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Mapping educational opportunities for healthcare workers on antimicrobial resistance and stewardship around the world

Human Resources for Health201816:9

https://doi.org/10.1186/s12960-018-0270-3

Received: 28 February 2017

Accepted: 19 January 2018

Published: 5 February 2018

Abstract

Background

Antimicrobial resistance is an important global issue facing society. Healthcare workers need to be engaged in solving this problem, as advocates for rational antimicrobial use, stewards of sustainable effectiveness, and educators of their patients. To fulfill this role, healthcare workers need access to training and educational resources on antimicrobial resistance.

Methods

To better understand the resources available to healthcare workers, we undertook a global environmental scan of educational programs and resources targeting healthcare workers on the topic of antimicrobial resistance and antimicrobial stewardship. Programs were identified through contact with key experts, web searching, and academic literature searching. We summarized programs in tabular form, including participating organizations, region, and intended audience. We developed a coding system to classify programs by program type and participating organization type, assigning multiple codes as necessary and creating summary charts for program types, organization types, and intended audience to illustrate the breadth of available resources.

Results

We identified 94 educational initiatives related to antimicrobial resistance and antimicrobial stewardship, which represent a diverse array of programs including courses, workshops, conferences, guidelines, public outreach materials, and online-resource websites. These resources were developed by a combination of government bodies, professional societies, universities, non-profit and community organizations, hospitals and healthcare centers, and insurance companies and industry. Most programs either targeted healthcare workers collectively or specifically targeted physicians. A smaller number of programs were aimed at other healthcare worker groups including pharmacists, nurses, midwives, and healthcare students.

Conclusions

Our environmental scan shows that there are many organizations working to develop and share educational resources for healthcare workers on antimicrobial resistance and antimicrobial stewardship. Governments, hospitals, and professional societies appear to be driving action on this front, sometimes working with other types of organizations. A broad range of resources have been made freely available; however, we have noted several opportunities for action, including increased engagement with students, improvements to pre-service education, recognition of antimicrobial resistance courses as continuing medical education, and better platforms for resource-sharing online.

Keywords

AMRAntimicrobial resistanceAntimicrobial stewardshipEducationHealthcare workers

Background

Antimicrobial resistance (AMR) is a looming global health problem; misuse and overuse of antimicrobials in the past 50 years has accelerated the development of resistance to antibiotics and other antimicrobial drugs [1]. With few new antibiotics in development [24], it is essential that we preserve the usefulness of existing antimicrobials. In their capacity as prescribers and educators, healthcare workers (HCWs) will need to shoulder much of the burden in stewarding the preservation and longevity of antimicrobial agents. The inappropriate use of antimicrobials—such as prescribing antibiotics for viral illnesses or prescribing broad spectrum antibiotics where a narrow spectrum antibiotic would be preferable [5]—drives the development of resistance [6]. In making smart prescribing choices, HCWs can reduce genetic selection pressures that drive the development of resistance [1]. Beyond prescribing, HCWs have roles in infection prevention and control (IPC), in advocating for rational antibiotic use, and in educating their patients on the responsible use of antibiotics.

Changing HCW and patient habits will require substantial effort to ensure that all prescribers and patients are aware of the challenges associated with AMR. Surveys suggest that many HCWs receive too little training on AMR and rational antibiotic use. In Saudi Arabia, nearly half of surveyed physicians felt that they had inadequate knowledge of antibiotic prescribing [7]. The Infectious Disease Society of America has previously stated that clinician training on antimicrobial use in the United States of America (USA) is highly variable and non-standardized [8], and medical students in both Europe and the USA have reported a desire for increased training on choosing antibiotic therapies [9, 10]. The lack of coordinated approaches to AMR education of HCWs poses a challenge to ensuring prudent antimicrobial prescribing.

The WHO Global Action Plan on Antimicrobial Resistance expresses a need for all countries to include antibiotic resistance as a core component of both HCW training and continuing education [11]. To better understand this field, we present an illustrative mapping of educational programs and resources on AMR and antimicrobial stewardship (AMS) aimed at HCWs. This effort included an investigation of resources for AMR/AMS education, opportunities for continuing education, and actors in the field. This mapping exercise has allowed us to understand existing efforts and identify key areas for action in AMR education.

Methods

We sought to identify AMR educational programs targeting HCWs. For breadth, programs were identified through multiple methods, including contact with key experts, web searching, and academic literature searching. An initial literature search in August and September 2016 identified educational programs and key academic researchers who had published in the field over the previous decade. We emailed these and other key experts identified by WHO regional office contacts to request information on AMR and AMS-related educational programs. Additional experts were identified via a snowball strategy and web-searching. Experts were asked to identify recent or ongoing educational programs on AMR/AMS.

We further identified educational programs through online web-searching. We hand-searched the websites of several relevant organizations to identify past and current educational initiatives. We also conducted a non-systematic web search using combinations of a range of search-terms including “antimicrobial resistance”, “antibiotic resistance”, “antimicrobial stewardship,” “antibiotic stewardship”, “education”, “course”, “curriculum”, and “workshop” and region or country in September and October 2016. Relevant articles, project reports, course flyers, and other resources were reviewed to identify programs. We examined national action plans concerning AMR in search of references to educational initiatives. Once identified, these programs were followed up with additional online research as necessary.

We summarized the identified programs in tabular form, including participating organizations, program types, region, and intended audience. We created codes to classify programs by program type, organization type, and WHO region. Programs that were not associated with any specific region (such as resources that were globally available and without a geographical target population) were classified as “global”. Multiple program codes were assigned as necessary. Program type and organization codes were developed and updated iteratively as programs were identified to identify commonalities between initiatives.

Results

Mapping educational initiatives

In total, we identified 94 educational initiatives related to AMR/AMS. The 94 initiatives represent a diverse array of programs including formal courses, workshops, conferences, guidelines, public outreach materials, and online-resource websites. The complete list of initiatives is presented in Table 1.
Table 1

Listing of identified educational initiatives

#

Program

Lead organization

Country

Region

Target audience

Description

1

Clinical Antibiotic Stewardship for South Africa

South African Antibiotic Stewardship Programme

South Africa

Africa

Medical students, physicians

This self-paced online course aims to introduce antimicrobial stewardship, describe how to implement stewardship programs, provide guidance for prescribing and interpreting clinical results, and teach about infection prevention and control. The course is taught online through video lectures and is free.

https://www.openlearning.com/courses/clinical-antibiotic-stewarship-for-south-africa

a,b

2

Distance Learning Course in Antimicrobial Stewardship for Africa

Infection Control Africa Network

Multiple

Africa

Physicians,

clinical pharmacists, clinical microbiologists, nurses

This 3.5-month-long online distance learning course comprises five modules relating to infectious diseases, one of which is focused on Antimicrobial Stewardship. The program includes lectures, reading materials, and discussion forums to engage with tutors and other students. Program is free for African participants.

http://www.icanetwork.co.za/education/distance-learning-course-in-antimicrobial-stewardship-for-africa/

a,b

3

Online Rational Medicines Use Module

University

of the Western Cape

South Africa

Africa

Healthcare professionals

This semester-long online course focuses on the rational use of medicines and associated problems. Content is taught through online media and reading materials, and learning is encouraged through weekly tasks, online discussion forums, and written assignments.

http://www.fidssa.co.za/Content/Documents/UWC_RATIONAL_MEDICINES_USE_CE_MODULE_2015_ADVERTFinal_(2).pdf

b

4

Antibiotic Pharmacology Webcasts

Cleveland Clinic: Centre for Continuing Education

USA

Americas

Physicians

A collection of 6 continuing education webcasts on AMR focusing on different types of antimicrobial. Webcasts can be completed for credit towards the American Medical Association’s Physician Recognition Award Credit System.

http://www.clevelandclinicmeded.com/online/pharmacology/pharm-antibiotic.htm

b

5

Antimicrobial Management Team

University of Kentucky

USA

Americas

Healthcare professionals

Resource website including policies, institution-specific antibiotic guidelines, and personnel training resources.

