Abstract
Background
The growing need for clinicians with antimicrobial stewardship (AS) skills has resulted in an examination of educational methods for pharmacy and medical learners. This study explores characteristics associated with student assessment of didactic infectious diseases (ID) education quality and variables associated with a career interest in ID and/or AS.
Methods
Infectious diseases faculty from US pharmacy schools were sent a 15-question survey in September 2017. Faculty members e-mailed the survey link to graduating pharmacy students.
Results
Participants from 29 pharmacy schools, representing 21 states, resulted in 537 student responses. Quality of ID didactic education was rated as Very Good by 41%, Good by 40%, Acceptable by 14%, and Poor by 4% of participants. The mean number of faculty-provided learning resources differed by quality rating and was significantly associated with perceived educational needs. Infectious diseases was identified as a career interest by 29% of students. These students more frequently rated their ID didactic education as Very Good (52% vs 37%, P < .01) and were more likely to become interested in ID during or after it was taught in pharmacy school (39% vs 21%, P < .01).
Conclusions
In this cohort of graduating pharmacy students, the perceived quality of didactic ID education was associated with a career interest in ID and/or AS. Factors associated with quality of education were quantity and quality of faculty-provided resources. Increasing the quality of the didactic ID curriculum has potential to increase interest in ID/AS careers among pharmacy students.
Keywords: career, curriculum, education, infectious diseases, teaching
Antimicrobial resistance is a serious threat to global public health [1]. In efforts to combat this resistance, antimicrobial stewardship (AS) programs are now required across healthcare systems in the United States [2]. The importance of pharmacists to AS programs is recognized by the Joint Commission, Center for Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Society for Healthcare Epidemiology of America. In this role, pharmacists are the medication experts responsible for improving antimicrobial use as well as educating other professions on resistance and appropriate prescribing [2].
The growing need for clinicians trained in the optimal use of antimicrobials has resulted in an examination of educational practices [3]. A recent survey of US pharmacy schools evaluated if and how AS was incorporated into the curriculum [4]. The authors found that AS education was included in the required didactic content in 68% of schools, 37% offered elective didactic classes, and 84% of schools offered experiential rotations that focused on stewardship. A 2014 survey found that 94% of pharmacy students believed knowledge of antimicrobials was important for their careers and 89% desired more education on the appropriate use of antimicrobials [5].
Two cross-sectional surveys exploring factors influencing medical residents on their career choice were recently performed in light of the drop in applications to infectious diseases (ID) fellowships [6, 7]. This study reports a similar survey of a cohort of graduating pharmacy students. The objectives of this study were to explore characteristics associated with student assessment of the quality of their didactic ID education and identify education-related variables associated with a career interest in ID/AS.
METHODS
Design
This was a cross-sectional study of students graduating from Accreditation Council for Pharmacy Education-accredited pharmacy schools in the United States during the spring of 2018. Student responses were collected in the fall of 2017. This study was reviewed and approved by the Colorado Multiple Institutional Review Board at the University of Colorado Anschutz Medical Campus.
Procedures
In September 2017, ID course directors and faculty at 137 US pharmacy schools were sent e-mails and asked whether they were willing to forward a survey link to graduating pharmacy students at their respective schools. Contact information for ID faculty was obtained via an Internet search of each pharmacy school. Faculty who agreed to participate were sent a Qualtrics survey link and optional text to include in an e-mail to graduating students at their school. Two follow-up emails were sent to faculty who were asked to send as reminders to graduating students. The survey was open for 12 weeks from September 2017 to November 2017. Student responses were anonymous and no incentive was provided for participation.
Instrument
A 15-question survey was developed by the authors and distributed to the Infectious Diseases Educator Network steering committee, which consisted of 17 ID pharmacist faculty from a range of pharmacy schools. Feedback from the committee was incorporated into the final version of the survey. The final survey included quantitative and qualitative sections. The quantitative section asked respondents about the quality of their didactic ID education, methods of and time allocated to active learning in their didactic ID education, ID topics in need of more classroom hours, career interests, and factors related to career interest. The qualitative section of the survey asked respondents 3 open-ended questions about successes, concerns, and desired changes within the ID curriculum at their school.
