A Summary Report. Developing an Antibiotic Prescribing online training resource for Foundation Year Doctors

Transcription

1 A Summary Report Developing an Antibiotic Prescribing online training resource for Foundation Year Doctors

2 Background Antibiotic stewardship is central to the Scottish Action Plan on Antimicrobial Resistance (SEHD, 2002). The Scottish Medicines Consortium (SMC) and Scottish Executive have also highlighted prudent prescribing of antibiotics as a key area to be addressed in clinical practice and in training for prescribers (SEHD 2005; Nathwani, 2006). The Scottish Executive s HAI taskforce has commissioned NHS Education for Scotland (NES) to develop educational solutions aimed at improving clinical practice and reducing the impact of HAI in healthcare in Scotland. We describe the development of an online training resource on Antibiotic Prescribing for Foundation Year Doctors in Scotland and discuss the potential application for other clinical practitioners. The project outline Initial discussions between NES and subject experts focussed on the content, mode of delivery and target group for the materials. The development of the materials involved the following processes: Identification of project team and curriculum advisory group Identification of target group Content development Assessment Review process Identification of VLE provider Consultation Launch Ongoing development The project team and advisory group A project team was identified by NES. The team included subject experts, external consultants on graphic design, content development and IT support. The work of the project team was overseen by a Curriculum Advisory Group (CAG) which met on a regular basis throughout the project and was involved in review of materials at key stages. The CAG included representation from the Foundation Year Doctors curriculum development team, subject experts, other prescribing groups and educational advisors (see Appendix 1). 1

3 The target group The target group identified for the first phase of the project was Foundation Year Doctors. There were a number of benefits in selecting this group for the initial development of materials: Foundation Year Doctors are engaged in postgraduate training through the Foundation Year Curriculum and access other online training programmes via the Doctors Online Training System (DOTS); concentrating on a single practitioner group gave a clear focus to the development process for the first phase of the project. In addition, junior doctors have been highlighted as a group requiring further training in the area of antibiotic prescribing, particularly in the application of undergraduate learning in the clinical context (Nathwani, 2006). Antibiotic stewardship links with two competencies currently described in the foundation year curriculum: prescribing and control of infection. The CAG and project team worked with the Foundation Year Curriculum representatives to ensure that the Antibiotic Prescribing training programme would be allocated space in the current Foundation Year curriculum. One hour of online training time was allocated. Unfortunately, there was no scope to allocate any off-line training time to the project. Representatives from other prescribing groups were involved in the development and review of the materials as it is planned to extend the application of the training materials to other clinical practitioner groups in later phases of the project. Content development A curriculum advisory group (Appendix 1) chaired by Professor Dilip Nathwani was set up by NES to oversee the development of the materials for Foundation Year Doctors. A workshop with Educational Supervisors, Foundation Year Doctors and representation from other clinical groups was held to get feedback from potential users. The materials were in part developed and adapted from an earlier project for undergraduate training, Appropriate Prescribing for Tomorrow's Doctors, which was conducted on behalf of the British Society of Antimicrobial Chemotherapy (BSAC) and the Scottish Executive Health Department. Members of the CAG also contributed to writing and reviewing new materials. 2

4 Content We presented background information on areas relevant to antibiotic prescribing, including diagnosis and assessment, investigations and interpretation, clinical management, infection control and public health. This information was followed by four case-based vignettes which highlighted key points in relation to clinical management and antibiotic stewardship. The vignettes were scored to allow assessment of learning. Throughout the vignettes, supporting text was provided as questions were answered. This gave the opportunity to address key points in the context of clinically based scenarios. Assessment The vignettes provided a means of online assessment of learning. All Foundation Year Doctors taking part in the course had to pass a minimum of 3 of the 4 vignettes presented. The pass mark was set at 60%. If any of the doctors failed a vignette they were given the chance to resit the vignette. A record of learning was available to print off after completion of each of the vignettes. Competencies relating to antibiotic prescribing for Foundation Year Doctors were proposed (Table 1) and we detailed how each of these competencies related to the content presented in the vignettes (Table 2). Both of these were available through the training programme for printing as a pdf file. We felt it was not possible to evidence the competencies solely from the online training materials. The online materials could be complemented by inclusion of some offline assessment, clinical supervision or reflective practice exercises. Graphic design A graphic design template was developed for the programme to be consistent with the overall look and feel of NES s HAI virtual learning environment (VLE). Review process The CAG contributed to the review of the materials throughout their development. Regular meetings were held and materials circulated for discussion and presented to the group at appropriate points. Once materials were available online and before launching to the Foundation Year Doctors, the CAG were given the opportunity to review the online programme. This approach allowed peer review at key stages in the development of the materials. 3

