Mapping educational opportunities for healthcare workers on antimicrobial resistance and stewardship around the world

Transcription

1 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 DOI /s RESEARCH Open Access Mpping eductionl opportunities for helthcre workers on ntimicrobil resistnce nd stewrdship round the world Susn Rogers Vn Ktwyk 1,2, Sr L. Jones 1,5 nd Steven J. Hoffmn 1,3,4* Abstrct Bckground: Antimicrobil resistnce is n importnt globl issue fcing society. Helthcre workers need to be engged in solving this problem, s dvoctes for rtionl ntimicrobil use, stewrds of sustinble effectiveness, nd eductors of their ptients. To fulfill this role, helthcre workers need ccess to trining nd eductionl resources on ntimicrobil resistnce. Methods: To better understnd the resources vilble to helthcre workers, we undertook globl environmentl scn of eductionl progrms nd resources trgeting helthcre workers on the topic of ntimicrobil resistnce nd ntimicrobil stewrdship. Progrms were identified through contct with key experts, web serching, nd cdemic literture serching. We summrized progrms in tbulr form, including prticipting orgniztions, region, nd intended udience. We developed coding system to clssify progrms by progrm type nd prticipting orgniztion type, ssigning multiple codes s necessry nd creting summry chrts for progrm types, orgniztion types, nd intended udience to illustrte the bredth of vilble resources. Results: We identified 94 eductionl inititives relted to ntimicrobil resistnce nd ntimicrobil stewrdship, which represent diverse rry of progrms including courses, workshops, conferences, guidelines, public outrech mterils, nd online-resource websites. These resources were developed by combintion of government bodies, professionl societies, universities, non-profit nd community orgniztions, hospitls nd helthcre centers, nd insurnce compnies nd industry. Most progrms either trgeted helthcre workers collectively or specificlly trgeted physicins. A smller number of progrms were imed t other helthcre worker groups including phrmcists, nurses, midwives, nd helthcre students. Conclusions: Our environmentl scn shows tht there re mny orgniztions working to develop nd shre eductionl resources for helthcre workers on ntimicrobil resistnce nd ntimicrobil stewrdship. Governments, hospitls, nd professionl societies pper to be driving ction on this front, sometimes working with other types of orgniztions. A brod rnge of resources hve been mde freely vilble; however, we hve noted severl opportunities for ction, including incresed enggement with students, improvements to pre-service eduction, recognition of ntimicrobil resistnce courses s continuing medicl eduction, nd better pltforms for resource-shring online. Keywords: AMR, Antimicrobil resistnce, Antimicrobil stewrdship, Eduction, Helthcre workers * Correspondence: steven.hoffmn@globlstrtegylb.org 1 Globl Strtegy Lb, Dhdleh Institute for Globl Helth Reserch, Fculty of Helth nd Osgoode Hll Lw School, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Cnd 3 Deprtment of Helth Reserch Methods, Evidence, nd Impct nd McMster Helth Forum, McMster University, Hmilton, ON, Cnd Full list of uthor informtion is vilble t the end of the rticle The Author(s) Open Access This rticle is distributed under the terms of the Cretive Commons Attribution 4.0 Interntionl License ( which permits unrestricted use, distribution, nd reproduction in ny medium, provided you give pproprite credit to the originl uthor(s) nd the source, provide link to the Cretive Commons license, nd indicte if chnges were mde. The Cretive Commons Public Domin Dediction wiver ( pplies to the dt mde vilble in this rticle, unless otherwise stted.

2 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 2 of 18 Bckground Antimicrobil resistnce (AMR) is looming globl helth problem; misuse nd overuse of ntimicrobils in the pst 50 yers hs ccelerted the development of resistnce to ntibiotics nd other ntimicrobil drugs [1]. With few new ntibiotics in development [2 4], it is essentil tht we preserve the usefulness of existing ntimicrobils. In their cpcity s prescribers nd eductors, helthcre workers (HCWs) will need to shoulder much of the burden in stewrding the preservtion nd longevity of ntimicrobil gents. The inpproprite use of ntimicrobils such s prescribing ntibiotics for virl illnesses or prescribing brod spectrum ntibiotics where nrrow spectrum ntibiotic would be preferble [5] drives the development of resistnce [6]. In mking smrt prescribing choices, HCWs cn reduce genetic selection pressures tht drive the development of resistnce [1]. Beyond prescribing, HCWs hve roles in infection prevention nd control (IPC), in dvocting for rtionl ntibiotic use, nd in educting their ptients on the responsible use of ntibiotics. Chnging HCW nd ptient hbits will require substntil effort to ensure tht ll prescribers nd ptients re wre of the chllenges ssocited with AMR. Surveys suggest tht mny HCWs receive too little trining on AMR nd rtionl ntibiotic use. In Sudi Arbi, nerly hlf of surveyed physicins felt tht they hd indequte knowledge of ntibiotic prescribing [7]. The Infectious Disese Society of Americ hs previously stted tht clinicin trining on ntimicrobil use in the Sttes of Americ (USA) is highly vrible nd non-stndrdized [8], nd medicl students in both Europe nd the USA hve reported desire for incresed trining on choosing ntibiotic therpies [9, 10]. The lck of coordinted pproches to AMR eduction of HCWs poses chllenge to ensuring prudent ntimicrobil prescribing. The WHO Globl Action Pln on Antimicrobil Resistnce expresses need for ll countries to include ntibiotic resistnce s core component of both HCW trining nd continuing eduction [11]. To better understnd this field, we present n illustrtive mpping of eductionl progrms nd resources on AMR nd ntimicrobil stewrdship (AMS) imed t HCWs. This effort included n investigtion of resources for AMR/AMS eduction, opportunities for continuing eduction, nd ctors in the field. This mpping exercise hs llowed us to understnd existing efforts nd identify key res for ction in AMR eduction. Methods We sought to identify AMR eductionl progrms trgeting HCWs. For bredth, progrms were identified through multiple methods, including contct with key experts, web serching, nd cdemic literture serching. An initil literture serch in August nd September 2016 identified eductionl progrms nd key cdemic reserchers who hd published in the field over the previous decde. We emiled these nd other key experts identified by WHO regionl office contcts to request informtion on AMR nd AMS-relted eductionl progrms. Additionl experts were identified vi snowbll strtegy nd web-serching. Experts were sked to identify recent or ongoing eductionl progrms on AMR/AMS. We further identified eductionl progrms through online web-serching. We hnd-serched the websites of severl relevnt orgniztions to identify pst nd current eductionl inititives. We lso conducted non-systemtic web serch using combintions of rnge of serch-terms including ntimicrobil resistnce, ntibiotic resistnce, ntimicrobil stewrdship, ntibiotic stewrdship, eduction, course, curriculum, nd workshop nd region or country in September nd October Relevnt rticles, project reports, course flyers, nd other resources were reviewed to identify progrms. We exmined ntionl ction plns concerning AMR in serch of references to eductionl inititives. Once identified, these progrms were followed up with dditionl online reserch s necessry. We summrized the identified progrms in tbulr form, including prticipting orgniztions, progrm types, region, nd intended udience. We creted codes to clssify progrms by progrm type, orgniztion type, nd WHO region. Progrms tht were not ssocited with ny specific region (such s resources tht were globlly vilble nd without geogrphicl trget popultion) were clssified s globl. Multiple progrm codes were ssigned s necessry. Progrm type nd orgniztion codes were developed nd updted itertively s progrms were identified to identify commonlities between inititives. Results Mpping eductionl inititives In totl, we identified 94 eductionl inititives relted to AMR/AMS. The 94 inititives represent diverse rry of progrms including forml courses, workshops, conferences, guidelines, public outrech mterils, nd online-resource websites. The complete list of inititives is presented in Tble 1. We identified 24 multi-component umbrell progrms, which typiclly included web-bsed resources, videos, references to guidelines, nd promotionl mterils, such s posters, pmphlets, or infogrphics. Progrms tht incorported four or more progrm types were defined s umbrell progrms. Umbrell progrms tended to hve broder trget udiences nd wider scopes; in mny cses, their wreness cmpign mterils were trgeted