http://www.hosp.uky.edu/pharmacy/amt/default.html

 

6

Antimicrobial Stewardship - Moving Knowledge to Action

Public Health Ontario

Canada

Americas

Healthcare professionals

A workshop series focused on providing support to develop and grow hospital AMR stewardship programs. Workshops included lectures, participant networking, and highlighted local experiences. The workshops occurred in 4 cities in Ontario and were broadcast via teleconference. Presentation notes and slides are available freely online.

https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/AntimicrobialStewardshipProgram/Pages/Antimicrobial_Stewardship_Workshop.aspx

a

7

Antimicrobial Stewardship Program (ASP) at Nebraska Medicine

Nebraska Medicine

USA

Americas

Healthcare professionals

Program includes video lectures, restricted antimicrobial list, institution-specific antibiotic guidelines, microbiology information, and other educational material. A mobile app provides clinical guidelines, protocols, and dosing adjustments for antimicrobial use. Many web sources are available freely online, but the app requires specific login credentials.

http://www.nebraskamed.com/careers/education-programs/asp

a

8

Antimicrobial Stewardship: A tipping point, transforming practice

Mount Sinai Hospital-University Health Network

Canada

Americas

Physicians, pharmacists

A three-day workshop to identify key ASP priorities and resources, better understand the microbiology laboratory, and consider infectious disease management from an ASP perspective.

Weblink no longer available; Courtesy of Andrew Morris Mount Sinai Hospital.

 

9

Antimicrobial Stewardship: Optimization of Antibiotic Practices

Stanford University

USA

Americas

Healthcare professionals

A MOOC covering the Infectious Disease Society of America guidelines, stewardship principles for special populations, and evidence based antibiotic management for surgical prophylaxis, outpatient care, and sepsis treatment.

http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/news/news/2014/05/massive-online-open-course-mooc-on-antimicrobial-stewardship

 

10

Antimicrobial Stewardship: Taking it to the Next Level

Mount Sinai Hospital-University Health Network

Canada

Americas

Physicians,

pharmacists

Offered in 2011, a course providing information on how to (1) prepare a business case for funding an ASP, (2) identifying the data elements required to start and monitor an ASP, (3) choose ASP priorities, (4) change prescriber behavior, (5) report success and challenges. Continuing Education credit was available for this course.

http://www.antimicrobialstewardship.com/educational-opportunities

b

11

Bugs and Drugs

Alberta Health Services

Canada

Americas

Healthcare professionals

The Bugs & Drugs reference guide provides recommendations for antimicrobial use and infection prevention and management to improve patient care and limit AMR, toxicity, and costs. It is available as a book and mobile app.

http://www.bugsanddrugs.ca/thebook.php

a

12

Cleveland Clinic Guidelines for Antimicrobial Use 2012–2013

Cleveland Clinic

USA

Americas

Physicians

The Cleveland Clinic Guidelines for Antimicrobial Use consists of tables describing laboratory tests, treatment guidelines for infections, and preferred antimicrobial use in various situations such as pregnancy and transplants. Topics addressed include cost-effectiveness, resistance patterns, antimicrobial usage data.

http://www.clevelandclinicmeded.com/medicalpubs/antimicrobial-guidelines/

a

13

Décision+ / Décision+2

Université de LavalGovernment of Quebec

Canada

Americas

Physicians, residents

Decision+ (and Décision+2) integrates multiple educational/behavioral change components to promote shared decision making on antibiotic treatment options. Includes a Diagnostic Decision Support Tool for physician and patient to illustrate risks and benefits. It has been pilot tested, and embedded as a mandatory component of family medicine residency in Quebec.

http://www.decision.chaire.fmed.ulaval.ca/en/research/projects/decision/

 

14

Do Bugs Need Drugs?

Government of Alberta,Government of British Colombia

Canada

Americas

Healthcare professionals

Do Bugs Need Drugs is a community education project that includes resources and accredited courses for physicians and pharmacists, non-accredited courses for students and other professionals, and campaigns for the general public. Health professional students are involved in delivering the program to school children.

http://www.dobugsneeddrugs.org/about/#bc

a,b

15

Get Smart

Centers for Disease Control and Prevention

USA

Americas

Healthcare professionals

The Get Smart for Healthcare program is a comprehensive program produced by the US CDC to improve antibiotic use. Resources for healthcare professional include a collection of program examples,

Implementation resource, fact sheets, research evidence, video commentaries, and PowerPoint slides. General resources include video and radio public service announcements, pamphlets, posters, online resources, and more. This program includes Get Smart About Antibiotics Week, an annual awareness campaign complete with educational and promotional materials such as posters, graphics, press materials, and interactive activity ideas.

http://www.cdc.gov/getsmart/

a

16

Get Smart About Antibiotics

Wake Forest School of Medicine;Centers for Disease Control and Prevention

USA

Americas

Medical students

Wake Forest University has developed a medical school curriculum around antimicrobial resistance. Several resources have been developed to assist with student learning including a series of video lectures and lecture notes, case studies and exam style questions.

http://www.wakehealth.edu/School/CAUSE/Get-Smart-About-Antibiotics.htm

a

17

Get smart Colorado: use antibiotics wisely

Coalition

USA

Americas

Healthcare professionals,

patients and the public

This campaign used pamphlets and posters, billboards, radio, television, website, letters, guidelines, and seminars to promote proper antibiotic use. Resources specifically for healthcare providers included newsletters, externally sourced treatment guides, pediatric academic detailing sheets, and links to external resources. Multiple resources were directed to healthcare providers but for use with patients, such as examination room posters and educational “prescription pads” for viral infections; these types of resources were availablein English and Spanish. The website also shares tips for non-prescription care and appropriate antibiotic use.

http://www.getsmartcolorado.com/

a

18

Healthy Canadians Collection: Antibiotic Resistance

The Government of Canada

Canada

Americas

Healthcare professionals, patients and the public

The Government of Canada produced an online resource for bacteria, antibiotics, AMR, surveillance, and Canada’s efforts on these fronts. Resources for healthcare professionals include guidelines on infection management from The Public Health Agency of Canada, posters about reducing the spread of resistance in healthcare settings, and external resources such as Bugs and Drugs (see program #11). Other resources include educational videos, letters, infographics, posters, and pamphlets for the general public and for First Nations and Inuit peoples specifically.

http://www.healthycanadians.gc.ca/drugs-products-medicaments-produits/buying-using-achat-utilisation/antibiotic-resistance-antibiotique/index-eng.php

a

19

Infectious Diseases Management Program at UCSF

University of California San Francisco

USA

Americas

Healthcare professionals

An inter-professional inter-hospital collaboration to better antimicrobial use and patient care. The program includes guidelines for antimicrobial therapy for various conditions, hospital-specific guidelines, and antimicrobial susceptibility information relevant to hospitals in San Francisco.

http://idmp.ucsf.edu/

 

20

Johns Hopkins Antimicrobial Stewardship Program

Johns Hopkins

USA

Americas

Physicians

Resource site for physicians including guidelines for acceptable and unacceptable use of antibiotics, antibiotic dosage and toxicity for adults, antifungals and vaccines, institution-specific guidelines and regulations, microbiology information, and treatment recommendations for specific infections.

http://www.hopkinsmedicine.org/microbiology/specimen/index.html http://www.hopkinsmedicine.org/amp/guidelines/Antibiotic_guidelines.pdf

 

21

Making a Difference in Infectious Disease Pharmacotherapy (MAD-ID) Canada

MAD-ID and University of Toronto

Canada

Americas

Pharmacists

A workshop held in Toronto in 2010, using an adapted version of the MAD-ID program that included additional content for the Canadian context. Topics included de-escalation and streamlining, and Making Antimicrobial Stewardship work.

