Training activity information
Details
Select, perform and interpret tests for bacterial and fungal causes of superficial skin, soft tissue and nail infections using the following techniques and suggest options for management:
- Microscopy
- Culture, identification and AST
Type
Developmental training activity (DTA)
Evidence requirements
Evidence the activity has been undertaken by the trainee.
Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.
An action plan to implement learning and/or to address skills or knowledge gaps identified.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- How will this DTA provide experience in diagnosing common superficial infections?
- What are the common bacterial and fungal pathogens causing skin, soft tissue, and nail infections (e.g., dermatophytes)?
- What is your understanding of microscopy (e.g., direct mounts with KOH), culture, identification, and AST in this context?
- What specific skills in preparing and examining skin, hair, and nail samples for fungal elements do you hope to develop?
- How will you improve your ability to differentiate between different dermatophyte species in culture?
- How will this activity enhance your understanding of suggesting appropriate topical and systemic antimicrobial/antifungal treatments?
- How will you prepare for this DTA?
- Will you review the techniques for collecting skin, hair, and nail samples for microscopy and culture?
- Will you discuss with your training officer the common pitfalls in diagnosing superficial fungal infections?
- What challenges might arise due to contamination of superficial samples with environmental organisms?
- How will you interpret negative results in the presence of clinical suspicion?
- How do you feel about learning to diagnose these common infections that often present in primary care?
In action
- What specific bacterial and fungal superficial infection tests are you currently performing or interpreting (e.g., Gram stain of skin scraping, culture of a wound swab, KOH preparation of nail clippings, dermatophyte culture)?
- How are you approaching the execution or interpretation of these assays? Why are you doing it this way (e.g., understanding the common bacterial and fungal pathogens involved in skin and soft tissue infections, the growth requirements of dermatophytes)?
- What decisions are you making regarding the identification of potential pathogens and the interpretation of AST results?
- What aspects of performing or interpreting these tests feel intuitive to you, and what requires more conscious effort (e.g., differentiating skin commensals from true pathogens, identifying dermatophyte macroconidia and microconidia)?
- How effective are your current actions in obtaining or interpreting clinically relevant results for superficial infections?
- What challenges are you facing during the process (e.g., overgrowth of non-pathogenic bacteria in culture, difficulty in isolating dermatophytes)?
- What can you learn about diagnosing superficial skin, soft tissue, and nail infections as the activity unfolds?
- How does this activity connect to your understanding of common skin pathogens and their management?
- Are there alternative approaches you could be considering if initial tests are negative but clinical suspicion remains high (e.g., requesting a deeper tissue biopsy for culture, using specific media for fastidious organisms)?
- What support or guidance might you need in this moment from a senior colleague or the training officer regarding the identification of unusual skin pathogens?
- Are you working within your scope of practice when selecting, performing, and interpreting these tests and considering management options?
On action
- Begin by summarising the key points of the experience working with samples from superficial skin, soft tissue, and nail infections.
- What were the most significant observations regarding sample collection quality, the techniques used (Microscopy, Culture, AST), or the common bacterial and fungal pathogens encountered?
- What skills or knowledge did you develop or improve through this DTA, specifically in processing these sample types, performing microscopy (e.g., for fungal elements), culture, identification, and AST for skin/soft tissue pathogens, interpreting combined results, or suggesting management?
- Were there any unexpected challenges (e.g., polymicrobial samples, identifying dermatophytes) or successes?
- What did you learn from these? In what ways did your ‘reflection-in-action’ influence your approach during the activity, such as deciding on specific media or incubation times for fungi?
- What areas for continued development have been identified, perhaps concerning the morphological identification of fungal elements in skin/nail samples or interpreting AST for polymicrobial soft tissue infections?
- How can you apply the learning from this activity to your routine practice when handling samples from superficial infections?
- Identify the specific actions or ‘next steps’ you will take to enhance your proficiency with these sample types and pathogens.
- What support or resources might you need to further develop in these areas?
Beyond action
- Revisit your initial reflect-on-action notes for this DTA. What additional insights have you gained since the initial reflection?
- Has discussing common skin/soft tissue infections or unusual presentations with colleagues or clinicians altered your perspective?
- How did this specific superficial infection testing experience compare to testing from deeper sites?
- What patterns or recurring challenges (e.g., managing polymicrobial samples, identifying commensals vs. pathogens, applying appropriate AST for skin flora) have you identified across multiple skin/soft tissue samples?
- Have you discussed diagnostics for skin, soft tissue, or nail infections during professional discussions? What new perspectives did this bring?
- How have the skills (e.g., performing microscopy for fungal elements, selecting appropriate media for skin pathogens, interpreting cultures from mixed flora, interpreting AST for common skin/soft tissue organisms) you developed during this DTA influenced your approach to other common sample types?
- Have you applied the learning from this DTA, such as understanding the common pathogens associated with different types of skin infection or the relevance of AST for guiding topical vs. systemic treatment, to other aspects of your microbiology practice?
- How does the learning from this DTA contribute to your preparedness for performing microscopy and culture to identify dermatophytes?
- What transferable skills in managing common sample types, applying standard techniques effectively, distinguishing pathogens from commensals, and contributing to the management of widespread community infections, developed through this DTA, will be valuable throughout your training and beyond?
- Identify clear actions for continued development related to the microbiology of skin, soft tissue, or nail infections based on your cumulative experiences and reflections.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 1 |
Outcome
Select and perform tests to investigate common infections from a range of sample types following guidance and fulfilling health and safety requirements |
| # 2 |
Outcome
Interpret the results of tests used to investigate common infections from a range of sample types with consideration of laboratory quality assurance and quality control |
| # 3 |
Outcome
Identify options for management of common infections based on test results and clinical context, considering infection control, guidelines and public health requirements |