Analysis
All quantitative data were analyzed using SPSS Statistics, version 24 (IBM, Armonk, NY). Frequencies and percentages were used to summarize categorical variables. Descriptive statistics were used to summarize continuous variables. A χ2 analysis and Z-test was used to compare quality of education categories and categorical variables. An analysis of variance was used to compare continuous variables across quality of education categories, demographic data, and categorical variables. Multivariate conditional logistic regression analyses were performed using the outcome of a career interest in ID as the primary outcome. Factors thought to increase or decrease career interest were included in the original model; variables with P values greater than 0.2 were excluded from the final model. For all tests of statistical significance, a 2-tailed α value was set at 0.05. Qualitative free-response data were coded and analyzed by the authors (L. R. B. and M. N. J.). Authors were blind to quantitative survey responses while coding free text into categorical themes for each of the 3 comment sections in which respondents described successes, concerns, and proposed changes to their ID curriculum. A single free-text response could have multiple themes. Authors coded all responses independently and differences in coded theme(s) were reconciled.
RESULTS
The survey was completed by 537 graduating pharmacy students, which resulted in a response rate of 17%. Participants were from 29 pharmacy schools. The median number of student responses per school was 19 (range 2–51). The median class size was 108 (range 52–220).
Teaching Methods
The most common learning resource provided to students in their ID curriculum was lecture slides, whereas resources rated as most helpful was prior years’ tests or quizzes and patient cases (Table 1). The resources most commonly identified as not helpful were debates and group presentations. The topics rated most frequently as needing additional time in the didactic curriculum was intravenous to oral transition, biological markers, and de-escalation (Table 2).
Table 1.
Student Ratings of Faculty Provided Resources or Tools for Learning ID Content, n = 537a
| Provided Resource | Provided, n (%) | Very or Somewhat Helpful, n (%) | Not Helpful, n (%) |
|---|---|---|---|
| Prior years tests or quizzes | 204 (38.0) | 199 (97.5) | 5 (2.5) |
| Patient cases | 529 (98.5) | 513 (97.0) | 16 (3.0) |
| Handouts or worksheets | 453 (84.4) | 437 (96.5) | 16 (3.5) |
| Lecture slides | 534 (99.4) | 517 (96.3) | 17 (3.2) |
| Concept maps | 364 (67.8) | 348 (95.6) | 16 (4.4) |
| Simulation | 201 (37.4) | 190 (94.5) | 11 (5.5) |
| Recorded lectures | 447 (83.2) | 421 (94.2) | 26 (5.8) |
| Online or app-based study tool | 256 (47.7) | 236 (92.9) | 20 (7.8) |
| Videos or media clips | 305 (56.8) | 283 (92.8) | 22 (7.2) |
| Audience response systems | 493 (91.8) | 448 (90.9) | 45 (9.1) |
| Ungraded quizzes | 193 (35.9) | 170 (88.1) | 23 (11.9) |
| Muddiest point | 205 (38.2) | 178 (86.8) | 27 (13.2) |
| Games | 278 (51.8) | 227 (87.6) | 32 (12.4) |
| Think, pair, share | 238 (44.3) | 202 (84.9) | 36 (15.1) |
| Puzzles | 123 (22.9) | 102 (82.9) | 21 (3.9) |
| Flip cards, flash cards | 189 (35.2) | 153 (81.0) | 36 (19.0) |
| Debates | 178 (33.1) | 133 (74.7) | 45 (25.3) |
| Group presentations | 241 (44.9) | 169 (70.1) | 72 (29.9) |
Abbreviations: app, application; ID, infectious diseases.
aData are presented as frequency and percentages
Table 2.
