Numerous studies performed over the last 30 years suggest that doctors have poor knowledge of the costs of medical care. In most graduate medical education pro- grammes, trainees do not receive formal training in cost-effective medical practice. Methods Comprehensive literature search of electronic bibliographic databases for articles that describe health economics, cost-containment and cost-effectiveness curricula in graduate medical education. Critical appraisal of the literature and qualitative description is presented. Heterogeneity of curricula precluded quantitative summary of data.


We identified 40 articles that met the inclusion criteria for this review. Internal medicine residents were the targeted learners in 27 studies (68%); Family Medicine and Surgery residents were each targeted in five studies (13%); Rehabilitation, Paediatrics and Emergency Medicine residents were each targeted in one study. In general, the method- ological quality of the included studies was poor to moderate and mostly targeted knowl- edge of health economics or cost-containment as opposed to targeting cost-effectiveness. In terms of describing the standard curricular components, studies sufficiently described the different educational strategies (e.g. didactics, interactive, experiential, self-directed) and the component of learner assessment, but lacked the description of other elements such as needs assessment and curriculum evaluation.


Cost-effectiveness curricula in graduate medical education are lacking and clearly needed.


Prathibha Varkey MBBS MPH, Mohammad H. Murad MD MPH, Chad Braun MD, Kristi J.H. Grall MD and Vivek Saoji MBBS MS