The effect of increasing class size

[dagubananas]

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[DC DOC]

it is largely based on money and primary care. There are very few residency programs with any intent or ability to expand their class size and soon funding will be reduced even more, cutting the number of available positions. Med schools, especially osteopathic, don't have to worry because they don't have to obtain the residency for you. They are also primary care hungry, thinking that if they increase the class size they will bottle neck students into one of the underserved fields.

 

[DrBowtie]

Major negatives would be in the clinical years. They will either be diluting the experience at current sites, or finding new unseasoned preceptors.

 

[GraceEuphoria]

Major negatives would be in the clinical years. They will either be diluting the experience at current sites, or finding new unseasoned preceptors.

I'm not sure if the OP is a student at my school, which is expanding next year, but I can speak for our rotation situation. We added on one new rotation site for this next year (for 2014's starting year), and by 2016, my guess is they will have added a few more in order to not overwhelm the current sites. They keep the number of students fairly limited at each site as of now and based on their previous statements, I think it is their goal to keep it this way. Who knows how it will all actually go. On the note of unseasoned preceptors, at our sites for the most part, what I hear is that because we are establishing the first student programs to be rotating through their smaller hospitals, there's a good mix of very receptive and very unreceptive docs. The coordinators and directors that come and speak with us on our Hospital Day sound like broken records as they discuss how they find the most enthusiastic docs to put us with so that we get the best experience. They might "unseasoned" but I'll take an enthusiastic doc that's ready to teach any day! I have no idea how this will be at other schools, but at DCOM at least, this is the impression I'm getting. I'll know more once I get started this summer.

 

[DO Anes]

They might "unseasoned" but I'll take an enthusiastic doc that's ready to teach any day!

A better choice would be a professional clinical educator at a university medical center. This expansion of class size is reckless and irresponsible.

 

[DocEspana]

(not at all) novel thought. Increase class size and it will still have no effect on anyone's outcome. For real. Everyone loves gloom and doom but a legitimate argument made by medical education leadership (of both degrees) is that increasing class size won't change outcomes for anyone nor will it increase competition for anything but low level IM, and mid or low level FP and peds.

The argument is that every American medical student, wether they want to accept it or not, is matching where they deserve to match (if you account for an insignificant percent who apply stupidly). Adding more seats and more schools will not magically create new completely qualified students de novo. It will allow fringe students who would previously not be accepted to any medical school suddenly just make the cut somewhere. There are, in an absolute sense, lots of extra residency spots. Especially in FP, IM and similar fields.

The argument is that any American student will take precident over offshore students in these fields. And that the new students will go into those fields not because they are 'forced' to (which applies in some world they would be more qualified) but because that is the extent of their qualification because they represent students who only are in an american medical school because seats have expanded. Sure preclinical stats arent perfect predictors, but the hard truth is they generally are spot on. Everyone thinks they're exception, very few are.

 

[DO Anes]

(not at all) novel thought. Increase class size and it will still have no effect on anyone's outcome. For real. Everyone loves gloom and doom but a legitimate argument made by medical education leadership (of both degrees) is that increasing class size won't change outcomes for anyone nor will it increase competition for anything but low level IM, and mid or low level FP and peds.

The argument is that every American medical student, wether they want to accept it or not, is matching where they deserve to match (if you account for an insignificant percent who apply stupidly). Adding more seats and more schools will not magically create new completely qualified students de novo. It will allow fringe students who would previously not be accepted to any medical school suddenly just make the cut somewhere. There are, in an absolute sense, lots of extra residency spots. Especially in FP, IM and similar fields.

The argument is that any American student will take precident over offshore students in these fields. And that the new students will go into those fields not because they are 'forced' to (which applies in some world they would be more qualified) but because that is the extent of their qualification because they represent students who only are in an american medical school because seats have expanded. Sure preclinical stats arent perfect predictors, but the hard truth is they generally are spot on. Everyone thinks they're exception, very few are.

Wow, that is based on a lot of unsupported assumptions. I don't know where to begin, but the biggest fallacy is that every student matriculating into an expanded spot is "less qualified". Logically, there will be an increase in both sets of students. Given the variable nature of osteopathic clinical training, however, I suspect that the less qualified will come from that world. As one program director from a jointly accredited residency said, "We are sick of these DO students. They spend the first two years of residency learning everything the MD's already did in school".

 

[DocEspana]

Wow, that is based on a lot of unsupported assumptions. I don't know where to begin, but the biggest fallacy is that every student matriculating into an expanded spot is "less qualified". Logically, there will be an increase in both sets of students. Given the variable nature of osteopathic clinical training, however, I suspect that the less qualified will come from that world. As one program director from a jointly accredited residency said, "We are sick of these DO students. They spend the first two years of residency learning everything the MD's already did in school".

"Students entering into expanded spots will be less qualified." Period.This is *the* working assumption of both the AAMC and the AACOM. They know its imperfect, but they also know its not that far off either. The obvious caveat is that if Yale increased enrollment by 100 people they wouldn't be less qualified... but even then... they would draw 100 students who would have went to upper teir schools, which draws 100 from mid tier schools which draws 100 from DO schools into mid tier MD schools, which leaves 100 open seats for future DO students (and a few lucky straight to MDs) to fill with people who would have either gone caribbean or given up on medicine.