3 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 3 of 18 Tble 1 Listing of identified eductionl inititives # Progrm Led orgniztion Country Region Trget udience Description 1 Clinicl Antibiotic Stewrdship for South Afric South Africn Antibiotic Stewrdship Progrmme South Afric Afric Medicl students, physicins This self-pced online course ims to introduce ntimicrobil stewrdship, describe how to implement stewrdship progrms, provide guidnce for prescribing nd interpreting clinicl results, nd tech bout infection prevention nd control. The course is tught online through video lectures nd is free. 2 Distnce Lerning Course in Antimicrobil Stewrdship for Afric Infection Control Afric Network Multiple Afric Physicins, clinicl phrmcists, clinicl microbiologists, nurses This 3.5-month-long online distnce lerning course comprises five modules relting to infectious diseses, one of which is focused on Antimicrobil Stewrdship. The progrm includes lectures, reding mterils, nd discussion forums to engge with tutors nd other students. Progrm is free for Africn prticipnts. 3 Online Rtionl Medicines Use Module University of the Western Cpe South Afric Afric Helthcre professionls This semester-long online course focuses on the rtionl use of medicines nd ssocited problems. Content is tught through online medi nd reding mterils, nd lerning is encourged through weekly tsks, online discussion forums, nd written ssignments. MODULE_2015_ADVERTFinl_(2).pdf 4 Antibiotic Phrmcology Webcsts Clevelnd Clinic: Centre for Continuing Eduction USA Americs Physicins A collection of 6 continuing eduction webcsts on AMR focusing on different types of ntimicrobil. Webcsts cn be completed for credit towrds the Americn Medicl Assocition s Physicin Recognition Awrd Credit System. 5 Antimicrobil Mngement Tem University of Kentucky USA Americs Helthcre professionls Resource website including policies, institution-specific ntibiotic guidelines, nd personnel trining resources. 6 Antimicrobil Stewrdship - Moving Knowledge to Action Public Helth Ontrio Cnd Americs Helthcre professionls A workshop series focused on providing support to develop nd grow hospitl AMR stewrdship progrms. Workshops included lectures, prticipnt networking, nd highlighted locl experiences. The workshops occurred in 4 cities in Ontrio nd were brodcst vi teleconference. Presenttion notes nd slides re vilble freely online. AntimicrobilStewrdshipProgrm/Pges/Antimicrobil_Stewrdship_Workshop.spx 7 Antimicrobil Stewrdship Progrm (ASP) t Nebrsk Medicine Nebrsk Medicine USA Americs Helthcre professionls Progrm includes video lectures, restricted ntimicrobil list, institution-specific ntibiotic guidelines, microbiology informtion, nd other eductionl mteril. A mobile pp provides clinicl guidelines, protocols, nd dosing djustments for ntimicrobil use. Mny web sources re vilble freely online, but the pp requires specific login credentils. 8 Antimicrobil Stewrdship: A tipping point, trnsforming prctice Mount Sini Hospitl-University Helth Network Cnd Americs Physicins, phrmcists A three-dy workshop to identify key ASP priorities nd resources, better understnd the microbiology lbortory, nd consider infectious disese mngement from n ASP perspective. Weblink no longer vilble; Courtesy of Andrew Morris Mount Sini Hospitl. 9 Antimicrobil Stewrdship: Optimiztion of Antibiotic Prctices Stnford University USA Americs Helthcre professionls A MOOC covering the Infectious Disese Society of Americ guidelines, stewrdship principles for specil popultions, nd evidence bsed ntibiotic mngement for surgicl prophylxis, outptient cre, nd sepsis tretment Antimicrobil Stewrdship: Tking it to the Next Level Mount Sini Hospitl-University Helth Network Cnd Americs Physicins, phrmcists Offered in 2011, course providing informtion on how to (1) prepre business cse for funding n ASP, (2) identifying the dt elements required to strt nd monitor n ASP, (3) choose ASP priorities, (4) chnge prescriber behvior, (5) report success nd chllenges. Continuing Eduction credit ws vilble for this course. b b b

4 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 4 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 11 Bugs nd Drugs Albert Helth Services Cnd Americs Helthcre professionls TheBugs&Drugsreferenceguideprovidesrecommendtionsforntimicrobil use nd infection prevention nd mngement to improve ptient cre nd limit AMR, toxicity, nd costs. It is vilble s book nd mobile pp Clevelnd Clinic Guidelines for Antimicrobil Use Clevelnd Clinic USA Americs Physicins The Clevelnd Clinic Guidelines for Antimicrobil Use consists of tbles describing lbortory tests, tretment guidelines for infections, nd preferred ntimicrobil use in vrious situtions such s pregnncy nd trnsplnts. Topics ddressed include cost-effectiveness, resistnce ptterns, ntimicrobil usge dt Décision+ / Décision+2 Université de LvlGovernment of Quebec Cnd Americs Physicins, residents Decision+ (nd Décision+2) integrtes multiple eductionl/behviorl chnge components to promote shred decision mking on ntibiotic tretment options. Includes Dignostic Decision Support Tool for physicin nd ptient to illustrte risks nd benefits. It hs been pilot tested, nd embedded s mndtory component of fmily medicine residency in Quebec Do Bugs Need Drugs? Government of Albert, Government of British Colombi Cnd Americs Helthcre professionls Do Bugs Need Drugs is community eduction project tht includes resources nd ccredited courses for physicins nd phrmcists, non-ccredited courses for students nd other professionls, nd cmpigns for the generl public. Helth professionl students re involved in delivering the progrm to school children Get Smrt Centers for Disese Control nd Prevention USA Americs Helthcre professionls The Get Smrt for Helthcre progrm is comprehensive progrm produced by the US CDC to improve ntibiotic use. Resources for helthcre professionl include collection of progrm exmples, Implementtion resource, fct sheets, reserch evidence, video commentries, nd PowerPoint slides. Generl resources include video nd rdio public service nnouncements, pmphlets, posters, online resources, nd more. This progrm includes Get Smrt About Antibiotics Week, n nnul wreness cmpign complete with eductionl nd promotionl mterils such s posters, grphics, press mterils, nd interctive ctivity ides Get Smrt About Antibiotics Wke Forest School of Medicine;Centers for Disese Control nd Prevention USA Americs Medicl students Wke Forest University hs developed medicl school curriculum round ntimicrobil resistnce. Severl resources hve been developed to ssist with student lerning including series of video lectures nd lecture notes, cse studies nd exm style questions Get smrt Colordo: use ntibiotics wisely Colition USA Americs Helthcre professionls, ptients nd the public This cmpign used pmphlets nd posters, billbords, rdio, television, website, letters, guidelines, nd seminrs to promote proper ntibiotic use. Resources specificlly for helthcre providers included newsletters, externlly sourced tretment guides, peditric cdemic detiling sheets, nd links to externl resources. Multiple resources were directed to helthcre providers but for use with ptients, such s exmintion room posters nd eductionl prescription pds for virl infections; these types of resources were vilble in English nd Spnish. The website lso shres tips for non-prescription cre nd pproprite ntibiotic use Helthy Cndins Collection: Antibiotic Resistnce The Government of Cnd Cnd Americs Helthcre professionls, ptients nd the public The Government of Cnd produced n online resource for bcteri, ntibiotics, AMR, surveillnce, nd Cnd s efforts on these fronts. Resources for helthcre professionls include guidelines on infection mngement from The Public Helth Agency of Cnd, posters bout reducing the spred of resistnce in helthcre settings, nd externl resources such s Bugs nd Drugs (see progrm #11). Other resources include eductionl videos, letters, infogrphics, posters, nd pmphlets for the generl public nd for First Ntions nd Inuit peoples specificlly.

