Medical Students’ Perceptions and Knowledge About Antimicrobial Stewardship: How Are We Educating Our Future Prescribers?

Antimicrobial Resistance (AMR) is an ongoing threat to modern medicine throughout the world. The World Health Organisation has emphasized the importance of adequate and effective training of medical students in wise prescribing of antibiotics Furthermore, Antimicrobial Stewardship (AMS) has been recognized as a rapidly growing field in medicine that sets a goal of rational use of antibiotics in terms of dosing, duration of therapy and route of administration. We undertook the current review to systematically summarize and present the published data on the knowledge, attitudes and perceptions of medical students on AMS. We reviewed all studies published in English from 2007 to 2020. We found that although medical students recognize the problem of AMR, they lack basic knowledge regarding AMR. Incorporating novel and effective training methods on all aspects of AMS and AMR in the Medical Curricula worldwide is of paramount importance.

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Faces of Resistance: Using Real-world Patients and Their Advocates to Teach Medical Students about Antimicrobial Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz487 ◽

2019 ◽

Cited By ~ 1

Author(s):

Priya Nori ◽

Kelsie Cowman ◽

Amanda Jezek ◽

Joshua D Nosanchuk ◽

Magdalena Slosar-Cheah ◽

...

Keyword(s):

Medical Students ◽

Infectious Diseases ◽

Disease Control ◽

Antimicrobial Stewardship ◽

Real World ◽

Response Rate ◽

Control And Prevention ◽

Centers For Disease Control ◽

Patient Stories

Abstract We engaged medical students with antimicrobial stewardship (AS) and resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS and AMR (response rate=139/166, 84%).

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1306. Antimicrobial Resistance Knowledge, Attitudes, and Perceptions Among Medical Students in Southern India

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1139 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S399-S399

Author(s):

Olivia Menden ◽

Sumathi Prabhu ◽

Veena Shetty ◽

Chaithra Pandith ◽

Shobha Giri ◽

...

Keyword(s):

Multivariate Analysis ◽

Medical Students ◽

Antimicrobial Resistance ◽

Infection Control ◽

Antimicrobial Stewardship ◽

World Health ◽

Attitude Score ◽

Major Public Health Problem ◽

Antimicrobial Prescribing ◽

The Mean

Abstract Background Antimicrobial resistance (AMR) is a major public health problem in India. The World Health Organization recognizes that the education of medical students on antimicrobial stewardship plays a critical role in the efforts to combat AMR, but data related to knowledge, attitudes and practices (KAP) regarding AMR is limited in India. Methods This cross-sectional study was conducted in July-August 2017. Medical students at K.S. Hegde Medical Academy in Mangalore, India were surveyed with an anonymous questionnaire using a convenience sampling method involving second year, third year, fourth year, and intern students (n = 347). Data about demographics, sources of information, and antimicrobial training were collected. In addition, AMR knowledge and attitude scores were calculated. A Mann–Whitney U test was used to determine factors that were associated with significant differences in knowledge scores and attitude scores. The primary outcome measure of this study was to determine positive predictors of increased confidence in prescribing antimicrobials in the future using multivariate analysis. Results A total of 347 surveys were analyzed (response rate of 98.9%). The mean total knowledge score was 11.47 out to 31 with a standard deviation (SD) of 3.39, and the mean attitude score was 5.99 out of 16 (SD = 4.207). While 13.2% of students were “very familiar” or “familiar” with the term “Antimicrobial Stewardship,” and 88.2% of students said they would like more antimicrobial education in medical school. On multivariate analysis, female gender (OR 2.51, 95% CI (1.51, 4.18)), clinical vignette antimicrobial knowledge scores (OR 1.26, 95% CI (1.05, 1.51)), positive attitude scores (OR 0.94, 95% CI (0.88, 0.995)), awareness of Infection Control Policy (OR 1.87, 95% CI (1.09, 3.22)), and > 3 years of antimicrobial prescribing clinical training (OR 2.48, 95% CI (1.29, 4.75)) were predictors of confidence in antimicrobial prescribing. Conclusion This study identifies several possible interventions for improving confidence such as increased clinical knowledge through clinical experience, increased awareness of infection control policies and antimicrobial guidelines, and empowering students to be antimicrobial stewards to combat AMR. Disclosures All authors: No reported disclosures.

