Balancing the effectiveness and cost of online education: A preliminary realist economic evaluation

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Purpose: While online learning for faculty development has grown substantially over recent decades, it has been further accelerated in the face of the worldwide pandemic. The effectiveness of online learning has been repeatedly established through systematic reviews and meta-analyses, yet questions remain about its cost-effectiveness. This study evaluates how synchronous online supervision training workshops and their cost-effectiveness might work, and in what contexts. Methods: We conducted preliminary realist economic evaluation including qualitative (13 realist interviews), and quantitative approaches (cost Ingredients method). We developed a cost-optimised model based on identified costs and cost-sensitive mechanisms. Results: We identified 14 recurring patterns (so-called demi-regularities) illustrating multiple online workshop outcomes (e.g. satisfaction, engagement, knowledge), generated by various mechanisms (e.g. online technology, mixed pedagogies involving didactic and active/experiential learning, peer learning), and triggered by two contexts (supervisor experience levels, and workplace location). Each workshop cost $302.92 per learner, but the optimised model including senior facilitators cost $305.70. Conclusions: Our initial realist program theories were largely supported and refined. Although findings were largely concordant with previous literature, we illustrate how online workshop costs compare favourably with face-to-face alternatives. We encourage program developers to consider synchronous online learning for faculty development especially for remote learners, and in resource-constrained environments.

Original languageEnglish
Pages (from-to)977-985
Number of pages9
JournalMedical Teacher
Issue number9
Publication statusPublished - Sept 2022


  • online learning
  • realist economic evaluation
  • realist evaluation
  • Supervision training

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