title: The Decision to Incision Curriculum: Teaching Preoperative Skills and Achieving Level 1 Milestones.
abstract: OBJECTIVE
  To evaluate the effectiveness of a preoperative skills curriculum, and to assess and document competence in associated Obstetrics and Gynecology Level 1 Milestones.
  
  
  METHODS
  The Decision to Incision curriculum was developed by a team of medical educators with the goal of teaching and evaluating 5 skills pertinent to Milestone 1: Preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time-out. Competence, overall skill performance, and knowledge were assessed by evaluator rating using checklists before and after the educational intervention. Differences between preintervention and postintervention skills performance and competence were assessed using Wilcoxon rank test and Fisher exact test, respectively.
  
  
  METHODS
  Clinical Simulation Center at an academic medical center.
  
  
  METHODS
  Overall, 29 fourth year medical students matriculating into Obstetrics and Gynecology residencies.
  
  
  RESULTS
  The proportion of participants meeting Milestone competence significantly increased in all 5 skills, with competence achieved in 95.6% (95% CI: 92.1-99.0) of posttest skills assessments. Median overall performance also significantly improved for all 5 skills, with 83.6% (95% CI: 77.3-89.9) earning scores of 4 out of 5 or greater on the posttest. For knowledge testing, the proportion of correct responses significantly increased for both topics evaluated, from 45.2% to 99.7% (p < 0.0001) for positioning and from 32.8% to 83.1% (p < 0.0001) for time-out.
  
  
  CONCLUSIONS
  The decision to incision curriculum significantly improved preoperative skills, including skills that may be required on day 1 of residency. This curriculum also facilitated achievement and documentation of competence in multiple Milestones.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan. Electronic address: skinnerb@med.umich.edu.
authors.forename: Bethany
authors.initials: B
authors.lastname: Skinner
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Helen
authors.initials: H
authors.lastname: Morgan
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Emily
authors.initials: E
authors.lastname: Kobernik
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Neil
authors.initials: N
authors.lastname: Kamdar
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Diana
authors.initials: D
authors.lastname: Curran
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: David
authors.initials: D
authors.lastname: Marzano
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Maya
authors.initials: M
authors.lastname: Hammoud
mesh_terms: D002983:Clinical Competence; D003479:Curriculum; D003657:Decision Making; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency; D011300:Preoperative Care / Q000193:education*
keywords: Interpersonal and Communication Skills; Medical Knowledge; Patient Care; Systems-Based Practice; curriculum; education; milestones; preoperative; preparedness; residency