Teaching how to use antibiotics

Antibiotics are probably the best invention since the discovery of sliced bread. They are very effective, very safe, very cheap and every physician is allowed to prescribe them. Trained as internist, ID specialist and later clinical microbiologist, I would never consider myself qualified for performing an appendectomy. Yet, there is not a single surgeon I know (and that may be biased) that considers him/herself not qualified to prescribe a carbapenem. When asked about the mechanism of action, side effects, costs and ecological risks, the brave face usually turns into the typical “so what” mode.

Medical school doesn’t help. In our place, young doctors will only have had a few opportunities to learn something on antibiotics during these 6 years. That’s why our staff, or better said Miquel Ekkelenkamp, decided some years ago to design a course on antibiotics for medical doctors. In addition to the chemical structure, PK/PD, spectrum and side effects, we teach how microbiological diagnostics can be used, and how the results should be interpreted and translated to therapeutic decisions. No fancy tricks with innovative educational toys: 24 hours of frontal old-fashioned teaching in 3 days for about 50 persons. The course is very successful! As in: it’s held 3 times per year, there is a waiting list and even if we go to Madrid, Dutch attendees follow, and the average rating afterwards is a 9/10. But do they learn something?

We just don’t know. So, Paula van Ooik (resident internal medicine) and Florine Frakking (clinical microbiologist) developed an on-line test to measure basic knowledge of antibiotics and microbiology, that was taken before and after the last course (last week).


Participants were asked to do the test before the course (which 90% did) and after the course (so far 70% did). The average scores were 71% and 86% in the pre and post test. That’s promising, but without a control population. Therefore, next time we will also ask those on the waiting list to do the online exams, as a kind of sham-participants. Until now, the course is attended mainly by residents internal medicine. How to attract surgeons? For that we need speed, tension, competition, rewards and fun! So, Paula and Florine are developing a serious game (called DiagostiGo), covering the same content as the course. Next year you will see surgeons in our hospital playing the game, competing with their peers, bragging about their scores, and no longer misusing carbapenems and piptazo, while serving as guinea pigs in our cluster-randomized study on the effectiveness of learning tools for appropriate antibiotic use.


3 thoughts on “Teaching how to use antibiotics

  1. You hit the nail on the head here! ‘Yet, there is not a single surgeon I know (and that may be biased) that considers him/herself not qualified to prescribe a carbapenem.’
    Is it arrogance, or the truly don’t realise the implications of what they are prescribing? Don’t think they’d be so confident prescribing novel anticoagulants – they do recognise the risk involved in these drugs.


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