This study shows that, as their European colleagues, Swiss students do not feel sufficiently prepared on antibiotic prescribing and they feel they need more education. Although the preparedness scores of Swiss students largely overlap with the European results, some differences can be highlighted.
The proportion of Swiss students who felt prepared to prescribe a treatment without using guidelines was much lower than that reported across Europe and, looking in detail, this was reported by all the universities but Lausanne. On the other hand, the rate of students feeling prepared to select a treatment according to guidelines was similar to European average. A similar pattern had emerged for UK students, suggesting the hypothesis that large availability of local guidelines may be helpful, especially for young physicians, but could lead to the feeling of not being capable to prescribe a treatment independently . As guidelines will never be able to cover all possible clinical situations that prescribers face in real life practice, educators should pay particular attention to help students developing the skill to judge the applicability of guidelines.
Preparedness on use of point-of-care test was higher for Swiss students, but, as well as prescribing according to guidelines, this was one of the topics with the greatest variation in preparedness among countries, related to different availability of resources and variability in national recommendations .
Swiss students reported high scores of preparedness in diagnostic issues, as had their European colleagues involved in the Student-PREPARE survey and in previous studies [9–11,15]. However, misdiagnosis is one of the main reasons for unnecessary antimicrobial prescriptions, as well as misinterpretation of clinical or microbiological data . Therefore, this self-confidence might be at least partially biased by some lack of “real life” clinical practice experience and failure to appreciate the “swampy lowlands” of medical decision making with real patients that do not fit textbook descriptions .
In the Student-PREPARE survey, higher levels of preparedness were consistently reported in some countries. Possible explanations for these findings include a difference in the quality of education provided in different countries, but also cultural factors related to self-confidence and preparedness feeling [6,11,17]. Cultural differences between French speaking and German speaking regions in Switzerland have been pointed out as one of the factors influencing the disparities regarding use of antibiotics and rates of antimicrobial resistance among Swiss cantons [18–20]. Although we observed some differences in the preparedness for some topics and in the availability of teaching methods among universities, we did not observe a correlation in strengths and weaknesses when comparing French (Geneva and Lausanne) and German speaking faculties (Berne and Zurich).
Swiss students, as well as their colleagues from other countries and disciplines [11,21], stressed the importance of active methods of learning, as well as their inadequate availability. Infectious disease internships, whose effectiveness in improving knowledge and confidence in AMS principles has been shown in different studies, should be encouraged and made possible for every student [21–23].
As suggested by King et al., some of the skills where students report the lower preparedness, which involve more complex antimicrobial stewardship (AMS) strategies, could be more difficult to address with traditional teaching methods, leading to the need of frequent re-evaluation of both teaching contents and their delivery methods [21,24]. Only half of the Swiss students (as well as the Europeans) reported feeling prepared to work in a multidisciplinary team, suggesting the need to move towards interprofessional educational strategies [21,25]. Workshops where pharmacy and medical students collaborate dealing with clinical case simulations have been shown to help both in conveying AMS concepts and in highlighting the importance of interprofessional collaboration . Promoting interaction among different health care professions, by inviting pharmacists, dentists, nurses and midwives to participate in lectures where AMS concepts are taught to medical students, could set up the basis for cooperation.
The validity of our results may be partially limited by the low response rate, but this was similar to response rates obtained across Europe and to those reported by previous similar studies [8,10,11]. Nevertheless, as previously published, the low response rate does not necessarily undermine the study’s representativeness [26,27]. Due to the small number of respondents, differences in responses between the different universities should be interpreted with caution. A larger participation could help to better understand possible gaps in the education program, as well as differences among Swiss universities, in order to define targets that need to be improved. Furthermore, the responses are self-reported and therefore do not necessarily reflect the objective “real degree” of preparedness or real practices with patients.
Since 2015 Switzerland has adopted a national strategy on antibiotic resistance . Improved education of medical students is currently not a core component of the strategy. In 2019 ESCMID published a set of generic competencies in antimicrobial prescribing and stewardship relevant to every independent prescriber. Educators could benefit from this list to guide the revision of curricula and teaching materials . More active and interprofessional teaching activities seem like an essential step to guarantee that future physicians will use antibiotics more responsibly than the preceding generations.