ABC: AMR Conference Team and King’s College London (Winner – Antibiotic Guardian Awards 2018)

Provide a brief overview of your project:

It is widely acknowledged that health professionals are the front-line defense in preventing the spread of AMR; however, only a handful of schemes have engaged students and trainee health professionals in Antimicrobial Stewardship. We, a group of students and young health professionals, recognized this gap and worked to hold the first national student AMR conference; “Antimicrobial Resistance: Advocating for a behavioral change” (AMR:abc). The aim of the conference was to educate health students on the importance of a ‘One Health’ approach to tackling AMR, allowing students to network with leaders in the field and partake in workshops to develop skills take back to their respective universities.

Eight months of intense preparation which included identifying speakers, sponsors and workshop topics led to over 150 delegates from over six different professions to attend the conference. The conference consisted of three lectures from leaders in the field of AMR: Dr. Susan Hopkins, Professor Liz, Dr Raheela Ahmad and Esmita Charani. There were several workshops that delegates attended during the day with topics ranging from motivational workshops to workshops on how to run a public health campaign. In addition, we ran a poster competition where students could showcase AMR research they have been involved in.

We received excellent feedback for the event. To evaluate the conference, we conducted a ‘before and after’ study to identify any gains in knowledge about AMR. We identified a significant increase in knowledge in a multitude of areas showing that our conference has had a positive impact on student’s attitudes, knowledge and behavior towards AMR. We hope that the delegates will pass this knowledge onto their course-mates and be inspired to continue to be Antibiotic Guardians at their respective university.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

1) Few events are targeted at bringing health-professional students from different disciplines together, so we ensured that the event was open to all healthcare professional students including vets and dentists. Feedback highlighted that delegates discussed AMR and shared ideas with individuals from a range of disciplines they are usually not exposed to. Thereby promoting good interdisciplinary relationships which hopefully will not only impact attitudes and behaviors towards antibiotics but also other parts of healthcare. Additionally, delegates particularly from dentistry, pharmacy and medical backgrounds, acknowledged a gain in knowledge surrounding the importance of antibiotic protection in agriculture. We wanted to ensure that this industry was well represented and invited previous Vice-President of the National Farmers Union, Gwyn Jones, to lead the discussion on AMR in the agriculture industry.

2) Workshops were designed to give students the tools of how to develop public health campaigns to promote positive antibiotic behavior. The workshop “The Multidisciplinary Team: Antibiotic Stewardship” helped delegates understand how different actors involved in patient care each have a responsibility to be good antibiotic stewards. Additionally, our other workshops “How to run a Public Health Campaign” and “Communication Skills: Positive Influencing” introduced students to the basics of behavior change and how models of behavior change can be used to influence both the public and professionals’ attitudes towards antibiotic resistance, which they could use in their own campaigns.

3) The conference raised awareness about AMR stewardship and protection of antibiotics. In a pre-conference survey, only 55.8% of respondents had heard about antimicrobial stewardship, which increased to 96.4% after the conference. Although it is difficult to evaluate the impact our conference had on delegates’ knowledge on AMR, all students who responded in feedback forms, stated that they had built upon their knowledge of antimicrobial stewardship and its importance . These individuals will help towards protecting antibiotics, in their professional lives, with their additional knowledge of antimicrobial stewardship.

How is the project to be developed in the future?:

Given the success of the conference and the positive feedback th at we received we hope that the conference will become an annual event. This year’s conference topic was broad so that we could gauge what students wanted from the conference. However, in the future we would like to focus the conference on more specific topics within AMR but still maintaining a ‘One Health’ approach.

Importantly through this project we hope to have set an example for other passionate students around the globe to run their own campaigns and conferences. With the hopes of in a couple of years’ time an international conference for students can be held.

Currently the findings of the before-and-after study are being analyzed and will be written up for submission to a peer-review journa l. We hope that this will encourage other students and organizations to acknowledge the benefits of student conferences on AMR. Additionally, we are analyzing the feedback forms so that the conference can be improved upon next year, making it bigger and better.

