The third AMR Frontline Workshop, organized by Superheroes against Superbugs in collaboration with Ashoka University, was held at the Government Institute of Medical Sciences (GIMS) in Greater Noida. Under the mandate of the Alliance for Pathogen Surveillance Innovations (APSI)-India supported by the Rockefeller Foundation, the event on December 13, 2023, focused on educating budding medical professionals about Antimicrobial Resistance (AMR).
The half-day workshop at GIMS engaged over 130 medical students, aged 18-21, in their first and second year of medical school. This phase of their education, covering microbiology and pharmacology, was selected to complement their curriculum and enhance their practical understanding of AMR through interactions with practicing clinicians and AMR experts. The workshop aimed to build early awareness and a thorough understanding of AMR, preparing these future healthcare professionals to effectively confront AMR challenges. The goal was to cultivate responsible practices and a proactive approach towards AMR, contributing to improved patient care and reinforcing the battle against AMR in their future medical roles.
The workshop commenced with an inaugural session that highlighted the significant involvement of two major departments. Dr. Anurag Srivastava, Head of R&D and Professor of Community Medicine, delivered the welcome remarks, setting the tone for the event. This was followed by the official inauguration by Dr. (Big) Rakesh Gupta, Director of GIMS. Subsequently, Dr. AK Sahni, Professor and Head of the Department of Microbiology, GIMS, provided an overview of AMR during the second half of the workshop.
The participants were then immersed in a rich learning environment, benefiting from expert lectures and interactive activities. The workshop showcased presentations by notable experts, including Ms. Sehr Brar from the Office of Technical Focal Point for AMR, IPC and Labs at World Health Organisation- India, Dr. Vijay Pal Singh, a Technical Expert in Food Safety from WHO-India and Principal Technical Officer and Associate Professor at CSIR, Dr. Prabhav Aggarwal, Associate Professor from the Department of Microbiology at Maulana Azad Medical College, Dr. Bansidhar Tarai, heading Microbiology, Molecular Diagnostics & Infection Control Departments at Max Hospitals, and Dr Aradhita Baral, Senior Program Manager, Health Research, Ashoka University. They provided comprehensive insights into the various aspects of AMR.
Ms. Sehr Brar began with demystifying AMR that helped in laying a solid foundation for understanding the nuances of AMR. She started by connecting the dots between fundamental concepts such as microbes, infections, and antimicrobials, and the topics medical students encounter in their studies like the epidemiological triad and commensal flora.
Drawing on her experience with the World Health Organisation’s AMR team, Ms. Brar highlighted the critical importance of AMR on a global scale. She delved into both global and programmatic action plans, and specifically discussed India’s response, including the National Action Plan on AMR and various state-level initiatives and surveillance strategies that are under development. She concluded by emphasizing the vital role that medical students can play in combating AMR right from the start of their medical careers.
Continuing the session, Dr. Vijay Pal Singh expanded on the One Health approach, emphasizing its importance in addressing AMR. He specifically focused on the use of antibiotics in food production and livestock feed, a critical factor contributing to the proliferation of antibiotic-resistant genes in the environment. Dr. Singh explained how antibiotics used in agriculture and animal husbandry not only affect the animals but also have a cascading effect on the surrounding environment. He stressed that such practices add to the complexity of the AMR problem, underscoring the need for a holistic approach that considers environmental, animal, and human health. Dr. Singh advocated for collaborative efforts across various sectors, including agriculture, healthcare, and environmental management, to mitigate the impact of antibiotic use and limit the spread of AMR.
Then Dr. Bansidhar Tarai shared his 13-year journey of developing and leading the Antimicrobial Stewardship (AMS) program at Max Hospital, providing insights into the practical aspects of managing AMR in a clinical setting. 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.
He wrapped up by discussing the introduction of a new technology for rapid syndromic testing which marks a significant advancement in diagnostics, capable of identifying a range of pathogens and resistance genes quickly, thus enhancing the hospital’s response to infectious diseases and AMR.
The workshop then shifted focus to infection control practices, with Dr. Prabhav Aggarwal leading this crucial segment. His talk spanned a wide range of topics, starting from the fundamental biology of AMR. He explained how resistance develops and spreads among bacteria and other microorganisms, including the transmission modes of resistant infections. He then transitioned to discussing key strategies for combating AMR, with a particular emphasis on the implementation of antibiotic stewardship programs.
A notable aspect of his presentation was the emphasis on the role of Water, Sanitation, and Hygiene (WASH) and Infection Control practices in preventing infections in community settings and hospitals. Dr. Aggarwal engaged the students with various case studies, prompting them to think critically about how they would respond to such situations in a real-world medical setting.
The final talk of the day shifted the focus to practical solutions for AMR, with an emphasis on surveillance for AMR. Dr. Aradhita Baral discussed the work of the Alliance for Pathogen Surveillance in India (APSI) in setting up scalable AMR wastewater surveillance across the nation for better AMR control and prevention and how this method could allow for a quicker response to AMR-related challenges.
The workshop wrapped up with a series of engaging and educational activities. One of the highlights was a game of Taboo, an interactive word-guessing game where participants had to deduce AMR-related terms based on verbal cues from their peers. This fun yet challenging game allowed the participants to consolidate and apply the new terminology and concepts they had learned throughout the workshop, reinforcing their understanding in an enjoyable way.
Following this, a quiz competition was held, featuring questions derived from the expert talks. The quiz was an effective way to engage the students in a recapitulation of the key points from the workshop, ensuring that the knowledge imparted was well understood and retained. These interactive activities not only made the learning process enjoyable but also reinforced the educational objectives of the workshop, leaving the participants with a lasting impression of the importance and need to take action against AMR.
This format of the workshop had additional expert talks, one focused on one-health by Dr Vijay Pal Singh and a detailed talk on microbiological aspects of AMR by the HoD of microbiology at the institute, Dr AK Sahni. Due to this, sufficient time could not be dedicated to activities, unlike the previous formats of the workshop. The time constraints also meant formal feedback could not be collected from the students. This is an important learning that will be taken into consideration in the future workshops.
Despite these challenges, the efforts put into the workshop yielded a significant outcome. The management of GIMS expressed their appreciation and interest in organising a focused workshop for their hospital staff on AMR. This development is a positive indication of the impact and relevance of our workshop.