The second workshop in the AMR Frontline series, a Superheroes against Superbugs initiative, was conducted in collaboration with Ashoka University at the University College of Medical Sciences (UCMS), Delhi. Funded by the Rockefeller Foundation as a part of the Alliance for Pathogen Surveillance Innovations (APSI) in India, the event took place on December 12, 2023, and was designed to address the critical issue of Antimicrobial Resistance (AMR) for aspiring medical professionals.
At UCMS, Delhi, the half-day workshop engaged over 120 medical students between the ages of 18 and 21, who are in their second year of medical school. This period in their education, when they study microbiology and pharmacology, was chosen to build on their curriculum to enhance their learning about AMR. The aim was to instil an early awareness and comprehensive understanding of AMR, equipping these future health guardians to tackle AMR challenges head-on. The workshop endeavoured to foster responsible habits and a proactive stance towards AMR, aiming to ultimately better patient care and strengthen the fight against AMR in their ensuing careers.
The event began with an introduction by Dr. Shukla Das, the Director Professor and Head of the Department of Microbiology, followed by welcoming remarks from the Principal of the college, Dr. Piyush Gupta. In his address, Dr. Gupta emphasised the fact that “an antibiotic-less prescription takes more time and effort than one with antibiotics on it,” challenging the students to consider which approach they would choose. This statement set a thought-provoking tone for the workshop, inspiring the students right from the start.
Participants were then provided with a dynamic educational experience, which included in-depth expert lectures and interactive activities. The workshop featured presentations from eminent specialists, Dr Anuj Sharma, Focal Point of AMR at the World Health Organisation Office, India, Dr Sonal Saxena, Director Professor and Head at the Department of Microbiology at the Maulana Azad Medical College, Dr Bansidhar Tarai, Associate Director and Head at Microbiology, Molecular Diagnostics & Infection Control Departments, Max Hospitals, and Dr Shraddha Karve, Research Faculty Fellow at Ashoka University. They provided comprehensive insights into the various aspects of AMR.
Decoding AMR: Knowledge Exchange with Experts
Dr. Anuj Sharma delivered the keynote address, focusing on demystifying AMR. He began by discussing microbes, infections, and antimicrobials, linking these topics to subjects medical students learn about such as the epidemiological triad, commensal flora, etc. Dr. Sharma also touched on the emergence and drivers of AMR, laying the groundwork for understanding the subject. He highlighted the global burden of AMR, describing it as an ‘invisible pandemic’ now recognized as a critical issue demanding immediate action.
Sharing insights from his work with the World Health Organisation, Dr. Sharma illustrated the prioritisation of AMR, detailing global and programmatic action plans as well as India’s specific strategies like the National Action Plan on AMR, state-level initiatives, and surveillance efforts. He concluded with a motivational message, outlining the role medical students can play in curbing AMR from the outset of their careers.
Navigating Clinical Challenges: The Impact of AMR in Healthcare
Following the keynote address, Dr. Bansidhar Tarai then took the stage to share his experience with the Antimicrobial Stewardship (AMS) program at Max Hospital he has been running and working on for the past 13 years. He outlined the procedures for antibiotic audits and the execution of AMR stewardship, offering attendees a glimpse into the practical side of AMR management in a hospital environment.
Detailing the digital management of AMR stewardship in line with WHO and ICMR guidelines, Dr. Tarai provided an in-depth look at the components of the AMS program at Max, including the use of antibiograms, antibiotic policies, and monitoring antibiotic consumption. He introduced the AMS committee members, highlighting the collaborative efforts of various specialists, including the Director of Internal Medicine, Microbiologists, Clinical Pharmacologists, Critical Care Consultants, Anaesthetists, and others. He emphasised the need for clinical microbiologists to go on patient rounds for efficient monitoring as well as implementation of the recommendations from the stewardship program in conjunction with the treating physician, a factor that he attributes the success of his AMS program to.
Furthermore, he emphasised the importance of accountability, mentioning that doctors are required to provide justification when prescribing restricted antibiotics.His many years of data from the AMS program showed surgical prophylaxis as an area where most antibiotic misuse happens emphasising the need to pay special attention to this in the AMS programs.
Wastewater Surveillance: APSI’s Role in AMR Monitoring
As the workshop progressed, the focus shifted from identifying the problem of AMR to exploring solutions, specifically the role of AMR surveillance. The significance of integrating clinical and environmental surveillance was underlined as a crucial approach for predicting and managing AMR outbreaks. Dr. Shraddha Karve detailed the initiatives of the Alliance for Pathogen Surveillance in India (APSI) in establishing scalable AMR surveillance systems throughout the country. She explained that synthesizing clinical data with environmental indicators is essential for more effective AMR management and prevention strategies.
