ObjectivesWe reviewed the published literature on antimicrobial
stewardship training in undergraduate and postgraduate medical education to
determine which interventions have been implemented, the extent to which they
have been evaluated, and to understand which are most effective.
MethodsWe searched Ovid MEDLINE and EMBASE from inception to
December 2016. Four thousand three hundred eighty-five (4385) articles were
identified and underwent title and abstract review. Only those articles that
addressed antimicrobial stewardship interventions for medical trainees were
included in the final review. We employed Kirkpatrick’s four levels of
evaluation (reaction, learning, behaviour, results) to categorize intervention
evaluations.
ResultsOur review included 48 articles. The types of intervention
varied widely amongst studies worldwide. Didactic teaching was used heavily in
all settings, while student-specific feedback was used primarily in the postgraduate
setting. The high-level evaluation was sparse, with 22.9% reporting a
Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one
article reported positive results from the intervention. No articles evaluated
the impact of an intervention on undergraduate trainees’ prescribing behaviour
after graduation.
ConclusionsThis study enhances our understanding of the extent of
antimicrobial stewardship in the context of medical education. While our study
demonstrates that medical schools are implementing antimicrobial stewardship
interventions, rigorous evaluation of programs to determine whether such
efforts are effective is lacking. We encourage more robust evaluation to
establish effective, evidence-based approaches to training prescribers in light
of the global challenge of antimicrobial resistance.
This qualitative thematic synthesis provides key insights into the experiences of individuals with spinal cord injuries who received physical rehabilitation. Recommendations for practice, based on the findings, include creating a diverse, encouraging, and educational physical rehabilitation experience with supportive staff who focus on communication and person-centred care. Implications for Rehabilitation Physical rehabilitation provides psychological as well as physical benefits to people with spinal cord injuries, including motivation, hope, improved self-confidence, and acceptance. Challenges identified during physical rehabilitation for people with spinal cord injuries, such as comparisons, negative emotions, recovery expectations, and slow progress, should be addressed by healthcare professionals to ensure person-centred care. People with spinal cord injuries identified a need for support from health care professionals, family, and friends, as well other people with spinal cord injuries. There is an issue of control in physical rehabilitation for people with spinal cord injuries, which can result in a fight with oneself or with healthcare professionals to regain the control that has been lost.
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