Readying Medical Students for Antibiotics Conversations

For family physicians, antibiotics are a frequent topic of conversation. To help prepare medical students for these discussions, physicians at Albert Einstein College of Medicine and the Warren Alpert Medical School of Brown University—with support from the ABIM Foundation—developed the first measure of students’ competency in antibiotic stewardship and their ability to communicate with patients about the appropriate use of antibiotics.

“Antibiotic resistance is a growing global health threat and teaching medical students early about how they can promote antibiotic stewardship with their patients is important,” said Pablo Joo, MD, who led the project at Albert Einstein and is now the Associate Dean for Clinical Medical Education at the University of California, Riverside School of Medicine. “Developing effective communication skills with patients about appropriate antibiotic use is critical. There has been a paucity in evidence on how best to assess students on their Choosing Wisely communication skills in this area.”

For this project, Albert Einstein and Brown medical students doing their family medicine clerkships reviewed Choosing Wisely materials related to the overuse of antibiotics to treat upper respiratory infections, including video communications tutorials. These materials reinforced what students had learned about antibiotic stewardship in their preclinical course on microbiology and infectious disease.

At the end of the clerkship, students participated in observed structured clinical encounters (OSCE) with standardized patients (SP). Each student had to interview and counsel an SP who requested antibiotics for viral pharyngitis or viral rhinosinusitis. Students were then evaluated on eight criteria, including their explanation of side effects and whether they explored the patient’s reason for requesting antibiotics. They scored particularly highly on providing clear information about etiology and symptom resolution.

The project leaders reported that the instrument successfully distinguished among the students, supporting its use in other institutions. “We learned that third year medical students can be assessed on their counseling skills linked to a Choosing Wisely communication framework,” Dr. Joo said. “Our study demonstrated good reliability and concurrent validity of this tool and approach at two medical schools.”

The tool is available from the authors.

Readers can learn more about the project in the article “Assessing Student Competencies in Antibiotic Stewardship and Patient Counseling,” published in the journal Family Medicine