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Results call into question any causal relationship between approximate, non-symbolic arithmetic and precise symbolic arithmetic. Many U.S. medical schools are modifying their curricula with limited understanding of the impact on students' clinical knowledge. The surgical rotations and Surgery Shelf Exam score reports of 1514 students at a single medical school over nine academic years (2010-2018), which included a four-year transition period to a condensed pre-clerkship curriculum. Subject-specific results were compared by rotation type