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Purpose: We evaluated suturing skills performance and retention in senior medical students (MS4) at the beginning of their fourth year and 7 months later., Methods: MS4 students entering a surgery specialty were randomized to a proficiency-based suturing/knot-tying curriculum at the beginning of fourth year (Intervention, n = 11) versus no training (Control, n = 10). Time and technical proficiency (TP, proficiency ≥3) were assessed at baseline and 7 months. Performance was compared with past "Boot-Camp" MS4, categorical PGY-1 interns and PGY-2 residents. Data are mean ± SD., Results: At baseline, Intervention and Control MS4 had similar total task times (848 ± 199 vs 845 ± 209 seconds) and TP scores (1.8 ± 0.15 vs 1.8 ± 0.3). At 7 months, Intervention MS4 total task times were faster (549 ± 80 vs 719 ± 151 seconds, P < .01) and mean TP scores greater (3.3 ± 0.6 vs 2.1 vs 0.4, P < .001) than Control MS4. Intervention MS4 also performed better at 7 months than Boot-Camp MS4 (662 ± 171 seconds and 2.6 ± 0.5, P < .04) and were similar to PGY-1 interns (601 ± 74 seconds, TP 2.7 ± 0.7 seconds) and end of PGY-2 residents (475 ± 81 seconds and 3.6 ± 0.3 seconds)., Conclusion: A proficiency-based suturing and knot-tying curriculum taught early in the fourth year results in improved MS4 performance compared with no training or a traditional "boot camp" program., (Copyright © 2013 Mosby, Inc. All rights reserved.)