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Background: The goals of this study were to (1) determine the extent of preclerkship surgical participation in American medical colleges; (2) examine policies regarding such surgical participation; and (3) elicit medical school administrators' perceptions about such exposure., Methods: Surveys were sent to 128 accredited medical schools (1 administrator each). The 54 (42%) replies were analyzed using descriptive statistics and Student's t tests, with significance defined as a P value of ≤ .05., Results: Of the respondents, 55.6% did not permit student surgical participation. Only 22.2% of responding institutions offered preclerkship surgical skills electives. Administrators from the former group of schools perceived significantly greater risk (P = .001) to patient safety with student surgical participation than did administrators at schools permitting such participation, even though no respondents reported malpractice or worker's compensation cases arising from student participation., Conclusions: Medical students have limited opportunities for preclerkship surgical participation at most American medical institutions, possibly because of unsubstantiated concerns for patient safety., (Copyright © 2013 Elsevier Inc. All rights reserved.)