Successful Intervention to Teach Antimicrobial Pharmacology to Medical Students

Abstract

BackgroundGraduating students at the Herbert Wertheim College of Medicine (HWCOM) expressed a lack of confidence in prescribing and utilizing antimicrobial agents. A challenge for early learners is developing a framework for relating antimicrobial pharmacology to emerging clinical knowledge. We developed a longitudinal curriculum incorporating a visual tool and spaced repetition through team based CBL (TB‐CBL) to foster deliberate practice of a 3‐step process to help learners: 1) Recognize localizing clinical signs of infection, 2) Identify most likely infectious agents, and 3) Prescribe appropriate antimicrobial coverage. We studied the outcomes of this curriculum on medical student knowledge and confidence.MethodsThe new curriculum was launched in 2017 with the CO 2021. Prior to 2017, all students participated in traditional lecture‐based learning of antimicrobial pharmacology. With the new flipped‐classroom curriculum, students review a series of short videos prior to 2 TB‐CBL sessions during the 1st year pharmacology course and 5 TB‐CBL sessions across the 2nd year organ systems courses. During sessions, students participate in a series of cases to utilize the visual tool and work together to practice the 3‐step method. A pocket card version of the visual tool is provided to students prior to entering clerkships when they participate in an additional TB‐CBL. In the 3rd year, students participate in didactic sessions during the 8‐week Family Medicine and Internal Medicine clerkships and complete a note‐based exercise on antibiotic management. Outcomes were measured at the end of the 4th year, just prior to graduation. Knowledge outcomes were assessed by voluntary non‐graded 20‐question MCQ quiz administered to the CO 2021 (intervention) and the CO 2017 (control). Each MCQ was mapped to either basic pharmacology objectives (mechanism of action, adverse drug reactions, spectrum of activity, and mechanisms of resistance) or to clinical pharmacology objectives (treatment of choice and/or causative microorganism). Student confidence was assessed through a voluntary 6‐question survey.Results114 students in the CO 2017 (91.2%) and 113 students in the CO 2021 (100%) participated in the end of 4th year knowledge assessment and confidence survey. Mean overall performance for students participating in the new curriculum was 82.39% (SD 15.27) compared with 66.7% (SD 15.82) for the control group (p < 0.0001, Figure 1). Mean performance on basic pharmacology questions was 82% (SD 0.38) for CO 2021 vs. 62% (SD 0.49) for CO 2017 (p<0.0001). Mean performance on clinical pharmacology questions was 82% (SD 0.49) for CO 2021 vs. 70% (SD 0.46) for CO 2017 (p<0.0001). Mean overall confidence for students in the CO 2021 was 3.83 (SD 0.72) compared with 2.95 (SD 0.99) for the CO 2017 (p <0.0001, 5‐point Likert Scale, Table 1).ConclusionThe use of a longitudinal antimicrobial curriculum incorporating a visual tool, active learning, spaced repetition, and deliberate practice led to improvements in medical student knowledge and confidence. This innovative approach may be used to teach antimicrobial pharmacology to medical students. Future studies should focus on retention and impacts on patient care.