19th November 2021

Medical students are the prescribers of the future. Unfortunately, extremely little attention has been focused on training them in the principles of antimicrobial stewardship (AMS) and antimicrobial resistance (AMR), as evidenced by surveys that have consistently shown that final-year medical students lack confidence in correctly prescribing antibiotics.

As part of the Keep Antibiotics Working (KAW) undergraduate programme, a joint BSAC and Medical Schools Council initiative, competencies on AMR/AMS for UK undergraduate medical students were formulated through a modified Delphi process.3 A total of 58 consensus-based NICE endorsed competency descriptors within six overarching domains were agreed on; these domains included antimicrobials and antimicrobial resistance, antimicrobial prescribing and stewardship, infection prevention and control (IPC) and the role of vaccines in tackling AMR.

We need to ensure that medical students receive training to achieve these competencies. This agenda cannot wait; antimicrobial resistance (AMR) is one of the greatest threats to the future of healthcare.4,5 High quality, assessable resources including top-tips, aminations and interactive online cases have been developed for medical students, and slide sets on AMR, AMS and IPC have been produced for educators as part of the KAW programme. The challenge we now face is ensuring that medical schools are committed to prioritising AMS and AMR within the vast array of teaching being offered within undergraduate medical curricula. Not only do we need to advocate for AMS to be formally included in the curriculum of every UK medical school, we need to think innovatively about how this content can be delivered. This needs to include non-infection specialists role modelling the importance of AMS during clinical blocks.

In addition, ensuring that medical students are assessed on AMS is likely to focus the minds of both medical students and medical schools; the Prescribing Safety Assessment (PSA) taken by final year medical students in the UK has helped to shine a light on the importance of prescribing and now a set of practice questions has been developed in partnership between BSAC and the British Pharmacological Society to further highlight this important area of prescribing to medical students.

This agenda doesn’t need to be limited to the UK and doesn’t need to be restricted to medical students. AMS is a multidisciplinary process and such an approach can be applied to undergraduate nursing and pharmacy training. However, whatever we do, we need to do it now!

Dr Sanjay Patel, Consultant in Paediatric Infectious Diseases; Officer for Stewardship and Surveillance, BSAC and Chair of Keep Antimicrobials Working (KAW) programme


  1. Brinkman DJ, Tichelaar J, Graaf S et al. Do final-year medical students have sufficient prescribing competencies? A systematic literature review. Br J Clin Pharmacol 2018; 84: 615–35.
  2. Dyar OJ, Pulcini C, Howard P et al. European medical students: a first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. J Antimicrob Chemother 2014; 69: 842–6.
  3. McMaster D, Courtenay M, Santucci C et al; Keep Antibiotics Working (KAW) group. Consensus-based antimicrobial resistance and stewardship competencies for UK undergraduate medical students. JAC Antimicrob Resist. 2020 Dec 4;2(4). https://doi.org/10.1093/jacamr/dlaa096.
  4. WHO. Antimicrobial Resistance, February 2018. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance.
  5. O’ Neill J. Tackling drug-resistant infections globally: final report and recommendations. The Review on Antimicrobial Resistance. 2016. Online.
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