Conditions Of Extreme Poverty Research Articles

Re-examining extreme poverty before and after the transition to capitalism, 1300s–1900s: the issue of definition, periodization, measurement, and causal responsibility

ABSTRACT The ‘standard narrative’ about capitalism and extreme poverty holds that the transition to the former was associated with a staggering reduction of the latter. Recently, this has been strongly called into question by a critical narrative grounded in a battery of non-GDP-based measures of extreme poverty and living standards, such as subsistence welfare ratios, skeletal height data, and famine reports. This critical narrative holds that extreme-poverty conditions were + rare in normal circumstances before the transition to capitalism, and that a significant deterioration amounting to extreme poverty happened in Europe and globally only afterwards. The present paper re-examines the issue, drawing on these and additional non-GDP-based historical sources of living standards, including formerly overlooked cases, such as pre-conquest Aztec Empire and Tokugawa-era Japan. It finds that the standard narrative’s portrayal of the prevalence of extreme poverty before capitalism is indeed mistaken. However, it also takes issue with parts of the critical narrative, mainly the idea that capitalism caused severe deterioration in living standards. On a widely shared definition of capitalism, and a quantitatively demonstrated periodization of the transition, the notion that living standards were generally poor before a society’s transition to capitalism and only started systematically improving afterwards has better support.

Types, determinants, and outcomes of entrepreneurial behaviours during crises

ABSTRACT Entrepreneurs usually have several means at their disposal to deal with and overcome adverse circumstances, ranging from simple non-resourceful coping strategies to more elaborate resourceful behaviours. However, entrepreneurs who find themselves in conditions of prolonged adversity and disadvantage have few effective possibilities to withstand sudden adversity such as crises and income shocks. Based on these premises, we develop theory on the types, antecedents, and outcomes of entrepreneurial responses to adversity by investigating how entrepreneurs living in conditions of extreme poverty may behave resourcefully while facing two major crises in a short timeframe. Through an analysis of entrepreneurship in South-West Cameroon, we identify three behaviours entrepreneurs enact in response to crises: passive, hustling, and future-oriented, which differ with regards to activities, driving motivations, main objectives, approaches towards present and future adversity, and dominant focus concerning the use of resources. We also find that entrepreneurs’ enacted behaviours depend chiefly on the nature of the losses they incur and on the type of social capital they can avail of in the aftermath of a crisis. Lastly, we suggest that the different behaviours result in further changes in the entrepreneurs’ resource levels, which subsequently influence the likelihood that entrepreneurs will shift between behaviours.

Evaluating the effect of individual characteristics and COVID‐19 pandemic on people living under extreme poverty conditions in Greece

AbstractPoverty dimensions and COVID‐19 are risk factors for a low quality of life and anxiety. The aims of this study are to: (a) examine the quality of life and anxiety levels of citizens living under poverty and (b) explore whether this population's characteristics shaped the way the pandemic affected their anxiety and quality of life. Data were collected from two groups, each one consisting of 50 citizens of the Attica region of Greece who live in poverty. The first wave was collected in 2019 and the second in 2021. The same information was collected in both waves, including individual characteristics, quality of life dimensions, and anxiety traits. Both sample groups were receivers of “TEBA,” a social solidarity allowance for people living in poverty in Greece. Specific individual characteristics were more strongly associated with better quality of life and different anxiety levels during the COVID‐19 pandemic. The results offer potential insights into specific sociodemographic characteristics which are strongly associated with quality of life and/or anxiety, factors which are being constantly affected by the poverty phenomenon.

Indigenous communities and climate-related hazards: A protocol for a systematic review

As reported by World Bank figures, in 2020, there were about 476 million indigenous people living in more than 90 countries around the world. They represented more than 6 % of the world's population. Approximately 15 % of these indigenous people lived in conditions of extreme poverty, facing economic disparity and chronic vulnerability [36]. This review analyzes the risks faced by indigenous communities due to climate change and their perception of risk. Hazards are identified in different regions, considering direct and indirect impacts on territories, resources and ways of life.

