Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum Need

Clinical Infectious Diseases BRIEF REPORT Antimicrobial Stewardship Training for Infectious Diseases Fellows: Program Directors Identify a Curriculum Need Vera P. Luther,1 Rachel Shnekendorf,2 Lilian M. Abbo,3 Sonali Advani,4 Wendy S. Armstrong,5 Alice E. Barsoumian,6 Cole B. Beeler,7 Rachel Bystritsky,8 Kartikeya Cherabuddi,9 Seth Cohen,10 Keith W. Hamilton,11 Dilek Ince,12 Julie Ann Justo,13 Ashleigh Logan,2 John B. Lynch III,10 Priya Nori,14 Christopher A. Ohl,1 Payal K. Patel,15 Paul S. Pottinger,10 Brian S. Schwartz,8 Conor Stack,16 and Yuan Zhou10 1 A needs assessment survey of infectious diseases (ID) training program directors identified gaps in educational resources for training and evaluating ID fellows in antimicrobial stewardship. An Infectious Diseases Society of America–sponsored core curriculum was developed to address that need. Keywords. antimicrobial stewardship; needs assessment; infectious diseases fellows; education; curriculum. Antimicrobial resistance is a growing threat to public health [1, 2]. Antimicrobial stewardship (AS) is one tactic to combat this danger and simultaneously improve patient outcomes [2, 3]. The importance of AS efforts has been recently recognized by the White House, the World Health Organization, and the United Nations [1, 4]. In response, healthcare accreditation standards from the Centers for Medicare and Medicaid Services and the Joint Commission were updated to require acute care hospitals and long-term care facilities to have active AS programs with dedicated medical staff expertise and leadership [5, 6]. Guidelines published by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America for implementing an AS program (ASP), along with METHODS Needs assessment questions were developed collaboratively by the Workgroup and collated using SurveyMonkey. The survey was distributed by e-mail to all US adult ID training program directors in 2016, responses were anonymous. Questions focused on assessing current fellowship AS training activities, satisfaction with training if provided, and the resources and methods used. In addition, faculty oversight for AS teaching and fellow participation in restricted antimicrobial approval was explored. Several questions asked about program interest in a national stewardship curriculum developed by IDSA and what resources and training tools would be most useful. Participants were provided the option to skip questions if they did not wish to respond to a particular item. RESULTS Received 23 February 2018; editorial decision 5 April 2018; accepted 12 April 2018; published online April 16, 2018. Correspondence: V. P. Luther, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston Salem, NC 27157 (). Clinical Infectious Diseases®  2018;67(8):1285–7 © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: . DOI: 10.1093/cid/ciy332 Of 151 fellowship directors, 87 (58%) responded to the request for survey participation, and 84 (56%) completed the survey. Sixty-five (77%) reported that AS training is very or extremely important for ID fellows. Likewise, most program directors reported offering multiple AS educational activities during fellowship training: lectures (n = 72; 85%), quality improvement BRIEF REPORT • CID 2018:67 (15 October) • 1285 Department of Medicine, Wake Forest School of Medicine, Winston Salem, North Carolina; Infectious Diseases Society of America, Arlington, Virginia; 3Department of Medicine, University of Miami Miller School of Medicine, Florida; 4Department of Medicine, Yale School of Medicine, New Haven, Connecticut; 5Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; 6Department of Medicine, San Antonio Military Medical Center, Texas; 7Department of Medicine, Indiana University School of Medicine, Indianapolis; 8 Department of Medicine, University of California San Francisco Medical Center; 9Department of Medicine, University of Florida College of Medicine, Gainesville; 10Department of Medicine, University of Washington School of Medicine, Seattle; 11Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia; 12Department of Medicine, University of Iowa Hospital and Clinics, Iowa City; 13Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia; 14Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; 15Department of Medicine, University of Michigan Health System, Ann Arbor; and 16Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 2 professional society white papers, endorse clinician education in AS [7, 8] and recommend that academic medical centers and teaching hospitals integrate AS education into their training curricula [7]. These guidelines also state that ASPs should be directed by an infectious diseases (ID) physician, ideally with an ID-trained clinical pharmacist [9]. The importance of ID physician leadership in ASPs is further emphasized in a recent professional society white paper [10]. Because of recent changes in accreditation standards and the rising demand for ID physician leadership in ASPs, the need for ID physicians with a defined focus in AS has increased dramatically. An AS curriculum designed to leverage such training would be especially effective if tailored to distinct learners, such as ID fellows [11, 12]. Moreover, training future leaders and innovators to meet the challenges of multidrug resistance, better patient safety, and improved healthcare quality should be a goal of all ID training programs. In 2016, the IDSA Board of Directors supported developing a training initiative to ensure the future IS workforce is equipped to oversee or participate in AS efforts. In August 2016, IDSA formed an Antimicrobial Stewardship Curriculum Workgroup (hereafter, “the Workgroup”) to develop an AS curriculum for ID fellows. To formally assess existing AS education for fellows and the need for additional training resources, the Workgroup developed and distributed a needs assessment survey. Table 1. be very or extremely useful to their fellowship program (n = 65; 77%) and that they would be very or extremely likely to incorporate resources from that curriculum (n = 67; 80%). Program directors identified case-based questions (n = 71; 85%), lecture slides (n = 67; 80%), and recommended quality improvement activities (n = 55; 66%) as desirable educational resources within a national AS curriculum. Fellow assessment tools (n = 61; 73%) and resources on teaching leadership skills (n = 67; 80%) were frequently requested as well. DISCUSSION In response to this needs assessment, the Workgroup developed a core curriculum for ID fellows to provide foundational training in AS. An advanced curriculum aimed to prepare fellows to lead AS programs is in dev (...truncated)