Training in Neurology: Implementation and Evaluation of an Objective Structured Clinical-Examination Tool for Neurology Postgraduate Trainees in Lusaka, Zambia. (17th August 2021)

• Record Type: Journal Article
• Authors: DiBiase, Rebecca Marie; Salas, Rachel Marie E.; Gamaldo, Charlene E.; Nutakki, Aparna; Elicer, Isabel; Attarian, Hrayr P.; Kapembwa, Kenneth C.; Strowd, Roy E.; Tackett, Sean; Saylor, Deanna R.
• Is Part Of: Neurology. Volume 97:Number 7(2021)
• Publication Date: 2021-08-17
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012134
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : 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.