421. Effectiveness of a Novel Case Based Antimicrobial Stewardship (AS) Education Intervention that Emphasizes Clinical Reasoning (CR)
Session: Poster Abstract Session: Innovations in Medical Education
Thursday, October 8, 2015
Room: Poster Hall
  • 421_IDWPOSTER.pdf (460.3 kB)
  • Background: Education is essential for effective AS, but usual approaches are marginally effective and lack sustained impact.  This study aims to evaluate the efficacy of a novel CR curriculum to improve knowledge of appropriate antibiotic (ABX) use among resident physicians.  

    Methods: Residents participated in a 1-year AS CR curriculum consisting of monthly, uniformly structured, case-based conferences that were facilitated by an AS team. After a case presentation, residents were tasked with generating: a general and specific assessment, a causal analysis, cognitive biases, implications and solutions. Internal Medicine residents (IMR) participated in year 1 (n=44) and Family Medicine residents (FMR) in year 2 (n=22). All continued their usual clinical and didactic training.  A 33-question “appropriate ABX use” knowledge exam was administered at baseline and after years 1 and 2. A 2 (medical specialty: IMR vs FMR) × 3 (exam score: 1st vs. 2nd vs. 3rd) repeated measures analysis of covariance was computed with exam score as the within-subjects variable and residency year as a covariate.   

    Results: The analysis revealed a main effect of exam score and medical specialty. Pairwise analyses showed that 1st exam scores did not differ between IMR and FMR (Figure). However, after IMR completed the curriculum, IMR significantly outscored FMR on the 2nd exam, t(126) = 8.93, p < .001.  After FMR completed the curriculum, exam scores again did not significantly differ. IMR exam performance was sustained after 1 year. Course evaluations showed self-reported improved knowledge for AS concepts (Table).

    Conclusion: A significant and sustained improvement in knowledge of appropriate ABX use among resident physicians can be achieved through a CR curriculum using case-based reflective thought exercises. This approach may be an important strategy to improve appropriate ABX use knowledge. 

    Table: Selected Course Evaluation Items (N=32)

    Item with improved ability to:

    Strongly Agree or Agree, n (%)

    Select ABX therapy

    29 (91)

    Select appropriate diagnostic studies in order to streamline/de-escalate ABX therapy

    28 (88)

    Discontinue or withhold ABX therapy

    31 (97)

    Understand & interpret sensitivity testing on resistant bacteria

    29 (91)

    Self-assess & engage in practice-based learning

    32 (100)


    Vera Luther, MD1, John Petrocelli, PhD2, James Beardsley, PharmD3, James Johnson, PharmD4, John Williamson, PharmD3 and Christopher Ohl, MD, FIDSA1, (1)Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, (2)Wake Forest University, Winston-Salem, NC, (3)Department of Pharmacy, Wake Forest Baptist Medical Center, Winston-Salem, NC, (4)Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC


    V. Luther, None

    J. Petrocelli, None

    J. Beardsley, None

    J. Johnson, None

    J. Williamson, None

    C. Ohl, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.