Study 2: Advancing Costing Methodology in Health Professions Education: A State-of-the-Art Review and Research Agenda

SUMMARY OF THE STUDY This state-of-the-art review examines how methodological approaches to costing in health professions education have evolved over the past three decades and identifies the persistent challenges that continue to limit the quality and comparability of economic evidence in the field. The review includes all publication types addressing the costs of designing, developing, implementing, or evaluating HPE. It synthesizes methodological challenges, both explicitly reported and implicitly observed, across nine established phases of economic research: study design, perspective, time horizon, identification, measurement, valuation, reporting, comparability, and quality appraisal. The analysis reveals two parallel but largely unintegrated streams of methodological development (domain-specific and general guidance) and highlights recurrent problems such as inconsistent cost definitions, difficulty distinguishing educational from clinical costs, limited primary cost data, and the absence of HPE-specific reporting and appraisal standards. These findings inform a forward-looking research agenda outlining priority actions needed to harmonize cost methodology and strengthen the production of rigorous, comparable, and decision-relevant cost evidence in HPE. ORCID ID: https://orcid.org/0000-0002-4976-5202 DESCRIPTION OF THE DATA FILES Although this study is primarily conceptual and relies on published sources rather than generated data, the following tables from the manuscript can be included to enhance transparency and accessibility while the article remains unpublished: Table 1. Nine Key Phases of Cost Research: Framework outlining the nine phases used to categorize methodological challenges in HPE cost research, with accompanying examples. Table 2. Summary of Current Methodological Challenges in HPE Cost Research: Overview of the explicit and implicit challenges methodological challenges mapped across the nine phases of HPE cost research. Table 3.Methodological Gaps, Relevance, and Future Research Priorities: For each of the nine phases of cost research, the table links identified methodological gaps to their practical implications and presents targeted priorities to strengthen future cost methodology in HPE.