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In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.With leadership by two senior academics and the Transitions Implementation Committee, three working groups helped implement these transitions projects, which addressed (1) the medical-school-to-residency transition, (2) career planning and the residency matching process, and (3) the residency-to-practice transition. Work products include the development of a learner education handover protocol and the establishment of pan-Canadian entrustable professional activities to be used nationally to help define expectations for new graduates entering residencies. A postmatch boot camp tool and a simulated night on-call tool were developed and are available to all medical schools. National standards are being promoted for career services counseling and best practices in residency selection. A practice management curriculum framework, mentorship resources, resiliency training for graduating residents, and the entry-level disciplines of residency are also being explored.Ultimately, with system-wide change and better integration of all players, transitions for Canada's learners will greatly improve.

To examine the stability and switching patterns of student career interests over the course of medical school.From 2001 through 2004, during the first two weeks of classes, a survey on career interest was distributed to first-year students in 15 classes at eight Canadian medical schools. Students indicated interest in eight broad career paths (emergency medicine, family medicine, internal medicine, obstetrics-gynecology, pediatrics, psychiatry, surgery, and "other") and ranked their top three. Following these students' residency match three to four years later, student residency career choice was linked to their career interest at medical school entry. For students whose career interests switched be-tween medical school entry and exit, switching patterns were examined in terms of careers' matching difficulty scores (MDSs).Of 1,941 eligible students, 1,542 contributed to the final analysis. Family medicine, internal medicine, and surgery had the greatest student interest at both the beginning and end of medical school. Family medicine, surgery, obstetrics-gynecology, psychiatry, and "other" careers showed a net gain of student interest during medical school with the remaining careers showing a loss of interest. The most stable careers were family medicine, surgery, and internal medicine. The least stable were pediatrics and obstetrics-gynecology. Students tended to switch between careers with similar MDSs.Student career choice is relatively stable with a number of careers showing approximately 50% of stability from the entrance to the exit of medical school. Students tend to switch to careers with similar MDS, but some specific switching patterns exist.

PURPOSE Most diagnostic errors involve faulty diagnostic reasoning. Consequently, the authors assessed the effect of querying initial hypotheses on diagnostic performance. METHOD In 2007, the authors randomly assigned 67 first-year medical students from the University of Calgary to two groups and asked them to diagnose eight common problems. The authors presented the same primary data to both groups and asked students for their initial diagnosis. Then, after presenting secondary data that were either discordant or concordant with the primary data, they asked students for a final diagnosis. The authors noted changes in students' diagnoses and the accuracy of initial and final diagnoses for discordant and concordant cases. RESULTS For concordant cases, students retained 84.2% of their initial diagnoses and were equally likely to move toward a correct as incorrect final diagnosis (6.9% versus 8.9%, P = .3); no difference existed in the accuracy of initial and final diagnoses: 85.9% versus 84.0% (P = .4). By contrast, for discordant cases, students retained only 23.3% of initial diagnoses, change was almost invariably from incorrect to correct (76.3% versus 0.4%, P < .001), and final diagnoses were more accurate than initial diagnoses: 80.7% versus 4.8% (P < .001). Overall, no difference existed in the accuracy of final diagnoses for concordant and discordant cases (P = .18). CONCLUSIONS These data suggest that querying an initial diagnostic hypothesis does not harm a correct diagnosis but instead allows students to rectify an incorrect diagnosis. Whether querying initial diagnoses reduces diagnostic error in clinical practice remains unknown.

Lao People's Democratic Republic (Lao PDR) is a small, tropical, landlocked country in southeast Asia. It is one of the least developed countries in the region, and its socioeconomic indicators are among the lowest 25% in the world. The World Health Organization has long called for increased equity in primary health care access around the world. To meet this need in Lao PDR, the Family Medicine Specialist Program was developed, a Lao-generated postgraduate training program designed to produce community-oriented primary care practitioners to serve the rural, remote areas of Lao PDR, where 80% of the population lives. An innovative method of needs assessment was required to determine the health care priorities to be met by this new program. Through the use of a modified Delphi technique, local key leaders in medical education, clinical specialists, and teachers were consulted to develop prioritized objectives for the hospital-based curriculum of the program. By setting priorities for teaching and learning in the unique and needy circumstances of Lao PDR, a novel approach to curriculum planning in a low-income country was explored and ultimately formed the foundation of the new curriculum. This process served to direct the allocation of scarce resources during implementation of this groundbreaking program. More importantly, this model of needs assessment could potentially be used to customize medical curricula in other low-income countries facing challenges similar to those in Lao PDR.