A randomized matched-pairs study evaluating a hybrid, structured skills course for clinical officers in Tanga, Tanzania

  • Rajan Bola
  • Badria Mushi
  • Lucheri Kweka
  • Ronald Lett
Keywords: clinical officers, COVID-19, Fundamental Interventions, Referral and Safe Transfer (FIRST) course, objective structured clinical examination (OSCE), Tanzania


Background: A hybrid training programme for the Fundamental Interventions, Referral and Safe Transfer (FIRST) course was conducted because of the COVID-19 pandemic to prepare clinical officer students for the FIRST OSCE. The course occurred in Tanzania with in-person instruction, while a Canadian team lectured remotely. This study determined the effectiveness of the hybrid course by comparing OSCE performance between students who did and did not take the course. Student and instructor feedback on the virtual portions of the FIRST course were also evaluated.

Methods: Clinical officer students were matched in pairs based on age, sex, work experience, and school performance. One student from each pair was assigned to take the hybrid course (intervention), while the other did not (control). Both groups of students took the OSCE, and their performance was scored. The FIRST course was provided to the control group after the OSCE. Both groups then completed precourse and postcourse surveys to identify successes and challenges with conducting the course. Analyses were based on descriptive statistics, as well as paired t-test and Wilcoxon signed-rank test analysis.

Results: The 22 students in the intervention group outperformed the 22 control students (P<0.001). The intervention group’s mean score was 39/50, compared with 27/50 for the control group. The hybrid FIRST course successfully prepared students for all OSCE skills. There was no difference between the 2 groups in terms of performance on written quizzes. The survey response rate was 77%. Almost all students (94%) believed the course would help them provide better patient-centred care. Overall, 88% of the students recommended that the college continue teaching the hybrid FIRST course.

Conclusions: COVID-19 has prompted adaptation. We demonstrated that hybrid courses are feasible and effective strategies for providing future clinicians with the skills needed for patient-centred care, during and potentially even after the resolution of the COVID-19 pandemic.

Original Research