Virtual or In-Person Training: Applying Activity-Based Costing in Nursing Education

Document Type: Original Article


1 Assistant professor of medical education. Clinical education research center. Shiraz university of medical sciences.

2 1- Ph.D. Department of health in disasters and emergencies, Shiraz University of Medical Sciences, Shiraz, Iran 2- MSc, Medical Education, Shiraz University of Medical Sciences, Shiraz, Iran

3 MSc, Medical Education, Shiraz University of Medical Sciences, Shiraz, Iran

4 English Department, Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Cost assessment with modern costing systems can be conducive to the efficiency of education. In this study, activitybased costing was applied to calculate the cost of in-person training for undergraduate nursing students, and to evaluate the adjustable cost in virtual education. Methods: It was a descriptive-applied research using cross-sectional economic analysis. The statistical population included undergraduate nursing students in Lamerd, Iran. Data analysis was performed using the data obtained from a 4-year undergraduate program (2012 to 2016). The data were compiled in three categories, namely educational costs, support costs and cultural-welfare expenditure. The acquired data in face-to-face education were considered as the reference for comparison. Furthermore, the adjustable costs for the alternative e-learning approach were measured. Results: The total training cost at Lamerd Nursing School during the four-year study program stood at US$382,761. The per capita cost in this period was equal to US$13,693. It was measured at US$8,659 for educational activities, US$3,933 for support, and US$1,077 for welfare. Therefore, the highest per capita cost was in the area of education and the lowest cost was attributed to welfare. Furthermore, the curriculum cost in face-to-face training was calculated to be US$664. Finally, it was found that virtual education would reduce the total cost by US$156,199. Conclusion: Activity-based costing system is a new model that helps restructure the financial systems of universities. It enables the senior management in these institutions to make informed decisions on adjusting educational activities based on the information acquired. One of these decisions involves comparing the cost-effectiveness of in-person paramedical training with that of virtual training. This is especially important in adopting modern educational models.