5 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 5 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 19 Infectious Diseses Mngement Progrm t UCSF University of Cliforni Sn Frncisco USA Americs Helthcre professionls An inter-professionl inter-hospitl collbortion to better ntimicrobil use nd ptient cre. The progrm includes guidelines for ntimicrobil therpy for vrious conditions, hospitl-specific guidelines, nd ntimicrobil susceptibility informtion relevnt to hospitls in Sn Frncisco Johns Hopkins Antimicrobil Stewrdship Progrm Johns Hopkins USA Americs Physicins Resource site for physicins including guidelines for cceptble nd uncceptble use of ntibiotics, ntibiotic dosge nd toxicity for dults, ntifungls nd vccines, institution-specific guidelines nd regultions, microbiology informtion, nd tretment recommendtions for specific infections Mking Difference in Infectious Disese Phrmcotherpy (MAD-ID) Cnd MAD-ID nd University of Toronto Cnd Americs Phrmcists A workshop held in Toronto in 2010, using n dpted version of the MAD-ID progrm tht included dditionl content for the Cndin context. Topics included de-escltion nd stremlining, nd Mking Antimicrobil Stewrdship work. Courtesy of Lind Dresser t University Helth Network in Toronto 22 Mking Difference in Infectious Disese Phrmcotherpy (MAD-ID) USA MAD-ID USA Americs Phrmcists MAD-ID offers bsic nd n dvnced ntimicrobil stewrdship trining progrm which re designed for phrmcists nd physicins. Continuing eduction credit is vilble for phrmcists in the USA Michign ntibiotic resistnce reduction colition Colition USA Americs Helthcre professionls, ptients nd the public This stte cmpign provided informtion bout ntimicrobils nd resistnce to helthcre providers nd the public using TV nd rdio nnouncements, pmphlets, eductionl crtoons for children, nd posters. Helthcre professionls were trgeted specificlly with infogrphics, nd pmphlets bout prescribing nd communicting with ptients. A webinr on ntibiotics in upper respirtory trct infections ws lso promoted to helthcre providers Multipronged Eduction Strtegy on Antibiotic Prescribing in Quebec INESSS Quebec Cnd Americs Physicins, phrmcists, medicl residents Eductionl milout with guidelines trgeting the most common conditions in outptient settings, clinicl informtion on dignosis nd ntibiotic recommendtions. The emphsis ws on proper ntibiotic regimens nd not using ntibiotics when virl infections were suspected, plus using shorted possible tretment. Guidelines were produced by the Quebec Mediction Council in collbortion with physicins nd phrmcists. A letter of support from ll key stkeholders (MOH, College of Physicins, College of Phrmcists, Medicl Associtions) ccompnied the mil-out. Weiss et l. Clin Infect Dis 2011; 53(5): Ntionl informtion progrm on ntibiotics Colition Cnd Americs Physicins, phrmcists, ptients nd the public This progrm uses pmphlets nd posters, print medi, rdiondletterstosummrize informtion on ntibiotics, bcteril infections, ntibiotic use, nd resistnce NCCID Resources for Helthcre Providers Website (Antibiotic Awreness Week Webinr Archives nd NCCID Resources for helthcre providers) Ntionl Collborting Centre for Infectious Diseses Cnd Americs Helthcre professionls The Ntionl Collborting Centre for Infectious Diseses (NCCID) website provides free online resources focused on ntibiotics nd AMR. The Antibiotic Awreness Week Webinr Archives is n online resource tht compiles YouTube videos, trnscripts, nd presenttion slides from previous seminrs. Resources re vilble in English or French nd online ccess is free. Resources for Helthcre Providers include fctsheets, prescription sheets, script outlining how to communicte with ptients, tretment guidelines Nebrsk pproprite ntibiotic use cmpign Regionl deprtment of helth USA Americs Helthcre professionls, ptients nd the public A stte ntibiotic wreness cmpign. Resources for helthcre providers include links to locl AMR stkeholder orgniztions such s the Nebrsk Infection Control Network, nd other externl resources such s links to CDC resources Nursing Home Antimicrobil Stewrdship Modules Agency for Helthcre Reserch nd Qulity, Deprtment of Helth nd Humn Services USA Americs Nurses Nursing Home Antimicrobil Stewrdship Guide provided by the Agency for Helthcre Reserch nd Qulity seeks to trin nurses nd other nursing home stff on AMR, tretment decisions. The progrm provides toolkits on b