Student Perceptions of ID Topics That Deserve More Time in the Didactic Curriculum, n = 537a
| Topic | N (%) |
|---|---|
| Intravenous-to-oral antimicrobial transition | 271 (50.5) |
| Biological makers (procalcitonin, C-reactive protein) | 234 (43.6) |
| De-escalation, streamlining, or narrowing spectrum | 228 (42.5) |
| Selecting appropriate empiric therapy | 222 (41.3) |
| Antimicrobial fundamentals (PK, PD, spectrum, adverse reactions, interactions) | 215 (40.0) |
| Disease-specific therapeutics (pneumonia, UTI, skin infections) | 203 (37.8) |
| Antibiotic stewardship | 191 (35.6) |
| Communicating with prescribers about antimicrobial recommendations | 186 (34.6) |
| Optimal duration of antibiotic exposure | 180 (33.5) |
| Point-of-care diagnostic tests (influenza, Group A strep, HIV) | 143 (26.6) |
| Rapid diagnostics of pathogens (PCR, PNA FISH, molecular assays) | 135 (25.1) |
| Calculating or measuring antimicrobial consumption | 104 (19.4) |
| Antibiotic allergies testing and history taking | 81 (15.1) |
| Nonhuman antimicrobial consumption (livestock feed and topical application on crops) | 81 (15.1) |
| Concept of collateral damage | 78 (14.5) |
| Mechanisms of antimicrobial resistance | 76 (14.2) |
| Relationship between antimicrobial use and microbial resistance | 63 (11.7) |
| Consequences of antimicrobial resistance | 53 (9.9) |
| Epidemiology of bacterial resistance | 53 (9.9) |
| Infection prevention and control precautions | 40 (7.4) |
Abbreviations: ID, infectious diseases; FISH, fluorescent in situ hybridization; PCR, polymerase chain reaction; PD, pharmacodynamics; PK, pharmacokinetics; PNA, peptide nucleic acid; UTI, urinary tract infection.
aData are presented as frequency and percentages.
Quality of Didactic Education
Quality of ID didactic education was rated as Very Good by 220 (41%), Good by 219 (40%), Acceptable by 76 (14%), and Poor by 22 (4%) graduating pharmacy students (Table 3). Both the total number of provided resources and the number of helpful resources increased as quality of education increased. Students who rated their ID education as Very Good received 11 helpful resources from faculty, compared with 9 resources for Good, 7 resources for Acceptable, and 5 resources for Poor (P < .01). Specific resources associated with a Very Good education rating compared with other categories were concept maps, online or application-based study tool, or games. The percentage of classroom time allocated to active learning was significantly different among Very Good (32%), Good (26%), and Acceptable (24%, P = .03).
Table 3.
Student Assessment of Quality of Didactic ID Education Based on Learning Resources Provided
| Provided Resource | Very Good, n = 220 | Good, n = 219 | Acceptable, n = 76 | Poor, n = 22 | P Value |
|---|---|---|---|---|---|
| Number of resources provided, mean ± SD | 11.1 ± 4.0 | 9.7 ± 4.3 | 8.6 ± 4.7 | 7.6 ± 4.4 | <.01 |
| Number of helpful resources provided, mean ± SD | 10.6 ± 3.8 | 8.8 ± 3.8 | 7.4 ± 4.1 | 5.1 ± 4.3 | <.01 |
| Percentage of classroom time allocated to active learning, mean ± SD | 32.3 ± 22.8 | 26.1 ± 21.8 | 23.8 ± 24.9 | 30.2 ± 37.9 | .03 |
| Lecture slides | 220 (100.0) | 218 (99.5) | 74 (97.4) | 22 (100.0) | .06 |
| Patient cases | 219 (99.5) | 219 (100.0) | 70 (92.1) | 21 (95.5) | <.01 |
| Audience response | 205 (93.2) | 203 (92.7) | 68 (89.5) | 17 (77.3) | .06 |
| Handouts and or worksheets | 193 (87.7) | 189 (86.3) | 57 (75.0) | 14 (63.6) | <.01 |
| Recorded lectures | 187 (85.0) | 183 (83.6) | 64 (84.2) | 13 (59.1) | .02 |
| Concept maps | 173 (78.6) | 138 (63.0) | 44 (57.9) | 9 (40.9) | <.01 |
| Videos or media clips | 151 (68.6) | 115 (52.5) | 32 (42.1) | 7 (31.8) | <.01 |
| Online or app-based study tool | 129 (58.6) | 92 (42.0) | 28 (36.8) | 7 (31.8) | <.01 |
| Games | 126 (57.3) | 103 (47.0) | 24 (31.6) | 6 (27.3) | <.01 |
| Think-pair-share | 121 (55.0) | 86 (39.3) | 22 (28.9) | 9 (40.9) | <.01 |
| Group presentations | 114 (51.8) | 95 (43.4) | 26 (34.2) | 6 (27.3) | .01 |
| Simulation | 103 (46.8) | 68 (31.1) | 26 (34.2) | 4 (18.2) | <.01 |
| Prior years tests or quizzes | 96 (43.6) | 76 (34.7) | 25 (32.9) | 7 (31.8) | .16 |
| Muddiest point | 93 (42.3) | 77 (35.2) | 27 (35.5) | 8 (36.4) | .45 |
| Flip cards, flash cards | 91 (41.4) | 75 (34.2) | 18 (23.7) | 5 (22.7) | .02 |
| Debates | 89 (40.5) | 67 (30.6) | 15 (19.7) | 7 (31.8) | .01 |
| Ungraded quizzes | 89 (40.5) | 76 (34.7) | 24 (31.6) | 4 (18.2) | .13 |
| Puzzles | 58 (26.4) | 49 (22.4) | 13 (17.1) | 3 (13.6) | .26 |
Abbreviations: ANOVA, analysis of variance; app, application; ID, infectious diseases; SD, standard deviation.
