The AMR Frontline Workshop, organized at Centre for Cellular and Molecular Biology (CCMB), Hyderabad on December 23, 2023, was the fourth workshop in our series of educational events aimed at creating awareness among medical students across India on the critical issue of Antimicrobial Resistance (AMR). Collaborating with CCMB and supported by the Rockefeller Foundation‘s Alliance for Pathogen Surveillance Innovations (APSI)-India, with the Infection Control Academy of India (ICFAI) as a knowledge partner, the workshop delved into different facets of the issue for a comprehensive understanding of this global threat..
The workshop targeted 28 medical students (18-21 years old) in their second and third years of study from 26 different medical institutions of India. These students were concurrently attending a two-week Medical Students Research Training (MedSRT) program at CCMB. MedSRT caters specifically to medical students interested in research, providing an extensive overview of research methodologies. The program includes lectures, hands-on experiments, and exposure to important aspects such as scientific ethics, good laboratory practices, biosafety, and the research facilities at CCMB. Their involvement in MedSRT reflects their strong interest in research, going beyond the standard medical curriculum.
The Rationale behind Targeting this Group
The purpose of selecting this particular group was to complement their existing coursework in microbiology and pharmacology with practical insights into AMR. This strategic integration at this stage of their educational journey was aimed at fostering early awareness and understanding of AMR, thereby preparing them to effectively address AMR-related challenges in their upcoming medical careers.
Additionally, recognizing their interest in the MedSRT program, we saw an opportunity to introduce these students to APSI-India work on AMR surveillance. Our goal was to use their engagement to broaden our outreach to their medical colleges across India, raising awareness about AMR as a critical issue that needs more recognition and action within the medical community.
The workshop was structured to be dynamic and engaging, featuring expert lectures, interactive activities, and a focused group discussion. This format was carefully designed to ensure a comprehensive and immersive educational experience about AMR, aligning with the students’ advanced interest in research and their educational needs.
The workshop included talks from distinguished experts: Dr. Ranga Reddy Burri, President of the Infection Control Academy of India, Dr. Umabala Pamidimukkala, Professor, Dept. of Microbiology, Nizam’s Institute of Medical Sciences (NIMS), Dr. Sivaranjini Santosh, Paediatrician, Magna Centre, Hyderabad and Dr. Rakesh Mishra, Director, Tata Institute for Genetics and Society, Bangalore. They provided valuable insights on various dimensions of AMR.
AMR Demystified: Insights from the Keynote Address
The keynote address was delivered by Dr. Ranga Reddy Burri. He began by introducing the medical students to AMR’s significant health and economic impacts on a global scale. Dr. Reddy emphasized the urgency of addressing this issue, describing AMR as a crisis that has transitioned from being a ‘silent’ pandemic to a prominent global concern requiring immediate action.
Dr. Reddy also highlighted how AMR is hindering progress towards the Sustainable Development Goals (SDGs), presenting a major obstacle in global efforts towards sustainable development. He delved into the timeline of antibiotic resistance, elucidating how contradictions like excess versus access and branded versus sub-standard quality medications are influencing the spread of AMR. These paradoxes were described as key drivers and disseminators of AMR.
Furthermore, he discussed the global burden caused by AMR, illustrating how it poses a significant challenge worldwide. Dr. Reddy explained the efforts being made through global and national action plans to combat AMR.
Additionally, Dr. Reddy stressed the importance of making the complexities of AMR understandable to the general public. He underscored the crucial role of public awareness in the fight against AMR and advocated for the need to actively engage the public. By highlighting their role in contributing to the spread of AMR, he emphasized the importance of taking collective steps to prevent and control it. His address was not only informative but also inspirational, encouraging the students to perceive AMR as a multifaceted challenge that requires a united and collaborative approach for effective management.
Infection Control Practices and Antibiotic Policy: A Comprehensive Overview
After the keynote address, the workshop moved to a session led by microbiology expert Dr. Umabala, which focused on infection control measures. Her segment was crucial in linking theoretical knowledge with practical applications in hospital settings.
Dr. Umabala began her comprehensive discussion with an overview of AMR, explaining the development and spread of resistance among bacteria and other microorganisms, and the transmission of resistant infections. She then highlighted the importance of antibiotic stewardship programs, outlining their objectives A significant part of her presentation was dedicated to the importance of Infection Control Practices in preventing hospital-acquired infections. She used engaging case studies, prompting students to think about their responses to these real-world scenarios. This interactive approach was appreciated by the students for its practical insights.