 Lydia Bagg – University of Manchester (Winner, Healthcare Student of the Year – Antibiotic Guardian Awards 2017)

Provide a brief overview of your project?: Lydia Bagg, a Year 3 undergraduate medical student, at The University of Manchester has led the design, implementation and delivery across Manchester of a primary school project called “Beat the bugs campaign”. The aim of the project is to raise awareness amongst young children and their parents about antibiotic resistance. The intervention comprises of classroom-based activities in primary schools, Years 5 & 6, recruited from the most deprived areas in Manchester.
The main objectives of the project are to work directly with young children to:
Introduce the three classes of microbes
Practice recommended hand-washing and understand its’ importance
Raise basic awareness that common medicines like antibiotics are not always needed
Explain coughs and colds do not usually need medicine such as antibiotics
Explain that all medicines must be used as recommended by a healthcare professional
Encourage children to get their parents to pledge support to the antibiotic guardian campaign

Lydia took the initiative to lead this project by responding to a general request for volunteers from Dr Harrison, Senior Lecturer at The University of Manchester. This is the first time this intervention has been offered to primary schools by medical students from UoM and Lydia has been responsible for it’s continued success and high rates of satisfaction.

Lydia has liaised with local schools to host the classroom visits. She has developed greater insight into delivering basic health-promotion / health education to children, and their baseline knowledge & skills. In designing the intervention, Lydia increased her awareness of Public Health England’s work on antibiotic resistance, and resources available from the e-bug project. Some of these have been used as part of the classroom activities. However, Lydia has continued to produce written and classroom based activities that are tailored to local childrens’ needs based on their feedback.

List any supporting partners or organisations worked with: Consultant in Public Health at Health Protection Unit, Public Health England (northwest)
Senior academics, clinicians and student volunteers across the Divisions of Pharmacy & Optometry; Population Health, Health Services Research and Primary Care; Dentistry; Medical Education; Nursing, Midwifery and Social Work.

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: Lydia has successfully developed and implemented a package of classroom activities for primary school children to introduce the topic of antibiotic resistance and improve basic hand-hygiene practice. She has promoted the Antibiotic Guardian campaign to children and encouraged them to share the campaign resources with their parents to pledge their support and introduced the e-bug classroom and online-based resources.
The pilot phase included six school visits, with around 150 primary school children directly experiencing this intervention in deprived parts of Manchester with highest rates of antibiotic prescribing and contributed to the UoMs agenda on widening participation. The Programme has attracted considerable local media attention, with press-coverage and internal features on blogs and facebook pages

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?: Already 150 primary-school children in six pilot visits given hand washing instruction; played games about antibiotic resistance to raise awareness and encouraged to get their parents to pledge support to the Antibiotic Guardian campaign.
– Superb written feedback from primary school children and classroom teachers; examples include “we learnt difference between virus and bacteria”; “it was awesome”; “know how germs get into my body”; “I washed my hands and the bad bugs then went”.
– The “Beat the Bugs Campaign” has been accepted as a formal programme activity within the established “Medics in Primary Schools” Student Society. This is the first –time a topic other than Basic Life Support has been accepted onto their remit, and will ensure continued delivery and expansion of the Beat the Bugs Campaign with more primary schools in Greater Manchester.

Key outcomes of project?: The pilot phase showed the potential for this approach as outreach to primary schools in Greater Manchester; that schools and school-children were receptive and wanted repeat visits; that basic evaluation forms completed by children showed they had understood key principles for hand-hygiene and proper use of antibiotics.
Recruiting student volunteers, within a governance framework, has shown the potential to then expand the project across more schools
The process of the developing and delivering the project has supported interdisciplinary learning by bringing together student volunteers from a number of different health-related disciplines on undergraduate programmes

How is the project to be developed in the future?: Lydia is working with Medics in Primary School Society to increase the number of school visits and repeat visits, prioritizing schools in most deprived parts of Manchester
A series of meetings will be held with students on undergraduate programmes across the Faculty of Biology, Medicine and Health Sciences, Univ Manchester, to investigate ways to expand further the range and number of student volunteers as a way to raise awareness across different disciplines.
The more formal evaluation of the project will be supported as part of a research-programme now funded by Health Education England.

