What medical students learn outside the classroom -- and more importantly, where they learn it -- will be the determining factor on how the Medical College of Georgia School of Medicine expands in Augusta. But leaders of other hospitals say they are willing to do more to make it happen.

In a report presented last week to the University System of Georgia Board of Regents, consultant Tripp Umbach projected that MCG could increase from 190 to 240 medical students per class by 2017. At around 900 students, that would be the "maximum capacity" for the community, consultant Paul Umbach said, with 60 of the third-year and fourth-year students rotating through clinical campuses in Albany and Savannah.

Adding 50 or so students would probably not be a problem in the first two years of medical school if the school gets a new $99 million medical education commons that can handle it, said D. Douglas Miller, the dean of School of Medicine. Clinical exposure in those first two years is limited, and the teaching can be primarily handled at the school through the use of standardized patients, people paid to act as patients, and simulation, Dr. Miller said. But in the third and fourth years, also called the clerkship years, about 90 percent of the instruction is clinical, he said.

"That's where the real demand is," he said.

At 50 more students per class, that would be 100 more slots to have to fill.

The school is planning to take off some of the pressure by expanding a clinical campus in Albany and establishing one in Savannah. There are now six to eight third- and fourth-year MCG students doing clinical rotations in Albany, and that is scheduled to increase to 30 by July 2010. MCG hopes to establish a program of similar size in Savannah in conjunction with St. Joseph's/Candler health system by July 2011.

The Tripp Umbach plan calls for 6,000-square-foot medical facilities, at a cost of $2.4 million apiece, in each city, with funding requested in 2009.

But that would still mean finding many more clinical slots and doctors willing to teach in Augusta.

Augusta is ready to respond, said Randolph R. Smith, the chairman of University Health Inc., which oversees University Hospital.

"I think there's a spirit of cooperation amongst all of our institutions to do exactly what we can," he said.

After plans to expand MCG's School of Medicine to Athens were revealed last year, Dr. Smith and many at University who are MCG alumni wanted to know why the school wouldn't try to do more locally. Since then, Dr. Smith and other physician leaders in Augusta have talked with MCG about doing more in-town.

"I really think it's doable because we're basically untapped at University Hospital," Dr. Smith said.

Students already are rotating through other facilities around town. About four students at a time rotate through the Joseph M. Still Burn Center at Doctors Hospital, medical director Fred Mullins said.

"It's a rotation that they use a lottery system to give out because it is so popular," he said. "There's a lot they can do. There's a lot they can learn. It's just been a good all-around rotation for them as well as for us."

With 2,000 to 3,000 new inpatient burns a year, the unit's beds stay full and patients sometimes have to go to other units. The burn center and the other Augusta facilities can do so much more teaching, Dr. Mullins said.

"Without a doubt, I know they will," he said.

With the demand of 1,200 medical students by 2020 envisioned in the Tripp Umbach plan, MCG is likely to look both near and far, Dr. Miller said.

"We do want to take advantage of all of our opportunities to partner with people, whether it is in Augusta or outside, because that will likely be necessary to meet the workload of training these folks in the community," he said.

At the same time, the school will have to expand in a way that meets the guidelines of the Liaison Committee on Medical Education, the school's accrediting body. That will govern not only what the school does if it expands to Athens in partnership with the University of Georgia but also how it expands to clinical offices in Augusta and elsewhere.

The accrediting body has 123 standards that it adheres to, said consultant Paul Umbach, and that should provide some comfort for Augustans who fear an Athens campus would gravitate to the control of UGA. The Athens campus would be accredited under MCG and control and funding would rest with MCG as far as the accrediting body is concerned.

"The dean is in charge of the money, the dean is in charge of the program," Mr. Umbach said. "And the regional deans report to the dean, who is in charge of the money. So the money will flow through MCG into statewide expansion and that's a rule that the LCME won't change."

The school views the accrediting process not as a burden but as a way to try to improve itself, Dr. Miller said. Keeping the same high-quality education, whether in Augusta or Athens, Savannah or Albany, is the goal, he said.

"Growth with quality is what we seek," Dr. Miller said.