a laparoscopic surgery intern curriculum that integrated proficiency- based pre-training with FLS training, as well as level-appropriate cognitive material. Methods: Surgery interns (n=37) were en- rolled in an IRB-approved prospective study. Residents partici- pated in a 2-part curriculum (18 weeks). Lap I Skills included Southwestern Stations (5 tasks), Camera Navigation (2 tasks), and MIST VR (8 tasks). Lap I Cognitive included SAGES Biliary Grand Rounds and Top 14 videos. Lap II Skills included FLS (5 tasks) and Cognitive included FLS didactic video material. Previ- ously published proficiency levels were used as training endpoints for all simulators during self-practice. Three proctored skills tests were administered using the 5 FLS tasks (1 repetition of each task, time and error-based scoring): Test 1 (baseline), Test 2 (after Lap I), and Test 3 (after Lap II). Two sets of multiple choice cognitive tests were administered: Lap I Cognitive (before and after Lap I) and Lap II Cognitive (before and after Lap II) with mandatory remediation as needed. Costs were calculated using list prices for all consumable materials. Comparisons were by one-way ANOVA and Chi-square (mean  s.d, p0.05 significant). Results: 36 residents completed the curriculum over the allotted 18 week period; 1 resident was excluded at the request of the residency director. All 36 residents achieved proficiency on all simulators as specified except for 5 residents who could not com- plete MIST VR training due to equipment failures. To reach proficiency, trainees completed 299  106 repetitions over 20.9  9.5 hours (including time for cognitive components). With only modest ongoing laparoscopic operative experience, trainees dem- onstrated significant improvement in technical skill performance following simulator training: Test 1 (102.5 104.6), Test 2 (321.7  67.7), and Test 3 (470.1  18.9) with p0.001 for all compari- sons. At completion, 94% of trainees felt that their laparoscopic skills were improved. Cognitive performance significantly im- proved between pre-testing and post-testing: Lap I cognitive (2.7% vs. 100% pass rate, p0.001) and Lap II cognitive (0% vs. 100% pass rate, p0.001). Curriculum implementation required 592 man-hours using 4 proctors. Consumable materials cost $5.20 per trainee using donated sutures and equipment already on hand in the skills lab. Conclusion: This integrated curriculum is feasible, beneficial, and cost-effective. Using proficiency-based practice and mandatory remediation allows participants to uniformly master skills and cognitive material appropriate for basic laparoscopic training. More widespread adoption of integrated proficiency- based curricula is encouraged. 107. GENERAL SURGERY VERSUS SPECIALTY ROTA- TIONS: A NEW PARADIGM IN SURGERY CLERKSHIPS. Mary K. Sandquist, Danid P. Way, Anna F. Patterson, Donna A. Caniano, Mark W. Arnold, Benedict C. Nwomeh; The Ohio State University, Columbus, OH Background: The modern paradigm for third-year surgery clerk- ships is a 6-12 week rotation period that places the general sur- gery service at its core, while providing limited exposure to sub- specialty services. A novel surgery clerkship system in which students were assigned to either a general surgery or subspecialty rotation for the entire clerkship was recently trialed at a large U.S. medical school. The purpose of this study was to analyze the outcome of the novel clerkship system with regard to student academic achievement and success in the surgical residency match. Methods: Academic performance, as measured by the NBME Surgery Content Exam Score (SCE) and the Faculty Eval- uation Score (FES), was analyzed for students who completed their third-year surgery clerkships. The control group (Group 1) consisted of all students in academic years 2002-2004 who under- went a traditional 6 week clerkship on a general surgery service. The experimental group (Group 2) included all students in aca- demic years 2004-2006 who were assigned to a single clerkship rotation in either a general surgery (Group 2a) or subspecialty service (Group 2b). Differences in pre-clerkship academic prepa- ration were controlled for using USMLE Step 1 Scores. The final analysis design is a multivariate analysis of covariance (MAN- COVA) with experimental group as the independent variable, Surgery Content Exam and Faculty Evaluation Scores as the dependent variables, and USMLE Step 1 Scores as the covariate. Statistical differences in this omnibus test were followed up with univariate and multiple comparison post-hoc analyses. Results: The mean scores for measures of academic performance (SCE and FES) are summarized in Table 1. The MANCOVA results showed a main effect for group on FES (F=28.03; p  0.001), but no main effect for group on SCE (F=2.32, ns). In summary, students who rotated solely on subspecialty surgical services scored signifi- cantly lower on the FES than students who rotated on general surgery, but no differences in performance were observed between groups on the SCE. The overall success rate in the surgery resi- dency match was 16.8%, and there was no difference based on type of surgical clerkship rotation. Conclusion: The objective academic performance of students on subspecialty surgical services was equivalent to the performance of students who rotated on general surgery services. The differences in the subjective FES scores may reflect the relative unfamiliarity of subspecialty faculty with as- sessing student performance on the clerkship, a situation which might improve as they adjust to an increased role in the clerkship program. Therefore, surgical educators should consider a more prominent role for subspecialty surgery rotations in the third-year surgical clerkships; however, subspecialty faculty development in student performance assessment is advised. TABLE 1 Mean Scores for Measures of Academic Performance Group/Subgroup N Subject Exam Score ( SD) Average Faculty Evaluation Score ( SD) Group 1 (Control) 415 70.17 (8.139) 40.65 (5.389) Group 2a (Experimental General Surgery) 245 71.97 (8.980) 41.25 (5.015) Group 2b (Experimental Sub- specialty) 158 71.37 (8.172) 37.56 (4.128) Total 818 70.93 (8.437) 40.24 (5.224) 108. GOAL DIRECTED LAPAROSCOPIC TRAINING LEADS TO BETTER LAPAROSCOPIC SKILL ACQUISITION. Atul K. Madan, Jason L. Harper, Raymond J. Taddeucci, David S. Tichansky; University of Tennessee Health Science Center, Memphis, TN Introduction: Laparoscopic skills training outside the operating room is becoming the standard for educating surgical residents. Due to restrictions of work week, it is imperative for this training to be efficient. We hypothesized that goal-directed laparoscopic training GDLT would result in better skill acquisition than laparoscopic training without goals (LT). Methods: Second year general surgery residents were utilized in this study. Metrics were scores which incorporated time and errors. One group of residents (LT) went through a 10- week laparoscopic training course without goals; one group of residents (GDLT) was given goals to achieve during their course. Each group practiced for the same amount of time. Statistical analysis was performed via two-tailed Mann-Whitney tests. Re- 225 ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS