1124 - Increasing Student Confidence in Antimicrobial Prescribing with a Novel Teaching Framework

Background: Physicians frequently prescribe antimicrobials inappropriately, increasing rates of resistance and adverse effects. Difficulty with antimicrobial reasoning likely begins during medical school, where many students learn infectious diseases by memorization. Past work has shown that learners benefit from tools such as schema and checklists. We report our experience using an antimicrobial reasoning teaching tool in a pilot medical student workshop.Figure 1: Antimicrobial Selection Tool
Figure 2: Usefulness of Session and Tool


Methods: We converted a published antimicrobial reasoning framework into a teaching tool (Fig 1). Students enrolled in the 2020 Internal Medicine Residency Preparation Course participated in one of two identical hour-long antimicrobial reasoning workshops. We started with an interactive didactic introducing the tool. Students used the tool to work through a clinical vignette in small groups, followed by a facilitated discussion. Students filled out pre- and post-surveys assessing their identification of factors impacting antimicrobial selection, and their self-efficacy regarding antimicrobial selection. The number of factors identified was analyzed using a t-test, while the change in self-efficacy scores was analyzed using a paired t-test. Students also rated the utility of the session.

Results: 87% of students (52/60) completed surveys. Prior to the session, only 59% (n=29) of students felt prepared to prescribe antimicrobials and the majority of students (59%, n=30) felt less confident managing infections than other conditions. After the session, there was a significant increase in students’ perception of their preparation to prescribe antimicrobials (t=2.08, p=0.04) and ability to identify factors important to antimicrobial selection (t=2.13, p=0.036). The majority of students found both the session and tool to be useful for future practice (Fig 2).

Conclusion: At baseline, medical students feel unprepared to prescribe antimicrobials and are less confident managing infections than other conditions. This workshop assessed the feasibility of using an antimicrobial reasoning tool to teach students. Despite its brevity, students felt more prepared to prescribe antimicrobials after the session and rated it as useful for future practice. They felt a simpler tool and longer session would improve future efforts.