Future Prescribing Research Articles

Escaping the ordinary: a review of escape rooms in medical and veterinary education

BackgroundEscape rooms (ERs), immersive role-playing games that require participants to solve a series of puzzles within a set time to achieve a specific goal, have gained popularity as innovative educational tools.MethodsA systematic review was conducted using the PRISMA guidelines, a comprehensive search of PubMed, Cochrane, Web of Science, and Scopus, for articles published between inception of journals to April 2024, focusing on the integration, outcomes, and participants’ perceptions of ERs in medical and veterinary education.ResultsA total of 619 articles were retrieved, of which 12 articles met the inclusion criteria for final analysis. These studies focused on medical students and included medical education topics such as nephrology, human physiology, and dermatology. Notably, no ERs focused on the veterinary sector or directly addressed the One Health approach. ERs demonstrated a significant impact on students’ self-reported knowledge, motivation, and collaboration skills gains. Participants reported improved confidence in clinical situations and a greater appreciation for interdisciplinary team dynamics. Most studies yield moderate MERSQI scores and impacts at Kirkpatrick Levels 1 and 2.ConclusionERs increased immediate educational engagement and showed potential in improving an understanding of complex, interrelated health issues. This gap suggests a need for curricula that incorporates ERs to bridge human, animal, and environmental health sectors. The integration of ERs could be instrumental in equipping future prescribers with the interdisciplinary knowledge and skills needed to tackle complex health crises.Clinical trial numberNot applicable.

Prescribing deprescribing for polypharmacy in Aotearoa New Zealand; experiences of a medication review activity in final year medical students on a general practice module.

Introduction This study explored the experiences of students and their supervisors undertaking a medication review activity during a 6-week general practice module in their final year of medical school at University of Otago, Wellington, Aotearoa New Zealand. Aim The study sought the self-reported value of the activity in learning about prescribing, reflecting on polypharmacy, deprescribing, and changes to future practice for both student and supervisor. Methods All students in the final year general practice module were invited to complete a survey over a 12-month period, as were their supervisors. An abductive thematic analysis of survey results was performed. Results Fifty-eight percent (48/87) of students and 30% (10/33) of supervisors completed surveys. Five themes were identified in the analysis of qualitative data: value of the medication review, complexities of medicines, importance of monitoring, value of resources, and supervisor reflections on value to the student. Student and supervisor responses reflected on prescribing practice beyond what medication to give when. All responses described benefit to patients and the majority expressed thoughts on how it would change their future prescribing. Discussion The medication review activity in the final year general practice module provides learning opportunities for both student and general practitioner supervisor. This activity emphasises the risks of polypharmacy and how to deprescribe. This study underlines the value of medication reviews as intraprofessional communication activities, allowing reflection beyond what medication to prescribe and for what condition. The results underline the importance of reflecting on practice and aids quality improvement benefit to patients.

Australian link worker social prescribing programs: An integrative review.

Link worker social prescribing programs are gaining recognition in Australia for addressing health and social needs outside routine medical care. The evaluation of these programs is essential for informing future social prescribing programs, research and evolving policy. However, diverse outcome evaluation measures present challenges for benchmarking across link worker social prescribing programs. An integrative review was conducted to identify and describe outcome domains and measures, and the methodological approaches and evaluation designs of link worker social prescribing programs in Australia. Comprehensive searches of the literature on link worker social prescribing programs in Australia were conducted across 14 electronic databases. In order to reduce the risk of bias, study selection and data extraction were conducted independently by multiple authors, and included studies underwent quality and risk of bias assessment using the standardised Mixed Methods Appraisal Tool. Six studies met the inclusion criteria. Outcome domains were categorised into 'person-level', 'system-level' and 'program implementation' domains. Despite the variation in participant groups, the 'person-level' domains of global well-being and social well-being were consistently evaluated. While measurement tools varied significantly, the WHO Quality of Life Brief Assessment and short-form UCLA Loneliness Scale were most commonly applied. At the system level, health service utilisation was primarily evaluated. This integrative review reports on the current state of evidence in Australia, with the potential to track changes and trends over time. Developing a core outcome set, incorporating stakeholder and consumer contributions for benchmarking aligned with the healthcare landscape is recommended. The findings may guide the refining of social prescribing initiatives and future research, ensuring methodological robustness and alignment with individual and community needs.

