#BeASteward: IDSA develops antimicrobial stewardship curriculum for ID fellows
Antibiotic overuse contributes to the growing problem of antibiotic resistance and the development of multidrug-resistant organisms, or MDROs. It is predicted that by 2050, 10 million people a year may die from MDRO infections. Currently, at least half of all hospitalized patients and up to 70% of long-term care facility residents receive antibiotic therapy, of which 30% to 50% is considered inappropriate. To highlight the need for urgent action in combating antimicrobial resistance, the CDC published a comprehensive analysis outlining the threats posed by MDROs. In 2014, WHO published a global report on antimicrobial resistance to further describe the threat, as well as outline efforts underway to combat antimicrobial resistance. Antimicrobial stewardship has been consistently identified as an important tool to combat antimicrobial resistance. In response to the national and international call to action, health care accreditation standards from CMS and the Joint Commission were updated to require acute-care hospitals and long-term care facilities to have active antimicrobial stewardship programs (ASPs) with dedicated medical staff expertise and leadership.
The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America have been long-standing proponents of antimicrobial stewardship. The IDSA and SHEA antimicrobial stewardship guidelines, along with professional society white papers, endorse the need for clinician education on antibiotic stewardship, along with its integration into training curricula at academic medical centers and teaching hospitals. These guidelines also specify that ASPs should be led by an infectious diseases physician, ideally with an ID-trained clinical pharmacist. The importance of ID physician leadership in ASPs is further emphasized in a recent professional society white paper. Because of these recent changes in accreditation standards, there is a growing need for ID physicians trained in antimicrobial stewardship.
To ensure the future infectious diseases workforce is prepared to implement and direct antimicrobial stewardship initiatives, in 2016 the IDSA board of directors supported the creation of a training program for ID fellows. Subsequently, IDSA formed an antimicrobial stewardship curriculum (ASC) workgroup to lead this initiative. A national survey of ID fellowship training program directors assessed existing antimicrobial stewardship education and identified a need for additional educational resources for the training and evaluation of ID fellows in antimicrobial stewardship. Approximately half of all ID training programs identified a lack of antimicrobial stewardship curricular materials as a significant barrier to teaching fellows about antimicrobial stewardship. This survey also identified the need for additional educational resources for training and evaluating ID fellows in antibiotic stewardship. Training program directors felt that a national curriculum would be very beneficial to ID fellows. The ASC workgroup developed a core curriculum in antibiotic stewardship that is designed to be integrated into existing ID fellowship program curricula.
This core ASC is intended for use by all ID fellows, regardless of ultimate career path, so that fellows can build a foundation in the principles and practice of antimicrobial stewardship. The curriculum has four main sections: an introduction to antimicrobial stewardship, antimicrobial stewardship in everyday practice, educating and coaching on antimicrobial stewardship, and ASP logistics. The curriculum package contains a variety of training resources including eLearning modules, lecture slides, case-based questions, videos, reading materials, pocket cards, group-based learning, role play exercises and simulations. Videos to demonstrate important antimicrobial stewardship communication tools, including motivational interviewing, are included as well. The curriculum content can be delivered via two options for each educational activity, and training programs can customize which option they will use for a given section. This allows the curriculum to be adapted to a program’s needs and allows programs to capitalize on local antimicrobial stewardship infrastructure. For each activity, there is an eLearning option that fellows can navigate through independently or a face-to-face option that a faculty member can use to instruct the fellows in their program. Faculty development resources and facilitator’s guides also are included. Reading materials and resources for additional self-directed learning are included for fellows. Assessment tools are included throughout each section. Additionally, fellows participate in a shortage simulation exercise titled, “Shortage Mitigation of Antibiotics in Real Time.” This exercise is intended to provide them the tools and resources needed to handle and approach an antibiotic shortage at their home institution.
The core ASC is currently being piloted at 58 programs across the United States, and evaluation data obtained during the piloting process will be used to make any enhancements or modifications to the existing materials. The curriculum will be broadly available through the IDSA in July 2019.
Training fellows to meet the challenges of multidrug resistance, patient safety and health care quality is imperative. IDSA’s core ASC addresses the need to train and engage ID fellows as partners in antimicrobial stewardship efforts. An advanced curriculum to prepare fellows to assume leadership positions in antibiotic stewardship is currently in development.
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- For more information:
- Sonali Advani MBBS, MPH, is an assistant professor of infectious diseases at the Yale School of Medicine and associate hospital epidemiologist at Yale-New Haven Hospital in New Haven, Connecticut.
- Rachel Shnekendorf, MPH, is director of education at the Infectious Diseases Society of America.
- Vera Luther, MD, is an associate professor of medicine and director of the infectious diseases fellowship training program at the Wake Forest School of Medicine in Winston Salem, North Carolina.
Disclosures: Advani, Luther and Shnekendorf report no relevant financial disclosures.