Background: Skills training plays an increasing role in residency training. Few medical schools have skills courses for senior students entering surgical residency. Methods: A skills course for 4th-year medical students matched in a surgical specialty was conducted in 2006 and 2007 during 7 weekly 3-hour sessions. Topics included suturing, knot tying, procedural skills (eg, chest tube insertion), laparoscopic skills, use of energy devices, and on-call management problems. Materials for outside practice were provided. Pre- and postcourse assessment of suturing skills was performed; laparoscopic skills were assessed postcourse using the Society of American Gastrointestinal and Endoscopic Surgeons' Fundamentals of Laparoscopic Surgery program. Students' perceived preparedness for internship was assessed by survey (1 to 5 Likert scale). Data are mean ± SD and statistical analyses were performed. Results: Thirty-one 4th-year students were enrolled. Pre- versus postcourse surveys of 45 domains related to acute patient management and technical and procedural skills indicated an improved perception of preparedness for internship overall (mean pre versus post) for 28 questions (p < 0.05). Students rated course relevance as "highly useful" (4.8 ± 0.5) and their ability to complete skills as "markedly improved" (4.5 ± 0.6). Suturing and knot-tying skills showed substantial time improvement pre- versus postcourse for 4 of 5 tasks: simple interrupted suturing (283 ± 73 versus 243 ± 52 seconds), subcuticular suturing (385 ± 132 versus 274 ± 80 seconds), 1-handed knot tying (73 ± 33 versus 58 ± 22 seconds), and tying in a restricted space (54 ± 18 versus 44 ± 16 seconds) (p < 0.02). Only 2-handed knot tying did not change substantially (65 ± 24 versus 59 ± 24 seconds). Of 13 students who took the Fundamentals of Laparoscopic Surgery skills test, 5 passed all 5 components and 3 passed 4 of 5 components. Conclusions: Skills instruction for senior students entering surgical internship results in a higher perception of preparedness and improved skills performance. Medical schools should consider integrating skills courses into the 4th-year curriculum to better prepare students for surgical residency.