The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy
Abstract Background Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-023-04286-1 |
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| author | Kusha Davar Tara Vijayan |
| author_facet | Kusha Davar Tara Vijayan |
| author_sort | Kusha Davar |
| collection | DOAJ |
| description | Abstract Background Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic reasoning, for post-graduate trainees. We describe here an approach to aid internal medicine interns in their therapeutic reasoning, particularly when it comes to diagnosing and empirically treating infections. Methods The PEST (pathology, epidemiology, severity, treatment) model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome. In February 2020, we conducted two independent teaching sessions for interns on the PEST approach. We assessed pre-and post-teaching responses to five clinical vignette-based questions. Results were presented as a percentage of interns who chose an appropriate antibiotic and provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria. Statistical analysis occurred via Fischer’s exact test to determine the level of statistical significance between responses. Results Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. Ten interns commented on the usefulness of such a systematic approach. While there was no statistically significant difference in antibiotic selection, the teaching session demonstrated a trend towards significance in improving therapeutic reasoning as defined by the PEST strategy. Conclusion Our results suggested an improvement in using a structured cognitive tool such as the PEST approach to reinforce therapeutic reasoning, but the method did little to improve antibiotic selection. Some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may enhance prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection. Further studies are needed to assess the impact of such teaching interventions. |
| first_indexed | 2024-04-09T14:02:34Z |
| format | Article |
| id | doaj.art-c4fe89a56943488993a839215326c624 |
| institution | Directory Open Access Journal |
| issn | 1472-6920 |
| language | English |
| last_indexed | 2024-04-09T14:02:34Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Education |
| spelling | doaj.art-c4fe89a56943488993a839215326c6242023-05-07T11:16:06ZengBMCBMC Medical Education1472-69202023-05-012311710.1186/s12909-023-04286-1The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapyKusha Davar0Tara Vijayan1Department of Infectious Diseases, David Geffen School of Medicine at UCLADepartment of Infectious Diseases, David Geffen School of Medicine at UCLAAbstract Background Selecting an empiric antimicrobial regimen can be difficult for early learners and misuse of antibiotics can lead to adverse events and antimicrobial resistance. There have been few interventions that have focused on improving antibiotic decision making, as a form of therapeutic reasoning, for post-graduate trainees. We describe here an approach to aid internal medicine interns in their therapeutic reasoning, particularly when it comes to diagnosing and empirically treating infections. Methods The PEST (pathology, epidemiology, severity, treatment) model was created as a four-step approach to therapeutic reasoning and choosing an appropriate antimicrobial regimen for a given infectious disease syndrome. In February 2020, we conducted two independent teaching sessions for interns on the PEST approach. We assessed pre-and post-teaching responses to five clinical vignette-based questions. Results were presented as a percentage of interns who chose an appropriate antibiotic and provided sufficient therapeutic reasoning as defined by using at least three out of the four PEST criteria. Statistical analysis occurred via Fischer’s exact test to determine the level of statistical significance between responses. Results Twenty-seven interns participated in the activity. At baseline, several interns had incorporated aspects of the PEST approach in their pre-teaching responses. Ten interns commented on the usefulness of such a systematic approach. While there was no statistically significant difference in antibiotic selection, the teaching session demonstrated a trend towards significance in improving therapeutic reasoning as defined by the PEST strategy. Conclusion Our results suggested an improvement in using a structured cognitive tool such as the PEST approach to reinforce therapeutic reasoning, but the method did little to improve antibiotic selection. Some interns used select “PEST” concepts prior to the intervention suggesting that the PEST approach may enhance prior knowledge or clinical reasoning skills. Continued incorporation of the PEST approach using a case-based framework may solidify conceptual and practical knowledge of antimicrobial selection. Further studies are needed to assess the impact of such teaching interventions.https://doi.org/10.1186/s12909-023-04286-1Graduate medical educationTherapeutic reasoningAntibiotic stewardshipCase-based learningInfectious diseases |
| spellingShingle | Kusha Davar Tara Vijayan The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy BMC Medical Education Graduate medical education Therapeutic reasoning Antibiotic stewardship Case-based learning Infectious diseases |
| title | The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy |
| title_full | The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy |
| title_fullStr | The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy |
| title_full_unstemmed | The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy |
| title_short | The PEST (Pathology, Epidemiology, Severity, Treatment) approach to optimizing antimicrobial therapy |
| title_sort | pest pathology epidemiology severity treatment approach to optimizing antimicrobial therapy |
| topic | Graduate medical education Therapeutic reasoning Antibiotic stewardship Case-based learning Infectious diseases |
| url | https://doi.org/10.1186/s12909-023-04286-1 |
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