Osenadia Joseph-Ebare – King’s College London

Provide a brief overview of your project?: I set out with a ‘One Health’ objective, to bring together students passionate about health care and the desire to engage in Antimicrobial Stewardship. The team I had created reached out to over 20 universities, 33 different health care student societies, and we had 100 nominated Antibiotic Guardian Representatives across the UK.
In partnership with the Antibiotic Guardian campaign, the project involved working with a multidisciplinary team from across the country. The team consisted of students in backgrounds ranging from Nursing, Medicine, Dentistry, Veterinary Medicine and Pharmacy.

Supervised by Dr Ashiru-Oredope at Public Health England, the team and I designed ‘How-to’ guides – a comprehensive PowerPoint on how to run a public health campaign at University. In collaboration with the BPSA, British Pharmaceutical Students’ Association, we had an active engagement from pharmacy students across the country, and the ‘Antibiotic Guardian Representatives’ role was to provide leadership for their campaign at the local level in their schools of health.
Throughout World Antibiotic Awareness Week (WAAW), I led the social media aspects of the student campaign, encouraging students to post and upload pictures of their campaign at university, and become ‘Antibiotic Guardian Champions’ through the Open Badge Academy app. This, I later presented at the National Antibiotic Guardian Conference, Wellcome Collection, November 2016, as a measure of the initiatives overall success.
During WAAW, my team and the nominated reps at King’s College secured a £300 sponsorship from the KCL institute of Pharmaceutical Sciences to produce handouts, leaflets and accessories. I posted students in Hospitals affiliated to King’s to allow a wider outreach. At KCL, we had much student engagement, and as Academic Officer of the pharmacy society, I organised a pre-campaign training session, where external speakers attended to give us a better understanding on AMR.

List any supporting partners or organisations worked with: BPSA – British Pharmaceutical Students’ Association
KCL IPS – Institute of Pharmaceutical Sciences

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: Students are the future of healthcare. In total, without hashtag #AGCStudents, we had over 400,000 impressions and over 100 participants on twitter alone. On the European Antibiotic Awareness Day, at King’s College, my student team mobilised out to Guy’s hospital, Guy’s Campus, Waterloo campus and St Thomas’ Hospital. Additionally, the activities around the 20 schools of health saw to the education of healthcare students, and where possible, at areas such as kcl, reps were encouraged to collaborate with other societies. This ensured the widest reach of our message “safe guarding the use of antibiotics, to improve patient outcomes, and reduce the spread of antimicrobial resistance”.
Social media has always been a powerful tool to push vital messages to people, and we capitalised on this. I also facilitated the establishment of a website: www.abcamr.wordpress.com please do visit for more information.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?: 1) – Encouraging students and staff to become “antibiotic guardians”. Being an antibiotic guardian is about putting knowledge into practice. Most people are aware that antibiotics need to be completed, and that medicines shouldn’t be shared. Being an “antibiotic guardian”, however, is a pledge made to take physical steps towards preserving the potency of antibiotics. Students who weren’t on a healthcare course were therefore encouraged to sign up and make a pledge. Staff consisted of individuals who worked at university, ranging from cleaners to lecturers.

2) – Training of students. Before World Antibiotic Awareness Week, I invited two speakers, Dr John Broughall, a Volunteer for Antibiotic Research UK and Dr Ashiru-Ordedope from Public Health England to come and speak to students at King’s College. This took place in the form of an evening workshop, and students used this information during WAAW, on the stalls, and in hospital, to speak to the public and provide up to-date information regarding the most prominent issues of Antimicrobial Resistance (AMR)

3) – Cross collaboration among professionals and students. Cross-collaboration allowed students to recognise that there are different roles to play in AMR. It promoted the Multidisciplinary team, sending a strong message that the protection of antibiotics is not a job for pharmacists alone. These different roles worked together in synergy to promote our message.