Courtesy of Linda Dresser at University Health Network in Toronto

 

22

Making a Difference in Infectious Disease Pharmacotherapy (MAD-ID) USA

MAD-ID

USA

Americas

Pharmacists

MAD-ID offers a basic and an advanced antimicrobial stewardship training program which are designed for pharmacists and physicians. Continuing education credit is available for pharmacists in the USA.

http://mad-id.org/antimicrobial-stewardship-programs/

b

23

Michigan antibiotic resistance reduction coalition

Coalition

USA

Americas

Healthcare professionals, patients and the public

This state campaign provided information about antimicrobials and resistance to healthcare providers and the public using TV and radio announcements, pamphlets, educational cartoons for children, and posters. Healthcare professionals were targeted specifically with infographics, and pamphlets about prescribing and communicating with patients. A webinar on antibiotics in upper respiratory tract infections was also promoted to healthcare providers.

http://www.mi-marr.org/

a

24

Multipronged Education Strategy on Antibiotic Prescribing in Quebec

INESSS Quebec

Canada

Americas

Physicians, pharmacists, medical residents

Educational mailout with guidelines targeting the most common conditions in outpatient settings, clinical information on diagnosis and antibiotic recommendations. The emphasis was on proper antibiotic regimens and not using antibiotics when viral infections were suspected, plus using shorted possible treatment. Guidelines were produced by the Quebec Medication Council in collaboration with physicians and pharmacists. A letter of support from all key stakeholders (MOH, College of Physicians, College of Pharmacists, Medical Associations) accompanied the mail-out.

Weiss et al. Clin Infect Dis 2011; 53(5):433–9. https://www.ncbi.nlm.nih.gov/pubmed/21791439

 

25

National information program on antibiotics

Coalition

Canada

Americas

Physicians, pharmacists, patients and the public

This program uses pamphlets and posters, print media, radio and letters to summarize information on antibiotics, bacterial infections, antibiotic use, and resistance.

http://www.antibiotics-info.org

a

26

NCCID Resources for Healthcare Providers Website (Antibiotic Awareness Week Webinar Archives and NCCID Resources for healthcare providers)

National Collaborating Centre for Infectious Diseases

Canada

Americas

Healthcare professionals

The National Collaborating Centre for Infectious Diseases (NCCID) website provides free online resources focused on antibiotics and AMR. The Antibiotic Awareness Week Webinar Archives is an online resource that compiles YouTube videos, transcripts, and presentation slides from previous seminars. Resources are available in English or French and online access is free. Resources for Healthcare Providers include factsheets, prescription sheets, a script outlining how to communicate with patients, treatment guidelines.

http://nccid.ca/antibiotic-awareness/ http://nccid.ca/antibiotics-and-health-care-providers/#patients

 

27

Nebraska appropriate antibiotic use campaign

Regional department of health

USA

Americas

Healthcare professionals, patients and the public

A state antibiotic awareness campaign. Resources for healthcare providers include links to local AMR stakeholder organizations such as the Nebraska Infection Control Network, and other external resources such as links to CDC resources.

http://dhhs.ne.gov/publichealth/HAI/Pages/Resistance.aspx

a

28

Nursing Home Antimicrobial Stewardship Modules

Agency for Healthcare Research and Quality, Department of Health and Human Services

USA

Americas

Nurses

Nursing Home Antimicrobial Stewardship Guide provided by the Agency for Healthcare Research and Quality seeks to train nurses and other nursing home staff on AMR, treatment decisions. The program provides toolkits on antimicrobial stewardship and antibiotic treatment which include informational handouts, online training resources, educational PowerPoint slides, and links to academic articles.

http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/nh-aspguide/index.html

 

29

Oregon alliance working for antibiotic resistance education

Coalition

USA

Americas

Healthcare professionals, patients and the public

This state coalition seeks to promote careful use of antibiotics by targeting healthcare providers, and the general public. Provider resources include posters, continuing education course links, prescribing statistics, treatment guidelines, and seminars and the CDC’s Get Smart week are promoted. Resources for the public include activity books for children, brochures and information sheets about prudent antibiotic use and resistance.

https://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/AntibioticResistance/Pages/index.aspx

a

30

Public Health Ontario Antimicrobial Stewardship Program

Public Health Ontario

Canada

Americas

Doctors, nurses, pharmacists

Public Health Ontario provides resources such as posters to promote appropriate prescribing in hospital settings, presentation slides on AMR and stewardship, webinars, and print guidelines. These resources are shared to support acute care facilities in meeting Accreditation Canada’s mandate requiring AMS programs.

https://www.publichealthontario.ca/en/BrowseByTopic/InfectiousDiseases/AntimicrobialStewardshipProgram/Pages/Antimicrobial-Stewardship-Program.aspx

a

31

South Carolina Careful Antibiotic Use (CAUse)

South Carolina Department of Health and Environmental Control

USA

Americas

Healthcare professionals, patients and the public

An adapted version of the CDC Get Smart program which initially targeted HCW for education on diagnostic and treatment guidelines, then targeted parents of young children about appropriate use.

Overview is available in this report: http://www.scstatehouse.gov/Archives/DHEC/AROStrategicPlan-final1-15-07dr_3.pdf

a

32

Stop antibiotic misuse in Minnesota

Coalition

USA

Americas

Healthcare professionals, patients and the public

This state program used pamphlets and posters, letters, guidelines, seminars and a childcare curriculum. The website provides links for professionals include policy statements, statistics, journal articles and guidelines relating to AMR and infections.

http://www.minnesotaarc.org/

a

33

Stop the resistance—use antibiotics wisely

Nevada Public Health Foundation

USA

Americas

Healthcare professionals, patients and the public

This state educational campaign seeks to reach healthcare providers the public to encourage and appropriate antibiotic use. This campaign provides resources including clinical practice guidelines, resources from the CDC, and information sheets informing prescribers about appropriate antibiotic use. General resources include educational brochures on AMR, colds, and infections in English and Spanish, and links to websites and games for children’s education on topics such as handwashing and bacteria.

http://www.nevadapublichealthfoundation.org/programs/nevadans-for-antibiotic-awareness/

a

34

The California Antimicrobial Stewardship Program Initiative

California Department of Public Health

USA

Americas

Healthcare professionals

This program shares resources associated with the California Department of Public Health, such as an antimicrobial stewardship webinar series directed to nursing homes, and a compilation of example stewardship programs. The focus of this program is to support the implementation of stewardship programs in California hospitals and healthcare facilities.

http://www.cdph.ca.gov/programs/hai/Pages/AntimicrobialStewardshipProgramInitiative.aspx

 

35

University of Pennsylvania Antimicrobial Stewardship

University of Pennsylvania

USA

Americas

Medical students, residents

This educational webpage includes presentation slides, PDF handouts, and lecture recordings relevant to antimicrobial education for medical students and residents. Topics include drug availability, prophylaxis, as well as University-specific stewardship policies, antibiotic prescribing recommendations, restrictions and economic considerations.

http://www.uphs.upenn.edu/antibiotics/

a

36

Washington state’s campaign to fight antibiotic resistance

Regional department of health

USA

Americas

Physicians, patients and the public

This state health department website compiled links to publications and external resources on AMR for patients, physicians, and educators. Resources for the public include school-based awareness programs, information sheets, and links to the FDA and CDC.

http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/AntibioticResistance

a

37

Awareness week, lectures and panel discussions

Students for Antimicrobial Stewardship Society

Canada

Americas

Healthcare students

This student society has chapters in medical, dental and pharmacy schools across Canada. They have organized an annual awareness week with lectures and panel discussions to educate students about AMR and AMS.

http://www.sass-canada.ca/

 

38

Antibioclic: Antibiotherapie rationelle en soins primaires

Societe de Pathologie Infectieuse de Langue Francaise/French Infectious Diseases Society (SPILF)

France

Europe

Physicians

This website offers therapeutic recommendations to primary care physicians. Physicians input their patients’ pathology and other clinical considerations, and the website provides recommended antibiotic treatment with considerations and options for allergies and contraindications, as well as brief information about the antibiotics. The website also shares news related to infections and antibiotics.

