Schools over enrolling

[Pluto98]

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What are some famous instances where schools have over enrolled and chaos ensued? Does the dean typically get the axe if this happens? What actually goes on when this does occur (what if people dont want to give up their seats for a year of free tuition for example).

 

[Goro]

Touro-NY did it just a few years ago. From what I remember, the Admissions Dean left before he got fired.

Stanford also had an overenrollment episode a few years ago, and it led to the firing of the Admissions dean.

Just to clarify, it's not the Dean of the med school whose head will roll, but the Admissions dean.

Just as with the airlines, schools will encourage people to defer, with either partial or even full tuition breaks. TouroNY did the opposite...they found some pretext to rescind admissions. This was one of the reasons they were on my Bad Boy list for a while.

I'm sure the wise @gyngyn can tell a few more juicy stories!

 

[mwsapphire]

Touro-NY did it just a few years ago. From what I remember, the Admissions Dean left before he got fired.

Stanford also had an overenrollment episode a few years ago, and it led to the firing of the Admissions dean.

Just to clarify, it's not the Dean of the med school whose head will roll, but the Admissions dean.

Just as with the airlines, schools will encourage people to defer, with either partial or even full tuition breaks. TouroNY did the opposite...they found some pretext to rescind admissions. This was one of the reasons they were on my Bad Boy list for a while.

I'm sure the wise @gyngyn can tell a few more juicy stories!

How are Admissions deans expected to randomly know these things? Like, how can you predict exactly how many people will enroll?

 

[Goro]

How are Admissions deans expected to randomly know these things? Like, how can you predict exactly how many people will enroll?

It's a Dark Art.

 

[paradoxic_toxic]

See: AdComs of SDN, I read that schools give more acceptances than they can matriculate? How does this really work?

 

[Kardio]

What are some famous instances where schools have over enrolled and chaos ensued? Does the dean typically get the axe if this happens? What actually goes on when this does occur (what if people dont want to give up their seats for a year of free tuition for example).

I think UNECOM overenrolled recently - they offered free tuition to students who would delay their matriculation by one year.

.they found some pretext to rescind admissions.

Oh my god that's terrible. How many lawsuits followed!?

 

[Tenk]

How are Admissions deans expected to randomly know these things? Like, how can you predict exactly how many people will enroll?

Except this is exactly what being a physician is like. Everyone expects you to know everything and when bad things happen it’s all your fault and hello you just got sued. Welcome to dr land.

 

[mwsapphire]

Touro-NY did it just a few years ago. From what I remember, the Admissions Dean left before he got fired.

Stanford also had an overenrollment episode a few years ago, and it led to the firing of the Admissions dean.

Just to clarify, it's not the Dean of the med school whose head will roll, but the Admissions dean.

Just as with the airlines, schools will encourage people to defer, with either partial or even full tuition breaks. TouroNY did the opposite...they found some pretext to rescind admissions. This was one of the reasons they were on my Bad Boy list for a while.

I'm sure the wise @gyngyn can tell a few more juicy stories!

See, that's why I didn't apply to Tuoro NY. That, the low pass rates, the low match rates, and the fact that they require a DO letter that I was never able to procure.

 

[mwsapphire]

Except this is exactly what being a physician is like. Everyone expects you to know everything and when bad things happen it’s all your fault and hello you just got sued. Welcome to dr land.

Idk, I think predicting how a disease will progress is easier than figuring out exactly how many accepted students will choose your school-especially if , and I may be wrong with this, there isn't as much cross-talk between DO's and MD's. So the idea of a bunch of students who got into just one DO school ( who you thought may choose your's) end up going to an MD school ...makes things more complicated.

 

[Tenk]

Idk, I think predicting how a disease will progress is easier than figuring out exactly how many accepted students will choose your school-especially if , and I may be wrong with this, there isn't as much cross-talk between DO's and MD's. So the idea of a bunch of students who got into just one DO school ( who you thought may choose your's) end up going to an MD school ...makes things more complicated.