Anatomically Correct! A qualitative evaluation of an integrated cadaveric clinical skills workshop series designed for future pharmacist prescribers

Abstract Introduction All newly qualified pharmacists in the UK will register as independent prescribers from 2026. Schools of Pharmacy are required to adapt current curricula to allow for greater embodiment of the skills future prescribers require. One essential element of the curriculum for prescribing pharmacists, set by the General Pharmaceutical Council, is understanding anatomy1. Clinical examination techniques can be difficult to grasp without anatomical understanding of physical landmarks. Previously, pharmacists have had little anatomy training. The need for a stronger foundation of clinical skills and knowledge of anatomical landmarks is imperative as graduates become prescribers. Aim To explore the student perceptions of integrated pharmacist anatomy education. Methods In September 2022, an interprofessional team of anatomy and pharmacy academics developed a novel, two-year workshop series using cadaveric examination to better dovetail with clinical skills practical classes, delivered in the same week and covering the same body systems. Within the dissection room, students were invited to complete self-directed exploratory tasks using cadavers followed by interprofessional direction about relevant anatomical landmarks needed for clinical examination techniques. Qualitative evaluation of student perspectives of this experience was undertaken in autumn 2023. Semi-structured interviews following a topic guide were arranged using purposive sampling by inviting students on the new programme (years one and two) and students who had received the non-integrated, anatomy-only programme (years three and four). Interviews were conducted and recorded using Microsoft Teams. Transcripts were cleaned and quality checked. Inductive, open-coding was conducted following Braun and Clarke’s reflexive thematic analysis to understand student experiences and perceptions, with coding and theme generation from one author (DD) with a second author (CEC) for sense-checking in a collaborative approach2. A combination of latent and semantic codes were used as appropriate. Epistemological considerations regarding the data were constructivist, with experiential orientation. Institutional ethical approval was granted for this study (reference: 36415/2023). Lead author (DD) noted his positionality as a fourth-year MPharm student. Results Seventeen one-to-one interviews (n=17) were conducted with post- (n=8) and pre-curriculum change participants (n=9). Five themes were derived from transcripts: navigating initial reactions to anatomy education; valuing integrated and experimental learning; transfer and consolidation of knowledge through staff and peer interaction; individualised perception comprising of student’s overall anatomy experience; prospective application of knowledge via content integration. Content integration was seen as beneficial by students, suggesting that it gave greater insight into the role and remit of a pharmacist and guided them towards the ‘more relevant’ information. Discussion and Conclusion An integrated approach of aligning clinical skills teaching with a multi-disciplinary-led, practical cadaveric anatomy series provided students with greater self-perceived confidence and understanding of clinical examination techniques. Students appreciated the importance of anatomy knowledge in prospective roles as prescribing pharmacists. Limitations of the study included the single site for recruitment at one School of Pharmacy, limiting transferability. Students highlighted benefits of being taught by practising clinical pharmacists who could illustrate the links to diagnosis and prescribing skills. Future research should focus on the longitudinal impact of an integrated anatomy education both pre- and post-registration.

First things first: measuring French Medical schools’ deans motivation to engage in smoke-free campus

Abstract Smoke-free campuses (SFC) prohibit smoking and vaping on all university grounds and for all users. Around a hundred of papers was published on that topic revealing how they reduce initiation and increase smoking cessation among students. Whereas it is key for the success of all project, including SFC, very rare research has investigated attitude of high-level leaders of universities toward SFC, their perceived barriers and motivation to adopt it. To fill this gap, we interviewed deans of medical schools in France, where SFC are limited. In-depth individual interviews were conducted on 31 deans and two associate-deans (representing 31 out of 35 French medical schools). Questions rose knowledge of SFC, perception of this measure, self-role to play and other factors influencing implementation. We targeted medical schools because they train future prescribers of smoking cessation, and can act as a model for policy dissemination to other schools. The 23 hours of interviews were analyzed using thematic analysis with Nvivo14. Regarding diffusion in 2023, only one medical school had a SFC, six were implementing it, 23 had no SFC and one abandoned it. 28 held positive attitudes towards SFC, explained by its impact on health and the mission of medical schools. Most of them considered SFC feasible with resources and engagement of students. Identified barriers were competing priority, lack of funding and of support from users and risk of stigmatization of smokers. A majority of deans thought they had a role to play in initiating, promoting and moderating the policy. SFC are recommended by the WHO but there is important room for improvement for their diffusion in France. Yet, a majority of deans we interviewed appeared motivated to adopt it. Solutions to encourage them and overcome barriers must be found. Key messages • Diffusion of SFC among medical schools remains limited in France. • Deans’s positive attitude towards SFC bring hope for a better diffusion of SFC among French universities.

