'Over 8,000 med students should take classes together, instead of current 3,000'

President Yoon Suk Yeol's announcement to push for increasing the medical school enrollment quota and healthcare reform, even after the crushing defeat in the 22nd general election, has left the medical community stunned.

The government's adamant push makes it difficult for trainee doctors to return to work and medical students to return to classrooms. Medical schools that resumed classes at the Ministry of Education's request to prevent mass flunking are facing a drop in class participation rates, and the spread of class boycotts among first-year students has also cast a cloud over medical education for 2025.

Unless the current situation is resolved, whether through massive flunking or granting of leaves of absence for medical students, disruptions in medical education next year are inevitable.

As things stand now, 8,116 students—3,058 in the 2025 class, 2,000 more in the 2025 class, and 3,058 who flunked this year—will have to be trained together for six years to graduate from medical school, as well as interns and residents. The Education Ministry hasn't done much to resolve the situation except repeating that "leave of absence is unacceptable."

The worst-case scenario of having to train 8,000 medical students at 40 medical schools next year may become a reality. When asked if training 8,000 medical students is possible, medical school professors dismissed the idea, saying, "Imagine eight people living in a house that used to house a family of four." The problem is even worse, they said, because education is not just about sharing physical space, adding that educational disruption is unavoidable.

In the case of Chungbuk National University College of Medicine, more than 250 people have to take classes together -- 49 students in original quota, 151 increased freshmen and 49 who will flunk this year -- next year. This is more than five times the current quota.

Based on the current status of lecture halls and labs at Chungbuk National University College of Medicine, as disclosed at a recent briefing by the Medical Professors Association of Korea (MPAK), the number of lecture halls that can accommodate 60 first-year students should be increased from one to four or more. Similarly, four more lecture halls, labs, and anatomy labs are needed to accommodate the growing number of students. The Clinical Skills Center, which has a capacity of 20 students, is already overcrowded with 49 students in training and needs to be five times larger to accommodate 250 students. Additional professors must also be hired to teach the students.

"We have already thoroughly planned for the expansion," said Chungbuk National University President Ko Chang-seop in a recent media interview, expressing confidence that the quality of medical education will not fall even if the number of students quadruples. Regarding the lack of space, the school plans to expand the two floors of the existing Medical School Building No. 2 and use the Osong Campus, which will open in September. The medical school will also add 100 more professors from the current 131.

Korean medical education is going backward

If expanding the physical space is not an immediate option, the professors said, switching to online classes or video training, which the Ministry of Education and universities have recently implemented to prevent mass layoffs, could be an option. However, educators and trainees alike shouldn't expect the "optimal medical education experience," they said. This is not in keeping with the direction of medical education in Korea, considering competency-based medical education, such as small discussion classes.

"Even if the physical environment is created, I don't think it is possible to maintain (medical education) because the quality of medical education cannot be guaranteed in an environment that is opposed to the direction of medical education, with no medical education philosophy," said a professor from a provincial private medical school. "The government seems to think that the first year of pre-med can be crammed into a space like a classroom, but medical education cannot be done that way."

A professor from a national university's medical college also said, "Competency-based medical education to cultivate patient safety and social responsibility is spreading worldwide, and Korea is also trying various educational methods to produce good doctors. Medical education requires small-scale discussion-based learning and clinical education through small-scale mentoring, but I don't know if we can produce good doctors through lecture-style classes alone."

Can students who undergo poor clinical practice pass accreditation?

The third and fourth years of medical school are also problematic, as they are where the real clinical training begins. Students must rotate through internal medicine, surgery, pediatrics, obstetrics and gynecology, and psychiatry to diagnose and treat real patients, but the infrastructure of teaching hospitals is insufficient. There is a shortage of space for medical students to stay and professors who teach them, especially in provincial hospitals, where there are fewer beds than the number of medical students who need to participate in real patient care.

It is also difficult to pass the accreditation of medical education by the Korea Institute of Medical Education and Evaluation. According to the institute’s medical education accreditation criteria, medical students must have at least 36 hours of clinical practice per week for at least 52 weeks. They must be able to learn the work of a doctor by participating in actual medical practice as part of a medical team in addition to passive methods, such as simple observation. If these criteria are not met, the medical school graduate cannot take the National Medical Examination.

Another professor at the medical college of a national university said, "Clinical practice is important for medical students. However, even the 2,000-bed Seoul National University Hospital cannot accommodate 200 medical students. Provinces are gradually losing population. As the population of the provinces is gradually decreasing, we cannot increase the size of teaching hospitals to train medical students. We need space for medical students to stay in hospitals, but there is no way to create free space."

A professor of the pediatrics department at a private university hospital said, "Professors don't just teach medical students. They also have to do clinical work and research. Teaching students is often pushed to the back burner regarding promotion. In this situation, the pressure on professors is much different when they must teach four students instead of two. From a clinical professor's point of view, if this year's students are flunked and pushed to next year, clinical education itself is not possible realistically."

The professor continued, "The decrease in population has also reduced the number of pediatric patients. Smaller teaching hospitals have no patients to show students, which is also a problem. This is not an environment for training doctors who need to experience enough patient cases and receive quality education."

The professor also noted the need to hire a separate clinical professor dedicated to clinical practice.

“However, I don't know if hospitals will hire pediatric professors who are not very helpful in hospital management. I think the government will have to legislate to hire clinical professors dedicated to education or reduce the burden of research and treatment so that they can devote themselves to education as much as possible," she added.

Medical professors worried about 'educational turmoil’ due to poor teaching

Concerns are also mounting that many medical schools will follow in the footsteps of the “Seonam Medical College,” which was closed due to poor education.

The medical school was closed due to problems, such as narrow classroom space, lack of clinical equipment facilities, lack of clinical practice, shortage of professors, and increase in enrollment and new students. At a time when the poor clinical practice environment and the departure of young clinical professors from the teaching field are accelerating, medical schools with increasing enrollment cannot help but worry about these issues.

Professors said in unison that there is no realistic way to train the 8,000 students who will be flooding medical school in the class of 2025. Even if medical school deans who are worried about the disruption of medical education declare that they will not accept students for the next year, the presidents of their universities will likely accept them. There are also concerns that if the situation gets out of hand and there is an unprecedented situation of not accepting next year's medical school seats, it could cause social chaos.

A medical education specialist professor said, "We have to consider various facilities, manpower, and budget. However, we can't just solve these problems even if we invest a huge budget because we can't increase facilities quickly. Even if we increase the facilities, we don't know how to find the manpower. Nor can we invest heavily assuming 8,000 students next year, knowing that the number will drop to 5,000 the following year. This is the reality."

The professor continued, "We can't say we won't accept medical school seats. It's a promise to society. High school seniors are preparing for medical school now, and if we say we won't accept increased quota this year, they will be competing with this year’s sophomores. Not only high school seniors and sophomores but also their parents will protest. It's a mess. The government should make a decision and come up with a solution."