Development and Pilot of a 4th year Medical Student Elective in Antimicrobial Stewardship

Development and Pilot of a 4^th year Medical Student Elective in Antimicrobial Stewardship         

Becky Zon BS, MS4 and Dr. Payal Patel MD, MPH
University of Michigan Health System, Ann Arbor, MI USA

Background:  Antimicrobial Stewardship (AS) has serious global implications for healthcare. Early introduction of AS during medical school may be a preventive and informative educational method to help coming generations of physicians prepare for and work to prevent antimicrobial resistance.

Methods: A detailed review of key literature and important aspects of AS was conducted to inform the curriculum. Foundational aspects of the AS elective include: microbiology and resistance mechanisms, interplay of public health and AS, and practice of clinical medicine with an AS perspective including the concept of an “antibiotic time-out” as recommended by the CDC. The interplay between these variables will demonstrate for students the crucial nature of understanding the social and individual impact of antimicrobial resistance and implications of decision-making in future treatment plans. Following the AS educational sessions, a pre and post test (attached) will be conducted to judge uptake of understanding of AS.

Results: A four-week clerkship addressing the “Triangular Balance of ID” was developed for a well-rounded experience of infectious disease and AS practices. The structure is as follows:

Week 1 (Micro): Attend lab meetings, read publications on antimicrobial resistance and meet with researchers exploring how certain microorganisms build resistance with a focus on VRE.

Week 2 (Macro): Clinical experience on ID Consult Service. Attend the Ann Arbor VA and University of Michigan Hospital AS meetings. Complete Wake Forest and CDC online study modules.

Week 3 (Public Health): Syllabus of public health work around public policy and AS, one-on-one meetings with researchers at the University of Michigan School of Public Health. Attend multidisciplinary Patient Safety Effectiveness Program, led by Dr. Sanjay Saint.

Week 4 (Synthesis): Create and present a final presentation of the microbiologic, clinical and public health components to AS to medical students and residents and perform pre and post-testing.

Figure: The Triangular Balance of ID

Conclusion:  Early introduction to AS for medical students may be a timely AS educational intervention.