Frailty Status, Not Just Age, is Associated With Postoperative Opioid Consumption: A Retrospective, Population-based Analysis.

To assess the relationship between postoperative opioid consumption and frailty status. Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty. We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within 30 days of surgery in oral morphine equivalents (OME). Our primary exposure was frailty status defined by the modified frailty index (mFi-5) criteria. Other covariates included patient demographic and clinical attributes, procedural factors, discharge opioid prescription size, and postoperative complications. Linear regression was performed to assess the association of frailty status and opioid consumption, stratified by age. In this cohort of 34,854 patients, 10,596 had an mFi-5 score of ≤1 and 3,635 had a score of >1. A score of >1 was associated with increased patient-reported opioid consumption (OMEs 3.3 greater; 95% CI = 1.5-5.1). This held true for individuals over 65 (OMEs 2.7 greater; 95% CI = 0.2-5.1). Frailty status, regardless of score, was negatively associated with an opioid prescription at discharge. Frailty status is associated with increased opioid consumption after common operations. Future prescribing guidelines and outcomes analyses should consider this marker when reviewing opioid consumption data and related adverse outcomes.

Knowledge and perception of antibiotic resistance and stewardship among pre-health and agriculture undergraduate students.

The global threat of antibiotic-resistant infections has resulted in health organizations compiling an Antibiotic Stewardship Program (ASP), in which the education of current and future medical prescribers and farmers is central to the preservation of current and future antimicrobial treatments. The purpose of this study was to assess and compare the knowledge and perceived threat of antibiotics and antibiotic resistance, as well as the perceived benefit of antibiotic stewardship education, among undergraduate students majoring in Biology and Agriculture at Fort Hays State University. I hypothesized that the difference in knowledge and perceptions between Biology and Agriculture students would be significantly different because of differences in curriculum requirements. Framed by the health belief model (HBM), a quantitative cross-sectional study was conducted using a structured online survey of 136 undergraduate student participants. A χ2 analysis was used to assess differences between the respondents in their knowledge and perceptions of antibiotics, antibiotic resistance, and antibiotic stewardship education at the undergraduate level. Results showed that, although Agriculture students perceived antibiotic resistance as less threatening than Biology/pre-health students, both undergraduate groups were knowledgeable about the problem and wanted more academic education on the issue. These findings create a solid foundation to initiate a conversation on the curriculum development to meet ASP goals and objectives at the undergraduate level while contributing to an ongoing international effort to educate future prescribers and farmers on the importance of antibiotics in medicine and farming and to reduce antibiotic resistance.

Continuous glucose monitoring among nurse practitioners in primary care: Characteristics associated with prescribing and resources needed to support use.

Continuous glucose monitoring (CGM) can improve health for people with diabetes but is limited in primary care (PC). Nurse Practitioners (NPs) in PC can improve diabetes management through CGM, but NPs' interest in CGM and support needed are unclear. We describe behaviors and attitudes related to CGM for diabetes management among NPs in PC. This cross-sectional web-based survey of NPs practicing in PC settings used descriptive statistics to describe CGM experience and identify resources to support prescribing. We used multivariable regression to explore characteristics predicting prescribing and confidence using CGM for diabetes. Nurse practitioners in hospital-owned settings were twice as likely to have prescribed CGM (odds ratio [OR] = 2.320, 95% CI [1.097, 4.903]; p = .002) than private practice; those in academic medical centers were less likely (OR = 0.098, 95% CI [0.012, 0.799]; p = .002). Past prescribing was associated with favorability toward future prescribing (coef. = 0.7284, SE = 0.1255, p < .001) and confidence using CGM to manage diabetes (type 1: coef. = 3.57, SE = 0.51, p < .001; type 2: coef. = 3.49, SE = 0.51, p < .001). Resources to prescribe CGM included consultation with an endocrinologist (62%), educational website (61%), and endocrinological e-consultations (59%). Nurse practitioners are open to prescribing CGM and can improve diabetes management and health outcomes for PC patients. Research should explore mechanisms behind associations with CGM experience and attitudes. Efforts to advance CGM should include educational websites and endocrinology consultations for NPs in PC.

