Educational antimicrobial stewardship programs in medical schools: a scoping review.
Journal
JBI evidence synthesis
ISSN: 2689-8381
Titre abrégé: JBI Evid Synth
Pays: United States
ID NLM: 101764819
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
pubmed:
16
8
2021
medline:
2
2
2022
entrez:
15
8
2021
Statut:
ppublish
Résumé
The objective of this scoping review was to identify the available evidence on antimicrobial stewardship programs for teaching medical students about rational antimicrobial use, including the content taught and the method of instruction used. Antibiotics are a precious resource whose discovery have saved millions of lives. They are used extensively in surgical procedures, cancer chemotherapy, and in the treatment of infectious diseases. However, the development of antimicrobial resistance and the slow rate of discovery of new agents with novel mechanisms of actions represent a threat to modern medicine. This scoping review considered papers that described medical school curricula that focused on the teaching and learning of the prescription of antimicrobial medication. Studies that described this concept in the curricula of other health profession students, such as nursing, pharmacy, or dentistry students, were excluded. The JBI three-step process was followed and conducted by two reviewers. The scoping review followed an a priori published protocol. Eight databases were searched for both published and unpublished literature and gray literature. Only studies published in English from 1996 onwards were included. Full texts of selected citations were assessed against the inclusion criteria by two independent reviewers. Data were independently extracted by two reviewers. Disagreements were resolved through discussion, and the need for a third reviewer was not required. Data extraction was undertaken using a modified charting table developed for the review objectives. The findings are presented using the narrative synthesis. Thirteen studies were included in the review, with most of the papers originating from the United States of America and Europe, with one from developing countries. Didactic lectures and web-based distance learning were the most common modes of instruction used in the included papers. Six of the included papers presented the outcomes of their interventions; different methods of assessment were used to evaluate students, which included baseline and post-instruction assessment or a series of short exams. Some of the concepts in the teaching material included the use of antimicrobial agents, prevention of antimicrobial resistance, antimicrobial stewardship, and infection prevention control. The programs (ranging from 75 minutes to 100 hours) were implemented from second to fourth year of study. A wide range of interventions were used to teach the principles of antimicrobial stewardship to medical students. There is a need to further evaluate these programs through follow-up of students after graduation to determine whether the skills learned are retained.
Identifiants
pubmed: 34392265
doi: 10.11124/JBIES-20-00330
pii: 02174543-202111000-00002
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
2906-2928Informations de copyright
Copyright © 2021 JBI.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Wake Forest School of Medicine, CDC, Association of American Medical Colleges. Get smart about antibiotics: an antibiotic stewardship curriculum for medical students [internet]. n.d. [cited 2020 Mar 14]. Available from: https://school.wakehealth.edu/Departments/Internal-Medicine/Infectious-Diseases/CAUSE/Antimicrobial-Stewardship-Curriculum.
World Health Organization. WHO global strategy for containment of antimicrobial resistance [internet]. 2001 [cited 2020 Mar 19]. Available from: https://www.who.int/drugresistance/WHO_Global_Strategy_English.pdf.
Tamma PD, Cosgrove SE. Antimicrobial stewardship. Infect Dis Clin 2011;25 (1):245–260.
Laks L, Guerra CM, Miraglia JL, Medeiros EA. Distance learning in antimicrobial stewardship: innovation in medical education. BMC Med Educ 2019;19 (1):191–199.
Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62 (10):e51–e77.
Baur D, Gladstone BP, Burkert F, Carrara E, Foschi F, Döbele S, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017;17 (9):990–1001.
Dellit TH, Owens RC, McGowan JE, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44 (2):159–177.
Ohl CA, Luther VP. Health care provider education as a tool to enhance antibiotic stewardship practices. Infect Dis Clin 2014;28 (2):177–193.
Davey P, Brown E, Charani E, Fenelon L, Gould IM, Holmes A, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.
Pulcini C, Gyssens IC. How to educate prescribers in antimicrobial stewardship practices. Virulence 2013;4 (2):192–202.
Luther VP, Ohl CA, Hicks LA. Antimicrobial stewardship education for medical students. Clin Infect Dis 2013;57 (9):1366–1367.
Melber DJ, Teherani A, Schwartz BS. A comprehensive survey of preclinical microbiology curricula among US medical schools. Clin Infect Dis 2016;63 (2):164–168.
Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: how are we educating our future prescribers? Clin Infect Dis 2013;57 (5):631–638.
Dyar OJ, Pulcini C, Howard P, Nathwani D. on behalf of ESGAP (ESCMID Study Group for Antibiotic Policies). European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother 2014;69 (3):842–846.
Minen MT, Duquaine D, Marx MA, Weiss DA. Survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist 2010;16 (4):285–289.
Wasserman S, Potgieter S, Shoul E, Constant D, Stewart A, Mendelson M, et al. South African medical students’ perceptions and knowledge about antibiotic resistance and appropriate prescribing: are we providing adequate training to future prescribers? S Afr Med J 2017;107 (5):405–410.
Hsu JL. Building an antibiotic stewardship program: an interactive teaching module for medical students. MedEdPORTAL 2018;14:10726.
MacDougall C, Schwartz BS, Kim L, Nanamori M, Shekarchian S, Chin-Hong PV, editors. An interprofessional curriculum on antimicrobial stewardship improves knowledge and attitudes toward appropriate antimicrobial use and collaboration. Open Forum Infect Dis. 2017:ofw225.
