Infection Control & Hospital Epidemiology


The American Society of Health-System Pharmacists, the organization that accredits most pharmacy residencies, clearly differ- entiates between pharmacy residencies and pharmacy fellowships.14 Pharmacy residencies are postgraduate training programs in an area of pharmacy practice, while pharmacy fellowships are postgraduate training programs designed to prepare the individual to be a researcher. Pharmacy residencies are further divided by year: PGY1 residencies usually focus on general clinical pharmacy practice; PGY2 residencies are focused on a single area of practice (eg, infectious diseases, critical care, ambulatory care).


Results Role of medical trainees in AS


In total, we identified 6 publications that describe the use of medical trainees in AS activities.15–20 Table 1 lists the details of 4 of the publications.15–18 Medical trainees were used to conduct AS activities in diverse patient populations (eg, hematology/oncology and medical ICU) with differing outcomes, and all publications were from academic medical centers or veterans affairs hospitals. The most common AS strategies used by medical trainees in these publications were streamlining and/or de-escalation of therapy and prospective audit with intervention and feedback. Strategies with no published studies in medical trainees were guidelines and clinical pathways and antimicrobial order sets. Additionally, Graber et al19 evaluated AS activities at all 130


Veterans Affairs (VA) medical centers with acute-care services in 2012. Based on these results, the VA National Antimicrobial Stewardship Task Force and the VA Healthcare Analysis and Information Group assessed for common variables because there is no common model among all VA centers. The variables associated with decreased inappropriate antibiotic use were (1) postgraduate physician/pharmacy training programs (although they did not specifically identify infectious disease programs), (2) general ward teams that involved pharmacists and/or infectious disease attend- ings, (3) the involvement of infectious disease attendings and/or fellows in antibiotic approvals, and (4) formally AS-trained phar- macist at the facility. A similar analysis by Chou et al20 further described AS activities in postgraduate training programs at VA acute-care centers. A 9% reduction in antibiotic use occurred if the facility had an infectious disease fellowship program and a 10% reduction occurred with an infectious disease trained pharmacist. However, no details were given about the activities that trainees performed within the AS programs, only details about the activities that the programs performed as a whole.


Role of pharmacy trainees in AS


Overall, 5 articles specific to pharmacy trainee involvement in AS were identified.21–25 Table 2 describes 4 of the articles in detail. The most common AS strategies used by pharmacy trainees in these publications were dose optimization and prospective audit with intervention and feedback. Strategies with no published studies in pharmacy trainees were guidelines and clinical path- ways and antimicrobial order sets. The published studies showed significant process outcomes (ie, interventions made and accep- ted) as well as clinical outcomes (ie, reduced drug costs and days of therapy).


by Chahine et al21 that focused on the currently available pub- lished data on pharmacy trainees (students, PGY1 residents,


Additionally, the fifth article found in the search was a review


201


PGY2 infectious diseases residents, and fellows) in AS activities; they also proposed a model to further engage pharmacy trainees in AS. Because of the limited clinical studies published at the time, most of the article reviewed academic standards for students and postgraduate trainees as they applied to AS activities. They pro- posed that even early on in training, pharmacy students com- pleting their introductory pharmacy practice experiences (IPPE) could be involved in some aspects of AS (eg, education, dose optimization, and parenteral-to-oral conversion). Accordingly, as pharmacy students advance through advanced pharmacy practice experiences (APPE), they could also participate in creating guidelines and clinical pathways and antimicrobial order forms, as wells as recommending streamlining and/or de-escalation of antimicrobial therapy. The authors proposed that postgraduate pharmacy trainees (PGY1 residents, PGY2 infectious diseases residents, and PGY2/3 infectious diseases fellows) be incorporated into all aspects of AS, including prospective audit with feedback and formulary restriction/preauthorization.


Discussion


Recent studies show that improvements in AS education for trainees are warranted. Abbo et al26 surveyed fourth-year students at various medical schools in the United States and found that 90% of respondents would prefer more education on appropriate antimicrobial use. Although medical students who finished a clinical infectious diseases rotation felt they had a higher quality of AS-related education compared to those who did not (mean Likert score, 3.93 vs 3.44; P = .0003), only one-third of students felt adequately prepared in fundamental principles of anti- microbial use. Justo et al. surveyed the knowledge and attitudes of graduating pharmacy students at various colleges of pharmacy in the United States toward appropriate antimicrobial use.27 Roughly 90% and 80% of pharmacy students wanted more edu- cation on appropriate use of antimicrobials and on antimicrobial resistance, respectively. Approximately two-thirds of pharmacy students felt that their education related to antimicrobial therapy initiation and selection was satisfactory. Additionally, only 68% of US doctor of pharmacy programs integrated AS education into the required didactic curricula. Notably, there are wide variances in AS principles taught.28 Similar results were found in studies assessing AS-related knowledge and perceptions of medical and pharmacy students across international programs.29–32 Luther et al33 captured the perspectives of adult infectious


diseases medical fellowship directors in the United States regarding their fellows’ AS training. Although 50% of programs had a formal curriculum dedicated to AS, only 20% of directors were either very or extremely satisfied with the medical fellow’s training. Also, 12% of fellowship directors felt that their fellows were either very or extremely well prepared to initiate an anti- microbial stewardship program. Approximately 75% of fellowship directors were very or extremely satisfied with their fellow’s ability to serve as a leader in an existing antimicrobial stewardship program and incorporate AS principles during their own practice. The lack of improvement of their fellow’s training was attributed to the deficit of curricular materials related to AS. Improvements to the core curriculum and trainee’s programs related to AS content are necessary to develop future AS leaders and promote optimal AS practices. The studies reviewed in this article demonstrate the impact medical and pharmacy trainees can have in relation to AS.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156