Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica

BACKGROUND: The Faculty of Medical Sciences, University of the West Indies first implemented the Objective Structured Clinical Examination (OSCE) in the final MB Examination in Medicine and Therapeutics during the 2000–2001 academic year. Simultaneously, the Child Health Department initiated faculty and student training, and instituted the OSCE as an assessment instrument during the Child Health (Paediatric) clerkship in year 5. The study set out to explore student acceptance of the OSCE as part of an evaluation of the Child Health clerkship. METHODS: A self-administered questionnaire was completed by successive groups of students immediately after the OSCE at the end of each clerkship rotation. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organisation, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. RESULTS: There was overwhelming acceptance of the OSCE in Child Health with respect to the comprehensiveness (90%), transparency (87%), fairness (70%) and authenticity of the required tasks (58–78%). However, students felt that it was a strong anxiety-producing experience. And concerns were expressed regarding the ambiguity of some questions and inadequacy of time for expected tasks. CONCLUSION: Student feedback was invaluable in influencing faculty teaching, curriculum direction and appreciation of student opinion. Further psychometric evaluation will strengthen the development of the OSCE

The ZIKApp for detection of potential arbovirus infections and pregnancy complications in pregnant women in Jamaica: a pilot study

Background: Evidence of the benefits of mHealth technology including symptom tracking Apps for research, surveillance and prevention is growing, including for arboviruses and for pregnancy interventions. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: To evaluate the use of a smartphone app (“ZIKApp”) designed to self-report arbovirus symptoms and pregnancy complications, and to assess compliance with daily symptom diaries until the end of pregnancy in a cohort of women in an arbovirus endemic, subtropical, middle-developing country (Jamaica). Methods: Pregnant women aged 16 and over, having a smartphone, and planning on delivering at the recruiting centre were enrolled from an antenatal clinic in February-July 2020. The ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arboviral infection and/or pregnancy complications that triggered automatic notifications to participants. Socio-demographic, epidemiological and obstetric information was collected at enrolment, with additional review of medical records; and users' perception through an exit survey. Descriptive analyses and logistic regression of possible factors associated with diary adherence were performed. Results: Of 173 women enrolled, 90% (157) used ZIKApp for median duration of 155 days between enrolment and pregnancy end, six used the app for 34 years versus those 25-29 (AOR 3.14 95%CI 1.10-8.98) and two-fold higher odds for women with tertiary versus secondary education (AOR 2.26, 95% CI 1.06-4.83). Of 161 women who ever made a diary entry, a total of 5454 individual symptom reports were made (median 17 per woman, max 278). Nine (5.3%) women reported symptom combinations triggering a “potential arbovirus episode” (none had an adverse pregnancy outcome) and 55 (32.9%) women reported painful uterine contractions, or vaginal bleeding, mainly in the month before delivery. The exit survey showed that 52% (71/137) of women rated the App as an excellent experience and were less likely to be poor diary adherers (p=.04); 138/139 women reported that the App was easy to understand and to use. Conclusions: In the era of telemedicine and mHealth, adherence to the ZIKApp in pregnancy was high. The pilot has demonstrated the feasibility and usability of the App in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arboviral infections in pregnancy and promise for implementation by direct treatment and care teams to optimise maternal care

Antenatal Seroprevalence of Zika and Chikungunya Viruses, Kingston Metropolitan Area, Jamaica, 2017-2019

To determine the extent of exposure to Zika virus (ZIKV) and chikungunya virus (CHIKV) in Jamaica, we collected serum from 584 pregnant women during 2017-2019. We found that 15.6% had antibodies against ZIKV and 83.6% against CHIKV. These results indicate potential recirculation of ZIKV but not CHIKV in the near future