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977. An Innovative 3-Year Medical Student Spiral Curriculum in Antimicrobial Stewardship and Infectious Diseases

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.093 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S40-S40

Author(s):

Peter Chin-Hong ◽

Arianne Teherani ◽

David Irby ◽

Brian Schwartz

Keyword(s):

Medical Student ◽

Medical Students ◽

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Prescribing Patterns ◽

Similar Proportion ◽

Antibiotic Prescribing ◽

Medicine Clerkship ◽

Spiral Curriculum ◽

Clinical Preparation

Abstract Background By 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns. Methods We designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training. Results Using GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training. Conclusion A spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians. Disclosures All authors: No reported disclosures.

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Increasing the documentation of 48-hour antimicrobial reviews

BMJ Open Quality ◽

10.1136/bmjoq-2019-000805 ◽

2020 ◽

Vol 9 (1) ◽

pp. e000805

Author(s):

Ramandeep Singh Sahota ◽

Kiran Kasper Rajan ◽

Jonathan Mark Sabine Comont ◽

Hyungeun Hans Lee ◽

Nikolina Johnston ◽

...

Keyword(s):

Quality Improvement ◽

Medical Students ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Quality Improvement Project ◽

Junior Doctors ◽

Healthcare Team ◽

Negative Consequences ◽

Improvement Project

Antimicrobial resistance is a growing problem worldwide. Encouraging antimicrobial stewardship can help to reduce the negative consequences of inappropriate antibiotic use. This quality improvement project targets to do this by aiming to improve the proportion of 48-hour antimicrobial reviews completed and documented on two surgical wards at Darent Valley Hospital with a goal of 100% compliance.This project used four PDSA (plan, do, study, act) cycles to achieve our aim: a trust-wide email; education sessions with junior doctors; sticker reminders in patient notes; presenting our study to surgical consultants and displaying posters on the wards.The proportion of antimicrobial reviews completed at 48 hours in the patient notes increased from 18% to 77% over 19 weeks from 10 October 2018 to 20 February 2019. The most successful intervention was providing a presentation for consultants at an audit meeting in conjunction with displaying posters on the wards.The most successful interventions (education sessions with junior doctors and presentation to surgical consultants alongside displaying posters on the wards) were found to be those that required minimal further input after their initial rollout. This project was carried out by medical students and is highly transferrable to other hospitals, and highlighted that a successful quality improvement project can be undertaken by any member of the healthcare team.

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Development of a Multifaceted Antimicrobial Stewardship Curriculum for Undergraduate Medical Education: The ASSURE Elective

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab231 ◽

2021 ◽

Author(s):

Rebecca Wang ◽

Kathleen O Degnan ◽

Vera P Luther ◽

Julia E Szymczak ◽

Eric N Goren ◽

...

Keyword(s):

Medical Education ◽

Medical Students ◽

Undergraduate Medical Education ◽

Antimicrobial Stewardship ◽

Antimicrobial Prescribing

Abstract To address the growing need for dedicated stewardship training in undergraduate medical education, we developed an antimicrobial stewardship (AS) curriculum for medical students with the objectives of increasing expertise in antimicrobial prescribing, introducing AS fundamentals, and enhancing comfort with engagement in interprofessional AS activities.

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Consensus-based antimicrobial resistance and stewardship competencies for UK undergraduate medical students

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa096 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

David McMaster ◽

Molly Courtenay ◽

Catherine Santucci ◽

Angharad P Davies ◽

Andrew Kirby ◽

...

Keyword(s):

Medical Education ◽

Medical Students ◽

Antimicrobial Resistance ◽

Undergraduate Medical Education ◽

Antimicrobial Stewardship ◽

Online Survey ◽

Undergraduate Curriculum ◽

Assessment Tools ◽

Undergraduate Medical Students ◽

The Uk

Abstract Background In the UK there is limited coverage of antimicrobial stewardship across postgraduate curricula and evidence that final year medical students have insufficient and inconsistent antimicrobial stewardship teaching. A national undergraduate curriculum for antimicrobial resistance and stewardship is required to standardize an adequate level of understanding for all future doctors. Objectives To provide a UK national consensus on competencies for antimicrobial resistance and stewardship for undergraduate medical education. Methods Using the modified Delphi method over two online survey rounds, an expert panel comprising leads for infection teaching from 25 UK medical schools reviewed competency descriptors for antimicrobial resistance and stewardship education. Results There was a response rate of 100% with all 28 experts who agreed to take part completing both survey rounds. Following the first-round survey, of the initial 55 descriptors, 43 reached consensus (78%). The second-round survey included the 12 descriptors from the first round in which agreement had not been reached, four amended descriptors and 12 new descriptors following qualitative feedback from the panel members. Following the second-round survey, a total of 58 consensus-based competency descriptors within six overarching domains were identified. Conclusions The consensus-based competency descriptors defined here can be used to inform standards, design curricula, develop assessment tools and direct UK undergraduate medical education.