6 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 6 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description ntimicrobil stewrdship nd ntibiotic tretment which include informtionl hndouts, online trining resources, eductionl PowerPoint slides, nd links to cdemic rticles. ptient-sfety-resources/resources/nh-spguide/index.html 29 Oregon llince working for ntibiotic resistnce eduction Colition USA Americs Helthcre professionls, ptients nd the public This stte colition seeks to promote creful use of ntibiotics by trgeting helthcre providers, nd the generl public. Provider resources include posters, continuing eduction course links, prescribing sttistics, tretment guidelines, nd seminrs nd the CDC s Get Smrt week re promoted. Resources for the public include ctivity books for children, brochures nd informtion sheets bout prudent ntibiotic use nd resistnce. AntibioticResistnce/Pges/index.spx 30 Public Helth Ontrio Antimicrobil Stewrdship Progrm Public Helth Ontrio Cnd Americs Doctors, nurses, phrmcists Public Helth Ontrio provides resources such s posters to promote pproprite prescribing in hospitl settings, presenttion slides on AMR nd stewrdship, webinrs, nd print guidelines. These resources re shred to support cute cre fcilities in meeting Accredittion Cnd s mndte requiring AMS progrms. AntimicrobilStewrdshipProgrm/Pges/Antimicrobil-Stewrdship-Progrm.spx 31 South Crolin Creful Antibiotic Use (CAUse) South Crolin Deprtment of Helth nd Environmentl Control USA Americs Helthcre professionls, ptients nd the public An dpted version of the CDC Get Smrt progrm which initilly trgeted HCW for eduction on dignostic nd tretment guidelines, then trgeted prents of young children bout pproprite use. Overview is vilble in this report: AROStrtegicPln-finl dr_3.pdf 32 Stop ntibiotic misuse in Minnesot Colition USA Americs Helthcre professionls, ptients nd the public This stte progrm used pmphlets nd posters, letters, guidelines, seminrs nd childcre curriculum. The website provides links for professionls include policy sttements, sttistics, journl rticles nd guidelines relting to AMR nd infections Stop the resistnce use ntibiotics wisely Nevd Public Helth Foundtion USA Americs Helthcre professionls, ptients nd the public This stte eductionl cmpign seeks to rech helthcre providers the public to encourge nd pproprite ntibiotic use. This cmpign provides resources including clinicl prctice guidelines, resources from the CDC, nd informtion sheets informing prescribers bout pproprite ntibiotic use. Generl resources include eductionl brochures on AMR, colds, nd infections in English nd Spnish, nd links to websites nd gmes for children s eduction on topics such s hndwshing nd bcteri. progrms/nevdns-for-ntibiotic-wreness/ 34 The Cliforni Antimicrobil Stewrdship Progrm Inititive Cliforni Deprtment of Public Helth USA Americs Helthcre professionls This progrm shres resources ssocited with the Cliforni Deprtment of Public Helth, such s n ntimicrobil stewrdship webinr series directed to nursing homes, nd compiltion of exmple stewrdship progrms. The focus of this progrm is to support the implementtion of stewrdship progrms in Cliforni hospitls nd helthcre fcilities University of Pennsylvni Antimicrobil Stewrdship University of Pennsylvni USA Americs Medicl students, residents This eductionl webpge includes presenttion slides, PDF hndouts, nd lecture recordings relevnt to ntimicrobil eduction for medicl students nd residents. Topics include drug vilbility, prophylxis, s well s University-specific stewrdship policies, ntibiotic prescribing recommendtions, restrictions nd economic considertions Wshington stte s cmpign to fight ntibiotic resistnce Regionl deprtment of helth USA Americs Physicins, ptients nd the public This stte helth deprtment website compiled links to publictions nd externl resources on AMR for ptients, physicins, nd eductors. Resources for the public include school-bsed wreness progrms, informtion sheets, nd links to the FDA nd CDC.

7 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 7 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 37 Awreness week, lectures nd pnel discussions Students for Antimicrobil Stewrdship Society Cnd Americs Helthcre students This student society hs chpters in medicl, dentl nd phrmcy schools cross Cnd. They hve orgnized n nnul wreness week with lectures nd pnel discussions to educte students bout AMR nd AMS Antibioclic: Antibiotherpie rtionelle en soins primires Societe de Pthologie Infectieuse de Lngue Frncise/French Infectious Diseses Society (SPILF) Frnce Europe Physicins This website offers therpeutic recommendtions to primry cre physicins. Physicins input their ptients pthology nd other clinicl considertions, nd the website provides recommended ntibiotic tretment with considertions nd options for llergies nd contrindictions, s well s brief informtion bout the ntibiotics. The website lso shres news relted to infections nd ntibiotics Antibioguide nd Antibioville Antibiolor Frnce Europe Physicins The Antibiolor guidelines were published to ssist physicins in the mngement of infections: Antibioguide (2005) for hospitl physicins nd Antibioville (2004) for community physicins. The guidelines re vilble online, in print, nd through n pp. Antibiolor lso provides Antibiotel, telephone dvice service for physicins requiring dvice regrding mngement of ptients with infectious diseses Antibiotic dvice in Île-de-Frnce Societe de Pthologie Infectieuse de Lngue Frncise/French Infectious Diseses Society (SPILF) Frnce Europe Physicins Telephone dvice relting to ntibiotics ws provided by physicins for physicins; Wng et l. in Med Ml Infect. 2015; 45(4): Antibiotic Awreness Cmpign Europen Phmcy Students Assocition Multiple Europe Phrmcy students The Europen Phrmcy Students Assocition creted n Antibiotic Awreness Cmpign in order to rise wreness bout ntibiotic use, decrese demnd for ntibiotics, nd to educte the public on AMR. The EPSA creted cmpign for their ssembly in 2013 nd digitl cmpign ws developed in prtnership with the ECDC for the Europen Antibiotic Awreness Dy. previous-cmpigns 42 Antibiotic Gurdin Public Helth Englnd Europe Helthcre professionls, ptients nd the public Antibiotic Gurdin consists of collection of pledges with over 30,000 signtures directed to helthcre professionls, students, nd the generl public. Resources for helthcre professionls include links to country-specific EAAD nd WAAW resources nd public resources include ptient stories, posters, leflets, nd links to other progrms including WAAD, e-bug, nd other informtionl websites Antibiotic Resistnce in Primry Cre E-Module Royl College of Generl Prctitioners Lerning Europe Helthcre professionls This hour long continuing professionl eduction course for primry cre physicins in the UK looking to lern bout ntibiotic prescribing, resistnce, nd resources for prctice Antibiotic Resistnce: The Silent Tsunmi Uppsl University Sweden Europe Helthcre professionls This 4-week-long online course discusses the spred of ntibiotic resistnce, the development of ntibiotics, the current stte of resistnce nd ntibiotic use, nd ctions to tckle AMR. This course is free nd composed of 3 h per week of online content Antibiotics only when necessry (Le Projet Gepie: Groupe d Etude et de Prévention des Infections de l Enfnt) Colition: cdemic centers, helth insurnce, medicl ssocition, institute for public helth Frnce Europe Physicins This cmpign employed pmphlets nd posters, website, letters, guidelines, nd cdemic detiling. The progrm s website contins resources such s guidelines for ntibiotic use or disuse, progression of conditions such s bronchitis, in ddition to generl guidelines nd guidelines for ntibiotic use in children. A list of publictions by the GEPIR group is provided. This group lso supports n inititive for techer nd youth eduction bout microorgnisms, infections, nd their tretment known s Projet E-bug Antibiotics, use them in n dequte wy Colition: phrmceuticl industry, deprtment of helth, professionl orgniztions Portugl Europe Helthcre professionls, ptients nd the public A sesonl cmpign to reduce ntibiotic use in Portugl tht used severl intervention types to trget wide rnge of professionls nd the public. Huttner et l. in Lncet Infect Dis. 2010; 10(1): Helthcre Infection Society Europe Residents This 3 dy long in-person course provides informtion on helthcre ssocited infections nd AMR, developing b, b b

