Dear Sir
Kieran Walsh provides a thoughtful critique of our paper, ‘The educational and financial impact of using patient educators to teach introductory physical exam skills’. Specifically, he questions the sources of cost included in our calculations comparing patient educators with physicians as instructors in teaching introductory physical exam skills. As he notes, “the costs of training, space, exam supplies, and faculty time were not included” and our claim of “amortization … is uncertain”. As he rightly points out, both of these points beg further explanation. The answer lies, at least in part, in the business model underlying our clinical skills programming, facilities and services. The University of Minnesota's Standardized Patient Program is housed within the Interprofessional Education and Resource Center (IERC). Since its opening in 2003, the IERC has provided clinical skills education and simulation services not only for the Medical School, but for all of the six health science schools at the University of Minnesota. As an interprofessional resource, overhead costs (such as professional staff and facilities) are shared across academic units. Our high volume (approximately 300 courses and projects for 12,000 learners each year) and the use of LEAN management principles allow us to provide the highest possible quality for the lowest possible cost. Additionally, the Standardized Patient Program Director (who is one of the authors of this article) has worked actively to maintain a high level of retention (∼95%) of patient educators. These efficiencies, combined with the significant differences in compensation between physicians and patient educators, reduce overhead costs associated with training, space and supplies significantly. Nonetheless, we agree with Mr. Walsh that more detailed accounts of the true cost of clinical skills education should be published. We look forward to reading these accounts and responding to any additional correspondence.