She specifically pointed out rigorous handwashing practices as a key strategy in controlling the spread of resistant microbes. Furthermore, she provided an overview of the vital role robust antibiotic policies play in healthcare settings, focusing on appropriate prescription practices and the monitoring of antibiotic resistance in hospitals.
Another key point of her address was the critical role clinicians play in combating AMR. This included a discussion on responsible prescribing practices and the importance of educating patients about the judicious use of antibiotics. Through these points, Dr. Umabala effectively conveyed the multifaceted approach needed to tackle AMR, blending theoretical knowledge with practical applications and highlighting the crucial roles played by various healthcare professionals in this fight.
Navigating AMR Challenges in Clinical Settings
Following Dr. Umabala’s informative session, the workshop welcomed Dr. Sivaranjani Santosh, a paediatrician and a well-known social media figure known for her engaging approach to debunking healthcare myths and spreading awareness on important health matters to the public. She kicked off her talk by engaging students with questions about their learnings from previous sessions and their understanding of AMR, effectively linking the earlier discussions to the title of her talk.
She then shared an intriguing statistic from her practice: a mere 1% antibiotic prescription rate for infants and babies. This revelation not only piqued the interest of the audience but also paved the way for an in-depth exploration of the individual role of clinicians in combating AMR. Dr. Santosh emphasized that the issue extends beyond doctors’ prescribing habits to include the practices of nurses and other healthcare staff, highlighting the collective responsibility of the entire healthcare team in combating AMR. She emphasised that the onus is on the clinician to train their respective teams on the right approaches and to drive the message of individual action and accountability.
Further delving into the topic, Dr. Santosh brought up the critical need for public awareness and behavior change regarding AMR. She advocated for a more direct approach in communicating the risks of AMR, suggesting that emphasizing the ‘potential threat to their children’ could significantly impact public perception and promote responsible antibiotic use.
The session was enriched with real-world examples and case studies from Dr. Santosh’s career as a pediatrician, illustrating the challenges and difficult decisions clinicians face due to emerging resistance. This practical perspective brought to life the complexities involved in managing AMR. She actively involved the students by asking them to consider specific scenarios, such as when and which antibiotics to prescribe. She also guided them through the WHO’s AWaRe classification, elucidating its practical application in clinical settings. Her session was not only informative but also inspiring, encouraging students to think critically about AMR and their future roles as medical professionals.
APSI’s Role in Wastewater Surveillance to Combat AMR
As the workshop progressed, the focus shifted towards practical solutions to the problem of AMR, culminating in a talk by Dr. Rakesh Mishra, Director of TIGS and part of the APSI-leadership team. Dr. Mishra’s presentation focused on wastewater surveillance being undertaken by the Alliance for Pathogen Surveillance in India (APSI) in four clusters: Delhi, Bangalore, Hyderabad, and Pune.
He underscored the importance of integrating clinical and environmental surveillance, highlighting it as a critical strategy for predicting and managing AMR outbreaks. Dr. Mishra detailed APSI’s initiatives in setting up scalable AMR surveillance systems across India, emphasizing the need to synthesize clinical data with environmental indicators for more effective AMR management and prevention.
Dr. Mishra delved deep into APSI’s efforts in wastewater surveillance, particularly in Bangalore. He explained the rationale behind focusing on wastewater, outlining the process from the selection of wastewater sample collection points to identifying markers for AMR surveillance. He described the ambitious goal of developing cost-effective, on-site testing kits for direct AMR surveillance from wastewater samples.
Furthermore, he shared insights on how this innovative approach is crucial in studying the prevalence of specific pathogens linked to particular infections in certain regions. This methodology not only aids in understanding regional pathogen dynamics but also plays a significant role in shaping a more targeted and proactive public health response. Dr. Mishra’s talk highlighted the forward-thinking approaches being employed to confront the AMR challenge, offering the workshop attendees a glimpse into the cutting-edge research strategies in the fight against the not-so-silent pandemic of AMR.
Engaging Minds: Interactive Games and Quiz
The workshop offered more than just expert interactions, providing a well-rounded educational experience with a variety of engaging activities designed to deepen the students’ understanding of AMR. These included engaging games like Taboo and a themed crossword puzzle.
