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Academic Medicine:
doi: 10.1097/ACM.0b013e318190164c
Letters to the Editor

Impact of Increasing Class Size

Bunton, Sarah A. PhD; Salsberg, Edward MPA

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Senior research analyst, Organization and Management Studies, Association of American Medical Colleges (AAMC), 2450 N Street, NW, Washington, DC; (sbunton@aamc.org). (Bunton)

Director, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC. (Salsberg)

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To the Editor:

In their article on the impact of increasing medical school class size on clinical clerkships, Hemmer et al1 conclude that increasing students has the potential to “adversely affect student education, faculty recruitment, and faculty morale.” While this article contributes to the growing national discussion regarding the process and outcomes of expansion, we wish to offer additional data that expand the dialogue.

First, we remind the community that the call to increase class size at medical schools was not an institutional mandate; the AAMC recommended an aggregate increase of 302 in enrollment to assure a sufficient supply of well-educated physicians to help assure future access to care. The recommendation assumed an increase at some existing schools and establishing new schools. The decision of how much a school chooses to increase enrollment—if at all—rests with the institution, taking into account individual missions and available resources.

Second, a recent AAMC study on the challenges of medical school expansion and strategies to overcome those challenges, based on interviews with over 185 administrators, faculty, and students,3 offered additional perspectives based on the lived experiences at medical schools that are significantly expanding enrollment. We found that while there are short-term challenges that schools face, they are offset by long-term gains. We support and emphasize follow-up research asking Hemmer’s survey participants about benefits of and opportunities presented by increasing class size.

We agree with Hemmer et al that increasing enrollment can lead to the need for more clinical sites, teachers, and material; however, we heard in our research that many schools have taken deliberate steps to ensure quality education during student clerkships. Through the various strategies that schools have employed (e.g., independent learning, clerkship schedule adjustments), curricular updates and innovations in education have occurred.

In conclusion, many of the challenges encountered during expansion identified by this and other research can serve as guidelines for the future. As other medical schools now increase class size, strategies to counter and address the challenges (e.g., additional educational infrastructure) can be in place so that both short-term and long-term gains can be realized.

Sarah A. Bunton, PhD

Senior research analyst, Organization and Management Studies, Association of American Medical Colleges (AAMC), 2450 N Street, NW, Washington, DC; (sbunton@aamc.org).

Edward Salsberg, MPA

Director, Center for Workforce Studies, Association of American Medical Colleges, Washington, DC.

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References

1Hemmer PA, Ibrahim T, Durniing SJ. The impact of increasing medical school class size on clinical clerkships: A national survey of internal medicine clerkship directors. Acad Med. 2008;83:432–437.

2AAMC Statement on the Physician Workforce. Washington, DC: Association of American Medical Colleges; June 2006.

3Bunton SA, Sabalis RF, Sabharwal RK, Candler C, Mallon WT. Medical School Expansion: Challenges and Strategies. Washington, DC: Association of American Medical Colleges; 2008.

© 2009 Association of American Medical Colleges

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