Infection Point of Care Tests (POCT) in simulated vignettes can improve the education of Antibiotic Stewardship Programmes. An observational comparative study of Clinicians vs Medical Students

Abstract

Abstract Background Point of Care Tests (POCTs) offer accurate rapid diagnostics for infections but have not improved antibiotic-free-days. This has been attributed to clinician prescribing behaviour rather than test performance. Hypothesising experience to influence prescribing behaviour, we compared the effect of POCT-use on antibiotic decision-making amongst clinical medical students versus intensive care clinicians. Methods In a within- and between groups cohort study, clinicians and students saw four clinical vignettes depicting resolving hospital acquired pneumonia on ICU, after a course of antibiotics. Each vignette comprised clinical and biological data, to create four distinct trajectories at the point of antibiotic decision: “clinical-biological improvement”, “clinical improvement/biological worsening”, “clinical worsening /biological improvement”, “clinical-biological worsening”. Participants made an initial antibiotic decision (stop/continue). Then a polymerase-chain-reaction POCT was offered (accepted/declined). Regardless, a negative POCT result was always subsequently presented. Participants updated their antibiotic decision. Stop decisions were compared between groups pre- and post-POCT. Results Eighty-eight students and seventy clinicians responded. Pre-POCT result, students stopped antibiotics significantly less than clinicians (42% vs. 53%, p = 0.007); most markedly in the “clinical improvement/biological worsening” case (36% vs. 73%, p < 0.001). Students and clinicians requested a POCT to assist their judgement with equal frequency (65% vs. 67%, p = 0.650). A negative POCT result raised student stop rates to those of clinicians in all scenarios (70% vs. 67%, p = 0.466); the greatest rise in student stop rate being the “clinical improvement /biological worsening” scenario (p = 0.006). Conclusion Infection-detecting POCTs (when negative) improved students’ antibiotic stop rates to the level of experienced clinicians, particularly in cases of clinico-biological trajectorial ambiguity. Utilisation of a POCT result, if negative, can reduce (over)cautious prescribing. Simulated vignettes of clinical infection incorporating POCT diagnostics offer a promising learning tool to improve students’ antimicrobial judgement, and confidence in decision making. Such educational interventions in the medical school curriculum may improve antimicrobial stewardship.