Effect of pharmaceutical promotion and incentives offered by pharmaceutical companies on the prescribing pattern of medical students: a cross-sectional study from a developing nation Pakistan

BackgroundPharmaceutical companies continuously pursue healthcare professionals, starting from the medical college level, which can ultimately lead to irrational prescribing of drugs and antibiotics. Therefore, our main aim was to evaluate the opinions and attitudes of medical students toward pharmaceutical promotion.MethodsThis study utilized a cross-sectional online survey that applied the snowball sampling technique. Data were collected from three public and three private sector medical colleges in Punjab, Pakistan using snowball sampling. A modified version of a pre-structured questionnaire was used to collect data between October 2020 and January 2021. Medical students from the third year onward were captivated. The tool was made available on Google Forms and students could access it by clicking the link shared. The effect of promotion on prescribing pattern and future prescribing of antibiotics were measured. Descriptive statistics, chi-square, and t-test were used to analyze the data.ResultsA total of 1,301 students filled out the survey, but only 1,227 responses were acceptable. The average age was found to be 23.4 ± 1.59 years. Slightly more than half of the respondents were male participants (57.7%), and a significant proportion (84.1%) reported being aware of pharmaceutical promotion. A smaller number (27.7%) felt that physicians who meet medical representatives more frequently tend to prescribe more antibiotics and 46.3% indicated they would be willing to prescribe antibiotics under the promotional influence. Medical students who were male, in senior college years, attended government institutions, and had lower parental income showed significantly higher perception and attitude scores (p &amp;lt; 0.05) which, in turn, may show their inclination to promotional activities. Many students agreed with the view that pharmaceutical promotion (PP) activities may alter prescribing practices and also believed that they contribute to the increased irrational prescribing of drugs and antibiotics.ConclusionThe study revealed that only a small number of students are willing to engage in promotional activities and accept rewards, which influences their choice toward selection of drugs and antibiotics. This study highlighted the necessity of giving proper educational instructions regarding the promotion of drugs to medical students. This study also focused on the educational prerequisites of the students.

Teaching prudent antibiotic use on the go: a descriptive report on development, utilization and listener satisfaction of an educational podcast format for medical students and young professionals

BackgroundAn important component in fostering the responsible use of antibiotics is training of new and future prescribers in this interdisciplinary topic. Because podcasts are playing an increasing role in medical education, we aimed to develop and evaluate a podcast format with practice and guideline-oriented learning content on antibiotic therapy for medical students and young medical professionals.MethodsWe developed the concept for the podcast with the direct involvement of medical students and medical experts with teaching experience. We used video conferencing when recording the episodes in order to have quick, easy, and nationwide access to the experts involved. We released an episode every 2 to 4 weeks on the popular podcast platforms. The podcast was promoted through mailing lists, social and print media, and at conferences. The evaluation of episodes was based on user data provided by the platforms and an anonymous feedback questionnaire linked to each episode in the podcast notes.ResultsBetween December 2021 and December 2022 19 episodes of InfectEd: der Antibiotika-Podcast were released. The mean duration of an episode was 91 min. By March 9, 2023, a total of 38,829 downloads and streams had been recorded. The majority of users listened to the podcast on a mobile device. The average playing time per episode was 65%. The feedback questionnaire was completed 135 times. 60.7% of respondents were female, 38.5% male. The majority of respondents were in their twenties and thirties (66.7%). 31.1% were medical students, 25.9% were residents, and 25.2% were specialists. Listeners were asked to rate episodes on a scale from 1 to 6, where 1 was “very good” and 6 was “insufficient.” Ratings did not differ significantly between female and male respondents or between medical students and others. 118 respondents (87.4%) reported an increase in knowledge. Free-text feedback frequently emphasized clinical and also exam relevance.ConclusionOur podcast format, developed with a user-centered approach, was broadly distributed and has been well accepted by both medical students and physicians alike. It provides a large number of learners with low-threshold access to current, guideline-orientated content and could be a useful supplement to conventional teaching formats.

