The viva voce innovation and experience at a new medical school in Rwanda

Traditional preclinical viva voce examinations have faced significant criticism due to inherent biases in their format. We developed a novel format and evaluated students' views and experiences with it.

This study consists of two parts. Part 1 describes the development, implementation and refinement of the preclinical viva voce examination at the University of Global Health Equity, in Rwanda, conducted over a four-year period. Part 2 describes students' perspectives obtained through a self-administered online questionnaire.

Part 1: The viva format features structured questions related to authentic clinical scenarios, that underscore the relevance of basic science knowledge to clinical practice. The examination consists of three oral stations plus one image-based station, which targets subjects that are traditionally difficult to examine like embryology, histology, and histopathology. The examination is vertically and horizontally integrated and provides students with multiple opportunities to demonstrate their knowledge. With four or more rotations of this kind, students are simultaneously examined, improving time efficiency, and reducing performance fatigue normally associated with long waiting times. Real-time scoring and commenting on individual student performances on shared files ensure examiner transparency and accountability, reducing bias. The examination ends with a faculty debrief conference, after which students receive individual feedback on their performance. Challenges encountered include examiner preferences for cases and the need for a substantial number of faculty to concurrently manage the numerous viva stations. Part 2: Students reported finding the viva format stressful but acknowledged its long-term benefits, including ability to foster mental agility, promote clinical reasoning, and improve their verbal communication skills. Compared to MCQ assessments, many students felt it was a better way of assessing knowledge, as it eliminated guesswork. Group discussions were identified as the most effective viva preparation strategy. Many students expressed a desire for more supportive interactions from examiners during the viva. Despite these challenges, there was broad agreement that the viva format should be retained.

The novel preclinical viva format described here enhances the reliability and validity of assessment while providing formative support and early clinical integration. It represents a balanced approach to addressing traditional viva limitations while maintaining educational value.