INTELLECTUAL IMPAIRMENT AND EXPERIENCE OF EXTREME POVERTY IN A SINGLE PARENT FAMILY (CASE STUDY IN THE REPUBLIC OF MOLDOVA CONTEXT)

The article analyzes the issue of family resources in a family with a single father with mental retardation raising two adolescents in conditions of extreme poverty. The research methodology is based on the model of case study qualitative research within the phenomenological “life world” approaches. The study has an entire description of the father’s “life world” and the structural, constituent, and essential elements of his day-to-day parenting experience. It is shown that the family experience is struggling with extreme poverty within the conditions of severe social exclusion and is governed by the father's family history with a class nature. Current family resources (health, education, social, and economic) are characterized as being affected by different types of deficiency and dependence on external “donors”. The discussion is raising awareness of the role of special education in the process of structuring essential elements of the “life world” experience in such families, in general, and conditions of extreme poverty, in particular.

Validation of a methodological model to incubate successful agribusinesses in marginalized areas from South Mexico

Given the situation of poverty and marginalization in which most of the communities in the rural areas of the Mexican South Southeast are found, a situation that affects 17 million people classified as in a situation of extreme poverty, agribusiness is an alternative under these conditions for it. An operational and practical methodology is required that allows a good identification and implementation of initiatives according to the situation and the environment. The objective of this work was to validate an operational methodological model called model for the competitiveness of small farmers in extreme poverty based on agribusiness. The validation project was developed in four pilot communities in the Mexican South Southeast considered to be highly marginalized and poor: San Andrés Tuxtla, Veracruz; Tahdziu, Yucatan; Ocotepec, Chiapas and San Jerónimo Taviche, Oaxaca. The applied model consists of four stages, diagnosis, incubation, development and maturity. The diagnosis considered in turn two sub-stages, one on the description of the environment and the actors and the second on the definition of the portfolio of opportunities. The incubation considered the sub-stages of prioritization through a qualification criteria and the business plan itself according to the conditions of the actors and the environment. The development stage is nothing more than the start-up and consolidation of the business with a view to continuous improvement. The results obtained were four agribusinesses in progress, one for each pilot community, with profitability indicators such as the Internal Rate of Return (IRR) of 35.0%, 100.0%, 41.0% and 45.9% for jam production in San Andrés Tuxtla Veracruz, Stevia production and marketing in Tadhziu Yucatán, Hass avocado production and marketing in San Pablo Huacanó Chiapas and tomato production and marketing in greenhouses in San Jerónimo Taviche Oaxaca, respectively. The operational methodological model to identify and develop agribusiness in poor and marginalized communities was successfully validated. It is concluded that it is possible to develop profitable and competitive agribusiness in conditions of extreme poverty and marginalization.

Protocol for a systematic review of the evidence-based knowledge on the distribution, associated risk factors, the prevention and treatment modalities for noma

Introduction: Noma (cancrum oris) is a devastating opportunistic infection resulting in severe tissue destruction that affects mouth and oro-facial structures. There are substantial gaps in our current knowledge and understanding of its aetiology, pathogenesis, prevention and treatment efficacy, as well as its distribution and burden. Although observed worldwide, the disease impacts the most vulnerable and marginalised populations, and is most reported in young children from sub-Saharan Africa. Noma often presents alongside conditions of extreme poverty, malnutrition and poor environmental sanitation. This protocol paper outlines the methodology for a systematic review planned to exhaustively synthesize the findings of the available noma literature. The project aims to generate an account of the present state of knowledge about the various aspects of noma to aid in framing effective strategies and interventions to curb this disease which disproportionately afflicts the poorest in society. Methods and analysis: The following databases have been searched by a medical librarian from database inception to 7 December 2022: OVID (MEDLINE/ Embase/ CAB abstracts/ Global Health), Scopus, Web of Science, African Index Medicus, African Journals Online: Health, French language search: Pascal, ClinicalTrials.gov, and WHO ICTRP. All primary research studies reporting on patients of any age diagnosed with noma will be eligible for inclusion in the review, including clinical trials, cohort studies, case-control, cross-sectional, other observational studies, case studies and case series. Data will be extracted from included studies to analyse the current evidence-based knowledge on the distribution, risk factors, microbiology, prevention and treatment modalities, and outcomes of noma. Ethics and dissemination: Results of this systematic review will be published in a peer-reviewed journal upon completion. PROSPERO Registration: CRD42019124839 (08/03/2019)

Some elements of political economy in the thought of Sir John Fortescue

This paper focuses on Fortescue’s analysis of the economic impact of various forms of government, based on a comparison between the material well-being which the English enjoy by virtue of their “political kingdom” and the conditions of extreme poverty of the common people in France, an effect of their political-legal system. Fortescue’s criteria for judging between different regimes are pragmatic: the main reason for his preference for the temperate monarchy of England is the fact that it gives all inhabitants full enjoyment of the fruits of their labour, and encourages the economic growth of all parts of the realm.

