Mine is 230 and I feel that it is a good size.
If I don’t personally know each person in my class (I do know probably 70-80%), I do know of everyone in the class.
None of us have really ever had a problem with “fighting over resources” and we are fortunate to have an almost exclusive partnership with a large county hospital for our third-year rotations; it is my understanding that very few, if any, students attend rotations away from the school during third year without electing to do so.
Of course, it’s also worth noting that I am in Texas along with several other large medical schools on the MD side, with Baylor, UTSW, UTMB, UT Houston, and UT San Antonio all being over 200 students.