Preceptor-Ranked Competencies in Osteopathic Medical Students: A Comparison of General Surgery and Surgical Subspecialties.

Introduction As the Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 and United States Medical Licensing Exam (USMLE) Step 1 have transitioned to pass/fail scoring, greater emphasis has been placed on clinical performance and subjective evaluations during surgical clerkships. While prior work explored preceptor expectations in general surgery, the competencies valued across surgical subspecialties remain less defined. This study aims to build on previous work by increasing the sample size and identifying the qualities and skills that surgical preceptors most value in medical students across both general surgery and surgical subspecialty disciplines. Methods A descriptive cross-sectional survey study was conducted among surgical preceptors within the faculty network at the Alabama College of Osteopathic Medicine (ACOM). A 10-item web-based survey, utilizing the Qualtrics XM platform (Qualtrics, North Sydney, Australia), was adapted from previous published work on general surgeons and distributed to additional surgery preceptors (Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO)). The survey captured data on six core competency domains and their respective subcomponents. Responses from general surgery preceptors (n = 25) were combined with newly collected responses from additional general surgeons and surgical subspecialty preceptors (n = 39), resulting in a total sample of 64. Descriptive and comparative analyses were performed to identify both shared and specialty-specific preferences. Results Across all specialties, nontechnical attributes were prioritized over procedural skills. Ranking questions were quantified using one-to-six or one-to-five scales so that higher values represented greater perceived importance (0 = least important; 5 or 6 = most important). Enthusiasm and willingness to learn (mean = 4.1), differential diagnosis (mean = 3.7), and anatomic knowledge (mean = 3.5) were rated highest, while leadership and deep suturing were consistently ranked lowest. Differences were observed between specialties for operating room knowledge and knot tying and suturing. Orthopedic preceptors rated deep suturing higher (mean = 1.3), while general surgeons valued hand ties more (mean = 2.9). Notably, 51% of preceptors reported adjusting expectations based on a student's intended specialty. Conclusion Surgical preceptors across specialties consistently valued enthusiasm, adaptability, and clinical reasoning over early technical skills. These findings highlight the need for medical students to prioritize interpersonal and cognitive competencies while gradually developing procedural abilities. Specialty-specific differences underscore the importance of tailored preparation, which may improve clerkship performance, evaluations, and residency readiness.