8 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 8 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description Antimicrobil Resistnce nd Helthcre Associted Infections Foundtion Course on Hospitl Infection Control surveillnce progrms, outbrek investigtion, hospitl hygiene, the bsics of ntimicrobil stewrdship, nd helthcre ssocited infections. It cn be tken s stnd-lone course or s prt of Msters or Diplom course Antimicrobil Resource Centre British Society for Antimicrobil Chemotherpy Europe Helthcre professionls This dtbse of resources compiles mny eductionl mterils nd links including links to open online courses, udio, guidelines, imges, press rticles, publictions, posters, reserch ppers, slide sets, systemtic reviews nd video lectures on diverse topics relting to ntimicrobils nd resistnce Antimicrobil Stewrdship Eductionl Workbook Scottish Antimicrobil Prescribing Group Europe Nurses, midwives This interctive workbook contins question prompts nd links to informtionl videos to support lerning round ntimicrobil stewrdship, specificlly including chpters on stewrdship in prctice, bcteri, resistnce nd ntibiotics, ssessment of infection, nd hospitl prctice. Print_Wkb_Jn_2016.pdf 50 Antimicrobil stewrdship: systems nd processes for effective ntimicrobil medicine use Ntionl Institute for Helth nd Cre Excellence Europe Helthcre professionls, ptients nd the public The Ntionl Institute for Helth nd Cre Excellence publishes guidelines including Antimicrobil Stewrdship. These guidelines include recommendtions for the implementtion of stewrdship progrms, ntimicrobil prescribing, nd new ntimicrobils Antimicrobil Susceptibility Testing nd Surveillnce: from Lbortory to Clinic. Europen Society of Clinicl Microbiology nd Infectious Diseses Germny Europe Clinicl microbiologists This 3-dy-long workshop consists of series of lectures nd lbortory sessions tht cover Europen Committee on Antimicrobil Susceptibility Testing (EUCAST) clinicl brekpoints, ntimicrobil susceptibility testing, ntimicrobil surveillnce systems, nd ntimicrobil guidelines. This is prt of series of microbiology workshops orgnized by the ESCMID. courses_nd_workshops/ ntimicrobil_susceptibility_testing_nd_surveillnce eucst_esgrs_ nd_epsg_perspective/ 52 Antimicrobils nd infection mngement Centre for Phrmcy Postgrdute Eduction Europe Phrmcists, phrmcy students, This 10-h e-lerning course focuses on describing the ction of ntimicrobils, selecting pproprite ntimicrobil gents, ntimicrobil prophylxis, ptient tretment, nd helthcre-ssocited infections. This progrm is only vilble to members of the Generl Phrmceuticl Council Bugs nd ntibiotics: the role of the Greek Physicin in the fight ginst microbil resistnce University of Athens Greece Europe Physicins A regionl eduction cmpign in 2009/10 orgnized by the medicl school t the University of Athens. A series of meetings were orgnized with primry cre physicins followed by 4 interctive cse study sessions. Prticipnts lso received set of guidelines nd booklet on mngement of community cquired infections. Plchours et l. in BMC Public Helth 2014;14: CNAMTS Progrm Ntionl Helth Insurnce Fund for Slried Workers (CNAMTS) Frnce Europe Physicins The Ntionl Helth Insurnce Fund for Slried Workers (CNAMTS) work for AMR includes holding meetings with Delegtes of the Ntionl Helth Insurnce (DAM) nd physicins. Informtion sheets nd recommendtions on medicl prctice re hnded out to physicins during these meetings, which re held 3 or 4 times yer. Huttner et l. in Lncet Infect Dis. 2010; 10(1): Collection: Antimicrobil Resistnce (AMR) Ntionl government UK Europe Helthcre professionls, The UK government supports n online collection of resources relting to AMR nd inks to reserch publictions, technicl nd clinicl guidelines, posters, reserch, news updtes, nd strtegic documents such s the UK AMR strtegies nd progress reports. One noteworthy resource is the Antimicrobil Resistnce Resource Hndbook which provides informtion on policy, recommendtions, eduction, tools, surveillnce, nd other resources tht support stewrdship nd AMR reduction.

9 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 9 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 56 Correct use ntibiotics Belgin Antibiotic Policy Coordintion Committee (BAPCOC) Belgium Europe Helthcre professionls, ptients nd the public This progrm swebpgesofferlinkstocdemicrticlesredirectedtowrds helthcre professionls. Webpges nswer bsic questions (e.g. wht re ntibiotics, sking dvice from your helthcre provider), promote children s eductionl comics on ntimicrobils nd infections, nd provide links to externl resources for the generl public. The progrm lso includes rdio commercils. Mny resources re vilble in French, English, Dutch nd Germn ESCMID Summer School Europen Society of Clinicl Microbiology nd Infectious Diseses Spin Europe Physicins, clinicl microbiologists This week long in-person course focuses on clinicl microbiology nd infections. Topics include infection mngement, therpy beyond ntibiotics, virl infections, multidrug resistnce, interntionl helth nd creer development ESCMID/ASM Conference on Drug Development to Meet the Chllenge of Antimicrobil Resistnce Europen Society of Clinicl Microbiology nd Infectious Diseses Austri Europe Helthcre professionls This 3-dy conference consists of series of lectures, symposiums, debtes, round tble discussions, nd interctive question nd nswer sessions relting to AMR. Topics include clinicl use of off-ptent ntibiotics, future res of reserch, brekpoints, nd chnging ntimicrobil dministrtion nd guidelines Europen Antibiotic Awreness Dy Europen Centre for Disese Prevention nd Control Europe Helthcre professionls, ptients nd the public Europen Antibiotic Awreness Dy promotes eduction bout ntibiotic use nd resistnce nnully on November 18th. The website contins diverse downlodble resourcesforprescribersswellsptientsndthepublic.toolkitsforprescribers include presenttions for in-hospitl trining on AMR, ptient dilog guides nd fctsheets Generl Prctitioner conferences to reduce over-prescribing Helth insurnce office, Créteil hospitl center Frnce Europe Physicins Conferences nd meetings involved discussion of prescribing profiles nd promoted wreness of ntibiotic use. Wng et l. in Med Ml Infect. 2015; 45(4): Interdisciplinry Regionl Progrm for the Control of ntimicrobil resistnce (PRIMAIR) Frnce Europe Physicins This progrm promoted continuing eduction nd ntibiotic tretment guidelines for generl prctitioners in the Frnche-Comté region of Frnce. Wng et l. in Med Ml Infect. 2015; 45(4): MedQul Centre Ressource en Antibiologie Frnce Europe Helthcre professionls, ptients nd the public This network is dedicted to monitoring ntibiotic use nd ntibiotic resistnce. The website provides online dvice nd decision trees for physicins mnging infectious diseses. It lso publishes monthly electronic newsletter. Telephone dvice to helthcre professionls is provided Ntionl Helth Service Scotlnd Eduction nd Trining Ntionl Helth Service Scotlnd/ NHS Eduction for Scotlnd Europe Physicins, nurses, phrmcists The Scottish Reduction in Antimicrobil Prescribing (ScRAP) Progrmme is n eductionl toolkit under this progrm to encourge reduction in unnecessry ntibiotic prescribing. ScRAP includes teching topics nd lesson plns for locl fcilittors, video lectures, nd videos of ptient-scenrios nd other teching mterils. Some progrms include clinicl vignettes nd multiple choice ssessments. Other resources include interctive ntimicrobil stewrdship eductionl textbooks/workbooks trgeted towrds nurses nd midwives, complete with informtion, best prctice exmples, evlution questions, nd reflection prompts, s well s PowerPoint presenttion slides for prctitioner eduction Nice Frnce teching hospitl telephone dvice service Nice teching hospitl Infectious Disese Deprtment Frnce Europe Physicins This service consisted of telephone dvice with the option of in person consulttions for generl prctitioners in the Provence-Alpes-Côte d Azur Est region of Frnce. Ws terminted due to lck of resources. Wng et l. in Med Ml Infect. 2015; 45(4): PrescQIPP Antimicrobil Stewrdship Webkit PrescQIPP Europe Helthcre professionls This webpge provides resources nd links to educte helthcre providers bout ntimicrobil stewrdship nd AMR. Types of resources include dt on infections, infogrphics, guidelines relting to AMR, informtion bout dignoses, nd online links. b