Data are presented as frequency and percentages unless otherwise indicated.
ANOVA was used to compare continuous data (number of resources and percentage of classroom) across 4 groups. The χ2 test was used to compare categorical data across 4 groups. To identify where statistical significance existed between categorical variables a Z-test was used. Significantly different values have different letters assigned within each cell. Cells with the same letter are not statistically different from each other.
Most students (56%, n = 299) provided responses to the open-ended question prompts (Table 4). There were 256 (48%) responses describing the most successful aspect of ID education, 260 (48%) describing biggest concerns, and 250 (47%) describing how they would change how ID was taught at their school. The proportion of students in each quality category that left free-text responses was similar to that of the whole group. Categorical themes among successes, concerns, and desired changes were similar and included teaching of antimicrobial fundamentals, teaching of disease states, teaching methods or strategies, and faculty. There were no differences in the frequency of comments about ID didactic successes between students in each quality group. A higher proportion of students who rated their didactic ID education as lower quality shared concerns about curriculum design/course duration and poorly performing faculty. The desired change theme that was statistically significant between quality groups was the desire to replace poor performing faculty.
Table 4.
Categorical Themes From Student Free-Text Responses About Successes, Concerns, and Desired Change Regarding Didactic ID Education
| Free-text Response Categorical Themes | Comments | Comparison of Frequency of Theme Among Students Rating Overall ID Education as | ||||
|---|---|---|---|---|---|---|
| Very Good | Good | Acceptable | Poor | P Value | ||
| Successes of didactic ID education | n = 256 | n = 129 | n = 89 | n = 26 | n = 12 | |
| Teaching of antimicrobials fundamentals (spectrum, PK/PD, AE) | 95 (37.1) | 48 (37.2) | 36 (40.4) | 8 (30.8) | 3 (25.0) | .65 |
| Variety in teaching activities, patient cases, active learning | 69 (27.0) | 38 (29.5) | 20 (22.5) | 9 (34.6) | 2 (16.7) | .43 |
| Teaching of disease state therapeutics | 49 (19.1) | 23 (17.8) | 19 (21.3) | 5 (19.2) | 2 (16.7) | .93 |
| High-performing faculty | 44 (17.2) | 29 (22.5) | 11 (12.4) | 3 (11.5) | 1 (8.3) | .16 |
| Concerns about didactic ID education | n = 256 | n = 113 | n = 93 | n = 35 | n = 18 | |
| Poor teaching of antimicrobials fundamentals (spectrum, PK/PD, AE) | 62 (23.9) | 24 (21.2) | 26 (28.0) | 9 (25.7) | 3 (16.7) | .60 |
| Poor teaching of disease state therapeutics | 60 (23.3) | 29 (25.7) | 19 (20.4) | 8 (22.9) | 2 (22.2) | .85 |
| Too much information, material not retained | 60 (23.2) | 26 (23.0) | 25 (26.9) | 6 (17.1) | 3 (16.7) | .60 |
| Lacks experiential or real-world application | 50 (19.3) | 25 (22.1) | 18 (19.4) | 5 (14.3) | 2 (11.1) | .59 |
| Curriculum design and duration | 41 (15.8) | 10 (8.8) | 20 (21.5) | 8 (22.9) | 3 (16.7) | .05 |
| Lack of learning activities, patient cases, active learning, too much emphasis on memorization | 34 (13.1) | 10 (8.8) | 13 (14.0) | 9 (25.7) | 2 (11.1) | .08 |
| Poor-performing faculty | 14 (5.4) | 1 (0.9) | 5 (5.4) | 3 (8.6) | 5 (27.8) | <.01 |
| Desired change for didactic ID education | n = 107 | n = 91 | n = 33 | n = 19 | n = 18 | |
| Increase variety of teaching and learning methods and strategies | 92 (36.8) | 32 (29.9) | 35 (38.5) | 17 (51.5) | 8 (42.1) | .13 |
