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Objective  To provide a model for conducting cost‐effectiveness analyses in medical education. The model was based on a randomised trial examining the effects of training midwives to perform cervical length measurement (CLM) as compared with obstetricians on patients' waiting times. ( CLM ), as compared with obstetricians.    Methods  The model included four steps: (i) gathering data on training outcomes, (ii) assessing total costs and effects, (iii) calculating the incremental cost‐effectiveness ratio ( ICER ) and (iv) estimating cost‐effectiveness probability for different willingness to pay ( WTP ) values. To provide a model example, we conducted a randomised cost‐effectiveness trial. Midwives were randomised to  CLM  training (midwife‐performed  CLM s) or no training (initial management by midwife, and  CLM  performed by obstetrician). Intervention‐group participants underwent simulation‐based and clinical training until they were proficient. During the following 6 months, waiting times from arrival to admission or discharge were recorded for women who presented with symptoms of pre‐term labour. Outcomes for women managed by intervention and control‐group participants were compared. These data were then used for the remaining steps of the cost‐effectiveness model.    Results  Intervention‐group participants needed a mean 268.2 (95% confidence interval [ CI ], 140.2‒392.2) minutes of simulator training and a mean 7.3 (95%  CI , 4.4‒10.3) supervised scans to attain proficiency. Women who were scanned by intervention‐group participants had significantly reduced waiting time compared with those managed by the control group ( n  = 65; mean difference, 36.6 [95%  CI  7.3‒65.8] minutes; p = 0.008), which corresponded to an  ICER  of 0.45  EUR  minute −1 . For  WTP  values less than  EUR  0.26 minute −1 , obstetrician‐performed  CLM  was the most cost‐effective strategy, whereas midwife‐performed  CLM  was cost‐effective for  WTP  values above  EUR  0.73 minute −1 .    Conclusion  Cost‐effectiveness models can be used to link quality of care to training costs. The example used in the present study demonstrated that different training strategies could be recommended as the most cost‐effective depending on administrators' willingness to pay per unit of the outcome variable.

Linking quality of care and training costs: cost‐effectiveness in health professions education