Review (Olsen) – Embracing a dialogue about cost in physiotherapy education

I would like start with saying thank you to the authors for inviting readers to a dialogue about costs in physiotherapy education. In summary, I find this editorial relevant and useful as it points to our responsibility as educators for considering costs when designing physiotherapy education. Your suggestions and tips are useful for both educators and managers of educational programs. Below I have some minor suggestions for changes and some questions you might want to consider.


I find the title short, catchy and to the point.


Do you need an abstract at all? I would say that you do not. However, if you do want to keep these lines, could you consider adding the word “cost” to the text, as this is the focus of the editorial? To me, it is not clear what you mean by “sustainability in achieving these outcomes” – just from reading the abstract.


Paragraph 1: Repeating myself, regarding “sustainability in achieving these outcomes” –  I see that sustainability is linked to issues that are linked to costs (directly or indirectly), for example re-using and sharing resources – however, will readers automatically see this link? Could you consider using the word “cost” in this introductory paragraph?

Paragraph 2: what does “this” refer back to when you write “despite this”? Consider rephrasing.

Paragraph 3: I believe you make an important point when you link the issue of cost in education to the expectations from WCPT regarding clinical education, as this is likely the most costly part of physiotherapy education.

Paragraph 4: I agree, and I think that you are right, regarding the importance of improved management for generating better learning outcomes for the same costs. To strengthen your argument, could you consider adding a reference to research evidence on this issue? Again, I am not sure what “this” refers back to; I am not sure if I can see the link between growing demand of physiotherapy services and the need for improved management. The purpose is clear.

“Body” of the editorial

Personnel costs: when you state that “Curriculum designers may optimise personnel usage by considering economies of scale” – could you also refer to “basic economic literacy”, as in your earlier paper, the Prato Statement” (Maloney et al. 2017)?

Equipment and material costs: I noticed that there is a new systematic review on the impact of flipped classroom (, with a more convincing conclusion than the review by Chen, Lui & Martinelli (2017). However, it could be that this review is less relevant for your argument.

Box 1:

  • The list of suggestions are important and informative, but could you organise it similar to Box 2, or alternatively highlight with bold the text that works as heading, e.g. “Look beyond physiotherapy”.
  • In the second point that you make in the box – you refer to the fact that “By using a 2:1 ratio, clinical educator time per learner is effectively halved”. This means that we need less clinical educators; an important point to make – as finding clinical educators is a big challenge. However, do we have evidence to support that this ratio means less time used on supervision (and thereby less costs)? I wonder if the argument that you make later in the second paragraph about facility costs – could also be applied for this point – somehow (“However, such approaches are highly heterogeneous (Liu et al., 2016), and depending on implementation, facility costs may not necessarily be different compared to traditional approaches (Maloney et al., 2015).”).
  • You also refer to an example of an international collaboration from medical school. Do we have something similar within physiotherapy education?

Client input costs: When you refer to the importance of keeping relevant stakeholder groups in mind; consider again referring to the Prato Statement and the points made there about considering multiple perspectives.


I find that the conclusion has a punch to it; in particular, in the last paragraph.  If possible, could you also add a few words on the importance of academics using economic reasoning to advocate for change – similar to the point made in the Prato Statement? Often educators need good arguments for making changes – and costs could be a good one.

Thank you for the opportunity to review this editorial!

Kind regards,

Nina Rydland Olsen, Associate Professor/Program director of Master in Clinical Physiotherapy, Faculty of Health and Social Sciences, Department of Health and Functioning, Western Norway University of Applied Sciences

One thought on “Review (Olsen) – Embracing a dialogue about cost in physiotherapy education

  1. Dear Nina Rydland Olsen,

    Thank you for your review, feedback, and suggestions. You have raised a number of interesting questions. We have done our best to address these as follows:

    Abstract: We have completely re-written the abstract. We have highlighted that ‘cost’ is the focus of this editorial.

    Paragraph 1: The word ‘cost’ is now explicitly used in the first paragraph.

    Paragraph 2: We have clarified that ‘this’ refers to resource allocation.

    Paragraph 4: We have clarified that ‘this’ refers to better management of educational resources, and added further references.

    Personnel costs: You suggest that we could discuss the Prato statement in this section. Rather than reference the Prato Statement here, we have discussed the Prato Statement in the conclusion as it relates to the whole article – not just the personnel costs.

    Box 1: We agree that a 2:1 ratio does not necessarily equate to a halving of cost. However, if we think about the types of tasks which each educator must do, such as initial training or administrative tasks, then it is still likely that we will achieve economies of scale. We have modified the text to reflect this. We have also changed the example used in dot point 4, on collaboration, to be physiotherapy specific.

    Equipment and material costs: I believe you are actually referring to the Facility costs section. We have chosen the Chen reference as it specifically relates to the argument made in the text, however have added the Hew reference as well to support the efficacy of flipped learning.

    Conclusion: We have added reference to the Prato Statement as suggested.

    Once again, thank you for contributing to this editorial through your review.

    Kind regards,

    Jonathan Foo and Stephen Maloney

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