The Surgical Skills and Technology Elective Program (SSTEP): A comprehensive simulation-based surgical skills initiative for preclerkship medical students Riaz J. Karmali a, * , Jennifer M. Siu a , Daniel Z. You a , Stefania Spano a , Andrea L. Winthrop a , John F. Rudan b , Richard K. Reznick b , Anthony T. Sanfilippo a , Paul Belliveau b a Undergraduate Medical Education Program, Queen's University, Kingston, ON, Canada b Department of Surgery, Queen's University, Kingston, ON, Canada article info Article history: Received 3 July 2017 Received in revised form 14 September 2017 Accepted 16 September 2017 This research was presented at the Canadian Conference on Medical Education (CCME) in Vancouver, British Columbia, Canada. Keywords: Preclerkship Medical education Surgical bootcamp Technical skill OSATS abstract Background: The Surgical Skills and Technology Elective Program (SSTEP) is a voluntary preclerkship surgical bootcamp that uses simulation learning to build procedural knowledge and technical skills before clerkship. Methods: Eighteen second year students (n ¼ 18) participated in simulation workshops over the course of 7 days to learn clerkship-level procedural skills. A manual was supplied with the program outline. Assessment of the participants involved: 1) a written exam 2) a single videotaped Objective Structured Assessment of Technical Skill (OSATS) station 3) an exit survey to document changes in career choices. Results: Compared to the mean written pre-test score students scored significantly higher on the written post-test (35.83 ± 6.56 vs. 52.11 ± 5.95 out of 73) (p ¼ 0.01). Technical skill on the OSATS station demonstrated improved performance and confidence following the program (10.10 vs.17.94 out of 25) (p ¼ 0.05). Most participants (72%) re-considered their choices of surgical electives. Conclusions: A preclerkship surgical skills program not only stimulates interest in surgery but can also improve surgical knowledge and technical skills prior to clerkship. © 2017 Elsevier Inc. All rights reserved. 1. Introduction Early exposure of preclerkship medical students to surgery, particularly through the form of simulation learning, can stimulate interest in a surgical career. 1e4 In 2004, the ACGME called for increased medical school and faculty investment in undergraduate surgical education in the context of declining applications to sur- gery residency programs and rising attrition rates amongst surgical residents. 5 More than 10 years later, we have seen the growth of structured preclerskhip experiences that offer exposure to surgery through observerships, surgical simulation workshops, faculty- student discussion groups, or a combination of all three approach- es. 3,6e12 Although each institution-specific program is unique, their objectives are relatively the same, and all have reported positive outcomes. 3,6e12 In addition to sparking an interest in surgery, however, simulation-based surgical skills programs can be geared toward better preparing medical students for the surgical clerkship in a safe, nonthreatening environment. The landscape of surgical education has changed over the past two decades. The implementation of resident work hour restrictions has brought new challenges for surgeons teaching residents. 13 In addition, the adoption of a competency-based curriculum in surgery embraces the idea that the best way to evaluate one's surgical ability is by an objective structured evaluation of specific clinical and procedural skills. 14 Furthermore, given the busy nature of surgical practice, the core surgical clerkship experience can be lacking in teaching and assessing certain technical skills. 15 This is particularly concerning as students are most likely to decide on their commit- ment to a career in surgery based on their surgical clerkship expe- rience. 16 Moreover, there is a heightened level of worry amongst medical students who feel the technical expectations of perfor- mance and proficiency during their surgical clerkship are not adequately addressed in their medical school curriculum. 17 There- fore, the introduction of a simulation-based program before clerk- ship could increase confidence in one's abilities in the delivery of * Corresponding author. 80 Barrie Street, Kingston, ON, K7L 3N6, Canada. E-mail address: rkarmali@qmed.ca (R.J. Karmali). Contents lists available at ScienceDirect The American Journal of Surgery journal homepage: www.americanjournalofsurgery.com https://doi.org/10.1016/j.amjsurg.2017.09.012 0002-9610/© 2017 Elsevier Inc. All rights reserved. The American Journal of Surgery xxx (2017) 1e7 Please cite this article in press as: Karmali RJ, et al., The Surgical Skills and Technology Elective Program (SSTEP): A comprehensive simulation- based surgical skills initiative for preclerkship medical students, The American Journal of Surgery (2017), https://doi.org/10.1016/ j.amjsurg.2017.09.012