Lol. The other week I diagnosed a PE in someone with flank pain whose pet jumped on them. It was pure dumb luck.

Patients don’t read text books and present however the hell they want.

 

[Kardio]

Idk, I think predicting how a disease will progress is easier than figuring out exactly how many accepted students will choose your school-especially if , and I may be wrong with this, there isn't as much cross-talk between DO's and MD's. So the idea of a bunch of students who got into just one DO school ( who you thought may choose your's) end up going to an MD school ...makes things more complicated.

Also - statistics from past application cycles tell a better story than patients (who are often poor historians).

 

[mwsapphire]

Also - statistics from past application cycles tell a better story than patients (who are often poor historians).

Mmm, okay. You guys are right I guess, but misdiagnosing one patient doesn't always result in being fired like over-enrolling does a for Dean of Admissions.

 

[Tenk]

Mmm, okay. You guys are right I guess, but misdiagnosing one patient doesn't always result in being fired like over-enrolling does a for Dean of Admissions.

No but it can result in someone dying which is worse.

 

[mwsapphire]

No but it can result in someone dying which is worse.

Oh right, ofc. I was thinking of the flank pain thing from earlier. ( Or a family med practice) My bad.
Well , in life or death cases, isn't there normally a few doctors who consult on a patient? I'm serious.

 

[Tenk]

Oh right, ofc. I was thinking of the flank pain thing from earlier. ( Or a family med practice) My bad.
Well , in life or death cases, isn't there normally a few doctors who consult on a patient? I'm serious.

PE = pulmonary embolism = potentially deadly.

Sometimes. Sometimes you’ll discharge a bacterial meningitis from the ED or your office that looks like every other URI during flu season and they will die in 24 hours. Practice long enough and you’re bound to miss badness. Just part of the job.

 

[Pluto98]

Dark Art my ass, over enrollment is bad process and planning, though AAMC made it more difficult without the former acceptance reports. I am sure as the new PTE/CTE becomes essentially required, and schools use their WL well, there should never be over enrollment . With over half of acceptees coming from the "upper corner" (ie categories with over 70% acceptees) Hell, acceptees with 3.6+ AND 514+ make up a third of all acceptees. My point to this is there are plenty of good acceptees to go around

Do you think PTE/CTE will change how many initial acceptances are given out?

 

[deleted1001426]

PTE/CTE?

 

[TheDataKing]

PTE/CTE?

plan to enroll
commit to enroll

see more info here

 

[Pluto98]

Yes

As in, less acceptances will initially be given out and more movement from the waitlists?

 

[deleted1001426]

This is why I believe that all prospective applicants need to pass a 100 -200 question exam prior to being allowed to use AMCAS. the process is too freaking complicated.

It is a required acronym that you should know
You are being redirected...

this isnt a half bad idea. We're past the halfway point in the cycle and tbh all I know is to look out for II emails and keep my phone handy for any incoming admissions calls lol

 

[KnightDoc]

Yes,

Not really -- last year, the increased movement from the WL never seemed to materialize. The speculation was that fewer initial As led to fewer applicants with multiple As (and, even those with multiple As having fewer As), which led to higher yields for schools and less WL movement. Check out last year's WL support thread for all the gory details.

 

[DNAJB6]

PE = pulmonary embolism = potentially deadly.

Sometimes. Sometimes you’ll discharge a bacterial meningitis from the ED or your office that looks like every other URI during flu season and they will die in 24 hours. Practice long enough and you’re bound to miss badness. Just part of the job.

Why not order labs to exclude other possible dxs?

 

[Pluto98]

Not really -- last year, the increased movement from the WL never seemed to materialize. The speculation was that fewer initial As led to fewer applicants with multiple As (and, even those with multiple As having fewer As), which led to higher yields for schools and less WL movement. Check out last year's WL support thread for all the gory details.

@gonnif ?

 

[Cornfed101]

Why not order labs to exclude other possible dxs?

