Training activity information
Details
Select, perform and interpret tests for the detection of multidrug resistance, including extended susceptibility testing, using the following techniques and suggest options for management:
- Disk diffusion
- Gradient strips
- Microbroth dilution
- Molecular assays
- Automated methods
- Culture methods
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
- Why is the detection of multidrug resistance a critical aspect of clinical microbiology?
- What is your understanding of different mechanisms of antimicrobial resistance (e.g., ESBLs, carbapenemases) and the techniques used for their detection (disk diffusion, gradient strips, microbroth dilution, molecular assays, automated methods, culture methods)? What experience do you have with performing and interpreting standard antimicrobial susceptibility tests?
- What specific skills in performing and interpreting extended susceptibility testing (e.g., double disk synergy tests, carbapenemase detection assays) do you hope to develop?
- How will you learn about the principles behind different phenotypic and genotypic methods for detecting resistance?
- How will this activity enhance your ability to suggest management options for infections caused by multidrug-resistant organisms, considering infection control implications?
- How will you prepare for this DTA?
- Will you review the current guidelines on detecting and reporting multidrug-resistant organisms?
- Will you discuss with your training officer the local protocols for confirming and managing such isolates?
- What challenges might arise in interpreting complex resistance profiles and distinguishing between different resistance mechanisms?
- How will you understand the clinical and epidemiological significance of different resistance genes?
- How do you feel about the growing challenge of antimicrobial resistance and the important role of the laboratory in its detection and management?
In action
- What specific multidrug resistance (MDR) detection tests are you currently performing or interpreting (e.g., setting up extended spectrum beta-lactamase (ESBL) combination discs, interpreting carbapenemase gradient strips, running molecular tests for resistance genes)?
- How are you approaching the execution or interpretation of these assays?
- Why are you doing it this way (e.g., understanding the principles behind different phenotypic and genotypic resistance detection methods)?
- What decisions are you making regarding which additional tests to perform based on initial susceptibility results?
- What aspects of performing or interpreting these tests feel intuitive to you, and what requires more conscious effort (e.g., recognising subtle phenotypic resistance patterns, interpreting complex molecular resistance reports)?
- How effective are your current actions in accurately detecting and interpreting MDR?
- What challenges are you facing during the process (e.g., interpreting borderline results, resolving discrepancies between phenotypic and genotypic methods)?
- What can you learn about the different methods for detecting MDR and their limitations as the activity unfolds?
- How does this activity connect to your understanding of antimicrobial resistance mechanisms and their clinical and public health significance?
- Are there alternative approaches you could be considering if results are unclear or if you suspect a novel resistance mechanism (e.g., sending isolates to a reference laboratory for further characterisation)?
- What support or guidance might you need in this moment from a senior colleague or the training officer regarding the interpretation of complex resistance profiles or the implementation of new resistance detection methods?
- 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 multidrug resistance detection.
- What were the most significant observations regarding the variety of techniques used (Disk diffusion, Gradient strips, Microbroth dilution, Molecular, Automated, Culture methods), the complexity of interpreting results, or the clinical significance of detecting resistance?
- What skills or knowledge did you develop or improve through this DTA, specifically in selecting and performing methods for resistance detection, interpreting results from multiple techniques, understanding resistance mechanisms, or contributing to management discussions based on resistance profiles?
- Were there any unexpected challenges (e.g., interpreting intermediate results, validating resistance mechanisms, dealing with new resistance patterns) or successes?
- What did you learn from these? In what ways did your ‘reflection-in-action’ influence your approach during the activity, such as repeating tests or seeking expert advice for complex patterns?
- What areas for continued development have been identified, particularly concerning understanding emerging resistance mechanisms or integrating molecular and phenotypic resistance data?
- How can you apply the learning from this activity to your routine practice when interpreting AST results, especially for problematic organisms?
- Identify the specific actions or ‘next steps’ you will take to enhance your understanding and interpretation of multidrug resistance. What support or resources might you need to further develop in these critical 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 multidrug-resistant organism (MDRO) cases at MDT meetings or with infection control teams altered your perspective on the clinical and public health impact?
- How did this specific MDRO testing experience compare across different organism types (e.g., Gram-negatives, Gram-positives) or resistance mechanisms (e.g., ESBL, CPE, MRSA)?
- What patterns or recurring challenges (e.g., identifying subtle resistance phenotypes, interpreting molecular results alongside phenotypic, managing breakpoints) have you identified across multiple resistant isolates?
- Have you discussed MDRO diagnostics, interpretation, or infection control implications during professional discussions or clinical meetings? What new perspectives did this bring?
- How have the skills (e.g., applying diverse phenotypic and molecular methods, interpreting complex AST profiles, recognising important resistance mechanisms, understanding infection control implications of MDROs) you developed during this DTA influenced your approach to routine susceptibility testing and reporting?
- Have you applied the learning from this DTA, such as appreciating the importance of timely and accurate MDRO identification for patient management and infection control, to other aspects of your microbiology practice?
- How does the learning from this DTA contribute to your preparedness for interpreting resistance data or communicating results with infection control implications?
- What transferable skills in applying and interpreting a wide range of susceptibility testing methods, identifying and reporting critical resistance mechanisms, understanding the epidemiology and infection control of MDROs, and contributing to antimicrobial stewardship, developed through this DTA, will be invaluable throughout your training and beyond?
- Identify clear actions for continued development related to MDRO detection, interpretation, or antimicrobial stewardship based on your cumulative experiences and reflections.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 3 |
Outcome
Identify options for management of common infections based on test results and clinical context, considering infection control, guidelines and public health requirements |
| # 5 |
Outcome
Select and interpret tests for the investigation and management of drug resistant pathogens |