1. EMILY W. ZANTOW, BSE, DOROTHY A. ANDRIOLE, MD, DONNA B. JEFFE, PHD, JULIE WOODHOUSE, RN, L. MICHAEL BRUNT, MD WASHINGTON UNIVERSITY SCHOOL OF MEDICINE ST. LOUIS, MO Is There Selection Bias among Senior Medical Students Who Choose to Participate in a Surgery Internship Preparation Course?

2. Disclosures Emily W. Zantow – no disclosures L. Michael Brunt – no disclosures

3. Background Medical schools are increasingly offering surgery internship preparation courses (SIPC) to senior medical students planning to enter surgical specialties SIPC are optional and may vary in student participation level Characteristics of students who participate vs those who do not have not been described

4. In 2006 we initiated a senior skills preparation course open to students in any surgical specialty Students planning to enter a surgical internship are invited via an email announcement Enrollment on a first-come, first- served basis JACS 2008; 206:897-907.

5. SIPC Course Structure at WUSM 3-hour sessions once per week for 7 weeks  Curriculum includes:  Basic suturing and knot-tying  Emergent procedural skills  On call problems  Energy devices and staplers  Basic laparoscopic skills  Animate lab  Final assessment

6. SIPC Course Structure at WUSM Sessions consist of a short didactic followed by hands-on instruction and practice Instruments and materials for independent practice

7. Hypothesis Students who participate in a SIPC might differ in background or other areas of performance than those who choose not to participate

8. Methods Database of individualized records was constructed for all graduates in the 2006-2011 classes who entered surgical residencies (IRB approval)  183 graduates total matched in surgical specialty  88 (48.1%) participated in the SIPC

9. Methods Independent associations between SIPC participation and the following were explored:  First-attempt USMLE Step 1 score  Third-year required clinical clerkships’ GPA  3 rd Year Surgical-skills score (self-reported, end of 3 rd year)  Surgical specialty  Gender

10. 3 rd Year Surgical-Skills Score Survey given at the end of the third year 6 skills were analyzed:  Peripheral IV placement (adult)  Incision and drainage of a superficial abscess  Suture a superficial laceration  Tie a two-handed knot  Debride a superficial wound  Orotracheal intubation (adult) Scored on a 1-5 scale: 1 = I have never been instructed in this; 5 = I can do this independently Mean surgical-skills score calculated for the analysis

11. Methods Database was analyzed using ANOVA, chi-square tests, and a logistic regression model p-values of < 0.05 were considered significant

12. Results In ANOVAs, participation was not associated with Step 1 score or GPA p = 0.171 p = 0.431

13. Results SIPC participation was associated with higher mean 3 rd year surgical-skills score p = 0.017

14. Results In chi-square tests, SIPC participation was associated with surgery specialty choice p < 0.001

15. Results In chi-square tests, SIPC participation was associated with surgery specialty choice p < 0.001 86% 38%

16. Results Participation was not associated with gender p = 0.883

17. Results In the logistic regression model, independent predictors of SIPC participation included:  Higher surgical-skills score  [aOR] = 1.80  95% CI = 1.05-3.07  p = 0.032  General surgery specialty choice  [aOR] = 11.00  95% CI = 3.89-31.15  p < 0.001

18. Summary SIPC participants comprised a higher-performing group on the basis of self-assessed surgical-skills scores SIPC participants consisted of a greater percentage of students entering general surgery, indicating some selection bias among participants No differences were seen on other objective pre-4th year performance measures

19. Conclusion Our results have implications for whether SIPCs should be offered as optional or required courses and for the design of evaluations of the impact of SIPC participation on surgical-intern preparedness