Is online case-based learning effective in helping undergraduate medical students choose the appropriate antibiotics to treat important infections? Niall T. Stevens 1 *, Catherine Bruen 2 , Fiona Boland 3 , Teresa Pawlikowska 2 , Fidelma Fitzpatrick 1,4 and Hilary Humphreys 1,4 1 Department of Clinical Microbiology, Royal College of Surgeons in Ireland, RCSI Education & Research Centre, Beaumont Hospital, Beaumont, Dublin 9, Ireland; 2 RCSI Health Professions Education Centre, Royal College of Surgeons in Ireland, St Stephen’s Green, Dublin 2, Ireland; 3 Data Science Centre, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin 2, Ireland; 4 Department of Clinical Microbiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland *Corresponding author. E-mail: nstevens@rcsi.ie Received 26 June 2019; returned 27 October 2019; revised 1 November 2019; accepted 7 November 2019 Background: Medical students are frequently confused about indication for and choice of antibiotic. We devel- oped an online learning resource that focused on antibiotic stewardship and important infections where medical students could practise their antibiotic decision-making skills safely. Methods: The resource was made available to third-year undergraduate medical students via their virtual learning environment. It covered the theory and fundamentals of antibiotic stewardship and five clinical cases covering important infections. We assessed the number of attempts taken to achieve the required level of under- standing to pass each activity and surveyed a selection of students for their feedback. Results: Of 310 students, over 80% engaged with the theory-based components, with an average score exceeding 90% (range 93.4%–99.7%). Eighty-three percent (258/310) engaged with the first two cases (Clostridioides difficile infection and pyelonephritis) but only 61% (189/310) of students completed the fifth case on bacterial meningitis. Only 49.4% (153/310) of students completed all five cases, with 48% (73/153) of these achieving 90% on their first attempt of the associated quizzes. Fifty-nine percent (23/39) agreed or strongly agreed that the quality of the learning resource was excellent. Seventy-two percent (28/39) agreed or strongly agreed that the objectives of the resource were relevant to their needs as undergraduate medical students. Only 33% (13/39) reported the resource would change their practice. Conclusions: Student feedback was positive but engagement with the cases needs improvement. Highlighting the utility of case-based technology-enhanced learning as a safe place to practise antibiotic decision-making skills among students may improve this. Introduction Antibiotic resistance is a global health concern. The emergence of antibiotic resistance and MDR organisms (MDROs) has arisen from the indiscriminate use of antibiotics and poor prescribing and dis- pensing practices. 1–3 Conserving these medicines and preventing the emergence of new MDROs is now a global health priority. Nationally, most countries have published antibiotic prescribing guidelines to direct prescribers. For example, in the UK, NICE has evidenced-based guidelines to manage common infections. In Ireland, the Health Service Executive has similar guidelines available, as does Australia, to name but a few. In recent years, the use of technology-enhanced learning (TEL) in the training of healthcare professionals has been used to provide better access to guidelines. 4 Many healthcare institutions have their own localized antibiotic guidelines accessible online and/or through applications accessible via portable smart devices. 5 Having informa- tion that is easily accessible improves patient care but knowing how to use that information correctly, without structure, curation or context to the relevant scenario, makes the practical application for the user more challenging. Choosing the appropriate antibiotic to prescribe empirically, or even in a directed way, can be difficult as there are a number of variables that can influence the choice. V C The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecom- mons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com 1 of 7 JAC Antimicrob Resist doi:10.1093/jacamr/dlz081 JAC- Antimicrobial Resistance Downloaded from https://academic.oup.com/jacamr/article/1/3/dlz081/5675092 by guest on 22 December 2022