Children Rights to ‘Zero Hunger’ and the Execution Challenges during the COVID-19 Crisis

‘Zero hunger is the world’s pledge under the Sustainable Development Goals 2030, which aims to end hunger, achieve food security and improve nutrition. Nevertheless, the mission had been seized as the world faced economic turndown due to the outbreak of the COVID-19 virus. The circumstances have brutally affected society’s ideal living standards and raised social problems such as extreme poverty, famishment, malnutrition, and medical conditions, specifically among vulnerable children. The essential purpose of this writing is to elucidate the ‘zero hunger goal as one of the central legal rights and identify challenges in executing it during the COVID-19 crisis. Data were collected through library studies and analyzed critically using the content analysis method. The writing finds that the progress of zero hunger is decelerated as the pandemic has caused few challenges. The paper concludes that all objectives under the SDG 2 are significant to be achieved to ensure vulnerable children’s survival. Thus, the paper recommends that humanitarian relief assists with food distribution among those in dire need, especially at-risk children. Furthermore, food and agricultural production must be maintained to guarantee enough food supply chain. Ultimately, every government must comply with SDG 2, specifically for the benefit of vulnerable children.

Influence of Social Determinants of Health on COVID-19 Infection in Socially Vulnerable Groups.

The coronavirus 2019 (COVID-19) pandemic has had a significant impact on the economy and health, especially for the most vulnerable social groups. The social determinants of health are one of the most relevant risks for becoming infected with COVID-19, due to the health consequences for those who are exposed to it. The objective of this study was to analyze the influence of social determinants in health on COVID-19 infection in vulnerable social groups. A transversal epidemiological study was carried out on 746 individuals in vulnerable situations living in conditions of extreme poverty in disadvantaged areas in the province of Almeria (southeast of Spain). Social determinants of health such access to drinking water (p < 0.001) and economic income (p = 0.04) influenced the infection of COVID-19. A binary logistic regression model showed that the significant predictors of COVID-19 infection were the lack of economic income and inaccessible drinking water. The government and social health services must be aware of this problem in order to play an active role in searching for solutions and implementing public health prevention measures to eliminate social inequalities in health.

Sub-national water–food–labour nexus in Colombia

Poorer countries often face a severe trade-off: the need to improve socio-economic conditions is hard to balance with the maintenance of key ecological processes. As a case study, we select Colombia, a Latin American country with almost 10% of its inhabitants living in extreme poverty. We elaborate a water–food–labour (WFL) nexus grounded on a sub-national Environmentally Extended Input–Output (EEIO) analysis to assess the virtual water trade (VWT) and virtual informal labour (VIL) flows across administrative departments and economic sectors related to domestic trade. The main results are the following: high cross-departmental resource interdependence both in terms of VWT and VIL, rich departments highly depend on the resources of their neighbouring trading partners, extreme poverty conditions shown by economically isolated departments, and considerable income inequality in the food production sectors. Moreover, departments that are net exporters of virtual water suffer from water stress that might be exacerbated by future high rainfall variability due to climate change. These results suggest that strategies to attain sustainable development goals (SDGs) must deal with the biophysical constraints and the economic and political feasibility of the proposed solutions. In this vein, we argue that a holistic framework, grounded on quantitative analyses, is necessary to support informed policy decisions for the simultaneous achievement of multiple (possibly contrasting) goals. Moreover, severe spatial imbalances call for local policy responses coordinated at the national level.

A Struggle for Survival: Meaning of Late Life in a Rural District in Uganda: A Qualitative Study.