http://antibioclic.com/

a

39

Antibioguide and Antibioville

Antibiolor

France

Europe

Physicians

The Antibiolor guidelines were published to assist physicians in the management of infections: Antibioguide (2005) for hospital physicians and Antibioville (2004) for community physicians. The guidelines are available online, in print, and through an app. Antibiolor also provides Antibiotel, a telephone advice service for physicians requiring advice regarding management of patients with infectious diseases.

http://www.antibiolor.org/

a

40

Antibiotic advice in Île-de-France

Societe de Pathologie Infectieuse de Langue Francaise/French Infectious Diseases Society (SPILF)

France

Europe

Physicians

Telephone advice relating to antibiotics was provided by physicians for physicians;

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

 

41

Antibiotic Awareness Campaign

European Phamacy Students Association

Multiple

Europe

Pharmacy students

The European Pharmacy Students Association created an Antibiotic Awareness Campaign in order to raise awareness about antibiotic use, decrease demand for antibiotics, and to educate the public on AMR. The EPSA created a campaign for their assembly in 2013 and a digital campaign was developed in partnership with the ECDC for the European Antibiotic Awareness Day.

http://www.epsa-online.org/index.php/projects/public-health-campaigns/previous-campaigns

a

42

Antibiotic Guardian

Public Health England

United Kingdom

Europe

Healthcare professionals, patients and the public

Antibiotic Guardian consists of a collection of pledges with over 30,000 signatures directed to healthcare professionals, students, and the general public. Resources for healthcare professionals include links to country-specific EAAD and WAAW resources and public resources include patient stories, posters, leaflets, and links to other programs including WAAD, e-bug, and other informational websites.

http://antibioticguardian.com/

a

43

Antibiotic Resistance in Primary Care E-Module

Royal College of General Practitioners Learning

United Kingdom

Europe

Healthcare professionals

This hour long continuing professional education course for primary care physicians in the UK looking to learn about antibiotic prescribing, resistance, and resources for practice.

http://elearning.rcgp.org.uk/course/info.php?popup=0&id=167

b

44

Antibiotic Resistance: The Silent Tsunami

Uppsala University

Sweden

Europe

Healthcare professionals

This 4-week-long online course discusses the spread of antibiotic resistance, the development of antibiotics, the current state of resistance and antibiotic use, and actions to tackle AMR. This course is free and composed of 3 h per week of online content.

https://www.futurelearn.com/courses/antibiotic-resistance

a,b

45

Antibiotics only when necessary (Le Projet Gepie: Groupe d’Etude et de Prévention des Infections de l’Enfant)

Coalition: academic centers, health insurance, medical association, institute for public health

France

Europe

Physicians

This campaign employed pamphlets and posters, website, letters, guidelines, and academic detailing. The program’s website contains resources such as guidelines for antibiotic use or disuse, progression of conditions such as bronchitis, in addition to general guidelines and guidelines for antibiotic use in children. A list of publications by the GEPIR group is provided. This group also supports an initiative for teacher and youth education about microorganisms, infections, and their treatment known as “Projet E-bug”.

http://www.gepie.org/

a

46

Antibiotics, use them in an adequate way

Coalition: pharmaceutical industry, department of health, professional organizations

Portugal

Europe

Healthcare professionals, patients and the public

A seasonal campaign to reduce antibiotic use in Portugal that used several intervention types to target a wide range of professionals and the public.

Huttner et al. in Lancet Infect Dis. 2010; 10(1):17–31. https://www.ncbi.nlm.nih.gov/pubmed/20129146

 

47

Antimicrobial Resistance and Healthcare Associated Infections Foundation Course on Hospital Infection Control

Healthcare Infection Society

United Kingdom

Europe

Residents

This 3 day long in-person course provides information on healthcare associated infections and AMR, developing surveillance programs, outbreak investigation, hospital hygiene, the basics of antimicrobial stewardship, and healthcare associated infections. It can be taken as a stand-alone course or as part of a Masters or Diploma course.

https://www.his.org.uk/education/courses/

b

48

Antimicrobial Resource Centre

British Society for Antimicrobial Chemotherapy

United Kingdom

Europe

Healthcare professionals

This database of resources compiles many educational materials and links including links to open online courses, audio, guidelines, images, press articles, publications, posters, research papers, slide sets, systematic reviews and video lectures on diverse topics relating to antimicrobials and resistance.

http://stage.bsac-arc.com/#

a

49

Antimicrobial Stewardship Educational Workbook

Scottish Antimicrobial Prescribing Group

United Kingdom

Europe

Nurses,

midwives

This interactive workbook contains question prompts and links to informational videos to support learning around antimicrobial stewardship, specifically including chapters on stewardship in practice, bacteria, resistance and antibiotics, assessment of infection, and hospital practice.

http://www.scottishmedicines.org.uk/files/sapg/Final_Antimicrobial_Stewardship_Print_Wkb_Jan_2016.pdf

a

50

Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use

National Institute for Health and Care Excellence

United Kingdom

Europe

Healthcare professionals, patients and the public

The National Institute for Health and Care Excellence publishes guidelines including Antimicrobial Stewardship. These guidelines include recommendations for the implementation of stewardship programs, antimicrobial prescribing, and new antimicrobials.

https://www.nice.org.uk/guidance/ng15

 

51

Antimicrobial Susceptibility Testing and Surveillance: from Laboratory to Clinic.

European Society of Clinical Microbiology and Infectious Diseases

Germany

Europe

Clinical microbiologists

This 3-day-long workshop consists of a series of lectures and laboratory sessions that cover European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints, antimicrobial susceptibility testing, antimicrobial surveillance systems, and antimicrobial guidelines. This is part of a series of microbiology workshops organized by the ESCMID.

https://www.escmid.org/profession_career/educational_activities/escmid_courses_and_workshops/antimicrobial_susceptibility_testing_and_surveillance_a_eucast_esgars_and_epasg_perspective/

 

52

Antimicrobials and infection management

Centre for Pharmacy Postgraduate Education

United Kingdom

Europe

Pharmacists, pharmacy students,

This 10-h e-learning course focuses on describing the action of antimicrobials, selecting appropriate antimicrobial agents, antimicrobial prophylaxis, patient treatment, and healthcare-associated infections. This program is only available to members of the General Pharmaceutical Council.

https://www.cppe.ac.uk/programmes/l/antimicro-e-01/

 

53

Bugs and antibiotics: the role of the Greek Physician in the fight against microbial resistance

University of Athens

Greece

Europe

Physicians

A regional education campaign in 2009/10 organized by the medical school at the University of Athens. A series of meetings were organized with primary care physicians followed by 4 interactive case study sessions. Participants also received a set of guidelines and a booklet on management of community acquired infections.

Plachouras et al. in BMC Public Health 2014;14:866.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148920/

 

54

CNAMTS Program

National Health Insurance Fund for Salaried Workers (CNAMTS)

France

Europe

Physicians

The National Health Insurance Fund for Salaried Workers’ (CNAMTS) work for AMR includes holding meetings with Delegates of the National Health Insurance (DAM) and physicians. Information sheets and recommendations on medical practice are handed out to physicians during these meetings, which are held 3 or 4 times a year.

Huttner et al. in Lancet Infect Dis. 2010; 10(1):17–31.

https://www.ncbi.nlm.nih.gov/pubmed/20129146

 

55

Collection: Antimicrobial Resistance (AMR)

National government

UK

Europe

Healthcare professionals,

The UK government supports an online collection of resources relating to AMR and inks to research publications, technical and clinical guidelines, posters, research, news updates, and strategic documents such as the UK AMR strategies and progress reports. One noteworthy resource is the “Antimicrobial Resistance Resource Handbook” which provides information on policy, recommendations, education, tools, surveillance, and other resources that support stewardship and AMR reduction.

https://www.gov.uk/government/collections/antimicrobial-resistance-amr-information-and-resources

a

56

Correct use antibiotics

Belgian Antibiotic Policy Coordination Committee (BAPCOC)

Belgium

Europe

Healthcare professionals, patients and the public

This program’s webpages offer links to academic articles are directed towards healthcare professionals. Webpages answer basic questions (e.g. what are antibiotics, asking advice from your healthcare provider), promote children’s educational comics on antimicrobials and infections, and provide links to external resources for the general public. The program also includes radio commercials. Many resources are available in French, English, Dutch and German.

http://www.correctuseantibiotics.be/en

a

57

ESCMID Summer School

European Society of Clinical Microbiology and Infectious Diseases

Spain

Europe

Physicians, clinical microbiologists

This week long in-person course focuses on clinical microbiology and infections. Topics include infection management, therapy beyond antibiotics, viral infections, multidrug resistance, international health and career development.

https://www.escmid.org/dates_events/escmid_summer_school/

 

58

ESCMID/ASM Conference on Drug Development to Meet the Challenge of Antimicrobial Resistance

European Society of Clinical Microbiology and Infectious Diseases

Austria

Europe

Healthcare professionals

This 3-day conference consists of a series of lectures, symposiums, debates, round table discussions, and interactive question and answer sessions relating to AMR. Topics include clinical use of off-patent antibiotics, future areas of research, breakpoints, and changing antimicrobial administration and guidelines.

https://www.escmid.org/research_projects/escmid_conferences/escmidasm_conference/

 

59

European Antibiotic Awareness Day

European Centre for Disease Prevention and Control

 

Europe

Healthcare professionals, patients and the public

European Antibiotic Awareness Day promotes education about antibiotic use and resistance annually on November 18th. The website contains diverse downloadable resources for prescribers as well as patients and the public. Toolkits for prescribers include presentations for in-hospital training on AMR, patient dialog guides and factsheets.

http://ecdc.europa.eu/en/eaad/Pages/Home.aspx

a

60

General Practitioner conferences to reduce over-prescribing

Health insurance office, Créteil hospital center

France

Europe

Physicians

Conferences and meetings involved a discussion of prescribing profiles and promoted awareness of antibiotic use.

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

 

61

Interdisciplinary Regional Program for the Control of antimicrobial resistance (PRIMAIR)

 

France

Europe

Physicians

This program promoted continuing education and antibiotic treatment guidelines for general practitioners in the Franche-Comté region of France.

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

b

62

MedQual

Centre Ressource en Antibiologie

France

Europe

Healthcare professionals, patients and the public

This network is dedicated to monitoring antibiotic use and antibiotic resistance. The website provides online advice and decision trees for physicians managing infectious diseases. It also publishes a monthly electronic newsletter. Telephone advice to healthcare professionals is provided.

http://www.medqual.fr/

a

63

National Health Service Scotland Education and Training

National Health Service Scotland/NHS Education for Scotland

United Kingdom

Europe

Physicians, nurses, pharmacists

The Scottish Reduction in Antimicrobial Prescribing (ScRAP) Programme is an educational toolkit under this program to encourage a reduction in unnecessary antibiotic prescribing. ScRAP includes teaching topics and lesson plans for local facilitators, video lectures, and videos of patient-scenarios and other teaching materials. Some programs include clinical vignettes and multiple choice assessments. Other resources include interactive antimicrobial stewardship educational textbooks/workbooks targeted towards nurses and midwives, complete with information, best practice examples, evaluation questions, and reflection prompts, as well as PowerPoint presentation slides for practitioner education.

http://www.nes.scot.nhs.uk/education-and-training.aspx

 

64

Nice France teaching hospital telephone advice service

Nice teaching hospital Infectious Disease Department

France

Europe

Physicians

This service consisted of telephone advice with the option of in person consultations for general practitioners in the Provence-Alpes-Côte d’Azur Est region of France. Was terminated due to lack of resources.

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

 

65

PrescQIPP Antimicrobial Stewardship Webkit

PrescQIPP

United Kingdom

Europe

Healthcare professionals

This webpage provides resources and links to educate healthcare providers about antimicrobial stewardship and AMR. Types of resources include data on infections, infographics, guidelines relating to AMR, information about diagnoses, and online links.

https://www.prescqipp.info/antimicrobial-stewardship/projects/antimicrobial-stewardship#diagnostics

a

66

Project children and antibiotics—for appropriate antibiotic use in children

Regional department of health

Italy

Europe

Physicians

This program targeted antibiotic prescribing to pediatricians by running seminars and adapting “Do Bugs Need Drugs” (see program #14).

Huttner et al. in Lancet Infect Dis. 2010; 10(1):17–31.

https://www.ncbi.nlm.nih.gov/pubmed/20129146

 

67

Reducing Antimicrobial Resistance

E-Learning for Healthcare, Health Education England

United Kingdom

Europe

Healthcare professionals, patients and the public

This program consists of an e-learning session, short videos, and links to other resources such as Antibiotic Guardian (see program #42) and Future Learn MOOC (see program #90). The objective is to discuss risks and development of AMR, the misuse of antibiotics, and improve responses to patients.

http://www.e-lfh.org.uk/programmes/antimicrobial-resistance

a

68

STAR: Stemming the Tide of Antibiotic Resistance

Healthcare CPD

United Kingdom

Europe

Physicians

This hour long training intervention informs medical practitioners about antibiotic prescription, resistance, and to encourage behavioral change and reflection about current practices.

http://www.healthcarecpd.com/course/star-stemming-the-tide-of-antibiotic-resistance

a

69

Strama

The Swedish Strategic Programme Against Antibiotic Resistance (Strama)

Sweden

Europe

Healthcare professionals

The Swedish Strategic Programme Against Antibiotic Resistance (Strama) shares action plans, scientific research protocols and data. They link to other resources, such as online courses for doctors and nurses. The National Strama Days are annual awareness campaigns meant to provide education on antibiotic issues including resistance and policymaking and facilitate networking.

http://strama.se/?lang=en See report: “Swedish work on containment of antibiotic resistance” http://strama.se/examples-of-projects/?lang=en

 

70

Strategic and Exploratory Workshop

Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)

Norway

Europe

Healthcare professionals

Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) facilitates a series of workshops. These workshops revolve around selected keynote lectures, breakout sessions and plenary discussions. Workshop titles include “The Interplay Between AMR Surveillance and Science” and “Early Discovery of New Antibiotics”.

http://www.jpiamr.eu/activities/the-interplay-between-amr-surveillance-and-science/

 

71

SWAB (Dutch Working Party on Antibiotic Policy)

Society of Infectious Diseases

The Netherlands

Europe

Healthcare professionals

The Dutch Working Party on Antibiotic Policy (SWAB) has developed numerous guidelines relating to antibiotics and AMR focusing on general information, specific infections, MRSA, and antibiotic prophylaxis. The group also holds an annual symposium on AMR and contributes to EAAD online resources.

http://www.swab.nl/swab/cms3.nsf/viewdoc/102D6425C642468DC125757F0039CDDE

 

72

The Regional Functional Unit of Infectious Diseases (UFIR)

Ajaccio hospital directorate, Corsica regional health authority

France

Europe

Physicians

This unit offered telephone advice for general practitioners in Corsica as well as post-graduate education on antibiotics.

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

 

73

Treat Antibiotics Responsibly, Guidance, Education, Tools (TARGET) Antibiotics Toolkit

Royal College of General Practitioners, Public Health England

United Kingdom

Europe

Healthcare professionals

This toolkit includes antibiotic prescribing data, toolkits for conducting audits, posters and pamphlets for patients, guidelines from Public Health England, resources to support implementation of the TARGET toolkit, and links to external resources and stakeholders relevant to AMR and antibiotics. Resources for general practitioners specifically include a self-assessment checklist evaluating good antimicrobial practices. Training resources include a webinar series, presentation templates and notes, and links to two e-modules. The webinar series runs from November to December 2016 and provides information on how to improve prescribing and patient care.

http://www.rcgp.org.uk/TARGETantibiotics

a

74

URPS Program

Regional health authority

France

Europe

Physicians

As a local initiative, information sheets were distributed to general practitioners at clinical presentations. Information sheets related to infection management, clinical presentation, and antibiotic prescribing for patients aged 15 to 65.