Key outcomes of project?: – Over 400,000 impressions and over 100 participants on twitter alone, excluding other social media platforms
– Around 20 Universities offering a healthcare course in the United Kingdom directly received education resources from us on Antimicrobial Resistance
-We facilitated a learning environment whereby students can learn from prominent voices in health on the topic of Antimicrobial Resistance.
– Helped students recognise that AMR is a ‘One Health’ approach, that demands cross-sectoral engagement.
– Provided students with electronic resource-packs and a level of competence that allows them to go back to their societies, and lead public health campaigns at their site of study
– The establishment of a student initiative that will live on past myself, reopening annually to educate students to shape a better future for Antibiotic usage

How is the project to be developed in the future?: This project will be even bigger this year. In February and March 2017, we opened up applications for health students across the UK to apply and be a part of our team. The vacancies are already oversubscribed. We will hold a conference this year on the 18th November, at King’s College London, where we will bring together prominent voices in healthcare to speak for us on Antimicrobial Resistance.

The healthcare team is intended to continue even after I graduate as a Master of Pharmacy in 2018, and applications will open up every year for students to be an active part in the planning of conferences and national campaigns. Our website is www.abcamr.wordpress.com for more information on this.

Clarissa Hemmingsen – University of Manchester

Provide a brief overview of your project?: I am a first-year medical student at The University of Manchester, and President of the Manchester Global Health Society. On November 17th, 2016, I was responsible for coordinating and hosting an evening seminar titled “Antibiotic Resistance: A Global Ticking Timebomb”. This event consisted of seven speakers from a variety of backgrounds, all experts on a range of related topics to antimicrobial resistance from a global perspective, as well as a Q&A and discussion.
Prior to this, I led Antibiotic Resistance and AG informational stands across the University of Manchester over WAAW, culminating in the capstone event on November 17th, the aim of which was to expand thinking and discussion beyond the medical/clinical model.
I made it primary to my society’s agenda to focus health education on AMR, and particularly to involving students outside of medicine, as AMR is a global problem which everyone is part of, requiring global solutions. Bringing together interdisciplinary thinking and innovation was vital to the event’s success and impact at the University and beyond.

I became involved with organising, programming and delivering this event following a request for student participation in the development of a project by Dr Roger Harrison, Senior Lecturer in Public Health at The University of Manchester.
Working closely with Dr Harrison over 7 weeks, I took leadership of the project despite limited resources in order to ensure coordinated communication was achieved between my team, the speakers and guests, and the University.
The tight time-scale for the event from a blank baseline meant that I had to identify, approach and coordinate speakers locally, nationally, and internationally, in order to craft a varied but robust event, and then follow-up editorial/promotional work.

On November 17th, I led a small team from the Global Health Society, and as the project had no funding I was able to use the global and interdisciplinary aspect of the event as public health engagement as an incentive to market an innovation collaboration with ReThinkX, Manchester, who then provided funding for the venue, refreshments, and media services.
The event was promoted within and external to the University, and was attended by 150+ participants. This included members of the public, with some bringing their children, healthcare professionals, under-and-postgraduate students and senior academics. The event was videoed and presenters interviewed individually. A review document was published on the society’s website, and along with the videos has since been disseminated widely on social media.

List any supporting partners or organisations worked with: The success of the event was a direct result of identifying and then working with a range of external and internal partners.

– Dr Claas Kirchelle, University of Oxford: the historical aspects of Antibiotic Resistance.
– Dr Katie Reed, University of Manchester: lessons learnt from Antimalarial Resistance.
– Dr. Enrique Castro-Sánchez, Health Protection Research Unit at Imperial College: antimicrobial stewardship and Antibiotic Resistance as a social, cultural and economic problem.
– Dr William Welfare, Public Health England: Public Health England, policy-making and the future of tackling Antibiotic Resistance in the UK
– Professor Aneez Esmail, University of Manchester: Professor Esmail chaired the discussion and Q&A, and also discussed his own experiences of Antibiotic Resistance at a primary care level.

– Dr Roger Harrison, The Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester.
– ReThinkX at Citylabs 1.0: provision of venue, refreshments, and funding for media services.

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: I was able to draw upon the support of national and international experts to engage a debate on the global and multidisciplinary aspects of the threat of antibiotic resistance. The event expanded discussion and the thinking of attendees and those who have since engaged with our social media content outside of the medical and clinical model, and helped people to appreciate the wider context, both historically and geographically, scientifically within clinical environments and community ones alike, in agriculture and then to their own individual experience.

