Critical fail concepts in surgery: highlighting the "must-know" concepts.

As the vast majority of medical students do not pursue further postgraduate surgical education, we suggest that failing to achieve certain learning objectives (LOs) has greater potential consequences than others. We developed a tiered LO architecture that classifies a high-priority subset of “critical fail” LOs within the current surgical learning objectives for medical students. Follow-up of student performance on written examinations revealed an improvement in applying critical fail concepts without sacrificing performance on other LOs. Here we describe how we modified our declared curriculum to incorporate these changes.