The cost of teaching an intern in New South Wales

To the Editor: In gathering their data, Oates and colleagues1 chose not to include the cost of the learner's time. However, in most cost analyses, learner inputs are accounted for — particularly if the learners are paid (as the interns are). While Oates et al concentrated on the cost of teaching personnel, they did not take into account the cost of facilities, equipment or consumables — which can be substantial. For example, the cost of a professor teaching in a tutorial room would be quite different to the cost of a professor facilitating a session on a high technology simulation suite.2

Their analysis shows that the costs of formal teaching episodes are considerably higher than the costs of informal episodes, and interns only spend a small proportion of their time attending any form of teaching. However, their data also beg another question that a follow-up study might answer by evaluating the relative effectiveness, benefits or utility associated with the formal and the informal teaching.3 These measurements of value could then be related back to the costs. The informal episodes could turn out to be highly effective and yet low cost. A greater emphasis on informal teaching on the wards could thus yield higher educational returns and yet be cost neutral.

Many have argued the case for greater integration of service and education in postgraduate medical training.4 A follow-up study could reveal a result that has been much sought after — a program of practical medical education that is high value and low cost.