title: Exploring the coverage of antimicrobial stewardship across UK clinical postgraduate training curricula.
abstract: Antimicrobial resistance (AMR) is a global political and patient safety issue. With ongoing strategic interventions to improve the shape of UK postgraduate clinical training, ensuring that all clinicians have appropriate knowledge and practical skills in the area of AMR is essential. To assess this, a cross-sectional analysis was undertaken of the coverage and quality of antimicrobial stewardship (AMS)/AMR within UK postgraduate clinical training curricula.
  
  
  
  UK clinical specialty training curricula were identified. Topics and individual learning points relating to AMS or AMR were extracted for each specialty. Learning points were quality assessed against the expected level of clinical competence. Inter-specialty analysis was performed.
  
  
  
  Overall 37 specialties were assessed, equating to 2318 topics and 42 527 learning points. Of these, 8/2318 (0.3%) topics and 184/42 527 (0.4%) learning points were related to AMS/AMR. Infectious diseases represented all eight topics and 43/184 (23%) of the learning points. In contrast, primary care, which is responsible for the highest proportion of antimicrobial usage, had no topics and only 2/1368 (0.15%) of the AMS/AMR learning points. This paucity of representation was reflected across most of the remaining specialties. On quality assessment, the majority of learning points (111/184; 60%) required knowledge only, with no demonstration of behaviour in clinical practice required.
  
  
  
  Coverage of AMS/AMR is poor across the majority of UK postgraduate clinical training curricula, with little depth of learning required. Given the threat of AMR, and evolving changes in clinical training pathways, we call for cross-specialty action to address this current lack of engagement.
authors.affiliation: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK timothy.rawson07@imperial.ac.uk.|Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Rawson
authors.affiliation: School of Medicine, Imperial College London, South Kensington, London SW7 2AZ, UK.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Butters
authors.affiliation: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.|Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Luke S P
authors.initials: LS
authors.lastname: Moore
authors.affiliation: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
authors.forename: Enrique
authors.initials: E
authors.lastname: Castro-Sánchez
authors.affiliation: Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QW, UK.
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Cooke
authors.affiliation: National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.|Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Holmes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003479:Curriculum; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods*; D006291:Health Policy; D006801:Humans; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents