P0765 - The Cost of Core Curriculum in Graduate Medical Education: A Cost Comparison of Didactic Educational Materials for Individual Fellowship Programs vs. Shared Flipped Classroom Materials from the National Neonatal Curriculum

Background: The Organization of Neonatal-Perinatal Medicine Training Program Directors (ONTPD) developed the National Neonatal Curriculum (NNC) utilizing flipped classroom (FC) learning for neonatal physiology. Neonatology faculty were recruited to create FC materials which were edited by NNC Council members(1). Using the NNC, an RCT was conducted to evaluate attitudes about FC and knowledge acquisition between FC and Traditional Didactics (TD)(2).

Purpose: To compare the cost of creating and updating TD materials vs. creating FC materials for NNC, based on fellowship size and number of learners reached.

Methods: In 2019 we conducted an IRB-approved national survey to query NPM faculty about time required to create and update TD materials. A separate survey was sent to faculty who created NNC FC materials regarding their time spent on these endeavors. Cost calculations were based on an average annual salary of $240,000 for academic neonatologists(3). Wilcoxon rank-sum test evaluated differences between time to create vs. update TD materials. Comparison of 2 Poisson rates evaluated differences between the cost to create new TD vs. new FC materials.

Results: 96% (298/309) of the educators responded to the survey on TD materials and 76% (38/50) responded to the survey on FC materials. Educators spent approximately 3.5 times more hours creating new peer-reviewed national FC materials (median 17 hrs, IQR 17, n=49) than new locally-used TD materials (median 5 hrs, IQR 5, n=309, P<0.001, Figure). TD materials developed at local institutions were associated with a cost that ranged from $192.30/fellow for small fellowship programs to $48.04/fellow for large programs (Table). In contrast, FC materials, which were disseminated nationally for use among 789 fellows, were associated with a fixed cost of $2.49/fellow (Table). Creating national FC materials resulted in a 19-72 fold savings compared to the cost of creating new locally-used TD materials. Finally, the time to update pre-existing TD materials (median 1 hr, IQR 1.5) was significantly less than creating new TD or FC materials. However, the cost to update existing TD materials per fellow, ranging from $38.46/fellow for small programs to $9.62/fellow in large programs, was still greater than creating new FC materials (Table).

Conclusions: The development of high quality, peer-reviewed national FC materials through the NNC is associated with a significant cost savings per learner vs. developing new or even updating pre-existing TD materials for local use at individual programs.

1) Gray MM, et al. Value, Strengths, and Challenges of e-Learning Modules Paired with the Flipped Classroom for Graduate Medical Education: A Survey from the National Neonatology Curriculum. Am J Perinatol. 2020; E-pub ahead of print
2) Manuscript in process
3) Horowitz E, et al. Neonatologist salary: factors, equity and gender. J Perinatol 2019;39(3):359-65.