Appropriate antibiotic use and antimicrobial resistance: knowledge, attitudes and behaviour of medical students and their needs and preferences for learning

Abstract

Background: The impact of an appropriate use of antibiotics on the prevention of antimicrobial resistance (AMR) has been demonstrated. Surveys have shown, however, that medical students do not feel sufficiently trained to use antibiotics wisely. The aims of our study were (1) to describe what medical students currently know about appropriate antibiotic use, and (2) to identify students' learning preferences as a basis for developing student-centred teaching modules to convey the basics of AMR prevention.

Methods: We performed an online survey at Charité Universitätsmedizin Berlin and the Julius-Maximilians-University Würzburg on the knowledge, attitudes, and behaviour (KAB) of medical students concerning AMR, antibiotic treatment options, and their perceptions of AMR topics addressed in the medical curriculum. Participants were able to fill out an online questionnaire between December 2019 and February 2020. In addition, we conducted focus group discussions with lecturers and medical students in winter 2019/2020 to identify AMR-related learning needs and preferences. Data were analysed descriptively.

Results: Overall, 356 students (response rate 5.1%) participated in the KAB survey. Of these, 192 (54%) strongly agreed that the topic of AMR is relevant to students' clinical practice and 48% (171/355) stated that their future antibiotic prescription behaviour will have an influence on AMR development in their region. Participating students seemed to be interested in the topic of AMR and antibiotic therapy. But even of them, only 46% answered the question about the length of antibiotic use for community-acquired pneumonia correctly and 57% the question about the appropriate use of antibiotics in Staphylococcus aureus infections. Focus group discussions with students (n = 7) and lecturers (n = 9) identified a lack of competence in the responsible use of antibiotics and the prevention of AMR. Respondents stated that the teaching formats and AMR-related content should emphasize clinical applications, interaction with peers/clinicians, and repeated formative feedback from instructors.

Conclusions: Our results show that even medical students who were interested in the AMR problem were not able to use antibiotics appropriately due to gaps in knowledge and a lack of clinical skills. Based on the insights gained in the learning preferences of students and their content priorities, improved student-centred teaching materials should be developed.

Keywords: Antimicrobial resistance; Appropriate antibiotic use; Medical students’ undergraduate education.

Fig. 1

Students' assessment of the level of the relevance of antibiotic resistance in the context of their studies and/or clinical internships. KAB survey, Germany 2019–2020. Early = semesters 1–5, Advanced = semesters from semester 6 onwards. No significant difference between students in early and advanced semesters (Fisher’s Exact Test, p = 0.3815)

Fig. 2

Medical students’ opinion on whether their future antibiotic prescribing behaviour will have an influence on the antibiotic resistance situation in their region. KAB survey, Germany 2019–2020. Early = semesters 1–5, Advanced = semesters from semester 6 onwards

Fig. 3

Areas where action should be taken to curb the increase in antimicrobial resistance: Answers of n = 356 students, multiple answers possible. KAB survey, Germany 2019–2020

Fig. 4

Assessment of the students to what extent the previous knowledge acquisition on the topic of appropriate antibiotic use and antimicrobial resistance is sufficient. KAB survey, Germany 2019–2020. Early = semesters 1–5, Advanced = semesters from semester 6 onwards