Pfeffer FT. Equality and quality in education. A comparative study of 19 countries. Soc Sci Res. 2015;51:350-68.  PMid:25769872 PMCid:PMC4359749
Del Rey E, Lopez-Garcia M-A. On government-created credit markets for education and endogenous growth. Economic Modelling. 2020;92:170-9. 
Watson R, Stimpson A, Topping A, Porock D. Clinical competence assessment in nursing: a systematic review of the literature. Journal of advanced nursing. 2002;39(5):421-31.  PMid:12175351
Alinier G, Hunt B, Gordon R, Harwood C. Effectiveness of intermediate‐fidelity simulation training technology in undergraduate nursing education. Journal of advanced nursing. 2006;54(3):359-69.  PMid:16629920
Dickinson M, Lee S, Fermin D, Veine K, Boeve T, Wilton P, et al. Division of the Patient Selection Committee (PSC) Process into Two Segments Has Improved the Rigor, Efficiency and Satisfaction in the Selection Process. The Journal of Heart and Lung Transplantation. 2017;36(4):S332-S3.
Jesus TS, Landry MD, Dussault G, Fronteira I. Human resources for health (and rehabilitation): Six Rehab-Workforce Challenges for the century. Human resources for health. 2017;15(1):8. PMid:28114960 PMCid:PMC5259954
Drennan VM, Ross F. Global nurse shortages-the facts, the impact and action for change. British medical bulletin. 2019;130(1):25-37.   PMid:31086957
Rezaei S, Zandian H, Baniasadi A, Moghadam TZ, Delavari S, Delavari S. Measuring the efficiency of a hospital based on the econometric Stochastic Frontier Analysis (SFA) method. Electronic physician. 2016;8(2):2025.  PMid:27054014 PMCid:PMC4821320 
Plank P. Price and product-mix decisions under different cost systems. Price and Product-Mix Decisions Under Different Cost Systems: Springer; 2018. p. 41-90.
Delavari S, Aryankhesal A, Delavari S, Lotfi F. Measuring Technical Efficiency of Schools in Tehran University of Medical Sciences Using Data Envelopment Analysis. Caspian Journal of Health Research. 2018;3(2):41-7.
Papadaki Š, Popesko B. Cost Analysis of Selected Patient Categories Within A Dermatology Department Using an ABC Approach. Global journal of health science. 2015;8(6):234-49.  PMid:26755477 PMCid:PMC4954901         
Wang Z, Ao Q, Luo Y, Wang Q, Lu Z, Liu J. Estimating the costs of the national basic public health services in Zhuhai, China, through activity-based costing: a cross-sectional study. BMJ open. 2019;9(6):e024831.  PMid:31256019 PMCid:PMC6609140         
Bayati M, Mahboub Ahari A, Badakhshan A, Gholipour M, Joulaei H. Cost Analysis of MRI Services in Iran: An Application of Activity Based Costing Technique. Iranian journal of radiology : a quarterly journal published by the Iranian Radiological Society. 2015;12(4):e18372.  PMid:26715979 PMCid:PMC4691520         
Javid M, Hadian M, Ghaderi H, Ghaffari S, Salehi M. Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital. Global journal of health science. 2015;8(1):165-72. PMid:26234974 PMCid:PMC4803948         
Rajabi A, Dabiri A. Applying Activity Based Costing (ABC) Method to Calculate Cost Price in Hospital and Remedy Services. Iranian journal of public health. 2012;41(4):100-7.  PMID: 23113171.      
Blaschke BL, Parikh HR, Vang SX, Cunningham BP. Time-Driven Activity-Based Costing: A Better Way to Understand the Cost of Caring for Hip Fractures. 2020;11:2151459320958202.   PMid:32974078 PMCid:PMC7495936
Pouragha B, Arasteh MT, Zarei E, Abdolahi M, Sheikhbardsiri H. Cost analysis of education for students in the School of Health of Alborz University of Medical Sciences: An application of activity-based costing technique. Journal of education and health promotion. 2020;9:165. PMid:32953897 PMCid:PMC7482637         
Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: A systematic review of the literature. Health Policy. 2017;121(7):755-63. PMid:28535996         
Yangyang RY, Abbas PI, Smith CM, Carberry KE, Ren H, Patel B, et al. Time-driven activity-based costing: A dynamic value assessment model in pediatric appendicitis. Journal of pediatric surgery. 2017;52(6):1045-9. PMid:28363470         
Cropper P, Cook R. Developments: activity-based costing in universities-five years on. Public money and management. 2000;20(2):61-8.
Allain E, Laurin C. Explaining implementation difficulties associated with activity-based costing through system uses. Journal of Applied Accounting Research. 2018.
McBain RK, Jerome G, Leandre F, Browning M, Warsh J, Shah M, et al. Activity-based costing of health-care delivery, Haiti. Bulletin of the World Health Organization. 2018;96(1):10.  PMid:29403096 PMCid:PMC5791872         
Čečević BN, Antić L. Suitability of activity-based cisting for learn business concept Facta Universitatis, Series: Economics and Organization. 2018:307-19.
Turney PB. Activity-based costing: An emerging foundation for performance management. Cost management. 2010;24(4):33. 
Aeenparast A, Farzadi F, Maftoon F, Moghadam TZ. Feasibility of estimating cost of diagnostic radiology and sonography services by using activity based costing. Payesh (Health Monitor). 2015;14(1):15-23.
Özyürek H, Ulutürk Y. Application of activity based costing methods given strategic decision in private education. European Journal of Accounting Auditing and Finance Research. 2015;3(4):1-14.       
Ebadi Azar F, A Gorj H, Hadian M, M Ahari A. Unit cost calculation of student training at different levels trough Activity Base Costing method (ABC) at the School of Management and Medical Information, Iran University of Medical Science: academic year, 2006-2007. Journal of Health Administration. 2006;9(24):23-8.
Najafi Ghezeljeh T, Rezapour A, Sharifi T, Soleymani Movahed M, Teimourizad A, Yousefi Y, et al. Analysis of the Education Costs of Nursing and Midwifery Students in the Autonomous Hospitals Affiliated to Iran University of Medical Sciences. Iran Journal of Nursing. 2019;32(121):13-25.
Dehghani H, Dehghani K, Fallahzadeh H. The educational problems of clinical field training based on nursing teachers and last year nursing students view points. Iranian journal of medical education. 2005;5(1):24-33.
Pacheco LF, Noll M, Mendonça CR. Challenges in teaching human anatomy to students with intellectual disabilities during the Covid‐19 pandemic. Anatomical Sciences Education. 2020.  PMid:32543006 PMCid:PMC7323016
Almarzooq Z, Lopes M, Kochar A. Virtual learning during the COVID-19 pandemic: a disruptive technology in graduate medical education. Journal of the American College of Cardiology; 2020.  PMid:32304797 PMCid:PMC7159871         
Goh P-S, Sandars J. A vision of the use of technology in medical education after the COVID-19 pandemic. MedEdPublish. 2020;9.
Keshavarzi MH, Soltani Arabshahi SK, Gharrahee B, Sohrabi Z, Mardani-Hamooleh M. Exploration of faculty members' perceptions about virtual education challenges in medical sciences: a qualitative study. J Adv Med Educ Prof. 2019;7(1):27-34. https:// doi: 10.30476/JAMP.2019.41042.
Yusoff MSB, Hadie SNH, Mohamad I, Draman N, Al-Aarifin IM, Rahman WFWA, et al. Sustainable Medical Teaching and Learning During the COVID-19 Pandemic: Surviving the New Normal. The Malaysian Journal of Medical Sciences: MJMS. 2020;27(3):137. PMid:32684814 PMCid:PMC7337950         
Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems. 2020;49(1):5-22.  PMCid:PMC7308790
Rose S. Medical student education in the time of COVID-19. Jama. 2020. PMid:32232420         
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. The Lancet Infectious Diseases. 2020.