Dr. Karve dived into her team’s work on wastewater surveillance as part of APSI’s efforts at Ashoka University. She outlined the process, from selecting wastewater sample collection points to identifying markers for AMR surveillance. The goal, she elaborated, is to develop cost-effective, on-site testing kits for AMR surveillance directly from wastewater samples. She also shared how this innovative approach assists in studying the prevalence of specific pathogens related to particular infections in certain regions, thereby contributing to a more targeted and proactive public health response.
Infection Control Practices: Key Strategies in Healthcare Settings
Then the workshop turned its focus to infection control measures with microbiology expert Dr. Sonal Saxena leading the discussion. Her presentation was meticulously structured to enhance understanding and engagement among the students. She began her session by focusing on Water, Sanitation, and Hygiene (WASH) in community settings, highlighting its crucial role in preventing infections. This introduction provided a foundational understanding of how basic hygiene practices are integral to controlling the spread of infections at the community level.
Moving from the broader community context, Dr. Saxena then shifted her focus to infection control in hospital settings. She discussed the “eternal cycle” of infection and emphasised the importance of rigorous infection control measures within healthcare facilities. Her approach in this segment aimed to connect the principles of WASH from community settings to the more complex environment of hospitals.
To further consolidate these concepts, Dr. Saxena incorporated several case studies into her presentation. These case studies were centred around antibiotic stewardship programs and their objectives, as well as how these resistant infections are transmitted.
Her interactive approach was well-received by the students. It not only allowed them to apply the theoretical knowledge they had gained about WASH and infection control but also to engage deeply with the complexities of AMR and stewardship.
Learning Through Action: Interactive Activities and Educational Games
The workshop’s offerings extended beyond the informative talks, providing a holistic educational experience through an array of engaging activities tailored to deepen the students’ comprehension of AMR. These activities included dynamic games such as Taboo and a crossword.
The workshop reached an exciting climax with a quiz competition that unfolded in two stages. Initially, participants tackled an online quiz comprising 10 questions that encapsulated the essence of the expert discussions. The top 20 scorers from this segment proceeded to the second round, which embraced the Jeopardy format and was conducted in teams. This segment was particularly interactive, fostering a sense of enthusiasm and competition among the students and the audience alike.
The event wrapped up with the much-anticipated revelation of the winning team, who were awarded prizes. This final quiz served not just as a reinforcement of the workshop’s teachings but also brought a lively and enjoyable conclusion to the event, leaving participants with both a sense of achievement and enjoyment.
Voices from the Future Medics: Student Feedback and Workshop Outcomes
The workshop garnered a positive and enthusiastic response from its attendees, highlighting its effectiveness and impact. The interactive approach of the workshop, including engaging activities like quizzes and discussions, was particularly appreciated, mirroring the successful engagement strategies of the previous event. These methods proved instrumental in enhancing understanding and retention of critical information about AMR among the students.
A substantial 84% of the participants reported an increased sense of empowerment and readiness to combat AMR, reflecting high confidence levels predominantly rated between 4 and 5. This boost in confidence is crucial for inspiring proactive actions in the medical community.
In terms of actionable outcomes post-workshop, there was a clear inclination towards three primary areas: 63% of the participants emphasised the judicious prescription of antibiotics, underlining the critical need for prudent and well-informed use of these medications. Hygiene and sanitation, often overlooked yet vital components in combating AMR, were highlighted by 14% of attendees, indicating a growing awareness of their importance in the healthcare setting. 22% of participants focused on the need for widespread awareness, signalling an understanding that combating AMR requires collective effort and education.
The workshop’s influence extended beyond the immediate attendees, with a remarkable 78% of participants expressing a strong intention to share their newfound knowledge about AMR with peers and family. This reflects a significant potential for community-wide impact and awareness, extending the reach of the workshop’s teachings.
Participants expressed a strong interest in delving deeper into AMR topics, with a desire for more comprehensive sessions, practical demonstrations, and increased interactive learning opportunities. While they appreciated the interactive elements of the workshop, there was a notable eagerness for more immersive and engaging activities. This eagerness for more in-depth exploration and a greater emphasis on hands-on and interactive experiences demonstrates that the workshop’s key objectives were effectively absorbed by the students, highlighting the success of the event.
The overwhelmingly positive feedback from the workshop, along with these constructive suggestions, indicates that the event was successful in both educating and inspiring the students. It also offers valuable guidance on how to further improve and enrich future workshops.