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

INTRODUCTION We established Zambia's first neurology residency program 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's three 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. ASSESSMENT & OUTCOMES 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. LESSONS LEARNED OSCEs improve trainees' self-confidence and can be modified and successfully implemented in a resource-limited neurology post-graduate training program. Important OSCE modifications involved using smartphones for videotaping and a real patient encounter rather than a standardized patient. Additionally, embedding the experience within a busy clinic day was practical, applicable, and efficient. 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 could also be used for remote mentorship and teaching purposes.