Background: The transition from pre-clerkship to clinical clerkship is a pivotal moment for medical students. At the University of Ottawa Faculty of Medicine, Unit IV and the Link Block are designed to facilitate this transition. Improvements to the current curriculum, specifically in Unit IV, may better prepare students for clerkship. We aimed to summarize existing literary evidence on the transition to clerkship and collect student feedback to generate recommendations for success with regard to clerkship preparedness at the University of Ottawa Faculty of Medicine. Methods: We conducted a literature search using PubMed, MEDLINE, ERIC, and CINAHL for studies evaluating the transition to clerkship in a four-year medical program. Using this data, we created two different versions of our survey (pre-transition and post-transition) for dissemination to second, third, and fourth-year medical students, plus MD/PhD students, in the Anglophone and Francophone stream. The survey was open for three weeks from October 10 to October 31, 2020, with weekly reminders to all eligible participants. Microsoft Excel 2016 was used for data analysis. Results: We obtained 176 respondents, of which 158 (70% Anglophone and 30% Francophone) were included in the analysis. The majority of students were in the MD2023 cohort (40%) and had completed a 4-year Bachelor’s degree (61%) prior to medical school. Students in the post-transition group were less anxious about the transition to clerkship than their junior colleagues, although differences between streams were marginal. The most notable difference concerning Entrustable Professional Activities was in terms of obtaining a complete history and performing a physical examination, with the post-transition cohort reporting increased competency compared to the pre-transition cohort in the Anglophone stream (2.9/5.0 pre-transition vs. 3.3/5.0 post-transition, +0.33 difference, p<0.05). Top two stressors for incoming clerks were a lack of clinical skills or experience, and lack of clarity around clerkship roles, responsibilities, and expectations.Conclusion: There is limited training to facilitate a seamless transition for incoming clerks at the University of Ottawa Faculty of Medicine. Changes can be made at the pre-clerkship level in the form of small-group orientation sessions, formative OSCEs, accelerated review of pre-clerkship material, and clerkship simulation sessions.

61-year-old woman presented to her family physician's office with long-standing bilateral leg swelling. She voiced that her legs had become "heavy" and that the skin was "thick" and "burning." She had started using a cane for gait instability.An insidious onset of swelling in her left lower leg had started more than 25 years earlier without any obvious cause. A diuretic was initially prescribed; however, the swelling progressed. The patient was subsequently prescribed various diuretic dosing regimens, with minimal improvement. The diuretic was eventually stopped 3 years before the current presentation.Over the years, the patient's right lower leg had also begun to swell. She had undergone venous Doppler ultrasonography of the peripheral extremities 16 years earlier to rule out venous pathologies and was evaluated for liver disease and congestive heart failure. The results of the investigations were negative.The patient's medical history included overactive bladder and osteoarthritis. She had no history of coronary artery disease, venous thrombosis or liver disease. There was no family history of lymphedema. She was taking solifenacin 5 mg/d for overactive bladder and a calcium supplement.

OBJECTIVES: To validate the economic advantages of Mirena, a new hormone releasing contraceptive system that can be inserted in the uterus for 5 years, compared to oral contraceptives (OC) in Canada. Mirena and OC offer equivalent contraceptive efficacy with a similar safety profile. METHODS: A cost‐minimization analysis with a third‐party payer perspective and a 5‐year horizon. Three major scenarios were analysed. In the first scenario, only the drug acquisition cost of both treatments was used. Mean cost of OC was calculated based on the amount reimbursed in the April 2000 list of the Régie de l'assurance‐maladie du Québec (RAMQ). In the second scenario, the pharmacy's dispensing fee (Quebec RAMQ fee) was added. In the third scenario, real‐life conditions of use of Mirena were applied, i.e. an expulsion rate of 6% and estimated continuation rate of 56% and 65% after 5 years. Sensitivity analysis was performed on OC cost using the lowest and highest costs from the RAMQ list. Discounting was performed at 0%, 3% and 5% over 65 time‐periods (13 cycles × 5 years) for OC. No discount rate was applied to Mirena since acquisition cost is paid once at treatment start. RESULTS: The mean cost of an OC is determined to be $11 per cycle, while drug acquisition cost of Mirena is $290. All scenarios favour Mirena. With a 5% discount rate, Mirena offered a mean saving of $346 over 5 years. When the pharmacist's dispensing fee was included Mirena offered a mean saving of $750. In real life conditions, with a 5% discount rate, the use of Mirena resulted in a mean saving of at least 30% (i.e., between $194 and $221). CONCLUSION: Mirena represents a less expensive alternative to long‐term contraception when compared to OC and this, in all proposed scenarios.

Pour les étudiants en médecine, la transition entre le pré-externat et l’externat est une période clé du programme médical de quatre ans. À l’Université d’Ottawa, il a été démontré qu’il y a un manque de satisfaction au sein des étudiants en ce qui a trait à leur préparation à l’externat.             Cette étude d’amélioration de la qualité vise à apporter des recommandations afin d’améliorer le curriculum médical actuel de manière à améliorer la préparation à l’externat en s’attardant particulièrement à l’unité d’intégration et au stage préparatoire. Une revue de la littérature a été complétée afin de faire ressortir les concepts théoriques sur lesquels se fondent les modifications au curriculum qui ont pour but d’améliorer l’intégration de connaissances lors du pré-externat. Le mapping du curriculum de l’unité d’intégration et du stage préparatoire a également été effectué afin de conceptualiser et concrétiser l’incorporation des modifications au curriculum.             Lors de l’unité d’intégration, le curriculum est divisé en 54% de cours didactiques, 19% d’activités pratiques et 21% d’ateliers. Pour le stage préparatoire, 22,3% était alloué aux cours didactiques, 28,6% aux ateliers et 48% à la pratique en milieu hospitalier. La préparation à l’externat peut être améliorée en optimisant l’intégration au cours du pré-externat, particulièrement durant la dernière unité de la deuxième année (unité d’intégration). Des modifications potentiellement bénéfiques comprennent : prioriser l’apprentissage actif à l’apprentissage passif ; mettre l’intégration cognitive en premier plan en salles de classe ; bâtir progressivement en complexité en visant à avoir les sujets les plus complexes à la fin du pré-externat en utilisant une approche de cycle de vie; et associer une séance de développement des compétences des cliniques à chaque séance d’apprentissage par cas.