P34 Targeting antimicrobial prescribing knowledge gaps among Foundation doctors through a focused microbiology education programme
Mecaelan Sardar, Darshana WickramasingheAbstract
Background
Antimicrobial stewardship relies on junior doctors making safe, early prescribing decisions. At a district general hospital in the UK, repeated microbiology enquiries from Foundation doctors suggested baseline knowledge deficits. Identifying local learning needs can help inform focused microbiology education and promote safer prescribing.
Objectives
To identify key antimicrobial prescribing knowledge gaps and use these findings to inform targeted microbiology education aligned with local Trust guidelines.
Methods
Cycle 1 involved an anonymized baseline quiz completed by 22 Foundation doctors during a scheduled teaching session. Domains assessed included antimicrobial spectrum of activity, first-line treatment for Clostridioides difficile infection, criteria for treating asymptomatic bacteriuria (ASB), principles of candidaemia management, and infection prevention knowledge. Findings informed a multifaceted educational intervention comprising: (1) immediate quiz debrief, (2) a 2-h consultant microbiologist-led teaching session, (3) bedside teaching reinforcement during microbiology ward rounds, and (4) signposting to local antimicrobial guidelines.
Results
Five key knowledge gaps were identified. Only 50% (11/22) selected the correct guideline-recommended first-line therapy for initial C. difficile infection, and 45.5% (10/22) chose an incorrect dose or duration. Recognition of the urgency of candidaemia was low, with just 4.5% (1/22) acknowledging that Candida in blood cultures is never a contaminant. ASB management showed a consistent tendency toward overtreatment of scenarios where antibiotics are not indicated: for example, 59.1% (13/22) would treat ASB before orthopaedic surgery. Spectrum-of-activity misunderstanding was notable: 68.2% (15/22) incorrectly believed that gentamicin provided anaerobic coverage, and recognition of antipseudomonal agents was frequently suboptimal. In contrast, 86.4% (19/22) correctly identified that ‘before touching patient surroundings’ is not one of the WHO Five Moments for Hand Hygiene.
Conclusions
A simple baseline assessment successfully identified specific, modifiable knowledge gaps in antimicrobial stewardship among Foundation doctors. Targeted microbiology teaching was developed to address these areas. A re-audit is planned to evaluate improvements in knowledge and their impact on safer prescribing practice.