| Curricular/course design or duration | 67 (26.8) | 24 (22.4) | 30 (33.0) | 11 (33.3) | 2 (10.5) | .11 |
| Increase preparation for experiential rotations and real-world application | 47 (18.8) | 21 (19.6) | 15 (16.5) | 6 (18.2) | 5 (26.3) | .78 |
| Increase time and/or resources toward learning antimicrobials fundamentals (spectrum, PK/PD, AE) | 43 (17.2) | 15 (14.0) | 17 (18.7) | 9 (27.3) | 2 910.5) | .28 |
| Increase time and resources toward learning therapeutics | 35 (14.0) | 10 (9.3) | 14 (15.4) | 6 (18.2) | 5 (26.3) | .18 |
| Replace poor-performing faculty | 16 (6.4) | 2 (1.9) | 4 (4.4) | 5 (15.2) | 5 (26.3) | <.01 |
Abbreviations: AE, adverse events; ID, infectious diseases; PD, pharmacodynamics; PK, pharmacokinetics.
Data are presented as frequency and percentages.
The χ2 test was used to compare categorical data across 4 groups. To identify where statistical significance existed between categorical variables a Z-test was used. Significantly different values have different letters assigned within each cell. Cells with the same letter are not statistically different from each other.
Career Interest
The top 10 career interests selected by graduating pharmacy students were ambulatory care (44%), community pharmacy practice (39%), ID (29%), critical care (23%), internal medicine ([IM] 20%), emergency medicine (16%), oncology (15%), pediatrics (12%), psychiatric (12%), and cardiology (10%). The most common education-related variable that had a positive influence on career choice was curriculum in pharmacy school (69%), followed by personal experience(s) (66%), faculty member(s) or mentor(s) (56%), employment experience (56%), and patient encounter(s) (50%). Pharmacy didactic education was very influential in career choice for 28%, somewhat influential for 56%, and not influential for 17% of students.
Among the 29% of graduating pharmacy students that identified ID as a career interest, the preferred future practice settings were inpatient (87%), inpatient antibiotic stewardship (71%), inpatient ID consult service (67%), academia (36%), outpatient ID consult service (34%), outpatient antibiotic stewardship (34%), outpatient ID clinic (32%), global health (29%), human immunodeficiency virus/acquired immune deficiency syndrome (19%), and immunocompromised/solid organ transplant (19%). Students with an ID career interest were more likely to identify antibiotic stewardship and rapid diagnostics as deserving of more classroom time (AS 47% vs 31%, P < .01; rapid diagnostics 31% vs 24%, P = .04). Students interested in an ID career were more likely to rate their ID didactic education as Very Good (52% vs 37%, P < .01).
Differences in career decisions between graduating pharmacy students with an ID career interest and those with other career interests included timing of career influence, positive career influences, and extent of pharmacy didactic education influence (Table 5). Students with an ID career interest were more likely to become interested in ID during or after it was taught in pharmacy school (39% vs 21%, P < .01), whereas students with other career interests were more likely to develop their career interest before pharmacy school (27% vs 12%, P < .01). More students with an ID career interest found pharmacy school curriculum and faculty member(s) or mentor(s) as positive career influences. Students with other career interests were more commonly influenced by K-12 curriculum and employment experiences.
Table 5.