Wang et al. in Med Mal Infect. 2015; 45(4):111–23.

https://www.ncbi.nlm.nih.gov/pubmed/25747501

 

75

Antimicrobial Stewardship: Principles and Practice

European Society of Clinical Microbiology and Infectious Diseases

 

Europe

Healthcare professionals

This course will discuss basic principles of AMR and consumption surveillance, implementation of AMS programs, how to change prescriber behaviors, and how to integrate AMS education in student, resident and postgraduate education at an institutional level. Planned for 2017.

https://escmid.pulselinks.com/event/13464

 

76

Antibiotic campaign

Health maintenance organization

Israel

Middle East

Physicians

A seasonal campaign to distribute guidelines and information on resistance to physicians, with a mass media component.

Huttner et al. in Lancet Infect Dis. 2010; 10(1):17–31.

https://www.ncbi.nlm.nih.gov/pubmed/20129146

a

77

Antibiotics Smart Use: Thailand

Antimicrobial Resistance Containment Program (AMRCP) in Thailand

Thailand

South East Asia

Healthcare professionals, patients and the public

Country-wide campaign that educated prescribers about antibiotics in half-day long in-hospital training sessions. Training included sharing experiences, learning about treatment guidelines and diagnostic tools, as well as instructions on implementing resources for patient education such as DVDs, pamphlets and other materials.

http://www.reactgroup.org/toolbox/thailands-work-to-limit-abr/#zp-ID-2628-280251-WJR8EDEQ

 

78

ASPIC (Antibiotic Stewardship, Prevention of Infection & Control)

Indian Council of Medical Research

India

South East Asia

Clinical pharmacists, clinical microbiologists

This workshop taught skills and knowledge about infection prevention and control, implementation of antimicrobial policy guidelines for rational use of antibiotics to curb resistance, conducting research projects in antibiotic policy. Workshop consisted of 5 days of lectures, site visits, practical training, demonstrations and project discussions.

Chandy et al. in Indian J Med Res 2014; 139(2):226–230. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4001333/

 

79

AMR Training

Songdo Hospital

Mongolia

Western Pacific

Physicians

Quarterly Education sessions and surveys of antimicrobial prescribing in hospital.

Courtesy of WHO WPRO Office: WHO Mongolia Country Report May 2016 by Koning and Peel

 

80

Antibiotic Awareness Week

Government of Viet NamWHO

Viet Nam

Western Pacific

Healthcare professionals, patients and the public

This awareness week campaign included a pledge initiative, public outreach events, posters and banners in hospitals, and social media use.

http://www.wpro.who.int/vietnam/mediacentre/releases/2015/antibiotics_resistance_week2015/en/

https://www.facebook.com/amrweekvietnam/

a

81

DOH Manual of Procedures for Implementing AMS in Hospitals

Department of Health (Philippines)World Health Organization

Philippines

Western Pacific

Physicians

The DOH Manual of Procedures for Implementing AMS in Hospitals is an operational guide that is also used as a reference for developing training programs and materials.

Information courtesy of the WHO WPRO regional office.

a

82

National Prescribing Service: Medicinewise Resource Website

National Prescribing Serivce (NPS): Medicinewise

Australia

Western Pacific

Healthcare professionals

The NPS website includes resources and online learning modules. The website of antibiotic resources for health care providers includes tools for consultation with patients, pamphlets and posters, guidelines. Five online case study-based modules are available for general practitioners, nurses, and healthcare professional students on the topics of antimicrobial prescribing, bacterial infections, urinary tract infections, pneumonia, and surgical antibiotic prophylaxis. These modules are recognized by The Royal Australian College of General Practitioners as fulfilling some requirements of their Continuing Professional Development program as well as by the Australian College of Rural and Remote Medicine for some of their Professional Development Program requirements.

http://www.nps.org.au/medicines/infections-and-infestations/antibiotics

http://www.nps.org.au/health-professionals/cpd

a,b

83

Training-of-Trainers Workshop on the Antimicrobial Stewardship Advocacy Training

Department of Health (Philippines)World Health Organization (WPRO)

Philippines

Western Pacific

Healthcare professionals

The Training-of-Trainers was delivered by a representative from NPS Medicinewise (Australia). This consisted of an interactive session on current initiatives and challenges of each hospital in relation to infection prevention and control, rational use of antimicrobials and surveillance of AMR. Also included was a consultation on draft AMS pilot program implementation.

http://www.ncpam.doh.gov.ph/index.php/en/training-of-trainers-workshop-on-the-antimicrobial-stewardship-advocacy-package

 

84

Training-workshop for government Level III hospitals on the implementation of the AMS

Department of Health (Philippines)World Health OrganizationCorazon Locsin Montelibano Memorial Regional Hospital

Philippines

Western Pacific

Physicians

This workshop began as a pilot program at Philippine General Hospital and Corazon Locsin Montelibano Memorial Regional Hospital. An AMS program with an educational component was tested and has now been scaled up to provide training at all DOH Level III hospitals.

Information courtesy of the WHO WPRO regional office.

 

85

WHO WPR Pledge to use antibiotics responsibly

World Health Organization Western Pacific Region

 

Western Pacific

Healthcare professionals

This pledge designed by the World Health Organization Western Pacific regional office discusses a commitment to the use of antibiotics as prescribed, good hygiene, and encouraging responsible use in friends and family. Includes information on AMR.

https://apps.wpro.who.int/amr/pledge.aspx

a

86

Win the War Against AMR

Department of Health

Philippines

Western Pacific

Healthcare professionals

Win the War Against AMR is a pledge for healthcare providers to use antimicrobials responsibly. Pledge documents comment upon judicious use of antimicrobials, continuing education of others, promoting preventative measures, and supporting research of antimicrobial drugs and diagnostic technologies.

http://www.ncpam.doh.gov.ph/index.php/en/major-program?id=52

a

87

Medication Shortage Fact Sheets and Infographics

National Centre for Antimicrobial Stewardship (NCAS)

Australia

Western Pacific

Healthcare professionals

This resource provides fact sheets and infographics designed in response to recent problems with the supply of antimicrobials in Australia. The fact sheets provide advice and possibilities for alternative therapy when vital medications are in short supply. The infographics provide information on antimicrobial prescribing in various healthcare facilities. Both resources are easily accessible online.

https://www.ncas-australia.org/education

a

88

AMS Implementation Toolkit

Clinical Excellence Commission

Australia

Western Pacific

Healthcare professionals

The Clinical Excellence Commission has developed resources to support the implementation of hospital AMS programs that embody the core elements required for program implementation and maintenance. These resources also facilitate to identify gaps present in currently established AMS programs.

http://www.cec.health.nsw.gov.au/patient-safety-programs/medication-safety/antimicrobial-stewardship/quah/ams-implementation-toolkit

 

89

Antibiotic Stewardship Clinical Care Standards

Australian Commission on Safetey and Quality in Health Care

Australia

Western Pacific

Healthcare professionals

This resource provides guidance to clinicians and health service managers on delivering appropriate care when prescribing antibiotics. The resource also provides a set of suggested indicators to assist with local implementation of the Antimicrobial Stewardship Clinical Care Standard. Clinicians and health services can use the indicators to monitor implementation of the quality statements.

https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard/

a

90

Antimicrobial Stewardship: Managing Antibiotic Resistance

University of Dundee;British Society for Antimicrobial Chemotherapy

United Kingdom

Global

Healthcare professionals

This 6-week-long Massive Open Online course focuses on improving antimicrobial prescribing and AMS in hospital settings and can be applied to other settings. The course has run twice on the FutureLearn platform and involves readings, case study videos, video interviews with experts, and online discussion with peers and educators. Course topics include an overview of resistance as a global problem, the importance and key elements of antimicrobial stewardship, measurement of antibiotic prescribing, emerging strategies for antimicrobial stewardship, behavior change, and the importance of collaboration and coordination.

