Aims To improve medical outcomes in a RPC by using improved assessments to drive up standards in learning.

Background Basic health indicators in Somaliland are among the worst in the world with high rates of maternal, newborn and child mortality and morbidity and poor immunisation coverage. There is a shortage of qualified healthcare professionals. This is exacerbated by Somaliland not being recognised internationally and therefore excluded from government aid. Hargeisa and Amoud Universities have established Faculties of Medicine with the aim of producing future doctors in Somaliland to address these healthcare issues.

Methods Five UK external examiners (including one paediatrician) travelled to Somaliland to work with the local faculty in implementing OSCE’s to replace traditional clinical exams. Each examiner worked with local faculty in his own specialty in designing the exam and acted as lead examiner in his own subject but also as a station examiner in other subjects.

Outcomes Barriers to implementing the OSCE’s were encountered. Somaliland has few experienced doctors many having fled the civil war. At Amoud University the most senior paediatrician had been qualified for 3 years. Very junior doctors had to be used as examiners and surrogates threatening the validity of the exam. Transport problems meant it was difficult to use out-patients as examination subjects and in-patients were generally too unwell. Local faculty varied in their understanding of the principals of an OSCE some marking generically while others followed the mark scheme rigorously but without considering overall performance. Having to repeat each OSCE three times led to potential and actual breaches in security.

Nontheless an 8 station paediatric OSCE was delivered (2 clinical exam, 2 history, 2 counselling, and 2 unmanned data interpretation and management). The clinical exam and counselling stations demonstrated a good level of discrimination. Of 32 candidates in Hargesia 2 failed and 2 were borderline. Individual candidate’s performance across the 5 OSCE’s showed a high degree of concordance suggesting that the results were valid and reliable. Feedback from candidates was overwhelmingly positive.

Conclusions OSCE’s are deliverable in RPC’s. Ethical and professional behaviour needs reinforcing. Validating medical students’ achievements will encourage further input from key stakeholders.