A SurgicalSkills Elective Can Improve Student Confidence Prior to Internship 1 Sarah E. Peyre, M.S.Ed., Christian G. Peyre, M.D., Maura E. Sullivan, Ph.D., M.S.N., and Shirin Towfigh, M.D. 2 Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA Submitted for publication January 10, 2006 Background. A focused surgical resident readiness curriculum for senior medical students can improve confidence in surgical skills compared to current sur- gical interns. Materials and methods. A 3-week surgical skills lab elective enrolled senior medical students applying to surgical residency programs, with the purpose of im- proving surgical skills and easing anxiety prior to sur- gical internship.Students were surveyed before and after the elective regarding their confidence in per- forming 21 skills covered by the curriculum. A similar confidence survey was administered to the incoming surgical intern class.Interns were also surveyed re- garding prior skills lab instruction during medical school.Statistical analyses included Student’s paired t-test and two-way analysis of variance. Results. Six medical students and 23 interns were surveyed. All medical students significantly improved their confidence by the end of the resident readiness curriculum (P ⴝ 0.0004). Although students initially had lower confidence than surgical interns in per- forming surgical skills and in their knowledge of anat- omy prior to the course, their confidence after the course was significantly higher than that of the incom- ing surgical interns (P ⴝ 0.035). Surgical interns with prior skills lab experience in their medical school re- ported higher confidence than those who did not have a skills lab experience (P ⴝ 0.019). Among all sub- groups,medical students with skills lab experience had the highest confidence score, followed by interns with previous skills lab experience,then by interns with no previous skills lab experience,and last, by medical student with no skills lab experience. Conclusion.Surgical interns often feel unprepared to perform skills necessary for residency. A focused skills lab elective during medical school can bridge the gap and improve confidence prior to internship. © 2006 Elsevier Inc. All rights reserved. Key Words:skills lab; medical student; resident; education; medical school curriculum; surgical skills. INTRODUCTION Most surgical residencies in the United States have moved away from a purely Halstedian preceptorship model of surgical skills training to one where surgical residents improve their skills in the operating room by learning in a Surgical Skills Center. As an example, since 2003, our Department of Surgery teaches a man- datory “Friday School,” which includes a 2-h skills curriculum, while protecting residents from clinical du- ties during this time.This shift away from the “oper- ating roomas the classroom” [1] is a result of multiple forces pushing programs to supplement training with nontraditionalmethods of teachingsurgical skills [2]: (1) Residents have limitations on their work hours, and therefore,are limited in the number of hours in the operatingroom [3]; (2) The public is pressing toward safer training and less reliance on humans as training models, thus reducing medical error [4, 5]; (3) Eco- nomic pressures require more efficient use of operating room time, thus shifting resident education away from the operating room [6]. Much research has been devoted to the development and implementation of skills training outside the op- erating room [7–9]. In a landmark study, Seymour et al. were the first to show that the skills learned in the lab can be directly translated to a safer and faster 1 Presented at the Association for Academic Surgeons 1st Aca- demic Surgical Congress, February 7-11, 2006, in San Diego, CA. 2 To whom correspondence and reprintrequests should be ad- dressed at Department of Surgery, USC Keck School of Medicine, 1200 N. State Street, Room 9900,Los Angeles, CA 90089-9202, E-mail: towfigh@surgery.usc.edu. Journal of Surgical Research 133, 11–15 (2006) doi:10.1016/j.jss.2006.02.022 11 0022-4804/06 $32.00 © 2006 Elsevier Inc. All rights reserved.