Most likely money and time

 

[es123]

Why not order labs to exclude other possible dxs?

can't do an LP on everyone with URI symptoms

 

[proudofmykids]

Do you think PTE/CTE will change how many initial acceptances are given out?

Yes,

Dark Art my ass, over enrollment is bad process and planning, though AAMC made it more difficult without the former acceptance reports. I am sure as the new PTE/CTE becomes essentially required, and schools use their WL well, there should never be over enrollment .

Even with the new rules, why wouldn’t students PTE for all Acceptances they receive up until April 15 at which time they have to reduce to 3.

 

[Tenk]

Why not order labs to exclude other possible dxs?

The only way to rule out meningitis is to do a lumbar puncture. This is a procedure that takes prolly 10-20 min of explaining to the patient and setup and then another 5 min - 10 min of actual procedure time. The results take about 1-2 hours to come back. If I did this on every fever/headache that came into the ED during winter months I would run out of LP kits in one day and the department would be so backed up I’d have everyone screaming at me. Thus we do it on select patients only.

 

[LizzyM]

The only way to rule out meningitis is to do a lumbar puncture. This is a procedure that takes prolly 10-20 min of explaining to the patient and setup and then another 5 min - 10 min of actual procedure time. The results take about 1-2 hours to come back. If I did this on every fever/headache that came into the ED during winter months I would run out of LP kits in one day and the department would be so backed up I’d have everyone screaming at me. Thus we do it on select patients only.

On the other hand, if the word gets out that this is the usual routine for Upper Respiratory Infections presenting to the ED ("and then they stick a needle in your spine and drain the fluid! it's ghastly."), you'll see a lot fewer of them there!

 

[Tenk]

On the other hand, if the word gets out that this is the usual routine for Upper Respiratory Infections presenting to the ED ("and then they stick a needle in your spine and drain the fluid! it's ghastly."), you'll see a lot fewer of them there!

hmmmmmmmmm....................

 

[DNAJB6]

On the other hand, if the word gets out that this is the usual routine for Upper Respiratory Infections presenting to the ED ("and then they stick a needle in your spine and drain the fluid! it's ghastly."), you'll see a lot fewer of them there!

Creative case load management, huh? (Just kidding...) 😛

 

[DNAJB6]

The only way to rule out meningitis is to do a lumbar puncture. This is a procedure that takes prolly 10-20 min of explaining to the patient and setup and then another 5 min - 10 min of actual procedure time. The results take about 1-2 hours to come back. If I did this on every fever/headache that came into the ED during winter months I would run out of LP kits in one day and the department would be so backed up I’d have everyone screaming at me. Thus we do it on select patients only.

Thanks for answering my question! Even though a LP is the only way to conclusively rule out meningitis, would it be feasible to look at procalcitonin and other blood tests (even if non-specific) to make a missed diagnosis less likely? The thought of even one person dying because of a misdiagnosis on my watch (if I ever became a physician) would bother me immensely.

 

[Select All That Apply]

@DNAJB6 Obtain urine cultures, obtain blood cultures, assess physiological symptoms and progression of symptoms (e.g. new/acute onset of nuchal rigidity? Photophobia? Do symptoms resolve on their own or do they continue to present even when patient has been transferred to the floor...), consult neurology, and run empiric abx after obtaining initial cultures. If patient is suspected of having viral meningitis, then put room on droplet precautions until different diagnosis or r/o.

 

[Tenk]

Thanks for answering my question! Even though a LP is the only way to conclusively rule out meningitis, would it be feasible to look at procalcitonin and other blood tests (even if non-specific) to make a missed diagnosis less likely? The thought of even one person dying because of a misdiagnosis on my watch (if I ever became a physician) would bother me immensely.

No. If you did blood work on every viral URI you would again clog your ED/office with unnecessary testing just to make yourself feel better. You learn to differentiate sick vs not sick in residency by seeing a ridiculous amount of not sick.

Yeah, missing a diagnosis does suck but it happens. People also die even if you make the diagnosis and do everything right. You just do your best, learn from it and move on.