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Supplemental materials for: Implementation and evaluation of an objective structured clinical examination (OSCE) tool for neurology post-graduate trainees in Lusaka, Zambia

Citation

DiBiase, Rebecca (2021), Supplemental materials for: Implementation and evaluation of an objective structured clinical examination (OSCE) tool for neurology post-graduate trainees in Lusaka, Zambia, Dryad, Dataset, https://doi.org/10.5061/dryad.2jm63xsnc

Abstract

Introduction: Despite the high burden of neurologic disease in Zambia, a low-middle income sub-Saharan African country of 18 million people, there are currently no Zambian neurologists. We established the first neurology residency program in Zambia at the University of Zambia School of Medicine and the University Teaching Hospital in Lusaka. We evaluated the feasibility and effectiveness of a modified Objective Structured Clinical Examination (OSCE) to assess clinical skills.  

Program Description: The neurology training program began in October 2018, and its 3 participants completed the OSCE exercise in February 2019. The exercise involved using a smartphone to videotape trainees performing a physical examination and oral presentation in the neurology clinic. Trainees and neurology faculty reviewed the videos independently and assessed performance using a standardized rubric. The faculty and trainee then met in person and discussed the activity and scoring rubric. 

Assessment & Outcomes: Three trainees completed pre- and post-OSCE surveys where they rated their confidence in elements of the history and neurological examination and provided feedback about the OSCE exercise. One faculty member reviewed each video and provided feedback to each trainee. 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 responses showed trainees found the OSCE helpful, routinely applied feedback, and would appreciate repeating OSCEs every few months. 

Lessons Learned: This study demonstrated that OSCEs can be modified and successfully implemented in a resource-limited neurology post-graduate training program and result in improved self-confidence among trainees. Important modifications to the OSCE involved using smartphones to videotape the OSCE’s and a real patient encounter rather than a standardized patient. Because there are many neurology patients and few providers in Zambia, embedding the experience within a busy clinic day was practical, directly applicable, and at a lower opportunity cost. 

Future Directions: 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 created could also be used for remote mentorship and teaching purposes.