Introduction As initiatives to broadly implement integrated training programs for surgery proceed, senior medical students (SMS) will need to be better prepared. Consequently, it is imperative that we prepare students to more effectively care for patients upon residency matriculation. Using cardiothoracic training as a model for integrated programs, we developed a course with a focus on cardiothoracic topics and examined its efficacy in preparing SMS for the management of cardiothoracic patients. Methods 22 SMS matched into surgical residencies completed a 4-week, competency-based, preparatory course incorporating didactics, simulation, skills labs, and covering areas essential for care of cardiothoracic surgical patients. Knowledge base, skill acquisition, and readiness were measured through written tests, performance examinations, and confidence self-assessments (5-point Likert scale). T-tests were used for pre- and post-course comparisons (alpha=0.05). Results Pre-course, students possessed significant measured anxiety related to both cognitive and technical skills needed for management of cardiothoracic patients. Cardiothoracic topics were ranked most important by the students, yet were the curricular areas of most substantial weakness. Measured confidence rose significantly (Table). Students demonstrated significant gains in knowledge base on the written test[mean pre-test score, 54.9%; post-test 86.4% (p ⁎ 4.18Emergent post-op events4.911.553.64 ⁎ 4.36Chest tubes, CVCs, art lines4.182.094.09 ⁎ 4.18Post-op cardiothoracic pts4.411.733.14 ⁎ 3.90Surgical critical care4.412.093.45 ⁎ 3.59Ventilators/ABGs4.252.463.89 ⁎ 3.80Post-op fluid mgmt4.272.363.95 ⁎ 3.95Post-op transplants4.321.592.82 ⁎ 3.50Bronchoscopy/endoscopy3.811.822.55 ⁎ 2.77⁎P Conclusions SMS have significant baseline deficits in skills necessary for seamless matriculation into integrated cardiothoracic surgery residencies. This study demonstrates the efficacy of a competency-based, preparatory course in significantly improving task-specific confidence, knowledge base, and technical proficiency. Further, these findings have broader implications for how we effectively prepare SMS for the transition to integrated surgical training programs.