Background: Between 2015 and 2050, the aging population of Uganda (aged 50 years and older) will be nearly doubled. Therefore, later-life problems have become an area of increasing research and policy interest. This study aimed at exploring how aging people living in extreme poverty in a low-income country experience their everyday life and what kind of meaning systems employed by them to understand and cope with their living conditions.Methods: We conducted a qualitative interview with 14 participants in the Buikwe district. In this interview, 11 women and 3 men were included, and a thematic analysis was employed for data processing and analysis.Results: Unanimously, all participants reported their condition as extreme poverty. The key informants (KIs) emphasized respect from descendants and the community as a foundation for a meaningful later life. In contrast, this aspect has been ever mentioned by no caregivers but by only one care-receiver. The willingness/ability of children to support the elderly who are in need of support formed a major part of the reflections of care-receivers, which would be decisive for their position in the society and the respect they would receive. In addition, both Christianity and traditional beliefs as well as beliefs in witchcraft and ancestral spirits were employed as a basis for actions and reflections.Discussion: The question arises whether life in extreme poverty conditions can be perceived as meaningful. Respect was mentioned as fundamental by the KIs, thereby giving priority to social relations as the most meaningful factor for living a meaningful life. The ability and willingness of the possible descendants for support as the focus of care-receivers might be a more down-to-earth description of this aspect but without using the same level of abstraction. For the majority, due to their belief system did not serve as a source of consolation their main focus was on social relationships for support. To improve the wellbeing of the old people, their sense of meaning must be restored through a system, guaranteeing the coverage of basic needs and measures to restore dignity through a reintegration in both community and congregations. Social service agencies who are targeting the elderly people need to work toward this objective.

Operating in quicksand: dark sides of informal entrepreneurship in extreme poverty contexts

Literature on informal economy largely debated on the positive role of informal entrepreneurs toward poverty alleviation in developing countries. However, such contexts are characterized by extreme poverty conditions with institutional voids and resource constraints that affect the entrepreneurial operations. While scholars documented why informality persists in developing countries, and what lead informal entrepreneurs to avoid the transition to formal economy, we currently miss the mechanisms by which informal entrepreneurs can effectively operate in contexts of extreme poverty. Our paper addresses this gap through a qualitative research based on 58 informal entrepreneurs in Uganda and Ghana. We discovered that informal entrepreneurs operate through practices of embeddedness in community to get necessary resources and creating informal institutions to fill institutional voids. However, such entrepreneurial practices generate also dark side effects, which also reinforce each other in a cross-bracing mechanism. We then theorized such dynamic of a cross-braced interplay between community embeddedness and informal institutions revealing how informal entrepreneurs are trapped in operating in a ‘quicksand’, which is the main cause of persistence in poverty condition. With our paper, we contribute to the literature on informal entrepreneurship in extreme-poor contexts, and especially we extend literature on the entrepreneurial processes which lead entrepreneurs to persist in informality. Future research and limitations are offered as well.

Understanding resilience: Lessons from lived experiences of extreme poverty in Bangladesh

AbstractMotivationA large donor‐funded programme in Bangladesh implemented multiple measures designed to graduate individuals and households out of extreme poverty. The programme was committed to lesson learning and advocacy. It monitored change through socioeconomic surveys, qualitative tracking methods, real time assessment and project evaluations. The qualitative tracking in particular shed light on the nature of extreme poverty and resilience.PurposeIs extreme poverty different from moderate poverty, and in what ways? Do the extreme poor experience more idiosyncratic poverty than structural or systemic poverty? Are the extreme poor more likely to be women and girls more socially isolated and marginalized due to their gender, thus impeding their capabilities? What support is needed to enable recovery and transformation from crises?Approach and methodsBetween 2011 and 2015, 72 life histories of households enrolled in a major poverty reduction programme were conducted, entailing repeated ethnographical engagement with informants. This showed how most households experience ups and downs in their poverty and vulnerability through time: an experience at variance with static understandings of hazards and responses. The limitations of resilience literature are thus critiqued to develop a new theory around time preference behaviour and discounting.FindingsExperiences of extreme poverty are not solely a function of systemic, class‐based inequality, but of the varied and reinforcing ways they intersect with idiosyncratic conditions of household life cycles, dependency ratios, gender and age balance, morbidity, ethnic discrimination and social isolation. Four key factors stand out as influencing deep poverty: (a) ill health, with significant internal opportunity costs; (b) intergenerational reproduction; (c) high incidence of female‐managed and ‐headed households, resulting from male desertion; and (d) a lack of income diversity and security.Policy ImplicationsOur findings provide fresh insights into policy responses to extreme poverty. These insights suggest a policy shift away from a narrow concern with graduation to a wider focus on resilience. Resilience as a poverty reduction outcome requires interventions that support individuals (micro level), target the intergenerational reproduction of poverty (meso level), and engage with wider power structures that exploit and neglect poor people (macro level). Policy‐makers need to engage more explicitly with the meso and macro levels in particular, recognizing how the three levels converge to reproduce conditions of extreme poverty.