Public preferences for pharmacogenetic testing in the NHS: Embedding a discrete choice experiment within service design to better meet user needs.

Genetic testing can be used to improve the safety and effectiveness of commonly prescribed medicines-a concept known as pharmacogenetics. This study aimed to quantify members of the UK public's preferences for a pharmacogenetic service to be delivered in primary care in the National Health Service. Members of the UK population were surveyed via an online panel company. Respondents completed 1 of 2 survey versions, asking respondents to select their preferred pharmacogenetic testing service in the context of a presentation of low mood or pain. A conditional logit model was estimated, before the best functional form for the dataset was identified. Preference heterogeneity was identified via latent class analysis. Coefficients from the final selected models were used to estimate uptake in the context of different hypothetical pharmacogenetic services. Responses from 1993 individuals were included in the analysis. There were no differences observed in preference between the 2 clinical scenarios. Conditional logit analysis, using maximum likelihood estimation, indicated that respondents preferred to have noninvasive tests and wanted their data to be shared between different healthcare organizations to guide future prescribing. There was a preference for regional over national data sharing initiatives, and respondents preferred to have access to their data. Predicted uptake varied considerably, ranging from 51% to >99%, depending on design of the service. This study identifies public preferences for a pharmacogenetic testing service and demonstrates how predicted uptake can be impacted by relatively minor adaptations. This highlights areas for prioritization during development of future pharmacogenetic services.

Learning of clinical pharmacology by future prescribers in Bologna: Teachers' and students' reflections on the way forward.

In this reflection paper, the authors, based on their experience as teachers and students of the courses of Pharmacology at the University of Bologna, reflect on their specific roles towards innovation in the teaching of Clinical Pharmacology. Strengths, weaknesses and challenges are presented as identified during the teaching and learning experience in the currently evolving medical degree programmes of the University in light of current trends in medical education. Keeping in mind the identified challenges together with the features proposed for the model prescriber (knowledgeable, contemporary, communicative and safe), we indicate some ways to improve the students' experience and make sure they develop up-to-date skills in Clinical Pharmacology taking advantage of recent ongoing collaborations at European level. International collaboration is indeed necessary to adequately address the current challenges of teaching clinical pharmacology. Our shared conclusion is that empowering students with a scientifically sound method to retrieve relevant information and developing their skills to communicate in an interprofessional and, wherever possible, international environment is the key to prepare future prescribers and, ultimately, to improve patient safety.

Factors affecting pharmacology learning in integrated PBL in diverse medical students: a mixed methods study

IntroductionProblem-based learning (PBL) was introduced to address passive teaching limitations. However, it is not fully characterised as a teaching modality in pharmacology. The present study investigated the factors affecting pharmacology learning in an integrated PBL-based curriculum in diverse learners.MethodsYear 1 undergraduate medical students from two cohorts at St. George’s University of London and University of Nicosia, participated. Statistical analysis of pharmacology knowledge scores, at the beginning (pre-test) and end of the academic year (post-test), investigated readiness to benefit from PBL based on diverse student characteristics (educational background, age, gender, country of origin, ethnicity, native language, PBL experience). Focus groups/interviews and a survey investigated aspects of integrated PBL impacting learning in depth.ResultsPre- and post-test scores were positively correlated. Students with biomedical sciences degrees performed better at the pharmacology pre- and post-tests, while post-graduate degree holders performed better only at the pre-test. Effect size was of moderate magnitude. However, progress in learning (post-test performance after controlling for pre-test scores) was unaffected. Qualitative analysis revealed three major themes: 1) PBL as a learning environment; 2) PBL as a learning environment in pharmacology; and 3) PBL as a learning environment and confidence in prescribing. Under theme one, skill development, knowledge acquisition through collaboration and self-directed learning, group dynamics and preferred teaching methods were discussed. Under theme two, contextual learning, depth of knowledge and material correctness were raised. Under theme 3, students expressed variability in prescribing confidence. They perceived that learning could be improved by better integration, further references earlier on, more lectures and PBL facilitators with greater content expertise. The survey findings were consistent with those from focus groups/interviews.ConclusionPharmacology learning in a PBL-based curriculum is facilitated by constructive, collaborative and contextual learning. While baseline pharmacology knowledge may be advantageous, the other aforementioned characteristics studied may not affect readiness to benefit from PBL. However, further instructional scaffolding is needed, for example through further resources, lectures and self-assessment. The results from our study can inform evidence-based curriculum reform to support student learning further. Addressing learning needs could ultimately contribute to reducing medication errors through effective training of future prescribers.

