Uncovering the economic costs of rotation in postgraduate clinical training: A UK case study using a novel methodology

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INTRODUCTION: Health professions education (HPE) frequently employs rotational models in which learners move between placements at distinct healthcare facilities. Rotational training is presumed to have educational benefits but it incurs costs and there is debate within undergraduate and postgraduate contexts concerning the optimal extent of rotation. Rotational training's costs are largely hidden and have not been rigorously studied. We aimed to analyse the cost of facilitating inter-hospital rotation within a learning programme using a novel, pragmatic approach. METHODS: The approach was applied to a UK postgraduate doctor specialty training programme to analyse costs from the perspective of the health system. Resources devoted to facilitating the movement of learners between hospitals were identified and costed using an ingredients-based approach. Resource uses were identified and estimated in conjunction with a multidisciplinary advisory group comprising of the key stakeholders involved in facilitating rotation. RESULTS: The facilitation of rotation was revealed to be complex with multiple hidden costs requiring the involvement of thirteen different staff roles. The estimated minimum cost per rotation event per doctor was £4,048 ($5,100 USD) and consumed ∼39 h of doctor time. Additional economic consequences, including reduced clinical productivity and impacts on doctor retention, were identified but could not be reliably quantified and were therefore excluded, suggesting that the cost estimate represents a conservative minimum. DISCUSSION: The cost of complex, system-wide educational interventions can be analysed using this simple methodological approach. Its principles are likely to be applicable in analysing the costs of a broad range of interventions in HPE. The case study's findings support calls to reconsider the structure of rotational training programmes, with positive impacts achievable through reduced rotation frequency and the use of centralised employment models.

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