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Lawrence F Borges,1 Jamie M Robertson,2 Steven M Kappler,3 Suresh K Venkatan,4 David X Jin,5 Edward L Barnes,6 Farouc A Jaffer,7 Fidencio L Saldana,8 David M Dudzinski,4,7 Ada C Stefanescu Schmidt,7 Douglas E Drachman,7 Michael N Young,9 Emily M Hayden,10 Stephen R Pelletier,11 Helen M Shields5 1Division of Gastroenterology, Mount Auburn Hospital and Harvard Medical School, Cambridge, MA, USA; 2Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; 3Cleveland Clinic Digestive Diseases Center, Port St. Lucie, FL, USA; 4Learning Laboratory, Massachusetts General Hospital, Boston, MA, USA; 5Division of Gastroenterology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; 6Division of Gastroenterology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA; 7Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; 8Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; 9Cardiology Division, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Lebanon, NH, USA; 10Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; 11Office of Educational Quality Improvement, Harvard Medical School, Boston, MA, USACorrespondence: Lawrence F BorgesDivision of Gastroenterology, Mount Auburn Hospital and Harvard Medical School, 330 Mt. Auburn Street, Suite # 405, Cambridge, MA 02138, USATel +1 (617) 498-9550Fax +1 (617) 498-9561Email Lawrence.Borges@mah.orgPurpose: Medical school simulations are often designed for a limited number of students to maximize engagement and learning. To ensure that all first-year medical students who wished to join had an opportunity to participate, we designed a novel method for larger groups.Patients and Methods: We devised a low technology “Orchestra Leader’s” chart approach to prominently display students’ roles, chosen by lottery. During simulation, the chart was mounted on an intravenous pole and served as a group organizational tool. A course instructor prompted students using the chart to accomplish the course objectives in a logical order. Real-life cardiologists and gastroenterologists provided the students with expert subspecialty consultation. We analyzed 125 anonymous student evaluation ratings for 3 years (2017– 2019) with a range of 8 to 19 students per laboratory session.Results: Our 2017– 2019 larger group sessions were all rated as excellent (1.26, Mean, SD ± .510) on the Likert scale where 1.0 is excellent and 5.0 is poor. There were no statistically significant differences in overall ratings among the 2017, 2018 and 2019 sessions. The subspecialists were uniformly rated as excellent. Verbatim free-text responses demonstrated resounding student appreciation for the role assignment by lottery method.Conclusion: We designed a novel, “Orchestra Leader’s” chart approach for accommodating larger groups in a multidisciplinary simulation laboratory using role assignment by lottery, roles depicted on an organizational chart, and expert instructor prompting. Our consistently excellent ratings suggest that our methods are useful for achieving well-rated larger group simulation laboratories.Keywords: medical student, manikin, large group simulation, gastroenterology, cardiology