https://www.futurelearn.com/courses/antimicrobial-stewardship

a,b

91

Basic Concepts Book

International Federation of Infection Control

United Kingdom

Global

Healthcare professionals

This book, Basic Concepts, by the International Federation of Infection Control contains a chapter on “Principles of Antibiotic Policies”. Key topics in this chapter include the rational use of antibiotics to combat resistance, the role of AMR stewardship programs, targeted antibiotic prescribing and treatment, and microbiology laboratory services in relationship to AMR. It is available in English, Arabic, French, Spanish, Italian, Bulgarian and Hungarian.

http://theific.org/basic-concepts-english-version-2016/

a

92

Basic Infection Control Training Programme Course

International Federation of Infection Control

United Kingdom

Global

Healthcare professionals

This infection control course contains a module that focuses explaining how antibiotic use selects strains of bacteria, identifying mechanisms of AMR stewardship programs, the role of microbiology laboratories in resistance, as well as healthcare associated infections and outbreaks in general.

http://theific.org/basic-ic-training-course-outline/

a

93

Coursera Course: Antimicrobial resistance - theory and methods

Technical University of Denmark

Denmark

Global

Healthcare professional

This 5 week long online MOOC teaches on antimicrobial action, antimicrobial resistance, antimicrobial susceptibility testing, interpretation, quality assurance, and bacterial genomic testing through online videos lectures and graded quizzes.

https://www.coursera.org/learn/antimicrobial-resistance

a

94

ReAct Toolbox

Uppsala University

Sweden

Global

Healthcare professionals

Resource website on AMR and AMS with profiles of useful interventions.

http://www.reactgroup.org/toolbox/

a

aThe resource was available free of charge

bThe resource was for continuing professional development credit or provided a certificate of completion or counted towards a degree program

We identified 24 multi-component umbrella programs, which typically included web-based resources, videos, references to guidelines, and promotional materials, such as posters, pamphlets, or infographics. Programs that incorporated four or more program types were defined as umbrella programs. Umbrella programs tended to have broader target audiences and wider scopes; in many cases, their awareness campaign materials were targeted towards a general audience, while online reading and guidelines were more often aimed at HCWs. Many umbrella programs targeted their messaging at HCWs—including physicians, pharmacists, and sometimes nurses—as a group, rather than targeting professions or specialties individually.

Of the programs identified (see Fig. 1), the most common program type was websites; typically, however, online resources were only part of a larger program. This is unsurprising as online resources are effective platforms for sharing other program types, including videos, guidelines, pamphlets, and workbooks. Guidelines and handbooks were also a common resource, often shared online in government and hospital education initiatives; these described information about key patient populations and prescribing guidelines and were intended as reference resources. By contrast, we also identified a small number of workbooks and question sets intended as a teaching resource.
Figure 1
Fig. 1

Number of identified AMR education programs by program type

Other teaching resources available online included videos, webinars, and lecture slides. Online courses, including massive open online courses (MOOCs), are becoming common and often incorporate online videos and discussion boards to engage participants. In Fall 2016, there were two MOOCs on the FutureLearn platform (see Initiatives #44 and #90). The MOOC run by the University of Dundee and British Society for Antimicrobial Chemotherapy (Initiative #90) has gained global popularity. Several experts referenced this course as a resource used in their country; the course has been offered three times to date and participants have come from more than 41 countries.

Figure 2 shows participating organizations grouped by type. Overall, the most commonly identified organizations were governmental bodies, often the national/provincial/state-level body responsible for health and/or education. We also found that health insurance companies often partnered with other organizations in the USA to support AMR education campaigns. Collaborations with industry came almost entirely from North America. Outside of the USA, the only other campaigns that partnered with a health insurance provider were in France. The European Centre for Disease Control contributed to the bulk of projects which we tagged as intergovernmental organizations.
Figure 2
Fig. 2

Number of identified AMR education programs by organization type

Professional societies, particularly those with a strong tie to AMR, were heavily involved in the creation and provision of resources for HCWs. Three examples are the British Society for Antimicrobial Chemotherapy, which has been involved in the creation of resource websites (Initiative #48), coordination of a MOOC (Initiative #90), and provision of funding for AMR education; the European Society of Clinical Microbiology and Infectious Diseases, which runs a study group on antimicrobial resistance, develops and coordinates courses, and carries out collaborative academic research; and the Infection Control Africa Network which organized a free distance learning course for HCWs in Africa in 2014. Many professional bodies with broader mandates, for example, medical associations and pediatric societies, have partnered with others to support larger projects, but were rarely the lead organization in the projects that we identified. For example, the NPSMedicineWise project (Initiative #82) in Australia engaged the Australian College of Nursing, Australian Association of Consultant Pharmacy, the Australian College of Rural & Remote Medicine, and the Australian Nursing and Midwifery Federation and many others alongside government bodies to produce resources and course content for the website.

University-led projects were typically related to online or in-person courses or to resource websites. Many of these sites provide lecture slides, or recorded video lectures (e.g. Initiative #16), as well as information on guidelines and policies (e.g. Initiative #35). Other types of organization were engaged in a wide variety of projects. Hospitals and healthcare centers, for example, engaged with umbrella programs, courses and workshops, intervention studies, and resource guides.

Most programs targeted HCWs as a broadly defined group. Figure 3 shows the target audiences for the 94 programs identified. Several programs also included components aimed at patients and the public. We found 33 programs aimed at physicians, including a small number that targeted specialists such as infectious disease physicians and pediatricians. Fewer programs specifically targeted nurses, pharmacists, and midwives, though these groups were targeted in the more general HCW programs. A small number of predominantly university-based programs targeted medical or pharmacy students. Four programs, mostly courses and workshops, targeted clinical microbiologists alongside other HCWs.
Figure 3
Fig. 3

Number of identified AMR education programs by target healthcare worker group

We identified programs from around the world, though, as expected, the programs were unequally distributed between countries and regions, with a larger share of the programs from North America and Europe. Figure 4 shows a map of the number of programs identified from each region. Many of the large-scale AMR/AMS educational campaigns took place in wealthy American and European countries (e.g. Initiatives #15 and #59), whereas many of the programs in Africa and Asia were workshop or course based (e.g. Initiatives #1, #78, #83). The interconnected nature of some programs made them more easily producible on the part of the organizations and more easily identifiable on our part as researchers. This strategy facilitated the growth of programming in specific regions, and has made online information about AMR/AMS widely available to HCWs and the public. For instance, state-specific AMR educational initiatives, such as “Get Smart Colorado: Use Antibiotics Wisely” (Initiative #17), appeared to tailor resources or share/endorse existing resources from the comprehensive national “Get Smart” program (Initiative #15) produced by the CDC in the USA.
Figure 4
Fig. 4

Map of AMR education programs by region. Map was generated using Microsoft Excel and Bing

Discussion

Our environmental scan shows that many organizations are working to develop and share course content and educational resources for HCW training and continuing education around the world. We identified several types of resources, from traditional in-person courses to workshops and conferences, to MOOCs, to online campaign materials, to handbooks, and to workbooks. Governments, hospitals, and professional societies appear to be driving action on this front, and these three types of organization have successfully built partnerships with others including non-profits, insurance companies, and WHO regional offices.

This level of collaborative work is promising; however, we have identified opportunities for action on several fronts. First, there is an opportunity for the development of better resources and training opportunities for students in the healthcare professions. Early engagement can provide a strong foundation of AMR knowledge that students draw upon as they progress through their careers as prescribers and patient educators. Second, it appears that training for current HCWs is probably under-recognized by professional development and continuing education programs. HCWs need to have their AMR learning efforts formally recognized, as they may lack incentives to engage in substantial additional training on a purely volunteer basis. Below we discuss how addressing these two elements of training, both pre-service and continuing education, can improve the content, delivery, uptake, and scale-up of AMR/AMS education, and identify programs that are interesting models for development of further resources.

