From the Department of Neurology (R.M.D., H.P.A.), McGaw Medical Center of Northwestern University, Chicago, IL; Department of Neurology (R.M.E.S., C.E.G., R.E.S., D.R.S.), Johns Hopkins School of Medicine, Baltimore, MD; Rush Medical College at Rush University (A.N.), Chicago, IL; Hospital Dr. Sótero del Rio (I.E.), Red Salud UC Christus, Clinica Las Condes, Santiago, Chile; University Teaching Hospital (K.C.K., D.R.S.), Lusaka, Zambia; Department of Neurology, Wake Forest School of Medicine (R.E.S.), Winston-Salem, NC; and Department of Internal Medicine (S.T.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
Neurology. 2021 Aug 17;97(7):e750-e754. doi: 10.1212/WNL.0000000000012134. Epub 2021 Apr 30.
We established Zambia's first neurology residency program at the University of Zambia School of Medicine and the University Teaching Hospital in Lusaka.
To evaluate the feasibility and effectiveness of a modified objective structured clinical examination (OSCE) to assess clinical skills.
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.
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.
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.
我们在赞比亚大学医学院和卢萨卡大学教学医院建立了赞比亚首个神经科住院医师培训项目。
评估改良后的客观结构化临床考试（OSCE）评估临床技能的可行性和有效性。
2019 年 2 月，神经科培训项目的 3 名参与者完成了 OSCE 考试。我们使用智能手机拍摄受训者在神经科诊所进行体格检查和口头报告的视频。受训者和教师使用标准化量表独立查看视频，然后进行面对面的反馈。
3 名受训者完成了 OSCE 前后的调查，对他们在病史和检查各要素方面的信心进行了评分。受训者的平均自我信心评分从 OSCE 前到 OSCE 后在每个类别中都有所提高（OSCE 前：平均评分 6.84，范围 4.8-7.8，SD 0.92；OSCE 后：平均评分 7.9，范围 5.67-9.33，SD 0.86）。定性反馈表明，受训者认为 OSCE 很有帮助，他们会常规应用反馈，并希望重复 OSCE。
OSCE 可提高受训者的自我信心，并可在资源有限的神经科研究生培训项目中进行修改和成功实施。重要的 OSCE 修改包括使用智能手机进行录像和真实患者的接触，而不是标准化患者。将该体验嵌入忙碌的临床日中是切实可行、适用和高效的。未来的工作应在赞比亚神经科住院医师培训项目和非神经科培训项目中进一步推广使用 OSCE。增加额外的视频评审员可以提高临床技能评估的有效性。视频还可用于远程指导和教学目的。