10 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 10 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 66 Project children nd ntibiotics for pproprite ntibiotic use in children Regionl deprtment of helth Itly Europe Physicins This progrm trgeted ntibiotic prescribing to peditricins by running seminrs nd dpting Do Bugs Need Drugs (see progrm #14). Huttner et l. in Lncet Infect Dis. 2010; 10(1): Reducing Antimicrobil Resistnce E-Lerning for Helthcre, Helth Eduction Englnd Europe Helthcre professionls, ptients nd the public This progrm consists of n e-lerning session, short videos, nd links to other resources such s Antibiotic Gurdin (see progrm #42) nd Future Lern MOOC (see progrm #90). The objective is to discuss risks nd development of AMR, the misuse of ntibiotics, nd improve responses to ptients STAR: Stemming the Tide of Antibiotic Resistnce Helthcre CPD Europe Physicins This hour long trining intervention informs medicl prctitioners bout ntibiotic prescription, resistnce, nd to encourge behviorl chnge nd reflection bout current prctices Strm The Swedish Strtegic Progrmme Aginst Antibiotic Resistnce (Strm) Sweden Europe Helthcre professionls The Swedish Strtegic Progrmme Aginst Antibiotic Resistnce (Strm) shres ction plns, scientific reserch protocols nd dt. They link to other resources, such s online courses for doctors nd nurses. The Ntionl Strm Dys re nnul wreness cmpigns ment to provide eduction on ntibiotic issues including resistnce nd policymking nd fcilitte networking. See report: Swedish work on continment of ntibiotic resistnce exmples-of-projects/?lng=en 70 Strtegic nd Explortory Workshop Joint Progrmming Inititive on Antimicrobil Resistnce (JPIAMR) Norwy Europe Helthcre professionls Joint Progrmming Inititive on Antimicrobil Resistnce (JPIAMR) fcilittes series of workshops. These workshops revolve round selected keynote lectures, brekout sessions nd plenry discussions. Workshop titles include The Interply Between AMR Surveillnce nd Science nd Erly Discovery of New Antibiotics SWAB (Dutch Working Prty on Antibiotic Policy) Society of Infectious Diseses The Netherlnds Europe Helthcre professionls The Dutch Working Prty on Antibiotic Policy (SWAB) hs developed numerous guidelines relting to ntibiotics nd AMR focusing on generl informtion, specific infections, MRSA, nd ntibiotic prophylxis. The group lso holds n nnul symposium on AMR nd contributes to EAAD online resources The Regionl Functionl Unit of Infectious Diseses (UFIR) Ajccio hospitl directorte, Corsic regionl helth uthority Frnce Europe Physicins This unit offered telephone dvice for generl prctitioners in Corsic s well s post-grdute eduction on ntibiotics. Wng et l. in Med Ml Infect. 2015; 45(4): Tret Antibiotics Responsibly, Guidnce, Eduction, Tools (TARGET) Antibiotics Toolkit Royl College of Generl Prctitioners, Public Helth Englnd Europe Helthcre professionls This toolkit includes ntibiotic prescribing dt, toolkits for conducting udits, posters nd pmphlets for ptients, guidelines from Public Helth Englnd, resources to support implementtion of the TARGET toolkit, nd links to externl resources nd stkeholders relevnt to AMR nd ntibiotics. Resources for generl prctitioners specificlly include self-ssessment checklist evluting good ntimicrobil prctices. Trining resources include webinr series, presenttion templtes nd notes, nd links to two e-modules. The webinr series runs from November to December 2016 nd provides informtion on how to improve prescribing nd ptient cre URPS Progrm Regionl helth uthority Frnce Europe Physicins As locl inititive, informtion sheets were distributed to generl prctitioners t clinicl presenttions. Informtion sheets relted to infection mngement, clinicl presenttion, nd ntibiotic prescribing for ptients ged 15 to 65. Wng et l. in Med Ml Infect. 2015; 45(4): Antimicrobil Stewrdship: Principles nd Prctice Europen Society of Clinicl Microbiology nd Infectious Diseses Europe Helthcre professionls This course will discuss bsic principles of AMR nd consumption surveillnce, implementtion of AMS progrms, how to chnge prescriber behviors, nd how to integrte AMS eduction in student, resident nd postgrdute eduction t n institutionl level. Plnned for