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2023. Antimicrobial Resistance and Stewardship Knowledge and Perception among Medical and Pharmacy Students in Nigeria

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1703 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S679-S679 ◽

Cited By ~ 1

Author(s):

Chukwuemeka Michael Ubaka ◽

Natalie Schellack ◽

Benedict Nwomeh ◽

Debra A Goff

Keyword(s):

Medical Students ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Pharmacy Students ◽

Professional Collaboration ◽

Cross Sectional ◽

Change Perceptions ◽

Study Results ◽

The Subject ◽

Populous Country

Abstract Background Nigeria is the most populous country in Africa and has high rates of antimicrobial resistance (AMR). The practice of antimicrobial stewardship in Nigerian hospitals is very limited and the subject is rarely included in undergraduate medical and pharmacy curriculums. To further acceptance and implementation of antimicrobial stewardship programs (ASP) in Nigeria health system, baseline measurements of the knowledge and perceptions held by graduating medical and pharmacy students was deemed essential. This study evaluated the knowledge and perceptions of a cohort of Nigerian medical and pharmacy students in concepts of AMR and ASP. Methods This was a cross-sectional questionnaire-based study of final year medical and pharmacy students from the two largest schools in the southeastern region of Nigeria. A previously published 20-items questionnaire measuring knowledge and perceptions toward AMR and ASP was adopted for the study. Results were expressed as frequencies and percentages. Results Completed questionnaires were received from 79.3% (361 of 455 students), over half (60%) were male, and mostly between 22 and 25 years old (68.7%). More pharmacy students had formal training on ASP compared with medical students (41.3% vs. 27.5%, P < 0.05). Pharmacy students (n = 84.3% and 90.5%) were significantly more knowledgeable of factors that promote the spread of AMR and interventions to combat resistance than medical students (n = 73.9% and 82.3%), P < 0.05, respectively. Interestingly, 23.3% of medical students thought pharmacists should lead ASP teams, while 5.8% of pharmacy students thought doctors should lead ASP. However, both held poor perceptions of each other’s roles in the ASP team. Conclusion Knowledge of AMR and ASP among medical and pharmacy students in Nigeria is lacking. Inter-professional collaboration to change perceptions and drive ASP in urgently needed. Disclosures All authors: No reported disclosures.

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Knowledge, perception and attitude of under-graduate and post-graduate medical students about antimicrobial use, resistance and stewardship at a tertiary care teaching hospital in rural Telangana, India

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20190087 ◽

2019 ◽

Vol 8 (2) ◽

pp. 193

Author(s):

Jayaram Chundru ◽

Shailendra D. ◽

Rahul R. Tirumalareddy ◽

Harsha Kumari ◽

Vishal P. Kovilakonda

Keyword(s):

Medical Students ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antimicrobial Agents ◽

Tertiary Care ◽

Good Knowledge ◽

Fisher Exact Test ◽

Antimicrobial Use ◽

Online Questionnaire ◽

Cross Sectional

Background: Inappropriate antimicrobial use contributes to antimicrobial resistance. Assessing knowledge, perception and attitude regarding antimicrobial use serves as a prelude to design and implement educational modules to promote rational antimicrobial use.Methods: An online questionnaire based cross-sectional study involving 338 medical students; under-graduates, interns and post-graduates was conducted in a medical college in south India. Chi-square test or Fisher exact test were used to determine association between variables.Results: Fifty percent of the participants (170/338) responded to the questionnaire. The responses were similar across undergraduates, interns and post-graduates. Majority of the responders had good knowledge regarding use of antimicrobials. Most of the participants (92.35%) expressed that a broad-spectrum antimicrobial should be started to treat a serious infection while awaiting culture and sensitivity reports and 88.82% did not prefer to use antimicrobial agents for common cold. Similarly, most of the respondents (93.56%) were aware of the fact that antimicrobial resistance is a global problem. However, many of them (74.71%) were not aware of antimicrobial stewardship programme in their college.Conclusions: This study revealed that most of the students had good knowledge, fair perception and positive attitude regarding the use of, and resistance to antimicrobial agents but not about stewardship programmes. Proactive measures are required to sensitise medical students on antimicrobial stewardship programmes.

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