Career Interest Variables Between Students Interested in a Career in ID vs Other Areas
| Career Interest Influences | ID Career |Interests, n = 157 | Other Career Interests, n = 380 | P Value |
|---|---|---|---|
| Timing of career interest area | |||
| Before pharmacy school | 19 (12.1) | 101 (26.6) | <.01 |
| During or after an experiential rotation (IPPE or APPE) | 62 (39.5) | 147 (38.7) | NS |
| During or after a topic was taught in pharmacy school | 61 (38.9) | 79 (20.8) | <.01 |
| Undecided | 11 (7.0) | 41 (10.8) | NS |
| Other | 4 (2.5) | 12 (3.2) | NS |
| Positive career influences | |||
| Curriculum K-12 | 19 (12.1) | 76 (20.0) | .03 |
| Curriculum in undergraduate college | 42 (26.8) | 110 (28.9) | .67 |
| Curriculum in pharmacy school | 127 (80.9) | 244 (64.2) | <.01 |
| Employment experience | 72 (45.9) | 226 (59.5) | <.01 |
| Faculty member(s) or mentor(s) | 106 (67.5) | 194 (51.5) | <.01 |
| Patient encounters | 78 (49.7) | 192 (50.5) | .92 |
| Peer influence | 24 (15.3) | 64 (16.8) | .70 |
| Personal experience(s) | 93 (59.2) | 259 (68.2) | .06 |
| Other | 2 (1.3) | 11 (2.9) | .36 |
| Pharmacy didactic education | |||
| Very influential | 61 (38.9) | 88 (23.2) | <.01 |
| Somewhat influential | 78 (49.7) | 220 (57.9) | NS |
| Not influential | 18 (11.5) | 72 (18.9) | <.01 |
Abbreviations: APPE, Advanced Pharmacy Practice Experiences; ID, infectious diseases; IPPE, Introductory Pharmacy Practice Experiences; K-12, kindergarten to 12th grade; NS, not significant.
Data are presented as frequency and percentages.
The χ2 test was used to compare categorical data between 2 groups.
DISCUSSION
We assessed student perceptions of their ID education, their career interests, and the relationship between the two across multiple pharmacy schools in the United States. These results are important given pharmacists’ key role in promoting appropriate antimicrobial use and limited availability of postgraduate training in ID for pharmacy graduates. Because postgraduate training is not required in pharmacy, most pharmacists will participate in AS supported primarily by their education received in pharmacy school. The cohort of graduating students surveyed in this study appeared aware of the need for knowledge and skills in ID/AS. The top 3 topics identified as needing more time in their didactic ID education are all fundamental stewardship skills (intravenous to oral antimicrobial transition, biological markers, and de-escalation of antimicrobials).
Our results regarding quality of ID education mirror findings of 2 studies investigating the relationship between ID education and fellowship choices of IM medical residents. The first was a cross-sectional mixed-methods (survey and interview) study of IM residents [6]. Of the 590 participating residents, 41% rated the ID curriculum as Very Good, 38% as Good, and 21% as either Acceptable or Poor. A similar study of 68 IM residents from military programs found that 36% rated the ID curriculum as Very Good, 31% as Good, 29% as Acceptable, and 3% as Poor [7].
It is interesting to note that both the number of resources and the number of helpful resources were associated with perceived quality of ID education. Students receiving 10 or more resources were more likely to rate their education as Very Good, regardless of the specific resource. However, some of the more innovative teaching materials such as concept maps, online or application-based study tools, and games were standouts and separated Very Good curricula from others. In the free-text responses, the most divisive variable was faculty. Although there was a trend in frequency of comments about high-performing faculty in successes of didactic ID education, significant differences were present in the concerns and desired changes where students wrote about the negative impact faculty had on their perception of their ID education. In contrast, faculty were more frequently cited as positive influence for a career interest in ID compared with other specialties.
The relatively high rate of career interest in ID may be explained by selection bias because survey completion was voluntary and this sample represents 17% of graduating students from 29 pharmacy schools. A larger survey would likely find a lower interest level; however, we are unaware of any such surveys of pharmacy trainees. In the Bonura et al [6] and Barsoumian et al [7] studies of medical residents cited above, 7% of respondents reported interest in a career in ID. In both studies, medical residents cited low salary as a deterring factor for a career in ID. A potential explanation for the difference in career interest between pharmacists and physicians is the lack of salary difference between an ID pharmacist and any other clinical specialty. Respondents in this survey were also earlier in their training than in the physician studies, which were performed among medical residents in their third year of residency. It is unknown whether residency would increase or decrease career interest in ID for pharmacy students.