11 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 11 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 76 Antibiotic cmpign Helth mintennce orgniztion Isrel Middle Est Physicins A sesonl cmpign to distribute guidelines nd informtion on resistnce to physicins, with mss medi component. Huttner et l. in Lncet Infect Dis. 2010; 10(1): Antibiotics Smrt Use: Thilnd Antimicrobil Resistnce Continment Progrm (AMRCP) in Thilnd Thilnd South Est Asi Helthcre professionls, ptients nd the public Country-wide cmpign tht educted prescribers bout ntibiotics in hlf-dy long in-hospitl trining sessions. Trining included shring experiences, lerning bout tretment guidelines nd dignostic tools, s well s instructions on implementing resources for ptient eduction such s DVDs, pmphlets nd other mterils ASPIC (Antibiotic Stewrdship, Prevention of Infection & Control) Indin Council of Medicl Reserch Indi South Est Asi Clinicl phrmcists, clinicl microbiologists This workshop tught skills nd knowledge bout infection prevention nd control, implementtion of ntimicrobil policy guidelines for rtionl use of ntibiotics to curb resistnce, conducting reserch projects in ntibiotic policy. Workshop consisted of 5 dys of lectures, site visits, prcticl trining, demonstrtions nd project discussions. Chndy et l. in Indin J Med Res 2014; 139(2): pmc/rticles/pmc / 79 AMR Trining Songdo Hospitl Mongoli Western Pcific Physicins Qurterly Eduction sessions nd surveys of ntimicrobil prescribing in hospitl. Courtesy of WHO WPRO Office: WHO Mongoli Country Report My 2016 by Koning nd Peel 80 Antibiotic Awreness Week Government of Viet NmWHO Viet Nm Western Pcific Helthcre professionls, ptients nd the public This wreness week cmpign included pledge inititive, public outrech events, posters nd bnners in hospitls, nd socil medi use. week2015/en/ 81 DOH Mnul of Procedures for Implementing AMS in Hospitls Deprtment of Helth (Philippines)World Helth Orgniztion Philippines Western Pcific Physicins The DOH Mnul of Procedures for Implementing AMS in Hospitls is n opertionl guide tht is lso used s reference for developing trining progrms nd mterils. Informtion courtesy of the WHO WPRO regionl office. 82 Ntionl Prescribing Service: Medicinewise Resource Website Ntionl Prescribing Serivce (NPS): Medicinewise Austrli Western Pcific Helthcre professionls The NPS website includes resources nd online lerning modules. The website of ntibiotic resources for helth cre providers includes tools for consulttion with ptients, pmphlets nd posters, guidelines. Five online cse study-bsed modules re vilble for generl prctitioners, nurses, nd helthcre professionl students on the topics of ntimicrobil prescribing, bcteril infections, urinry trct infections, pneumoni, nd surgicl ntibiotic prophylxis. These modules re recognized by The Royl Austrlin College of Generl Prctitioners s fulfilling some requirements of their Continuing Professionl Development progrm s well s by the Austrlin College of Rurl nd Remote Medicine for some of their Professionl Development Progrm requirements Trining-of-Triners Workshop on the Antimicrobil Stewrdship Advoccy Trining Deprtment of Helth (Philippines)World Helth Orgniztion (WPRO) Philippines Western Pcific Helthcre professionls The Trining-of-Triners ws delivered by representtive from NPS Medicinewise (Austrli). This consisted of n interctive session on current inititives nd chllenges of ech hospitl in reltion to infection prevention nd control, rtionl use of ntimicrobils nd surveillnce of AMR. Also included ws consulttion on drft AMS pilot progrm implementtion Trining-workshop for government Level III hospitls on the implementtion of the AMS Deprtment of Helth (Philippines)World Helth OrgniztionCorzon Locsin Montelibno Memoril Regionl Hospitl Philippines Western Pcific Physicins This workshop begn s pilot progrm t Philippine Generl Hospitl nd Corzon Locsin Montelibno Memoril Regionl Hospitl. An AMS progrm with n eductionl component ws tested nd hs now been scled up to provide trining t ll DOH Level III hospitls. Informtion courtesy of the WHO WPRO regionl office. 85 WHO WPR Pledge to use ntibiotics responsibly World Helth Orgniztion Western Pcific Region Western Pcific Helthcre professionls This pledge designed by the World Helth Orgniztion Western Pcific regionl office discusses commitment to the use of ntibiotics s prescribed, good hygiene, nd encourging responsible use in friends nd fmily. Includes informtion on AMR.

12 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 12 of 18 Tble 1 Listing of identified eductionl inititives (Continued) # Progrm Led orgniztion Country Region Trget udience Description 86 Win the Wr Aginst AMR Deprtment of Helth Philippines Western Pcific Helthcre professionls Win the Wr Aginst AMR is pledge for helthcre providers to use ntimicrobils responsibly. Pledge documents comment upon judicious use of ntimicrobils, continuing eduction of others, promoting preventtive mesures, nd supporting reserch of ntimicrobil drugs nd dignostic technologies Mediction Shortge Fct Sheets nd Infogrphics Ntionl Centre for Antimicrobil Stewrdship (NCAS) Austrli Western Pcific Helthcre professionls This resource provides fct sheets nd infogrphics designed in response to recent problems with the supply of ntimicrobils in Austrli. The fct sheets provide dvice nd possibilities for lterntive therpy when vitl medictions re in short supply. The infogrphics provide informtion on ntimicrobil prescribing in vrious helthcre fcilities. Both resources re esily ccessible online AMS Implementtion Toolkit Clinicl Excellence Commission Austrli Western Pcific Helthcre professionls The Clinicl Excellence Commission hs developed resources to support the implementtion of hospitl AMS progrms tht embody the core elements required for progrm implementtion nd mintennce. These resources lso fcilitte to identify gps present in currently estblished AMS progrms. ntimicrobil-stewrdship/quh/ ms-implementtion-toolkit 89 Antibiotic Stewrdship Clinicl Cre Stndrds Austrlin Commission on Sfetey nd Qulity in Helth Cre Austrli Western Pcific Helthcre professionls This resource provides guidnce to clinicins nd helth service mngers on delivering pproprite cre when prescribing ntibiotics. The resource lso provides set of suggested indictors to ssist with locl implementtion of the Antimicrobil Stewrdship Clinicl Cre Stndrd. Clinicins nd helth services cn use the indictors to monitor implementtion of the qulity sttements Antimicrobil Stewrdship: Mnging Antibiotic Resistnce University of Dundee;British Society for Antimicrobil Chemotherpy Globl Helthcre professionls This 6-week-long Mssive Open Online course focuses on improving ntimicrobil prescribing nd AMS in hospitl settings nd cn be pplied to other settings. The course hs run twice on the FutureLern pltform nd involves redings, cse study videos, video interviews with experts, nd online discussion with peers nd eductors. Course topics include n overview of resistnce s globl problem, the importnce nd key elements of ntimicrobil stewrdship, mesurement of ntibiotic prescribing, emerging strtegies for ntimicrobil stewrdship, behvior chnge, nd the importnce of collbortion nd coordintion Bsic Concepts Book Interntionl Federtion of Infection Control Globl Helthcre professionls This book, Bsic Concepts, by the Interntionl Federtion of Infection Control contins chpter on Principles of Antibiotic Policies. Key topics in this chpter include the rtionl use of ntibiotics to combt resistnce, the role of AMR stewrdship progrms, trgeted ntibiotic prescribing nd tretment, nd microbiology lbortory services in reltionship to AMR. It is vilble in English, Arbic, French, Spnish, Itlin, Bulgrin nd Hungrin Bsic Infection Control Trining Progrmme Course Interntionl Federtion of Infection Control Globl Helthcre professionls This infection control course contins module tht focuses explining how ntibiotic use selects strins of bcteri, identifying mechnisms of AMR stewrdship progrms, the role of microbiology lbortories in resistnce, s well s helthcre ssocited infections nd outbreks in generl Courser Course: Antimicrobil resistnce - theory nd methods Technicl University of Denmrk Denmrk Globl Helthcre professionl This 5 week long online MOOC teches on ntimicrobil ction, ntimicrobil resistnce, ntimicrobil susceptibility testing, interprettion, qulity ssurnce, nd bcteril genomic testing through online videos lectures nd grded quizzes ReAct Toolbox Uppsl University Sweden Globl Helthcre professionls Resource website on AMR nd AMS with profiles of useful interventions. The resource ws vilble free of chrge b The resource ws for continuing professionl development credit or provided certificte of completion or counted towrds degree progrm,b