El uso de internet en mujeres emprendedoras de zonas marginadas del sureste de México

El emprendedurismo favorece el desarrollo endógeno de las comunidades indígenas, ya que mejora su calidad de vida, fortalece sus competencias, evita la migración, promueve el desarrollo sostenible, contribuye a la preservación del patrimonio cultural y favorece su inserción en la sociedad de la información y del conocimiento. En México, se ha constituido como uno de los temas prioritarios para el desarrollo económico del país; sin embargo, a pesar de los esfuerzos llevados a cabo por los gobiernos federales y estatales de la nación, todavía se observan serias dificultades para la participación de las mujeres rurales en este rubro. Por ello, en este trabajo se llevó a cabo un estudio cuantitativo en el que participaron 92 mujeres emprendedoras que se encontraban en zonas sociales y económicamente marginadas o de condiciones de pobreza extrema. En concreto, las participantes residían en tres sectores del interior del estado de Yucatán, en el sureste de México, y se dedicaban a la fabricación artesanal de ropa, alimentos, adornos para el hogar y juguetes. Los resultados muestran que solo 38 % cuenta con servicio de internet y que la mayoría tiene poco entrenamiento para usarlo; además, su costo es elevado. Entre las razones para no contar con internet en el hogar se pueden mencionar el que no exista conexión en el municipio (52 %) y el que ellas no lo consideren necesario (43 %). Asimismo, se puede indicar que usan internet principalmente para ver películas, tomar fotos y escuchar música, así como para revisar el correo electrónico; de hecho, solo 13 % sabe usar un programa de contabilidad para su negocio.

Thinking of Biko in the time of Covid-19

The Covid-19 pandemic has presented serious questions; not only of a medical-scientific nature, but of a deeply philosophical nature as well. Often, when faced with the unknown—whether in the form of an environmental catastrophe or a general health threat—finding effective ways to overcome our fear of the unknown yields important clues regarding not only the nature of our self-understanding as human beings, but also our all-too-human perceptions of Other(s). While the impact of the Covid-19 pandemic has been especially harsh on people living in conditions of extreme poverty and material deprivation, our collective response has (predictably) proceeded from a position that privileges the interests and lifestyles of the rich, the well-resourced and the politically connected, in a manner that sadly confirms the biblical prophecy: the poor will always be among you. This essay seeks to examine the impact of Covid-19 in South Africa. Its analytic focus proceeds from the perspective of Steve Biko’s conception of Black Consciousness philosophy. It seeks to argue that Biko’s humanist project of liberation offers important insights that can assist us in the normative quest for a society “with a more human face.”

Barriers to the growth of micro tailoring businesses in Nigeria: assessing socio-economic and socio-cultural environments

Purpose The purpose of this study is to uncover ways to enhance the growth of micro tailoring businesses by assessing the socio-economic and socio-cultural environments at the bottom of the pyramid (BOP). Design/methodology/approach The study used a qualitative research design involving a multiple case study with data from semi-structured interview and non-participant observation. Findings The study reveals how micro tailoring businesses modify tailoring practices to cope with the religious practice of seclusion and use entrepreneurial actions to deal with unstable electricity, inadequate finance and conditions of extreme poverty that limit the growth of micro tailoring businesses at the BOP. Research limitations/implications The qualitative nature of this study with a focus on micro tailoring businesses in BOP context could limit the generalization of findings. However, replication of the study can be done in other contexts to validate the findings. Practical implications The study shows the need for entrepreneurial leadership which continually modifies tailoring practices in ways that sustain tailoring businesses and circumvent the possibility of failure in adverse socio-economic and socio-cultural conditions. Originality/value This study is the first to unravel the experiences of micro tailoring businesses at the BOP. Past studies have assessed barriers to the growth of small and medium scale enterprises in general, but this study uncovers the distinct aspects of tailoring business in a largely under-researched context.

