Background: Dedicated skills courses may help to prepare 4th-year medical students for surgical internships. The purpose of this study was to analyze the factors that influence the preparedness of 4th-year medical students planning a surgical career, and the role that our skills course plays in that preparedness. Methods: A comprehensive skills course for senior medical students matching in a surgical specialty was conducted each spring from 2006 through 2009. Students were surveyed for background skills, clerkship experience, and skills confidence levels (1-5 Likert scale). Assessment included 5 suturing and knot-tying tasks pre- and postcourse and a written examination. Data are presented as mean values ± standard deviations; statistical analyses were by 2-tailed t test, linear regression, and analysis of variance. Results: Sixty-five 4th-year students were enrolled; most common specialties were general surgery (n = 22) and orthopedics (n = 16). Thirty-five students were elite musicians (n = 16) or athletes (n = 19) and 8 regular videogamers. Suturing task times improved significantly from pre- to postcourse for all 5 tasks (total task times pre, 805 ± 202 versus post, 627 ± 168 seconds [P < .0001]) as did confidence levels for 8 skills categories, including management of on-call problems (P < .05). Written final examination proficiency (score ≥70%) was achieved by 81% of students. Total night call experience 3rd year was 23.3 ± 10.7 nights (7.3 ± 4.3 surgical call) and 4th year 10.5 ± 7.4 nights (7.2 ± 6.8 surgical call). Precourse background variables significantly associated with outcome measures were athletics with precourse suturing and 1-handed knot tying (P < .05); general surgery specialty and instrument tying (P = .012); suturing confidence levels and precourse suturing and total task times (P = .024); and number of nonsurgical call nights with confidence in managing acute on-call problems (P = .028). No significant correlation was found between these variables and postcourse performance. Conclusion: Completion of an accelerated skills course results in comparable levels of student performance postcourse across a variety of preclinical backgrounds and clerkship experiences.