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The Decision to Incision Curriculum: Teaching Preoperative Skills and Documenting Achievement of Level 1 Milestones

PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess competence in associated level 1 Milestones. BACKGROUND: With implementation of the Milestones, medical educators must ensure that incoming interns have met various level 1 Milestones, including those related to preoperative skills for which formal education is lacking. METHODS: Thirteen fourth-year medical students completed the Decision to Incision curriculum which taught preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time out. Knowledge, skills, and competency were assessed using checklists before and after the educational intervention. Performance was measured using a 5-point Likert scale, and competency was assessed as present or absent. Change in performance was analyzed using &khgr;2 and t tests. RESULTS: Overall performance significantly improved for 3 of 5 skills with scores improving from 2.69 to 4.33 (P<.001) for consent, 2.08–4.3 (P<.001) for positioning, and 2.23–3.69 (P<.001) for time out. The percentage meeting Milestone competency significantly improved from 30.8% to 84.6% (P=.005) for consent, 0–100% (P<.001) for positioning, 69.2–100% (P=.03) for scrub, and 15.4–100% (P<.001) for time out. Overall, competence was achieved in 93.8% (61/65) of skills assessments. DISCUSSION: The Decision to Incision Curriculum significantly improves preoperative skills, particularly skills students are unlikely to perform during medical school but may perform on day 1 of residency. This curriculum also facilitates achievement and documentation of competence in multiple Milestones.