Nori P, Madaline T, Munjal I, Bhar S, Guo Y, Seo SK, et al., editors. Developing interactive antimicrobial stewardship and infection prevention curricula for diverse learners: a tailored approach. Open Forum Infect Dis. 2017:ofx117.
Paterson Davenport LA, Davey PG, Ker JS. An outcome-based approach for teaching prudent antimicrobial prescribing to undergraduate medical students: report of a Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2005;56 (1):196–203.
Shekarchian S, Schwartz BS, Teherani A, Irby D, Chin-Hong PV. Is it time for a coordinated and longitudinal approach to antibiotic stewardship education? Clin Infect Dis 2016;63 (6):848–849.
Augie BA, McInerney PA, van Zyl RL, Miot J. Educational antimicrobial stewardship programs in medical schools: a scoping review protocol. JBI Database System Rev Implement Rep 2020;18 (5):1028–1035.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Aromataris E, Munn Z. Chapter 11: Scoping Reviews. JBI, JBI Manual for Evidence Synthesis [internet]. Adelaide:2020.
McGowan J Jr, Gerding DN. Does antibiotic restriction prevent resistance? New Horiz 1996;4 (3):370–376.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 2018;169 (7):467–473.
Marwick CA, Nathwani D. Improving antimicrobial prescribing through knowledge and skills. J Antimicrob Chemoth 2007;59 (4):819–820.
Kerr KG, Ottery C, Hawkey PM, Roberts TE. The teaching of appropriate use of antimicrobials. Lancet 2001;358 (9299):2173–2174.
Valente P, Lora PS, Landell MF, Schiefelbein CS, Girardi FM, Souza LDR, et al. A game for teaching antimicrobial mechanisms of action. Med Teach 2009;31 (9):e383–e392.
Silverberg SL, Zannella VE, Countryman D, Ayala AP, Lenton E, Friesen F, et al. A review of antimicrobial stewardship training in medical education. Int J Med Educ 2017;8:353–374.
Shankar R, Bajracharya O, Jha N, Gurung SB, Singh KK. Teaching medical students to use antibiotics rationally in a medical school in Nepal. Educ Med J 2011;2 (10):WMC002329.
McInerney P, Green-Thompson LP. Theories of learning and teaching methods used in postgraduate education in the health sciences: a scoping review. JBI Database System Rev Implement Rep 2020;18 (1):1–29.
Turner TL, Balmer DF, Coverdale JH. Methodologies and study designs relevant to medical education research. Int Rev Psychiatry 2013;25 (3):301–310.
Sullivan GM. Getting off the “gold standard”: randomized controlled trials and education research. J Grad Med Educ 2011;3 (3):285–289.
El-Moamly AA. Kattington LE. Curriculum development in medical education: a reflection in the 40 years - experience of Problem-Based Learning (PBL), the educational research and the accreditation programs of medical schools. Handbook of curriculum development. New York: Nova Science; 2010. 1–63.
Norman GR, Schmidt HG. Effectiveness of problem-based learning curricula: theory, practice and paper darts. Med Educ 2000;34 (9):721–728.
Chetty S, Reddy M, Ramsamy Y, Naidoo A, Essack S. Antimicrobial stewardship in South Africa: a scoping review of the published literature. Antimicrob Resist 2019;1 (3):dlz060.
Brink A, Schoeman J, Muntingh G. Undergraduate antibiotic stewardship training: are we leaving our future prescribers’ flapping in the wind’? S Afr Med J 2017;107 (5):357–358.
Bailey CM, Hsu CT, DiCarlo SE. Educational puzzles for understanding gastrointestinal physiology. Adv Physiol Educ 1999;276 (6):1–18.
Mann BD, Eidelson BM, Fukuchi SG, Nissman SA, Robertson S, Jardines L. The development of an interactive game-based tool for learning surgical management algorithms via computer. Am J Surg 2002;183 (3):305–308.
Kuhn MA. Gaming: a technique that adds spice to learning? J Contin Educ Nurs 1995;26 (1):35–39.
Rowell S, Spielvogle S. Wanted: “a few good bug detectives.” A gaming technique to increase staff awareness of current infection control practices. J Contin Educ Nurs 1996;27 (6):274–278.
Santos-Gomez L, Kalishman S, Rezler A, Skipper B, Mennin S. Residency performance of graduates from a problem-based and a conventional curriculum. Med Educ 1990;24 (4):366–375.
Wen-wei P. Self-directed learning: a matched control trial. Teach Learn Med 1989;1 (2):78–81.
Rosenbaum ME, Ferguson KJ, Lobas JG. Teaching medical students and residents skills for delivering bad news: a review of strategies. Acad Med 2004;79 (2):107–117.
Rad P, Roozbehi A, Delaviz H. Small group discussion for medical students to learning embryology. Future Med Educ J 2018;8 (2):8–12.
Luepke KH, Suda KJ, Boucher H, Russo RL, Bonney MW, Hunt TD, et al. Past, present, and future of antibacterial economics: increasing bacterial resistance, limited antibiotic pipeline, and societal implications. Pharmacotherapy 2017;37:71–84.
Harris AD, McGregor JC, Perencevich EN, Furuno JP, Zhu J, Peterson DE, et al. The use and interpretation of quasi-experimental studies in medical informatics. J Am Med Inform Assoc 2006;13:16–23.