Clarification of adverse drug reactions by a pharmacovigilance team results in increased antibiotic re-prescribing at a freestanding United States children's hospital.

Documentation of adverse drug reactions (ADRs) is a key factor in guiding future prescribing. However, incomplete documentation is common and often fails to distinguish implicated drugs as true allergies. This in turn leads to unnecessary avoidance of implicated drug classes and may result in sub-optimal prescribing. Pharmacovigilance (PV) programs utilize a systematic approach to clarify ADR documentation and are known to improve patient safety. Yet it remains unclear if PV alters prescribing. Or, if the existence of the ADR documentation itself continues to prompt avoidance of implicated drugs. To address this, our work presents a retrospective cohort study assessing if clarification of antibiotic ADRs by a hospital-wide PV team was associated with future, safe, re-prescribing at a freestanding pediatric hospital in the midwestern United States. First, we compared the likelihood of future prescribing in an antibiotic class with an active ADR, as compared to alternative drug classes, between PV-clarified and non-clarified patients. Second, we assessed differences in adverse event rates 30-days after future prescribing based on PV clarification status. For robustness, analyses were performed on patients with ADRs in four antibiotic classes: penicillin-based beta-lactams (n = 45,642), sulfonamides/trimethoprim (n = 5,329), macrolides (n = 3,959), and glycopeptides (n = 622). Results illustrate that clarification of an ADR by PV was associated with an increased odds of future prescribing in the same drug class (Odds Ratio [95%-CI]): penicillin-based beta-lactams (1.59 [1.36-1.89]), sulfonamides/trimethoprim (2.29 [0.89-4.91]), macrolides (0.77 [0.33-1.61]), and glycopeptide (1.85 [1.12-3.20]). Notably, patients clarified by PV experienced no increase in the rate of adverse events within 30-days following the prescribing of antibiotics in the same class as an active ADR. Overall, this study provides strong evidence that PV reviews safely increase the rate of re-prescribing antibiotics even in the presence of an existing implicated drug ADR.

Barriers and Facilitators to the Design and Delivery of Social Prescribing Services to Support Adult Mental Health: Perspectives of Social Prescribing Service Providers

Objective. To elicit the barriers and facilitators experienced by social prescribing service providers when designing and delivering social prescribing services to support adult mental health. Design. Semistructured interviews were conducted with social prescribing service providers across England and Wales in the third sector. Data were analysed in accordance with the Theoretical Domains Framework (TDF) and Thematic Framework Analysis (TFA). Results. Twenty‐one providers (15 females and 6 males) from 17 social prescribing services agreed to participate. Nine analytical themes were identified across seven TDF domains associated with the design of services (e.g., skills and environmental context and resources). Thirteen analytical themes across nine TDF domains were associated with the delivery of services (e.g., beliefs about consequences and optimism). Key recommendations for future social prescribing services were increasing public knowledge of social prescribing; clearly communicating the role of a social prescriber to the public and professionals; providing training to providers on how to safely and effectively lived experiences; adopting a person‐centred approach, including use of person‐centred measures of mental health and well‐being; and strategies to address sustainability of social prescribing services. Conclusions. Service providers are an essential part of the design and delivery of social prescribing services. Person‐centred care, sustainable funding, and improved knowledge of social prescribing all warrant further research. Sustainable funding for social prescribing remains a salient policy‐level barrier.

