150 Students. One Cadaver.

The arithmetic of medical education is brutal, and I've lived inside it for years: far too many students, far too few of the things they need to practise on.

A hundred and fifty students. A handful of cadavers. Limited equipment, limited supervised time. And a curriculum — rightly, under competency-based medical education — that demands every student actually *demonstrate* competence, not just pass a written exam. But how do you give a hundred and fifty students enough hands-on repetitions to become genuinely competent when the resources allow only a fraction of the practice each of them needs? You can't. So practice gets rationed. The most assertive students get more reps; the quieter ones get fewer. Everyone gets less than they need. And "competency," which CBME requires me to actually verify, becomes something I have to certify on thin evidence, because I couldn't possibly give every student enough supervised practice to be truly sure.

It weighed on me. I was signing off on competencies I hadn't been able to let students practise nearly enough to guarantee. The resources simply didn't stretch to a hundred and fifty pairs of well-practised hands.

Simulation broke the constraint, and tracking let me actually verify competency.

Now every student — all hundred and fifty — can practise the procedure as many times as they need, in immersive simulation, without competing for a scarce cadaver or a limited slot. The rationing is over. The quiet student gets the same unlimited reps as the assertive one. Everyone can practise until they're genuinely competent, not just until the resources run out. The constraint that limited every student's hands-on learning for my entire career simply lifted.

And the tracking gave me what CBME actually demands: real evidence. I can see how each student performed, how many reps they did, whether they reached genuine competency or are still struggling. When I certify a competency now, it's backed by data — I can actually see that the student has demonstrated it, repeatedly. I'm not signing off on hope anymore. I'm signing off on evidence.

A hundred and fifty students and one cadaver used to mean a hundred and fifty under-practised trainees and a stack of competencies I certified on faith. Now it means a hundred and fifty students who can each practise without limit, and competencies I can actually verify. The brutal arithmetic finally has a different answer.