Pre-service student engagement

We identified a small number resources for students in healthcare disciplines, though research suggests that medical students in Europe and the USA have a desire for increasing training on AMR [11, 12]. Researchers from the ESCMID Study Group for Antibiotic Policies have suggested that undergraduate training should be focused on principles of AMS and building good prescribing habits [12]. Resources on these topics are available, as the MOOCs we identified often included lectures, videos, and case studies on these themes. Students, however, are unlikely to have the time to pursue these courses outside their educational program. Educational research also suggests that training at the undergraduate level should ideally be delivered through active learning sessions which allow students to integrate knowledge with practice [12, 13]. We note that the small number of programs specifically targeting students have embraced opportunities for active student participation and interaction. To support their curriculum for medical students (Initiative #16), Wake Forest University designed series of small-group case studies with facilitator guides to allow group discussions of AMR issues. In Canada, the Do Bugs Need Drugs? Program (Initiative #14) has engaged students from medicine, pharmacy, nursing, and dentistry in delivering educational messages on AMR to students in elementary school. Canadian medical students have also been active in developing their own opportunities for AMR/AMS learning. In 2014, students at the University of Toronto created the Students for Antimicrobial Stewardship Society, which has now expanded to include students in dentistry and pharmacy and at other medical schools. The students have launched an annual awareness campaign on AMR, and organized educational lectures and interprofessional panels on stewardship to provide students with opportunities to ask questions (Initiative #37). Given the small number of programs that engage with students, there are undoubtedly more opportunities to develop resources for students. These might include the creation of educational curricula and support resources including videos and case studies, or engagement of students and student societies in broader educational programs.

Continuing education

We found that many excellent courses already exist, and several are available online at low or no cost. As content is already available, improving roll-out is a matter of ensuring that these courses can run repeatedly; preparing a course for a single session is likely a waste of resources. Another way to improve roll-out is to facilitate translation of course materials to other languages. Consulted experts noted that translating available content, such as a MOOC, from English into other languages is a slow and difficult process. Beyond the translation of lecture slides, there is a need to obtain other resources, such as academic articles and video content, in the foreign language. Creation of a database that brings together resources on AMR/AMS in other languages would facilitate the adaptation of courses between languages.

Improving uptake of existing educational opportunities is also key. We note that among the resources identified, very few are accredited as continuing professional education. This is probably a major oversight—and opportunity—as evidence suggests that HCWs are not receiving enough training on AMR/AMS [14]. HCWs would likely be incentivized to participate if the courses were accredited as CME, as HCWs in many countries must undertake several hours of CME per year. Experts that we consulted expressed a desire for courses qualifying as CME, but found the accreditation process challenging and slow. To date, most courses have been developed by academic societies and there is an opportunity here for greater collaboration between academic societies and professional societies. Academic societies have knowledge and resources at their disposal and, by partnering with professional societies such as pediatric societies or nurses associations, could adapt their existing programs to meet the specific training needs of these healthcare specializations and provide training to a larger number of HCWs. Regulators and professional councils should be engaged in devising strategies to facilitate the uptake and scale-up of AMR-related pre-service education and in-service training initiatives.

Other mechanisms of engagement

Many of the programs that we identified made their content freely available online. In addition to courses, we found lecture slides, video lectures, case studies, facilitator guides, handbooks, posters, and other campaign materials online. The presence of these many high-quality resources online suggests that it is not necessary for new educational campaigns and courses to reinvent the wheel; a large amount of information is already available. However, much of this content is scattered across the web. It would be very useful to develop a resource site or database of good AMR content. Collecting this content would allow educators to build off of existing educational materials and focus their efforts on developing course content specific to the local context. The ReAct Toolbox (Initiative #94) is an excellent model, providing basic information on several aspects of AMR/AMS and links to other online resources that are relevant to both LMICs and high-income countries. The main limitation of the site, and many of the other educational resources that we have identified, is that many resources are only available in English.

Strengths and limitations of this study

This project is the first attempt that we know of to map educational resources for HCWs around the world. We contacted more than 50 experts and identified educational resources and projects in all WHO regions. By identifying and classifying programs, we can see the breadth of resources already available for training HCWs on AMR/AMS.

As we relied extensively on web searching in addition to expert advice, it is likely that we identified more of some types of resource than others. Therefore, the quantity of identified programs of this type should not be interpreted as proof that these resources are the most common program type. We paired our web searching with expert input to identify those other resources that are more difficult to identify online. We recognize that some web resources, such as guidelines, are more likely to endure on the internet than others, such as advertisements for courses and conferences. We included mobile apps specific to antibiotic resistance if they were identified by experts or identified in web searches. However, it was beyond the scope of the study to search within existing medical apps to locate AMR/AMS content; this has been done elsewhere by Goff et al. [15].

We conducted our web and academic searching in English and relied upon on expert contacts to provide information on educational programs in other languages. We identified and reviewed some educational programs where the detailed information online was in French, but did not translate articles from other languages, and therefore likely missed other educational resources posted online that are only available in other languages.

Finally, we note that longevity of resources on the internet is an issue. We found many broken links, where program information could no longer be obtained. We identified many courses through course advertisements posted to the web; however, the limitations of our search strategy make it likely that we mainly identified recent courses. Further, for most courses, we cannot comment as to whether the course content has been archived on the web. While much of the content from a larger course, such as a MOOC, is likely to remain on the web, it is unlikely that the course content of shorter, in-person courses will be retained in the same way. Resource sites must monitor content to ensure it remains up to date. To facilitate the sharing of resources between countries, it will also be important to find a mechanism such that content does not become inaccessible after removal from the website.

Conclusions

In mapping the available educational programs on AMR/AMS for HCWs, we have identified 94 existing programs and resources, and several opportunities for improvement and expansion on the existing resources. Many high-quality educational campaigns already exist and there are many opportunities to adapt these programs to meet educational needs in other contexts. But gaps exist, particularly when it comes to resources for healthcare students, and provision of accredited training for current HCWs. National and international stakeholders should advocate for increased accreditation, the creation of a series of competencies for undergraduate curricula, and support resource sharing platforms. Action on these fronts would support both the goals laid out in many national AMR action plans and the desires of many HCWs to ensure that all HCWs receive sufficient training on AMR and AMS.

Abbreviations

AMR: 

Antimicrobial resistance

AMS: 

Antimicrobial stewardship

BSAC: 

British Society for Antimicrobial Chemotherapy

CDC: 

Centers for Disease Control and Prevention

HCWs: 

Healthcare workers

IPC: 

Infection prevention and control

MOOC: 

Massive open online course

USA: 

United States of America

Declarations

Acknowledgements

We thank Giorgio Cometto, Elizabeth Tayler, and Onyema Ajuebor at the WHO for their input towards the conceptualization and quality assurance of this analysis. We also want to thank all the experts who provided us with information and resources for this project.

Funding

This study was funded by the Japanese Ministry of Labour and Welfare through a grant administered by the World Health Organization and implemented by the AMR Secretariat and the Health Workforce Department. SJH is additionally supported by the Canadian Institutes of Health Research and Research Council of Norway.

Availability of data and materials

The dataset supporting the conclusions of this article is included within the article.

Authors’ contributions

SJH conceived of this project and led its design. SRVK co-led the design of the project and led the implementation of the project and the preparation of the manuscript. SLJ supported the implementation of the project. All authors critically revised and approved the manuscript.

Ethics approval and consent to participate

N/A

Consent for publication

All authors have reviewed and approved the manuscript for submission.

Competing interests

The authors declare that they have no competing interests.

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Authors’ Affiliations

(1)
Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada
(2)
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
(3)
Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Canada
(4)
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
(5)
Dalhousie Medical School, Dalhousie University, Halifax, Canada

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Copyright

© The Author(s). 2018

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