Infection Control & Hospital Epidemiology (2019), 40, 200–205 doi:10.1017/ice.2018.332
Review
All aboard!: Involvement of medical and pharmacy trainees in antimicrobial stewardship
Lindsey M. Childs-Kean PharmD, MPH, BCPS1, Heather L. Briggs MD, PhD2 and Jonathan C. Cho PharmD, MBA, BCPS3 1Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Gainesville, Florida, 2Division of General and Hospital
Medicine, University of Texas Health Science at San Antonio, San Antonio, Texas and 3Department of Clinical Sciences, University of Texas at Tyler College of Pharmacy, Tyler, Texas
Abstract
Antimicrobial stewardship (AS) involves the appropriate selection of antimicrobials. Antimicrobial stewardship programs are mandated in hospitals and are expanding to involve outpatient arenas. Multiple articles have been published describing the need for AS education for medical and pharmacy students, beginning early in the students’ career to develop into competent AS practitioners. Additionally, publications have described the role and impact of medical and pharmacy trainees on AS programs. Here, we review the published evidence describing medical and pharmacy trainees’ involvement in AS and call for future research in this area.
(Received 13 September 2018; accepted 24 November 2018)
tious diseases–trained physicians and pharmacists1,3; however, this demand is challenging to meet. The National Resident Matching Program revealed that 51 of the 151 (33.8%) training positions in infectious diseases medical fellowship programs in the United States remained unfilled in 2018.8 This high per- centage is consistent with previous years.9 The declining rate of applicant interest for a career in infectious diseases is con- cerning and may be attributed to factors such as a growing number of hospital-based positions, lack of mentorship in infectious diseases, and lower salary compared to other sub- specialties.10,11 Likewise, current infectious diseases training opportunities, such as residencies, fellowships, and certificate programs for pharmacists in the United States are considered inadequate to meet the demand for pharmacists with advanced
Author for correspondence: Lindsey Childs-Kean, PO Box 100483, Gainesville, FL 32610-0483. E-mail:
lchilds-kean@cop.ufl.edu
Cite this article: Childs-Kean LM, et al. (2019). All aboard!: Involvement of medical
and pharmacy trainees in antimicrobial stewardship. Infection Control & Hospital Epidemiology 2019, 40, 200–205. doi: 10.1017/ice.2018.332
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
A major global public health threat today is the development of antimicrobial resistance, which can emerge through the inap- propriate use of antimicrobial agents. Up to 50% of anti- microbial use is inappropriate in the hospital setting.1,2 In an effort to reduce the rates of antimicrobial resistance, the Joint Commission mandates that all hospitals and critical-access hospitals establish an evidence-based antimicrobial steward- ship program.2 Antimicrobial stewardship programs are an effective strategy to prevent the development of antimicrobial resistance, and antimicrobial stewardship programs have sig- nificant benefit in reducing mortality, length of stay, and healthcare costs.3–7 Antimicrobial stewardship programs should be led by infec-
training in antimicrobial stewardship (AS).12 Due to the demand, lack of infectious diseases training programs and personnel, and high prevalence of infections, it is likely that all physicians, pharmacists, and trainees will be involved with AS to some degree. Therefore, healthcare practitioners should receive education
on AS principles and practices during their didactic studies and throughout their postgraduate training. By receiving sufficient education and learning experiences, practitioners gain the knowledge and ability to perform AS during their training and as independent practitioners. Although specific AS education and curricula of trainees is not explored, this review summarizes the implementation of various AS practices by physician and phar- macist trainees.
Search strategy and selection criteria
An electronic search through PubMed was conducted (January 2000 to June 2018) using the following terms: antimicrobial stewardship, antibiotic stewardship, trainees, students, post- graduate education, medical education, fellowship, and education. All articles available in English and their references were reviewed for additional publications as well. All articles identified were included in this review.
Trainee definitions
Medical trainees can be classified as residents (including interns) or fellows. For the purposes of this article, medical residents are those trainees who are completing an internal medicine residency (usually post graduate years [PGY] 1–3) and fellows are those completing an infectious diseases fellowship after satisfactory completion of an internal medicine residency (PGY4 and up).13
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