5 VLE provision As part of the HAI initiative, NES issued an invitation to tender for the provision of a virtual learning environment (VLE) on which to host a range of materials relevant to HAI. The Knowledge Business (Appendix 2) was successful in securing the tender and currently provides NES with a VLE licenced for use by healthcare workers in Scotland and the Higher Education Sector. The content was uploaded onto the VLE using the Knowledge Business content management software. A direct link was created from the DOTS website to the Antibiotic Prescribing for Foundation Year Doctors materials hosted on the VLE. Assessment details were also sent to the DOTS system to update the Foundation Year Doctors individual training records. 4

6 Consultation In addition to consultation with the CAG, feedback on the materials and the development process was also invited from external representatives from a number of key groups including Foundation Year Educational Supervisors, Foundation Year Doctors, Specialist Registrars, Consultant Physicians, General Practice, DOTS project staff, Pharmacists and Nurse prescribers. Comments from national groups such as the British Society for Antimicrobial Chemotherapy (BSAC) were also sought. As part of this consultation process we hosted a workshop and invited participants from the groups listed above. A sample vignette and the competency list was circulated to participants in advance of the workshop. The workshop was well attended. The project group presented a brief background to the project and hosted four discussion groups: e-learning; Competencies; Content; Methods of Assessment. Delegates were allocated to a group and participated in each of the discussion topics. The facilitators reported back at the end of the session and comments informed the ongoing development of the materials. The feedback was positive with general comments supporting the proposed content and competencies. There was a general agreement that case-based assessments provided a useful tool. Some of the Foundation Year Doctors felt that it would be useful to review the casework with their Educational Supervisors but representatives from the Educational Supervisors in the groups felt that the schedule was already at capacity and there would be little extra time to devote to additional topics. Comments from the e-learning group focussed on technical requirements and the general perception was to aim for the minimum expected hardware and software specification for computers available for training within the NHS. Once the materials had been agreed by the CAG and uploaded onto the VLE, guest passwords were issued to invited reviewers before the materials were made available to the Foundation Year Doctors. Launch Following the consultation and development process described, the materials were launched to Foundation Year Doctors in January 2007 through a direct link via the Doctors Online Training System (DOTS) This link allowed the Foundation Year Doctors to access the materials when they logged into the learning zone in DOTS. 5

7 Evaluation All users were asked to complete an online evaluation form to provide feedback on the training materials. We asked for feedback on the training materials presented, assessment of competency, online training in general and relevance to clinical practice. The response rate was good with 301 responses (at 31 May 2007), of these, 88% (266) were Foundation Year 1 Doctors and 10% were Foundation Year 2 Doctors, the other 2% were made up of Educational Supervisors, Specialist Registrar and other. The results are summarised below: Training materials The response to the training materials was positive with >80% rating content, method of delivery, ease of use (core materials) and ease of use (vignettes) as good or excellent: Assessment The majority (95%) felt that the level the vignettes were set at was About right. Although this training programme was offered solely online, 88% of respondents felt that assessment of clinical competence in this area should be a mixture of workplace and online. 6

