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.