Training in Neurology: Implementation and Evaluation of an Objective Structured Clinical-Examination Tool for Neurology Postgraduate Trainees in Lusaka, Zambia

Background

We established Zambia’s first neurology residency program at the University of Zambia School of Medicine and the University Teaching Hospital in Lusaka.

Objective

To evaluate the feasibility and effectiveness of a modified objective structured clinical examination (OSCE) to assess clinical skills.

Methods

The neurology training program’s 3 participants completed the OSCE exercise in February 2019. We used smartphones to videotape trainees performing a physical examination and oral presentation in the neurology clinic. Trainees and faculty reviewed the videos independently using a standardized rubric and then met for in-person feedback.

Results

Three trainees completed pre- and post-OSCE surveys rating their confidence in elements of the history and examination. Trainees’ average self-confidence scores improved from the pre- to post-OSCE survey in every category (pre-OSCE: mean score 6.84, range 4.8–7.8, SD 0.92; post-OSCE: mean score 7.9, range 5.67–9.33, SD 0.86). Qualitative feedback showed trainees found the OSCE helpful, routinely applied feedback, and would appreciate repeating OSCEs.

Conclusions

OSCEs improve trainees’ self-confidence and can be modified and successfully implemented in a resource-limited neurology postgraduate training program. Important OSCE modifications involved using smartphones for videotaping and a real patient encounter rather than a standardized patient. Embedding the experience within a busy clinic day was practical, applicable, and efficient. Future work should expand use of OSCEs both within the Zambian neurology residency program and non-neurology training programs. Including additional video reviewers could add to the validity of clinical skills assessment. Videos could also be used for remote mentorship and teaching purposes.

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