Educator perspectives on costs and cost-conscious decision-making in health professions education: a Q-Method study

Intensification of resource scarcity in health professions education (HPE) requires careful consideration of educational costs. Educators play a significant role in this process, as they make resource allocation decisions when designing, developing, organizing and overseeing education, yet little is known about how educators view the idea of incorporating information on educational costs into decision-making. Therefore, this study maps educator views on cost-conscious decision-making in HPE. Using Q-Methodology, we explored how HPE educators perceive costs and cost-conscious decision-making. Participants ranked 34 statements and engaged in semi-structured interviews. By-person inverted factor analysis with varimax rotation was used to extract factors representing distinct patterns of thinking held by three or more educators. These patterns were interpreted using factor arrays, distinguishing and consensus statements, and interview transcripts, yielding narrative descriptions of unique educator perspectives. Twenty-five educators holding diverse educational responsibilities and 1-29 years of experience were classified into four distinct perspectives. Unaware Doubters (n = 3) are unexposed to educational cost considerations and lack motivation for involvement. Cautious Realists (n = 8) are personally impacted by resource constraints, yet hesitant about cost-conscious decision-making. Pragmatic Supporters (n = 8) hold implicit awareness of resource scarcity but remain open to participation in cost-conscious decision-making. Empowered Agents (n = 6) are aware, active and engaged in cost-conscious decision-making, yet seek a unifying vision and transparent communication from leadership. These four distinct educator perspectives on costs and cost-conscious decision-making in education illustrate varying levels of awareness, motivation and engagement, which indicates the need for tailored strategies to improve cost-conscious decision-making in HPE. This information can be used by educational institutes to develop a vision, policy and strategy to involve educators in considerations concerning educational costs in view of the increasing resource scarcity in HPE. Future research should evaluate the effectiveness of different strategies targeted to these perspectives and explore how perspectives vary across settings and contexts.