PEDU-4077 - Pediatric Antimicrobial Stewardship

PEDU-4077 - Pediatric Antimicrobial Stewardship

Elective Type: career
Pediatric Antimicrobial Stewardship
Course Number
Prerequisites: Successful completion of Year 3 
      Additional Requirements:
Responsible Faculty Director:
Diana Nguyen, MD
Other Faculty:
Jordan Burdine, Ph.D.
Location to Report on First Day
RB6 3.320
Periods Offered
1-7, 10-13
excluding holiday period 8
Maximum Enrollment

The goal of this course is to introduce the student the concept of antimicrobial stewardship and appropriate antibiotic use.

1. To describe the core elements of antimicrobial stewardship program (ASP).
2. To recall antibiotic classes and their spectrum of coverage and indications.
3. To apply knowledge of antibiotics and core elements of ASP in daily practice of proper antibiotic usage.

Description of course activities
The student will participate in prospective audit and feedback of antibiotics for pediatric patients. This will be predominantly be in the inpatient setting, but outpatient stewardship may be added. This involves reviewing the chart for antibiotic indication, duration, and dose. This will be discussed with faculty and recommendations will be made regarding antibiotic management. The student will round with the faculty to discuss recommendations with the primary team as needed. The student will also have the opportunity to participate or develop quality improvement, research, and/or medical use evaluation related to antimicrobial stewardship. Students will also attend institutional multi-disciplinary ASP meetings every Tuesday at 10:30, which may be in person or via Skype. There will be about 20 hrs a week faculty contact time, about 10 hours of data collection/analysis time and about 10 hrs of special projects.

Type of students who would benefit from the course
Students interested in Pediatrics, especially Pediatric Infectious Diseases. Students who wish to gain a better understanding of appropriate and judicious antibiotic use.

Weekly Schedule
  Clinical Activities (estimated schedule)
  Day of Week AM PM
  Monday 9 5
  Tuesday 9 5
  Wednesday 9 5
  Thursday 9 5
  Friday 9 5
   Average number of patients seen per week: 10-15  
   Call Schedule:   N/A  

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Faculty - Pediatric Infectious Diseases faculty or Pediatric Pharmacist
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
    The student will need to have reviewed the chart beforehand, noting reason for admission, medical history, what antibiotics the patient is on, indication, dose, and duration. The student will then propose recommendations to the primary team and justification/reason for the recommendations.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
  B. Format - What guidelines are set for the student's written work?
    Students will also be assigned a project during their rotation which may be an ongoing project or they will help start a new one. They will present a weekly written report of their progress. They may analyze data and present at weekly ASP meetings.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    Content will depend on current cases
  F. Audience - Who assesses the student’s written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?
    Attend weekly ASP meetings

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student’s abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.