Medical education is expensive (l). If it could be delivered at a lower cost, then substantial savings could be made and/ or substantially more learners could be educated (2). One way of saving funds or increasing productivity in any walk of life is to generate economies of scale. Economies of scale are the advantages that organizations achieve by increasing the scale of their operations (3). The term is most often used to describe efficient and large-scale practices in manufacturing. In the past 5 years there has been growing interest in cost and value in medical and surgical education and specifically in how to create more value for a given cost (4). Could one way to increase value be to drive economies of scale? The short answer is that in certain areas of activity medical and surgical education providers may be able to drive economies of scale. But there are many other areas where economies of scale may not be possible or where an attempt to create an economy of scale might adversely affect quality or where diseconomies of scale might inadvertently be created (5).