Yerel Yönetimlerin Yoksullukla Mücadeledeki Yeri: Küresel Düzeyden Yerel Düzeye Yeni Yönelimler

The United Nations Development Program (UNDP) estimates that around one billion people worldwide live under conditions of extreme poverty with under one dollar per day, cannot meet their basic human needs, and that at least one billion people live in relative poverty. This means more than one third of the world’s children are malnourished, more than 840 million adults, including more than half women, are illiterate and 1.2 million live without access to safe drinking water. This painful picture of global poverty clearly demonstrates that poverty has become a more chronic problem than ever before. Due to this situation, local governments have become more involved in the struggle against poverty recently. As a matter of fact, for various reasons, local governments can take an active role in the fight against poverty. However, local governments often lack data and information to identify causes of poverty, prioritize interventions, or target specific groups of the poor. Previously ignored by central planning, local governments have had little experience in the preparation and implementation of development plans. Inadequate delegation of power, disproportionate allocation of resources, or poor coordination between sectors further limited the capacity of local authorities to meet local needs. Limited downward accountability also limited the action of the political will of the newly authorized authorities. In short, local governments and local interventions have not been able to gain the deserved place and power in effective anti-poverty policies for a long time, but where they can play a more effective role in contemporary anti-poverty policies all over the world.

Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of...

Introducing the Objective Structured Clinical Examination in Haiti.

Haiti, a nation of approximately 10.7 million people located in the western Caribbean,1 is a low-income country, with 59% of its population living below the poverty line (less than $2.41 per day), and 24% living in conditions of extreme poverty (less than $1.23 per day).2 Haiti has a history of political instability and natural disasters, and remains the country with the highest rate of poverty in the Americas.2The health care system in Haiti is regulated by the Ministry of Public Health and Population (MSPP). MSPP is under-resourced, spending only US $13 per person on health care each year. This represents a mere 6.1% of the national budget, and is significantly less than its neighboring countries of Cuba (US $781) and the Dominican Republic (US $180).3Six universities in Haiti offer degree programs in medicine. Upon graduation, medical school graduates are required to complete 1 year of social service, and then can practice medicine independently or apply for entrance into one of Haiti's 37 residency programs.Zanmi Lasante (ZL), a sister organization to Boston, Massachusetts-based Partners In Health, in partnership with MSPP, offers 1 residency program at Hospital St. Nicolas (HSN) in Saint-Marc and 5 programs at Hôpital Universitaire de Mirebalais (HUM) in Mirebalais. The programs that have been accepted are in the preapproval phase with the Accreditation Council for Graduate Medical Education International (ACGME-I).As part of its system of assessment in 2015, we introduced the objective structured clinical examination (OSCE) in the family medicine residency program at HSN, with the help of 2 Canadian fellows who volunteered in Haiti. Faculty members were trained on the new technique and were given opportunities to practice their new skills. These “pioneers” then trained other faculty at HUM. Although widely used in high-income countries, ZL was the first institution in Haiti to use the OSCE.The OSCE is a group of tests that includes a succession of stations with simulated clinical problems, involving standardized patients or mannequins, that learners need to solve in a limited time. Each station has clearly defined objectives, and a checklist for the evaluation of the candidates.4 It is considered the gold standard for evaluating clinical competencies, including the physician-patient relationship, the physical examination, and interpersonal and communication skills (box).4In 2016, the Director of Graduate Medical Education at ZL implemented an OSCE as a pre-assessment tool during the orientation month at the start of postgraduate year 1 (PGY-1). Based on this positive experience, the Graduate Medical Education Committee (GMEC) voted to implement the OSCE as part of the recruitment process for all ZL programs. In 2017, we conducted the first OSCE session during recruitment, with 90 candidates who aspired to enter 1 of the 6 ZL residency programs.Each session consisted of 4 themed stations with different objectives and a break station. The duration of each station was 10 minutes. The OSCE was scored by faculty, the training and research department director, and representatives from the school of medicine.The OSCE was a new evaluation tool for medical educators in Haiti, and implementation faced challenges. We needed to train faculty and the standardized patients (SPs). Because of a lack of funds, we used medical students and residents as SPs. The use of medical students as SPs was helpful in multiple ways, allowing the students to learn clinical portrayal and trainee performance. Candidates and student SPs were nervous at first, but by the end of the day, all said they had benefited from the experience.We are currently testing the OSCE as an evaluation tool in 2 residency programs (anesthesiology and pediatrics), and we intend to implement it in all ZL residency programs.