The workshop’s highlight was an exciting quiz competition, conducted in a Jeopardy-style format. This quiz was particularly interactive and engaging, fostering a sense of enthusiasm and healthy competition among the students. Participants were grouped into teams, which added to the collaborative and competitive spirit of the event. The event reached its finale with the announcement of the winning team, who were awarded prizes. This part of the workshop was more than a mere test of knowledge; it was an enjoyable and spirited activity that reinforced the key teachings from the interactions and instilled a sense of accomplishment and enjoyment among the participants.
Following the quiz, the workshop concluded with a focused group discussion, enabling participants to reflect on and consolidate their learnings. This session facilitated meaningful dialogue, allowing for the exchange of ideas and discussions on the practical applications of their newfound knowledge in AMR. Additionally, it offered us a chance to gather further insights from the students, complementing the feedback questionnaire they filled out at the workshop’s end.
Students shared their appreciation for the workshop’s action and decision-making orientation, highlighting the value of the case studies-driven approach. They expressed a preference for future quizzes to mirror this focus, favoring questions that test decision-making and problem-solving skills over mere factual recall. This feedback underscores the students’ desire for more dynamic and applied learning experiences, emphasizing the importance of practical, real-world applications of theoretical knowledge in AMR. We gathered their views on the workshop’s strengths, areas for improvement, new information they learned, and their overall impressions of the event, ensuring a comprehensive understanding of their experience and expectations.
Feedback Roundup: Students’ Takeaways and Suggestions for Improvement
The workshop on AMR not only received a positive response but also led to a marked improvement in the participants’ understanding of AMR. 90% of the participants expressed a heightened sense of empowerment and preparedness in addressing AMR, indicating a significant boost in confidence levels, which were predominantly rated between 4 and 5 on a scale.
In terms of actions to combat AMR, the participants’ responses were diverse, reflecting a well-rounded comprehension of the issue. Common actions they identified included the rational use of antibiotics (56%), educating patients and peers about AMR (21%), and enhancing hygiene practices and infection control (23%). This variety in responses underlines their grasp of the multifaceted approach required to effectively tackle AMR.
The workshop had a notable ripple effect, with 100% participants planning to share what they learned about AMR with friends and family. This shows the workshop’s potential to increase awareness about AMR more broadly, extending its impact beyond just those who attended.
Along with other talks of medical relevance, the talk on AMR surveillance was very well-received, with noting its value in predicting and preventing future health outbreaks.
One attendee suggested to widen the workshop’s impact: ‘’training medical students from various colleges as volunteers to conduct similar workshops for different groups, including students, nurses, and patients, in diverse settings like medical colleges, public spaces, and clinics’’. This proposal aligns with our objective to expand outreach to more colleges.
Another participant praised the overall workshop, describing it as “quite informative” and a significant addition to their understanding of AMR as a “multimodal and multisectoral need.” He highlighted that while he had attended other AMR workshops in the past, this workshop stood out as the most comprehensive, attributing its success to the well-rounded structure with the detailed coverage of AMR, from basic concepts to policy discussions, along with the value of practical insights from clinician speakers and scientific advancements from APSI, an area that they rarely encounter in their regular medical training.
Building on this, the keynote speaker, Dr. Ranga Reddy Burri, provided feedback on structuring future workshops to maximize learning and impact. He recommended lining up talks to cover a comprehensive approach to managing health challenges, starting with the habit of proper diagnosis, followed by optimal treatment strategies based on diagnostics. The discussion can then broaden to encompass all ways of prevention, delve into stewardship practices—including both antimicrobial and antiseptic stewardship—and finally, explore actions beyond healthcare institutions. This structured approach aims to equip participants with a holistic understanding and practical strategies for addressing health issues within and beyond the medical setting, fostering a more integrated approach to public health and patient care.
The workshop’s interactive elements, such as quizzes and guest speaker sessions, were particularly popular, reinforcing the effectiveness of engaging and interactive methods in educational settings.The participants were particularly appreciative of the action oriented outcomes they learned through the interactive sessions and case studies. Participants expressed a desire for more in-depth discussions and knowledge intensive sessions.
Moreover, the interest shown by more than 90% of the participants in hosting similar workshops at their colleges underscores the perceived value and relevance of these sessions. It reflects a demand for engaging and informative workshops within the medical community, highlighting the need for continued efforts in AMR education and awareness.
