Update from 2025 Winner – The Das Pillay Antimicrobial Stewardship Memorial Award – Dr Miguel Vella, Dr Li Ling Choo, Dr Iram Lodhi (Frimley Health NHS Trust)

We’re deeply honoured to have won the Das Pillay Memorial 2025 Award for our project ‘Combating Resistance Through Education: Micro-Sim in Action’. Micro-Sim is the first simulation-driven educational programme targeting microbiology and antimicrobial stewardship (AMS). It provides participants with the opportunity to take on the role of ‘Infection Doctors’ for a few hours in a simulated, risk-free environment.

Our interest in antimicrobial education began two years ago, when we assessed antibiotic prescriptions in 180 patients on the acute block of our local hospital. Of these patients, 68% were not on the appropriate antibiotic as per trust guidelines. When investigating antibiotic knowledge among final-year medical students working in our own trust, we found that 75% of them did not know of a suitable antibiotic choice for treating bacterial meningitis. Historically, most education surrounding AMS has been entirely didactic (1) and all of this eventually persuaded us to create Micro-Sim.

The Micro-Sim programme is made up of 4 parts:
1: Interactive small group learning sessions.
2: Provision of antibiotic charts explaining the antibiotics’ individual uses and bacterial targets.
3: Dissemination of a newsletter about antibiotics throughout the programme.
4: Implementing Micro-Sim itself.

On the day, participants were divided into groups of two or three and were asked to answer bleeps from ‘different teams’ about ten infection cases. They then had to provide real-time antibiotic advice as well as other important information related to infection control. They were also provided with ten envelopes containing background information about the ten cases. Furthermore, in one instance, participants had to examine a mannikin with actual examination findings to identify the source of the infection, before taking cultures and changing antibiotics accordingly.

Micro-Sim has now been run ten times among 105 participants ranging from medical students to junior doctors, nurses and pharmacists. Antibiotic knowledge was assessed with a Single-Best Answer Questionnaire carried out before and after the intervention which found an improvement of 45% (unpaired t-test, p=<0.0005). Self-reported knowledge about antibiotics also improved by 90% following the intervention (paired t-test, p=<0.0001). Furthermore, 100% of participants found that the programme was at an appropriate level and was relevant to their training. 100% of participants stated that they would recommend the programme to others.

We believe that Micro-Sim is an easy and effective means of improving antibiotic knowledge among students and healthcare professionals alike with an aim of reducing prescribing errors and improving antimicrobial stewardship. By simulating real-life clinical scenarios, participants can experience the decision-making challenges they will face on the wards in a safe and structured environment. A key strength of Micro-Sim is its adaptability, each trust can tailor Micro-Sim to reflect their own local antibiotic guidelines and the most prevalent infections they encounter. This ensures that the training is not only relevant but also directly translatable into everyday clinical practice.

As a result, while Micro-Sim began as a relatively small initiative at Wexham Park Hospital, it has now expanded to Frimley Park with plans to expand to Oxford University and Stoke Mandeville. There are also plans to create an online version of Micro-Sim using the ‘Mind the Bleep’ platform which would allow students and clinicians nationwide to access the teaching programme on demand. Beyond expansion of the programme, we are also working on incorporating Micro-Sim into the induction of all new FY1s into the trust. We hope that this tool will equip all new doctors with the skills and confidence they need to safely prescribe antibiotics in the hospital environment. For any questions, our team is happy to be contacted at miguel.vella2@nhs.net . We are always keen to collaborate with others with an interest in education.

References:

1: Augie BM, Miot J, van Zyl RL, McInerney PA. Educational antimicrobial stewardship programs in medical schools: a scoping review. JBI Evidence Synthesis. 2021 Aug 13;19(11):2906–28.