Supposedly (I have NO proof except anecdotes from higher ups) this has been studied on the students who entered the medical training system in the late 90s. If they opened 5 schools in 3 years for a grand total of 700 new graduates that had never existed before (these numbers are fabricated, but the analysis is the point) you could identify pretty much each one of the 700 students who would have not made it into any other american medical school without these new schools opening. They primarily populated the DO sphere and they apparently had an overwhelming, even by DO standards, bend towards FM, IM, and peds. At the same time the number of applicants to comeptitive fields, both within ACGME and AOA, did not increase statistically. I dont mean "the odds" I mean, the raw number did not increase. 700 people join the system and a statistically negligible amount of them apply outside of the wide open fields.

Their argument is they've done the studies before and adding more students doesnt increase competition for "competitive" residency spots at all, it simply increases competition for spots that are generally not filled by US graduates. And it does this not by "forcing people down" but instead by upgrading people who would have been foreign grads as DOs. The assumption is that people are getting what they would have gotten no matter what, allowing more people in just allows more people to populate the bottom of the american graduate category. which isnt a bad thing, as "bottom of american grad" is still a competent physician in nearly all cases.

EDIT: I posted about this before, 6 months ago, before I had AAMC people confirm there was research done on the matter in the late 90's early 2000's. One of the issues i had back when i first brought this up was people assumed that I was saying that the "700 grads" literally represented the people occupying the seats in the new schools. The "700" are the 700 additional spots that exist in the entire US medical student graduating class as a result of new schools opening. They're somewhat unevenly spread around all medical schools, but can be estimated by measurement of pre-clinical performance.

 

[fiznat]

At the same time the number of applicants to comeptitive fields, both within ACGME and AOA, did not increase statistically.

If this is even true (not that you're lying, but if the study really accurately measures what happens), where do they draw the line with "competitive" fields? I'm not content to just rest on my laurels and believe that all of these new student's won't effect me because I'm not looking to do primary care. There's gotta be some upward pressure as well--- especially into the middle, quasi-competitive fields.

Quality of education is still an issue. I know everyone is of the mindset that the point of the first 4 years is to get students into residencies, but we're supposed to be learning as well. I'm sure there are plenty of studies out there that say smaller classroom sizes are more effective, and the teacher to student ratio is still used as a major indicator of institution quality. My COMLEX/USMLE score will depend on what kind of work I put in on my own of course, but I would think that my school has a hand in it also. What happens if these schools keep expanding, quality of training goes down, and DO students are increasingly perceived as ill-prepared for residency? What effect will that have on the match rates?

 

[DocEspana]

If this is even true (not that you're lying, but if the study really accurately measures what happens), where do they draw the line with "competitive" fields? I'm not content to just rest on my laurels and believe that all of these new student's won't effect me because I'm not looking to do primary care. There's gotta be some upward pressure as well--- especially into the middle, quasi-competitive fields.

Quality of education is still an issue as well. I know everyone is of the mindset that the point of the first 4 years is to get students into residencies, but we're supposed to be learning as well. I'm sure there are plenty of studies out there that say smaller classroom sizes are more effective, and the teacher to student ratio is still used as a major indicator of institution quality. My COMLEX/USMLE score will depend on what kind of work I put in on my own of course, but I would think that my school has a hand in it as well. What happens if these schools keep expanding, quality of training goes down, and DO students are increasingly perceived as ill-prepared for residency? What effect will that have on the match rates?

No worries my man. I've had the same conversation from your point of view when I was first hearing about this mindset. To be fair, it makes more sense to me now than the doom and gloom talk does. A superficial analysis, also known as "logic", suggests the AAMC is out of their minds... but actually stop and think about it for a while (a few days) it will probably make more sense than "logic" by then.

the way they explained it is there was no statistically significant difference in applicants to: Surgery, EM, Anesthesia, Pathology, Radiology, or Surgical Subspecialties. I have no clue what the impact was on psych. There was a significant increase in US applicants in IM, FM and Peds, with the increase being largest at community hospitals and non-university affiliated large care centers.

Literally... the places that are taking the best offshore students now. My understanding is the "increase" is a statistical artifact as they only measured american applicants; the number of applicants didnt change, simply the number of *american-trained* applicants. You'd quite literally only affect the residency class in that you would change 700 Ross/SGU/AUC grads to 700 VCOM/TCOM/Touro grads (I picked schools at random, that not a comment on those schools) but they'd go to the same places they were going to before because that was sort of their achievement ceiling, even unrelated to the degree they earned.

as for expansion being bad for the actual training itself. There I agree wholly. But it becomes hard because medical school is so much about what you do outside of the classroom. The success of independent study and PBL curricula is proof of that.

 

[Everglide]

Our school (MSUCOM) went from ~200 to 313. Without going into terrible detail, to accommodate the increase, there are now a fair amount of questionable places (such as only having a couple in-house rotations) that can be your home institution aka base hospital for 3rd/4th year. You could end up having to drive 1-2 hours each way just to do some basic core rotations. Some people are inevitably forced into these hospitals by the numbers.

Of course, administration tells us all the hospitals will all provide excellent learning opportunities in the clinical arena.

It has had basically no effect on 1st/2nd year other than some simple logistical changes.

 

[GraceEuphoria]

I suppose at DCOM, where we basically come in knowing we'll move for our 3rd and 4th year, it's not that big of a deal (as it seems to have been at MSU). Our administration is looking at opening new sites, so I think the transition here, though rough like any transition, will be manageable.

And 313 students as MSU??? That's so many, I can't imagine it...I didn't know your class size was up to that number.