How ID was taught influenced both quality rating and career interest in our study as well as both medical resident studies. Bonura et al [6] found that residents who indicated an interest in ID at the end of residency were more likely to rate their medical school curricula as Very Good (53%), compared with only 33% of those never interested in ID. In addition, residents who experienced case-based learning and nonmemorization learning had an increased likelihood of choosing ID (relative risk ratio, 3.7–3.9). The majority of military residents did not think the quality of education was influential on their interest in ID. However, learning ID through a curriculum primarily using active learning was different among residents who applied for or planned to apply for ID fellowships (80%), residents who considered ID (35%), and residents uninterested in ID (18%) [7].
Our results support the Infectious Disease Society of America Preclinical Curriculum Committee notes that traditional lecturing and curriculum does not stimulate participation or enthusiasm for ID [8]. Their recommendations include the use of active learning to stimulate participation, collaborative learning, and 2-way communication with the instructor. Utilizing active learning techniques at one institution led to a substantial increase in student interest in an infectious disease rotation [8]. Faculty providing varied types of resources for learning ID was associated with a higher category of education quality. In addition to active learning in the didactic setting, providing resources of concept maps, online or application-based study tools, and games were specifically associated with a Very Good education. These active learning techniques can also serve as study tools for independent learning.
A key limitation to the study is its representativeness of pharmacy students. Faculty identified as teaching ID at various schools of pharmacy were encouraged to share the survey with their students; it is possible that those faculty most engaged in teaching ID are likely to participate in the study and send the survey link to their graduating students. Participation in the survey was voluntary and titled, “Student survey of ID didactic curriculum.” Students with an opinion on the topic, positive or negative, would be more likely to participate, leading to a greater polarity of opinion than may be actually present.
CONCLUSIONS
In conclusion, in our study of graduating pharmacy students, we discovered that the quantity and innovation of faculty-provided resources was positivity associated with quality of didactic ID education and that the perceived quality of didactic ID education influenced career interest in ID and/or AS. Thus, an engaging and creative didactic ID curriculum has potential to increase interest in ID/AS careers among pharmacy students.
Acknowledgments
We thank all survey respondents for contributions and acknowledge the members of the Infectious Diseases Educators’ Network for support.
Financial support. This work was funded by the Associate Dean of Research Educational Research Seed Grant Program at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences.
Potential conflicts of interest. M.N.J. served as a consultant for Shionogi. C.M. served as a consultant for Allergan and Shionogi and has received grant support from Merck. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
References
- 1.Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Available at: www.cdc.gov/drugresistance/threat-report-2013. Accessed 1 April 2017. [Google Scholar]
- 2. Joint Commission on Hospital Accreditation. APPROVED: New Antimicrobial Stewardship Standard. Jt Comm Perspect 2016; 36:1, 3–4, 8. [PubMed] [Google Scholar]
- 3. Gallagher JC, Justo JA, Chahine EB, et al. Preventing the post-antibiotic era by training future pharmacists as antimicrobial stewards. Am J Pharm Educ 2018; 82:6770. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Kufel WD, Jeffres MN, MacDougall C, et al. Antimicrobial stewardship education in US colleges and schools of pharmacy. J Antimicrob Chemother 2018; 73:2252–8. [DOI] [PubMed] [Google Scholar]
- 5. Justo JA, Gauthier TP, Scheetz MH, et al. Knowledge and attitudes of doctor of pharmacy students regarding the appropriate use of antimicrobials. Clin Infect Dis 2014; 59(Suppl 3):S162–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Bonura EM, Lee ES, Ramsey K, Armstrong WS. Factors influencing internal medicine resident choice of infectious diseases or other specialties: a national cross-sectional study. Clin Infect Dis 2016; 63:155–63. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7. Barsoumian AE, Hartzell JD, Bonura EM, et al. Factors influencing selection of infectious diseases training for military internal medicine residents. Clin Infect Dis 2018; 67:1582–7. [DOI] [PubMed] [Google Scholar]
- 8. Southwick F, Katona P, Kauffman C, et al. Commentary: IDSA guidelines for improving the teaching of preclinical medical microbiology and infectious diseases. Acad Med 2010; 85:19–22. [DOI] [PubMed] [Google Scholar]