Practicing and Assessing Skills of Interpreting Culture and Sensitivity Reports 

By: Lana Gettman, Pharm.D. 

Infectious disease (ID) pharmacotherapy education is required in the pharmacy curricula by the Accreditation Council for Pharmacy Education because pharmacists are responsible for promoting the appropriate use of antimicrobials.¹ Inappropriate use of antibiotics leads to antimicrobial resistance and adverse patient outcomes.^2,3 Since pharmacist expertise is an essential element of antimicrobial stewardship, it is vital that the ID curriculum focuses on the knowledge of infectious processes, pathogens, antimicrobial properties, and skills of how to interpret culture and sensitivity reports (C&S). A survey of ID curriculum found that 33% of pharmacy ID curricula were dedicated to antimicrobial fundamentals and 67% to disease states. In the same study, 25% of class time was dedicated to active learning and 75% to lectures.⁴ This shows that more time is dedicated to the ID process rather than the proper use of antimicrobials, with less emphasis on active learning. 

As faculty and a preceptor, I observe students lacking skills in interpreting C&S reports and the ability to recommend an appropriate antimicrobial(s). In the article by Kufel et al., it was found that only 68% of pharmacy schools included antimicrobial stewardship in the didactic curriculum.² Justo et al. studied graduating pharmacy students from twelve colleges and found that 90% of students reported a desire for more education on proper use of antimicrobials and resistance.⁵ Therefore, in the last few years, our college has been more intentional about teaching antimicrobial stewardship, and demonstrating skills of how to interpret C&S reports.

To prepare pharmacy students for practice, I implemented an active learning exercise and an oral examination that involved interpreting C&S reports. This activity took place in the third year of the curriculum. The goal was to provide an active learning exercise and an assessment that allowed students to practice the skills necessary to interpret C&S reports and recommend appropriate antimicrobial therapy. 

Activity Description

At the beginning of the semester, students received two sets of C&S reports. The first set was discussed with students during a two-hour class period. A second set was used for the end-of-semester assessment. For the first set of reports, the discussion included a morphological description of a pathogen, the resistance mechanism and how it is reported on the C&S, interpretation of minimum inhibitory concentration, naming other pathogens known to cause an infection, and antimicrobial(s) of choice. Also, antimicrobial mechanism of action (MOA), side effects, toxicity, monitoring, pharmacokinetic (PK) parameters, and treatment duration were addressed. If the report had multiple pathogens, optimal antimicrobial selection was considered. 

Using the skills demonstrated during the in-class discussion for the first report, students were expected to apply them when evaluating the second set of C&S reports during the final exam. During the exam, a student would randomly choose a C&S report, spend 5 minutes reviewing it, and then meet with a faculty member for a 5-minute question-and-answer (Q&A) session. Each student was asked ten questions to test their knowledge and skills in interpreting the report. Tested information resembled information discussed during the in-class activity.

Faculty grading the Q&A session used a rubric with questions unique to each C&S report. Common questions included the morphology of a pathogen, known pathogen resistance, other pathogens known to cause an infection, antimicrobial(s) to treat an infection, antimicrobial MOA, PK parameters, side effects, and treatment duration. Part marks were given where appropriate. After the exam, students were asked to complete a voluntary survey about their experience. There was no incentive associated with the survey completion, and the Institutional Review Board was not sought since this active learning exercise was done as a quality improvement evaluation.

Activity Findings

The average on the exam was 77.5%. After the exam, a review of the rubric revealed that some students struggled with a variety of questions, from antimicrobial selection to mechanism of action. In this third-year cohort, 26 out of 27 students completed a survey. When asked if this activity increased student’s confidence in interpreting C&S data, twenty-two students found this learning exercise helpful.  In the survey, students also commented that it was beneficial to have an in-class discussion demonstrating skills they need to master. In addition, this learning exercise allowed students to spend time learning the process and skills required for C&S interpretation and drug selection. 

A goal was to create an active learning exercise followed by an assessment that allowed students to practice skills necessary to interpret C&S reports and recommend appropriate antimicrobial therapy. Students’ performance on the exam and their feedback demonstrated that it was a beneficial learning exercise. Active learning is a preferred method for students to gain knowledge.³ It encourages students to interact and participate and increases the time spent on tasks.

What other active learning exercises can you incorporate into the classroom to improve students’ skills in infectious diseases and make them practice-ready pharmacists?

Acknowledgments:

I thank Dr. Daniel Bailey for assisting with writing the exam and participating in its delivery. I also thank Drs. Ashley Castleberry and Andrea Sikora for guiding this blog post.

References

1. ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control. Am J Health Syst Pharm. 2010 Apr 1;67(7):575-7. doi: 10.2146/sp100001.
2. Kufel WD, Jeffres MN, MacDougall C, Cho JC, Marx AH, Williams DM. Antimicrobial stewardship education in US colleges and schools of pharmacy. J Antimicrob Chemother. 2018 Aug 1;73(8):2252-2258. doi: 10.1093/jac/dky166. PMID: 29846603.
3. Nasr ZG, Abbara DM, Wilby KJ. A Scoping Review of Antimicrobial Stewardship Teaching in Pharmacy Education Curricula. Am J Pharm Educ. 2021 Jun;85(6):8415. doi: 10.5688/ajpe8415. Epub 2021 Mar 12. PMID: 34315706; PMCID: PMC8341237.
4. Jeffres MN, Kufel WD, Biehle LR, et al. A Comprehensive Survey of Infectious Diseases Curriculum Among US Pharmacy Schools. Am J Pharm Educ. 2019 Nov;83(9):7168. doi: 10.5688/ajpe7168. PMID: 31871346; PMCID: PMC6920648.
5. Justo JA, Gauthier TP, Scheetz MH, et al. Knowledge and attitudes of doctor of pharmacy students regarding the appropriate use of antimicrobials. Clin Infect Dis. 2014 Oct 15;59 Suppl 3(Suppl 3):S162-9. doi: 10.1093/cid/ciu537. PMID: 25261543; PMCID: PMC4303059.

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Author Bio:

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Pulses is a scholarly blog supported by a team of pharmacy education scholars