A review of antimicrobial stewardship training in medical education.

OBJECTIVES: We reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective. METHODS: We searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick's four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations. RESULTS: Our review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees' prescribing behaviour after graduation. CONCLUSIONS: This study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.

Student and Preceptor Experiences at an Inter-Professional Student-Run Clinic: A Physical Therapy Perspective.

Purpose: Student-run clinics (SRCs) provide a unique opportunity for inter-professional education; they prepare health care students for a collaborative future by enabling them to interact with other such students in a clinical setting focused on inter-professional learning and collaboration. Physical therapy (PT) students are increasingly being included in SRCs; however, most research on student experiences in SRCs has been carried out with medical students. This qualitative study explores the perceived benefits of the PT experience in an SRC through the lens of PT students and their preceptors. Method: A qualitative interpretive-descriptive approach consisting of face-to-face, semi-structured interviews was used. Interviews were audiotaped and transcribed verbatim. Data were analyzed using a constant comparative approach. Results: Seven PT students and eight preceptors who volunteered at the SRC between September 2013 and May 2015 participated in the study. Three themes emerged from the interviews: (1) exposure to marginalized patient populations, (2) learning through inter-professional interactions, and (3) experience with different patient care approaches. Conclusions: Participating in an SRC enhances PT students' understanding of their and other health care professionals' roles. Students gained an appreciation for the social determinants of health and improved their knowledge of inter-professional collaboration. The knowledge gained from this study has the potential to inform PT professional development, SRCs, and PT education.

Objectif : les cliniques dirigées par des étudiants offrent une occasion unique de formation interprofessionnelle; elles préparent les étudiants en soins de santé à la collaboration en leur permettant d'interagir avec d'autres étudiants dans un environnement clinique axé sur la collaboration et l'apprentissage interprofessionnels. Les étudiants en physiothérapie sont de plus en plus inclus dans ces cliniques; cependant, la plupart des recherches portant sur les expériences étudiantes dans ce type de clinique ont été menées auprès d'étudiants en médecine. Cette étude qualitative examine les bienfaits perçus de l'expérience vécue par les étudiants en physiothérapie et leurs précepteurs en clinique dirigée par des étudiants. Méthode : une approche qualitative interprétative-descriptive comprenant des entrevues en personne semi-structurées a été utilisée. Les entrevues ont été enregistrées sur bande sonore et transcrites mot à mot. Les données ont été analysées au moyen d'une approche comparative constante. Résultats : sept étudiants en physiothérapie et huit précepteurs qui ont travaillé de manière bénévole dans une clinique dirigée par des étudiants entre septembre 2013 et mai 2015 ont participé à l'étude. Trois thèmes sont ressortis des entrevues : (1) l'exposition à des populations de patients marginalisés, (2) l'apprentissage au moyen d'interactions interprofessionnelles et (3) l'expérience de diverses approches de soins aux patients. Conclusions : la participation à une clinique dirigée par des étudiants améliore la compréhension des étudiants en physiothérapie de leur rôle et de celui des autres professionnels de la santé. Les étudiants ont pu observer les déterminants sociaux de la santé et améliorer leurs connaissances en matière de collaboration interprofessionnelle. Les connaissances acquises dans le cadre de cette étude peuvent servir au développement professionnel en physiothérapie, aux cliniques dirigées par des étudiants et à la formation en physiothérapie.