Jones & Bartlett Learning Health Blog

    Global Health and the Allocation of “Scarce Resources”

    Posted by Cassie Peterson on Oct 11, 2013 1:52:50 PM

    Richard Skolnik – Author of Global Health 101

    This month, I wanted to highlight the challenges of dealing with excess demand for courses. This is a variant, of course, on some of the themes discussed in the chapter of Global Health 101 that deals with Ethics and Global Health!!!

    The start of school is stressful for students and faculty. It can be especially stressful when more students try to get into your class then you can accommodate.

    We have capped enrollment in my undergraduate introductory Global Health course at Yale at 40 students. We have done this to try to maximize learning outcomes through a course that is taught in a completely interactive manner. Although it presented challenges, I am happy to report that 110 students tried to get into the course this semester.

    We began the course at Yale in the fall of 2012. In the spring of 2013, after news of the course spread to Yale students who had a large pent up desire for Global Health courses, the demand for the course was also greater than we could enroll. After canvassing other faculty on how they dealt with this issue, I took a multi-pronged approach to deciding who could enroll.

    • First, we had to enroll students for whom the course was required. Thus, we accepted “off the top” the students in Yale’s Global Health Fellows Program and the students in Yale’s five-year BA-BS/MPH program who would have a concentration in global health. This left us with about three students to select from for each of the remaining seats.
    • We then conducted a lottery that included students who had previously manifested a self-reported interest in Global Health through course work or Global Health experiences. The logic of this was to be sure to include as many students as possible who had been waiting to take such a course to further pursue their Global Health interests.
    • We also stratified the lottery by class. We included an equal number of juniors and seniors, to try again to give more opportunities to those who had waited for such a course. However, we also included the same number of sophomores as upper class students and four freshmen, to try to build a future cadre of Yale students interested in Global Health.

    My aim in basing enrollment on this approach was to be as fair as possible, while also taking account of the special concerns noted above. Nonetheless, even as we carried out the lottery, I was uncertain, although I did not know the students, that I could make objective decisions about “student interest” and “student experiences” that I had made criteria for entering the lottery. In fact, I believed increasingly that there was no form of gauging student interest that could lead me to “fair” decisions about who ought to be in the course.

    This semester, therefore, we changed the approach to dealing with excess demand for the class. Basically, after we took “off the top” the students who had to enroll, we conducted a lottery by class, so that we would have an equal mix of sophomores, juniors, and seniors, since we do not permit first semester freshmen to enroll in the course.

    The only complication this semester was that we had to decide what to do with students who had been in the lottery the semester before, but who had not gotten into the course, and who were trying again to enroll.

    We decided that we would enroll them into the course, “off the top,” as well, since even after doing that, we would still have about half of the course spots to fill through the lottery.  We were especially worried that if we did not do this, students would feel that it was “impossible” to get into the course and the demand for it would wane.

    This approach allowed me to avoid the concerns I had about “fair ways” to measure interest or experience. Instead, this approach was based on the idea that everyone who wanted for the first time to take the course voluntarily would be chosen through a lottery. I must admit that we wound up with an excellent mix of wonderfully motivated students and I slept a lot better about how we chose them.

    As an aside, I should say that somewhat amusingly (or not!), depending on where you teach, you should expect students to “lobby” you for admission, even when you make exquisitely and repeatedly transparent that places will be assigned by lottery.

    At the beginning of the semester, we also had an excess demand for my upper level case studies course in Global Health. We have no formal pre-requisites for the class, but do make clear that students who enroll must have an understanding of the concepts and frameworks covered in my introductory course.

    In the interest of “fairness,” I wanted to be sure that I had as objective a method as possible for giving a chance for enrollment to the nine students initially interested in the course who had not taken my intro course.

    Thus, I decided to give them a test. Prior to the term, I had given an old final exam to one of our five-year students who other faculty thought should enroll in the case studies course. When the term began, I decided to give the first 10 questions on that exam orally to the other students who thought they had the knowledge needed to succeed in the upper-level course.

    Of the eight students I tested, I admitted two to the course and the others were admitted to the lottery for the intro course. Most of the six who were not admitted realized after the first few questions I asked them that they did not belong in the advanced class and with good humor asked me to stop the test.

    Giving each of the interested students the same test orally gave me a good chance to hear their reasoning on the questions and provided me with additional insights about their knowledge.  If I had a large number of interested students who did not take the intro course who wanted to enroll, however, I would give them all the same written test.

    Making decisions about how to cope with greater student demand than you can enroll is challenging and I am extremely pleased that we have now laid out an approach that we can continue for my courses, if necessary. Having such an approach will save me time, sleep, and the need to explain to students why they have not been selected for the courses.

    Jared Augenstein, Nidhi Parekh, and Zerrin Cetin assisted Richard Skolnik, as Teaching Fellows at Yale, in considering the issues referred to in the blog and designing the lottery systems that were used.

    Hilary Rogers, a student at the Yale School of Public Health, commented on the draft of the blog.

    Richard Skolnik is a Lecturer at the Yale School of Public Health, where he teaches global health courses at the undergraduate and graduate levels. Richard was previously an Instructor in Global Health at The George Washington University, the Vice President for International Programs at the Population Reference Bureau, and the Executive Director of the Harvard School of Public Health PEPFAR program. Richard worked at the World Bank from 1976 to 2001, last serving as the Director for Health and Education for South Asia. Richard is the author of Global Health 101, a comprehensive, introductory text on global health.

    Topics: Richard Skolnik, Global health

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