Purpose: Education is essential to improve appropriate antibiotic use, but usual approaches are marginally effective and lack sustained impact. This study aims to evaluate the efficacy of a novel clinical reasoning curriculum to improve knowledge of appropriate antibiotic use among resident physicians.
Methods: A 1-year clinical reasoning curriculum was compromised of monthly, case-based conferences facilitated by an antimicrobial stewardship team. Conference structure was uniform. After a case presentation, residents were led through a reflective thought task where they generated: a general and specific assessment, a causal analysis, counterfactuals, then implications and solutions. Internal Medicine residents (IMR) participated in year 1 (n=44), Family Medicine residents (FMR) participated in year 2 (n=22). All residents continued their usual clinical and didactic training. A 33-question “appropriate antibiotic use” knowledge exam was administered at baseline, after year 1, and after year 2. A 2 (medical specialty: IMR vs FMR) × 3 (exam score: 1st vs. 2nd vs. 3rd) repeated measures analysis of covariance was computed with exam score as within-subjects variable and residency year as a covariate.
Results: The analysis revealed a main effect of exam score, F(2, 126) = 103.37, p < .001, h2 = .62, as well as a main effect of medical specialty such that IMR out-performed FMR, F(1, 63) = 15.61, p < .001, h2 = .20. These effects were qualified by a statistically significant medical specialty × exam score interaction, F(1, 126) = 27.23, p < .001, h2 = .30. On pairwise analysis, 1st exam scores did not differ. However, after IMR completed the curriculum, IMR significantly outscored FMR on the 2nd exam, t(126) = 8.93, p < .001. After FMR completed the curriculum, exam scores did not significantly differ (figure). IMR exam performance was sustained after 1 year. The conferences were well attended and course evaluations were highly favorable.
Conclusions: A significant and sustained improvement in knowledge of appropriate antibiotic use among resident physicians can be achieved through a clinical reasoning curriculum that incorporates case-based reflective thought task exercises. The addition of reflective thought task exercises may be an important strategy to improve appropriate antibiotic use knowledge.