13 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 13 of 18 towrds generl udience, while online reding nd guidelines were more often imed t HCWs. Mny umbrell progrms trgeted their messging t HCWs including physicins, phrmcists, nd sometimes nurses s group, rther thn trgeting professions or specilties individully. Of the progrms identified (see Fig. 1), the most common progrm type ws websites; typiclly, however, online resources were only prt of lrger progrm. This is unsurprising s online resources re effective pltforms for shring other progrm types, including videos, guidelines, pmphlets, nd workbooks. Guidelines nd hndbooks were lso common resource, often shred online in government nd hospitl eduction inititives; these described informtion bout key ptient popultions nd prescribing guidelines nd were intended s reference resources. By contrst, we lso identified smll number of workbooks nd question sets intended s teching resource. Other teching resources vilble online included videos, webinrs, nd lecture slides. Online courses, including mssive open online courses (MOOCs), re becoming common nd often incorporte online videos nd discussion bords to engge prticipnts. In Fll 2016, there were two MOOCs on the FutureLern pltform (see Inititives #44 nd #90). The MOOC run by the University of Dundee nd British Society for Antimicrobil Chemotherpy (Inititive #90) hs gined globl populrity. Severl experts referenced this course s resource used in their country; the course hs been offered three times to dte nd prticipnts hve come from more thn 41 countries. Figure 2 shows prticipting orgniztions grouped by type. Overll, the most commonly identified orgniztions were governmentl bodies, often the ntionl/ provincil/stte-level body responsible for helth nd/ or eduction. We lso found tht helth insurnce compnies often prtnered with other orgniztions in the USA to support AMR eduction cmpigns. Collbortions with industry cme lmost entirely from North Americ. Outside of the USA, the only other cmpigns tht prtnered with helth insurnce provider were in Frnce. The Europen Centre for Disese Control contributed to the bulk of Fig. 1 Number of identified AMR eduction progrms by progrm type

14 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 14 of 18 Fig. 2 Number of identified AMR eduction progrms by orgniztion type projects which we tgged s intergovernmentl orgniztions. Professionl societies, prticulrly those with strong tie to AMR, were hevily involved in the cretion nd provision of resources for HCWs. Three exmples re the British Society for Antimicrobil Chemotherpy, which hs been involved in the cretion of resource websites (Inititive #48), coordintion of MOOC (Inititive #90), nd provision of funding for AMR eduction; the Europen Society of Clinicl Microbiology nd Infectious Diseses, which runs study group on ntimicrobil resistnce, develops nd coordintes courses, nd crries out collbortive cdemic reserch; nd the Infection Control Afric Network which orgnized free distnce lerning course for HCWs in Afric in Mny professionl bodies with broder mndtes, for exmple, medicl ssocitions nd peditric societies, hve prtnered with others to support lrger projects, but were rrely the led orgniztion in the projects tht we identified. For exmple, the NPSMedicineWise project (Inititive #82) in Austrli engged the Austrlin College of Nursing, Austrlin Assocition of Consultnt Phrmcy, the Austrlin College of Rurl & Remote Medicine, nd the Austrlin Nursing nd Midwifery Federtion nd mny others longside government bodies to produce resources nd course content for the website. University-led projects were typiclly relted to online or in-person courses or to resource websites. Mny of these sites provide lecture slides, or recorded video lectures (e.g. Inititive #16), s well s informtion on guidelines nd policies (e.g. Inititive #35). Other types of orgniztion were engged in wide vriety of projects. Hospitls nd helthcre centers, for exmple, engged with umbrell progrms, courses nd workshops, intervention studies, nd resource guides. Most progrms trgeted HCWs s brodly defined group. Figure 3 shows the trget udiences for the 94 progrms identified. Severl progrms lso included components imed t ptients nd the public. We found 33 progrms imed t physicins, including smll number tht trgeted specilists such s infectious disese physicins nd peditricins. Fewer progrms specificlly trgeted nurses, phrmcists, nd midwives, though these groups were trgeted in the more generl HCW progrms. A smll number of predominntly Fig. 3 Number of identified AMR eduction progrms by trget helthcre worker group

15 Rogers Vn Ktwyk et l. Humn Resources for Helth (2018) 16:9 Pge 15 of 18 university-bsed progrms trgeted medicl or phrmcy students. Four progrms, mostly courses nd workshops, trgeted clinicl microbiologists longside other HCWs. We identified progrms from round the world, though, s expected, the progrms were uneqully distributed between countries nd regions, with lrger shre of the progrms from North Americ nd Europe. Figure 4 shows mp of the number of progrms identified from ech region. Mny of the lrge-scle AMR/ AMS eductionl cmpigns took plce in welthy Americn nd Europen countries (e.g. Inititives #15 nd #59), wheres mny of the progrms in Afric nd Asi were workshop or course bsed (e.g. Inititives #1, #78, #83). The interconnected nture of some progrms mde them more esily producible on the prt of the orgniztions nd more esily identifible on our prt s reserchers. This strtegy fcilitted the growth of progrmming in specific regions, nd hs mde online informtion bout AMR/AMS widely vilble to HCWs nd the public. For instnce, stte-specific AMR eductionl inititives, such s Get Smrt Colordo: Use Antibiotics Wisely (Inititive #17), ppered to tilor resources or shre/endorse existing resources from the comprehensive ntionl Get Smrt progrm (Inititive #15) produced by the CDC in the USA. Discussion Our environmentl scn shows tht mny orgniztions re working to develop nd shre course content nd eductionl resources for HCW trining nd continuing eduction round the world. We identified severl types of resources, from trditionl in-person courses to workshops nd conferences, to MOOCs, to online cmpign mterils, to hndbooks, nd to workbooks. Governments, hospitls, nd professionl societies pper to be driving ction on this front, nd these three types of orgniztion hve successfully built prtnerships with others including non-profits, insurnce compnies, nd WHO regionl offices. This level of collbortive work is promising; however, we hve identified opportunities for ction on severl fronts. First, there is n opportunity for the development of better resources nd trining opportunities for students in the helthcre professions. Erly enggement cn provide strong foundtion of AMR knowledge tht students drw upon s they progress through their creers s prescribers nd ptient eductors. Second, it ppers tht trining for current HCWs is probbly under-recognized by professionl development nd continuing eduction progrms. HCWs need to hve their AMR lerning efforts formlly recognized, s they my lck incentives to engge in substntil dditionl trining on purely volunteer bsis. Below we discuss how ddressing these two elements of trining, both pre-service nd continuing eduction, cn improve the content, delivery, uptke, nd scle-up of AMR/AMS eduction, nd identify progrms tht re interesting models for development of further resources. Pre-service student enggement We identified smll number resources for students in helthcre disciplines, though reserch suggests tht medicl students in Europe nd the USA hve desire for incresing trining on AMR [11, 12]. Reserchers from the ESCMID Study Group for Antibiotic Policies hve Fig. 4 Mp of AMR eduction progrms by region. Mp ws generted using Microsoft Excel nd Bing