Training activity information
Details
Select and interpret tests for Therapeutic Dose Monitoring of antimicrobials
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 therapeutic drug monitoring (TDM) important for certain antimicrobials? What is your understanding of the principles of pharmacokinetics and pharmacodynamics as they relate to antimicrobial therapy?
- What knowledge do you have of antimicrobials that commonly require therapeutic dose monitoring?
- What specific skills in interpreting TDM results and understanding their implications for adjusting antimicrobial doses do you hope to develop?
- How will you learn about the factors that influence antimicrobial drug levels in patients?
- How will this activity enhance your ability to contribute to the optimisation of antimicrobial therapy?
- How will you prepare for this DTA?
- Will you review the guidelines for therapeutic drug monitoring of specific antimicrobials used in your institution?
- Will you discuss with your training officer the clinical scenarios where TDM is most critical?
- What challenges might arise in interpreting TDM results without complete clinical information?
- How will you understand the target therapeutic ranges for different antimicrobials and patient populations?
- How do you feel about the role of the laboratory in optimising antimicrobial use beyond just susceptibility testing?
In action
- What specific Therapeutic Dose Monitoring (TDM) tests are you currently selecting or interpreting (e.g., vancomycin trough levels, gentamicin peak and trough levels)?
- How are you approaching the selection of appropriate TDM assays and the interpretation of the results? Why are you doing it this way (e.g., understanding the pharmacokinetic and pharmacodynamic principles for different antimicrobials)?
- What decisions are you making regarding the adequacy of the antimicrobial dose based on the TDM results?
- What aspects of selecting or interpreting these tests feel intuitive to you, and what requires more conscious effort (e.g., understanding the factors that can influence drug levels, relating drug levels to clinical efficacy and toxicity)?
- How effective are your current actions in providing clinically relevant interpretations of TDM results?
- What challenges are you facing during the process (e.g., interpreting results in patients with altered physiology, understanding the limitations of single time-point measurements)?
- What can you learn about the principles and application of TDM for antimicrobials as the activity unfolds?
- How does this activity connect to your understanding of pharmacology and the individualisation of antimicrobial therapy?
- Are there alternative approaches you could be considering if TDM results are not correlating with clinical response (e.g., considering more frequent monitoring, discussing with clinical pharmacy)?
- What support or guidance might you need in this moment from a senior colleague or the training officer regarding the interpretation of complex TDM scenarios?
- Are you working within your scope of practice when selecting and interpreting these tests and considering management options?
On action
- Begin by summarising the key points of the experience working with Therapeutic Dose Monitoring (TDM) for antimicrobials.
- What were the most significant observations regarding the process of TDM, the analytes measured, or the factors influencing drug levels?
- What skills or knowledge did you develop or improve through this DTA, specifically in selecting appropriate samples and timing for TDM, performing or overseeing the assays (implicitly), interpreting the results in the context of patient clinical status and drug regimen, or contributing to management suggestions based on TDM?
- Were there any unexpected challenges (e.g., interpreting results in patients with altered pharmacokinetics, assay interference) or successes? What did you learn from these?
- In what ways did your ‘reflection-in-action’ influence your approach during the activity, such as considering patient renal function or concurrent medications?
- What areas for continued development have been identified, particularly concerning understanding the pharmacokinetics/pharmacodynamics of antimicrobials or interpreting TDM results for specific patient populations (e.g., critically ill)?
- How can you apply the learning from this activity to your routine practice, especially when TDM is requested or could be beneficial?
- Identify the specific actions or ‘next steps’ you will take to deepen your understanding of antimicrobial TDM. 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 TDM requests or results with pharmacists or clinicians altered your perspective on optimal dosing and patient outcomes?
- How did this specific TDM experience compare across different antimicrobials or patient types?
- What patterns or recurring challenges (e.g., timing of samples, understanding patient factors, interpreting levels alongside clinical context) have you identified across multiple TDM requests?
- Have you discussed the role and interpretation of TDM during professional discussions or clinical meetings?
- What new perspectives did this bring regarding patient management?
- How have the skills (e.g., understanding the principles of TDM, interpreting drug levels in relation to clinical breakpoints and patient factors, liaising with pharmacists/clinicians) you developed during this DTA influenced your understanding of antimicrobial pharmacokinetics/pharmacodynamics?
- Have you applied the learning from this DTA, such as appreciating the importance of therapeutic levels for efficacy and toxicity or the need for close collaboration with clinical teams, to other aspects of your microbiology practice or involvement in antimicrobial stewardship?
- How does the learning from this DTA contribute to your preparedness for contributing to patient management discussions?
- What transferable skills in understanding the principles of antimicrobial therapy, integrating laboratory results with clinical context, liaising with pharmacy and clinical teams, and contributing to patient management and antimicrobial stewardship, developed through this DTA, will be invaluable throughout your training and beyond?
- Identify clear actions for continued development related to TDM, antimicrobial pharmacokinetics, 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 |