The event was largely attended by undergraduate and medical students. This was a unique opportunity for them to be introduced to this topic outside of the more medically focused stewardship competencies embedded within the MBChB program overall; it also proved useful to clinicians in attendance to understand and be able to relay public health information from a broader perspective to patients and their peers. The success of the event was evidence by the nature of the questions and projects generated, and some of the more controversial topics discussed during and after the seminars.

Since that time, I have helped raise the profile of antibiotic resistance in the medical curriculum and through the MCR Global Health Society. When talking about this subject generally, it is not uncommon for medical students to refer back to that event. I was also commended for the professional manner in which I hosted the event, in dealing smoothly with a number of technical issues that occurred and in helping to field questions and lead debate as the evening expanded. Following the event, I supervised the editing of short interviews from each speaker, and then disseminated these widely through social media: http://mcrglobalhealth.com/2016/12/22/6-important-lessons-learn-antibiotic-resistance-amr-event-2016/

As student lead for the overall multifaceted and interdisciplinary campaign for Antibiotic Resistance awareness that this WAAW event series was part of, I have since led society engagement with other extracurricular activities, which include social responsibility events campus-wide and with the local community, such as our involvement with Body Experience 2017 with other health and science education organisations. attracting approx. 3000 visitors consisting of children and families.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?: A public debate that introduced a more multidisciplinary holistic approach across social sciences and humanities to a global view on antibiotic resistance and the importance of protection of antibiotics and correct usage.

-Departmental and peer-led recognition of the importance of the project to undergraduate medical students, with continued engagement five months following the event.

-Use of unique video-footage of key speakers to be disseminated locally and globally using a range of social media networks.

Key outcomes of project?: -A well-attended public and health education focused seminar to widen understanding about antibiotic resistance within a global and interdisciplinary context.

-The event and follow up projects and campaigning highlighted the need to consider the global context to local issues in health and social care – as we do not live in a vacuum, and globalisation is a prime contributor to the spread of antimicrobial resistance, it is even more important to utilise the benefits of globalisation to also spread awareness and preventative measures. It is also vitally important to consider the global issues that contribute to Antibiotic Resistance, and the context of health and social inequalities that these exist within, so that innovative solutions and education can address these.

-The event and project overall highlighted the value of incorporating debates from social sciences and humanities when dealing with challenging health topics, and in the need to consider health inequalities and sociopolitical contexts from other communities when considering global topics and their impact locally.

-During the November leafleting and campaign stands around the University of Manchester Oxford Road campus and Manchester Medical School, Antibiotic Guardian was promoted and discussed with students from multiple disciplines; they were encouraged to sign up to become Antibiotic Guardians, and given official informational handouts to this end.

How is the project to be developed in the future?: I have continued through the MCR Global Health Society maintaining a close interest in this topic, and ensuring that it is revisited and promoted about frequently. I am now working with the Editorial Officer in the MCR Global Health Society and Dr Harrison to publish an overview and summary of the main themes arising from the seminar in a journal, as well as beginning to program next academic year’s continued Antibiotic Guardian campaign at The University of Manchester.
To this end, I intend to build on our work so far, and to expand our live Skype video link discussion sessions with medical students at Gulu University in Uganda to include students in Egypt and Thailand later this year to focus around the topic of Antibiotic Resistance in their home countries – this will include rapid problem solving and health education sharing between medical students in multiple countries and health professionals supervising and supporting.

With Dr Harrison, I also intend to further develop the interactive social media aspect and utilise technology to spread awareness and public engagement through twitter debates.
As part of my continued work towards antibiotic resistance awareness and stewardship as President of the MCR Global Health Society, we will also be continuing to develop this project by assisting the Medics in Primary Schools initiative to deliver workshops and fun educational sessions to school children around the topics of AMR, safe antibiotic use, and hand hygiene.
I intend to keep focusing upon improving local awareness through global interaction and public health education with projects individually, and in partnership with Dr Harrison of the Division of Population Health, Health Services Research and primary Care. This is intended to include primary education, and higher education.