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UT-Houston Medicine Magazine

Making Room for More Physicians

Increased Class Sizes Aim to Meet Physician Demand of the Future

By Darla Brown

Fast forward 20 years. You experience sharp chest pains as you hear gas prices have risen to $10 a gallon. You are rushed to the nearest emergency room only to see the last emergency medicine room doc being feted with "For He's a Jolly Good Fellow" – retiring, and he doesn't look a day over 60. Certainly there's someone else to fill his shoes and the rest of the physicians who are ready to retire, just as the Baby Boomers hit their golden years.

The situation could be grim, but thanks to planning led by national physician groups, such as the Association of American Medical Colleges (AAMC), our state and nation will be prepared to handle the health and well-being of the future's aging populace.

The AAMC is predicting a national shortage of physicians if medical schools stay the course of the last two decades and is recommending a 30 percent increase in enrollment by 2015 to meet the increased need. For the past 20 years, the number of medical school students has remained a constant as the population's life expectancy has expanded and those hospitalized are in need of greater care.

The University of Texas Medical School at Houston has been doing its part by taking cautious steps over the past three years to gradually increase the size of the entering class – accepting an additional 10 students per year, starting with the entering class of 2005.

"We have reached our maximum acceptance point with 230 students for the class of 2007," explains interim Dean Jerry Wolinsky, M.D. "By the year 2010, our school will be at its peak with numbers of admitted students." The AAMC is expecting a 15.9 percent increase in new enrollment slots nationally for medical schools from 2002-2012.

Nationwide, the number of physicians is expected to crest at 2020 and then fall just as the Baby Boomers begin to reach age 75.

"We need more physicians in Texas, and this is a trend all of the other Texas schools are following – UT Southwestern is already up to 230 for their entering class," says Patricia Butler, M.D., associate dean for educational programs.

"We are very encouraged by the progress being made on this front," says AAMC President Darrel Kirch, M.D. "After failing to add new capacity for 25 years, we are now responding positively to the real growth and aging of the U.S. population."

Faculty, staff, and the school are using new technology and resources and taking creative measures necessary to accommodate the additional students who will need room in first year classes this fall, on their way to becoming physicians of a growing, demanding, aged populace.

Tag teams at the tank

One of the hallmarks of the first-year medical school experiences is gross anatomy lab – it is the student's first patient experience. When the Medical School's lab was reconstructed in the basement, following 2001's Tropical Storm Allison, administrators made sure that it would be large enough to accommodate future growth in class sizes.

"Last year, when we found out the class size was going up, we had enough capacity to handle everyone by going to a tag-team format," explains Len Cleary, Ph.D., senior lecturer in the Department of Neurobiology and Anatomy.

The lab used to have four to five students sharing a cadaver, and now seven to eight students share.

"We divide them up as orange and white teams, and they come in on different days. Now we need fewer tanks and it has freed up time for students so that they can learn anatomy using computers and videos, and they can hold study and help sessions during the off time," Dr. Cleary explains.

Adding more computer-based tools, such as anatomy.tv, which is a 3-D model that students can rotate on screen, and a virtual human dissector that is available at the Learning Resource Center (LRC), students have access to a wealth of data outside of the gross anatomy lab.

The testing routine could be changed with large class sizes.

"Students have a practical test and a written test, and if we had more than 240 students, we would need a different arrangement because we would need to prevent group ‘a' from talking to group ‘b'," Dr. Cleary says. "I guess the test could be comprised of photographs in the lecture halls rather than in lab – but then students might think they could avoid lab altogether."

From the microscope to the Web

What do you get when you have 250 students, 180 functioning microscopes, 150 slide sets and one histology course for first-year students?

It is a riddle, which had to be unraveled through technology by Roger Bick, histology course director.

"We have a lot of resources online now – a Web page was constructed, there is study help, an online syllabus, an interactive slide site, and I'm digitizing all of our slides," Bick explains. "In terms of resources, the students lack for nothing."

The histology course has a new 30-DVD collection called "Visual Histology," which is available for check-out from the LRC, videos from the University of Colorado, and a virtual slidebox on the Web.

"I tell them the slides are there if you want it, but you don't need it. Ten percent actually like to look through a microscope, and they want to target pathology, or a microscope-based field in the future, but the rest don't need microscopes now. It's a shame – I love looking through microscopes," Bick says.

Bick says that the students eventually discover their unique studying and learning methods. "And for a lot of them, it's not coming to lab. Eventually they'll be talking face to face with patients, so they've got to talk with people – and not doing everything behind a computer screen," he says.

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