Assessment of knowledge, attitude, and practice of rational antibiotic use among medical students in a tertiary care teaching hospital of upper Assam – A cross-sectional study

Background: Antibiotics serve as wonder drug to combat against harmful microorganisms. Inappropriate and rampant antibiotics use is a major contributing factor for antibiotic resistance in the community. Insufficient knowledge about antibiotics usage and wrong prescribing pattern among the prescribers add to the magnitude of antibiotic resistance. Assessing the knowledge, attitude, and practices (KAP) of the future prescribers with regard to rational antibiotic use can help in planning and formulating suitable educational strategies for them during the course of study itself. Aims and Objectives: The primary objective of the present study was to evaluate the KAP of rational antibiotic usage among 3rd-year medical students in a tertiary care teaching hospital of Assam, India. Materials and Methods: A pre-validated and structured questionnaire was utilized to gather data on demographic profile and KAP of medical students pertaining to antibiotic usage. Data collected were subjected to descriptive analysis. Results were expressed as percentage under each response category. Results: A greater lot of the respondents (95.87%) had adequate knowledge about antibiotic use. The notion of antibiotic resistance was heard of but not clearly understood. The attitude results revealed that 79.34% of the respondents took antibiotics for common cold while 21.64% of respondents stopped taking antibiotic when they started feeling well. Approximately (25.77%) of participants admitted to have procured antibiotics without a valid prescription. Conclusion: The study provides baseline evidence and paucity in KAP regarding use of antibiotic among medical students in a tertiary care teaching hospital of Assam, India. Suitable educational interventions are a requisite to reinforce existent courses and instruction about rational use of antimicrobials with greater emphasis on antimicrobial stewardship.

Acquaintance of medical students with the National List of Essential Medicines

Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire-based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.

Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications.

Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.

Knowledge and perception of antimicrobial resistance and antimicrobial stewardship among healthcare students in Nigeria.

Assessment of knowledge and perception of healthcare students regarding antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) would facilitate more effective education of these future prescribers. To assess knowledge and perception of AMR and AMS among healthcare students in Nigerian universities. This was a questionnaire-based, cross-sectional survey of medical, nursing and pharmacy undergraduate students from November 2019 to January 2020, using both paper and electronic modes of self-administration. A total of 335 students participated in the survey. Mean age of respondents was 23±3 years; 114 (34.4%) were in their 5th year of study. Most (78.9%) of the respondents agreed that widespread use of antimicrobials promotes AMR. Only 70 (21.1%) were aware that poor hand hygiene promotes AMR; 45.9% (42.7%, 37.3% and 57.7% for medicine, nursing and pharmacy respectively, p = 0.007) agreed that AMR is promoted by substandard quality of antimicrobials. Majority (94.3%) perceived AMR as a worldwide problem. Over half (60.8%) were not familiar with the term 'antimicrobial stewardship'. Eleven (3.3%) and 122 (36.9%) rated their AMS knowledge as 'very good' and 'poor' respectively. Nigerian healthcare students had suboptimal knowledge of AMR and AMS. Current undergraduate healthcare curriculum should be reviewed to incorporate AMS principles.

Gamification as an educational tool to address antimicrobial resistance: a systematic review

Abstract Background Antimicrobial resistance (AMR) poses a serious threat to global healthcare, and inadequate education has been identified as a major challenge by the WHO. The human , animal and agricultural sectors contribute to the emergence of AMR. Gamification has emerged as an innovative tool to improve knowledge and change behaviours. Our study provides an overview of the literature on existing games in prescribers’ education across the One Health sectors, with a particular focus on the impact of gamification on learning. Methods Using the PRISMA guidelines, we searched Cochrane, PubMed, Scopus and Google Scholar for articles related to gamification for future prescribers of antimicrobials from inception until 28 March 2023. Retrieval and screening of articles was done using a structured search protocol with strict inclusion/exclusion criteria. Results A total of 120 articles were retrieved, of which 6 articles met the inclusion criteria for final analysis. High-income countries had the most studies, with one global study incorporating low- to middle-income countries. All games were evaluated in the human sector. Board and card games, featuring scoring and point systems, were the most prevalent game types. Most games focused on improving knowledge and prescribing behaviours of medical students, with bacteria or antibiotics as the only content. All studies highlighted the significant potential of gamification in mitigating AMR, promoting antimicrobial stewardship, and improving retention of information compared with conventional lectures. Conclusions Our review found an absence of studies in the animal and environmental sectors, disproportionately focused on medical students with questionable sample size, inadequate assessment of game content and effectiveness, and opportunities for game developers.