., Catton, P., Hays, R., Woolliscroft, J. O. (2000). The accountability of clinical education: Its definition and assessment. Medical Education, 34(10), 871–879.
Roberts, J. (1987). Perfectly and imperfectly competitive markets. In J. Eatwell, M. Milgate, & P. Newman (Eds.), The new Palgrave: A dictionary of economics. New York, NY: Macmillan.
Sandars, J. (2010). Cost-effective e-learning in medical education. In K. Walsh (Ed.), Cost effectiveness in medical education. Abingdon, UK: Radcliffe.
Sandars, J., & Walsh, K. (2005). A consumer guide to the world of e-learning. BMJ Career Focus, 330, 96–97.
Walsh, K., & Jaye, P. (2013). Cost and value in medical education. Education for Primary Care, 24(6), 391–393.
Walsh, K., Rutherford, A., Richardson, J., & Moore, P. (2010). NICE medical education modules: An analysis of cost-effectiveness. Education for Primary Care, 21(6), 396–398.
Zendejas, B., Wang, A. T., Brydges, R., Hamstra, S. J., & Cook, D. A. (2013). Cost: The missing outcome in simulation-based medical education research. A systematic review. Surgery, 153(2), 160–176. doi:10.1016/j.surg.2012.06.025
- There are currently no refbacks.