8 Online learning The majority (93%) of respondents had used other online training programmes and most (94%) rated this method of learning as OK or like a lot. Antibiotic prescribing Most respondents felt training in antibiotic prescribing was very relevant to clinical practice for foundation level doctors (99%) and other prescribers (89%). A small number (9%) felt that training in this area would be of interest only to other prescribers. Most respondents (90%) said that they would be interested in additional training in this area. As these results show, the general feedback to the materials has been very positive. We will continue to use this evaluation tool to obtain user feedback. Ongoing development An editorial board will be set up to review the materials to ensure that currency and accuracy are maintained. It is planned to extend the materials to other prescribing groups. This may require some revision of the materials, but where possible the content will remain the same. Input from representatives from other prescribing groups and training providers will be crucial to the next stage of development. Summary We have described the development process for an online training resource on antibiotic prescribing for Foundation Year Doctors. Appointing a curriculum advisory group at the start of the project allowed appropriate peer review during the content development process. Additional consultation provided feedback both on the content and the delivery of the materials from a wider group. This involvement throughout the development process led to the production of materials that gained a positive review from the target audience. Ongoing involvement of representatives from professional groups should ensure successful development of materials relevant to other prescribing groups. This training resource promotes appropriate use of antibiotics in the clinical setting with a general aim of improving antibiotic stewardship among Foundation Year Doctors. Extension of this resource to other professional groups will be a valuable next step in promoting prudent use of antibiotics. 7

9 References SEHD (2002) avaliable online at: SEHD (2005) avaliable online at: Nathwani (2006) avaliable online at: 8

10 Apendix 1 Dr Anne Boyter Lecturer in Clinical Practice University of Strathclyde Professor Peter Davey Director, Health Informatics Centre University of Dundee Mr Rodney Mountain Associate Postgraduate Dean NHS Education for Scotland Mrs Arlene Brailey Assistant Director, Pharmacy NHS Education for Scotland Dr Hazel Scott Director of Medical Education Wishaw General Hospital NHS Lanarkshire Professor Curtis Gemmell University of Glasgow Professor Dilip Nathwani Consultant Physician Ninewells Hospital and Medical School NHS Tayside Dr Margaret Brown HAI Project Leader NHS Education for Scotland Dr Martin Pucci GP NHS Grampian Primary Care Dr Stephanie Dancer Consultant Microbiologist Southern General Hospital NHS Greater Glasgow Dr Fiona Strachan Independent Consultant Mrs Liz Gillies Director, HAI NHS Education for Scotland Mr Andy Hyde Independent Consultant Dr Jean Ker Director, Clinical Skills Centre University of Dundee Ms Julie McDonald Centre for Medical Education University of Dundee Dr Andrew Seaton Infectious Diseases Consultant Gartnavel Royal Hospital NHS Greater Glasgow Dr A R Mackenzie Infectious Diseases Consultant Aberdeen Royal Infirmary NHS Grampian 9

11 Apendix 2 The Knowledge Business Research Park North Riccarton Edinburgh EH14 4AP Tel:

12 Competencies for foundation year doctors The foundation level doctor will apply up to date clinical, microbiological, pharmaceutical and public health knowledge to recognise, diagnose and assess the severity of a bacterial infection and then initiate antibiotic therapy where appropriate. The doctor should appreciate the basic principles related to prudent antibiotic prescribing, recognise some unique risks or adverse reactions related to antibiotic prescribing and recognise effective monitoring of treatment. Competencies have been divided into: Application: skills that the Foundation Level doctor should apply regularly in their work and be able to carry out with minimal supervision. Awareness: skills that the Foundation Level doctor would not be expected to have acquired but should be sufficiently aware to seek help. Shading indicates competencies that are generic and not specific to antimicrobial prescribing Table One The foundation level doctor will: 11

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14 How the Competencies relate to the vignettes The vignettes that form the online assessment for Antibiotic Prescribing for Foundation Year Doctors cover areas relevant to the competencies described. The following list can be used with your results from the vignettes to provide a record of the areas covered by completion of the vignettes. This list does not provide evidence of achieved competencies, as this would require some offline assessment and supervision. Table Two The foundation level doctor will: 13

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