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Table 1 Studies included in the systematic review and results

From: Does the problem begin at the beginning? Medical students’ knowledge and beliefs regarding antibiotics and resistance: a systematic review

Authors

Year

Country

Academic year

Sample size

(n)

Year

Data collected

Data-collection method

(questionnaire)

Appraisal tool for Cross-Sectional Studies (AXIS)

Results

Knowledge and sources of information

Knowledge (% correct responses)a

Sources of information/teaching used (%)a

Usefulness of the different sources of informationa

(% students who consider it useful)

Last courses

          

Sanchez-Fabra et al. [32]

2019

Spain

Final Year

441

2015

Online

1, 2, 4, 5, 8, 9, 11, 12, 15, 16, 17, 18, 19

NE

FL (59–93)

CC (42.2–91.2)

NT (65.1)

OHSP (67.3)

OTHS (71.7)

FL (59.4–68.8)

CC (49.2–76.9)

NT (40.7)

OHSP (62.3)

OTHS (62.9)

Rusic et al. [31]

2018

Croatia

5th and 6th

115

2017

Paper-based

1, 2, 4, 5, 6, 8, 9, 10, 11, 12, 15, 16 ,17, 18, 19, 20

KAMP (47–92)

TB (91.0)

MJ (38.5)

NT (62.8–73.1)

ABG (69.2)

NE

Dutt et al. [29]

2018

India

Final year

76

2017

Paper-based

1, 2, 4, 5, 8, 10, 11, 13, 15, 16, 17, 18, 20

KAMP (14.5–73.7)

NE

NE

Weier et al. [27]

2017

Australia

Final year

191

2015

Online

1, 2, 4, 5, 7, 8, 9, 10, 11, 12, 15, 16, 17, 18, 19, 20

NE

NE

NE

Tayyab et al. [26]

2017

Pakistan

4th, 5th

223

2016

Paper-based

1, 2, 4, 5, 8, 9, 11, 12, 15, 16, 17, 20

KAMP (57–96)

NE

NE

Wasserman et al. [25]

2017

South Africa

Final year

289

2015

Paper-based

1, 2, 4, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20

KAMP (19–59)

CRCV [RTICV (15–78), UTICV (69), OTHCV (43–69)]

NE

FL (77–81)

CC (54–56)

OHSP (85–87)

OTHS (63–87)

Chuenchom et al. [23]

2016

Thailand

6th

455

2014

Paper-based

1, 2, 4, 5, 8, 11, 12, 13, 15, 17, 19

KAMP (56.7–58.9)

CRCV [RTICV (21.5–84.3), UTICV (51.2), OTHCV (39.1–94.9)]

FL (71.8–79.1)

ABG (11.9–52.1)

OHSP (10.1–85.0)

NE

Yang et al. [21]

2016

China

4th

611

2015

Paper-based

1, 2, 4, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20

KAR (11.9–39.1)

KAMP (5.0–50.7)

CRCV [RTICV (45.0), UTICV (52.3), OTHCV (89.4)]

TB (80.2)

MJ (19.7)

NT (50.5-

52.1)

ABG (8.6–17.3)

PHC (13.6)

OHSP (22.1–38)

OTHS (57.7)

NE

Dyar et al. [18]

2013

Scotland, Switzerland, Sweden, Slovenia, Spain, France, England

Final year

338

2012

Online

1, 2, 4, 5, 8, 9, 11, 12, 15, 16, 17, 18, 19

KAR (59–83)

NE

NE

Dyar et al. [17]

2013

France

5th, 6th

60

2012

Online

1, 2, 4, 8, 9, 11, 12, 15, 16, 17, 18, 19

KAR (22–72)

ABG (62)

NE

Thriemer et al. [14]

2013

DR Congo

Final year

106

2011

Paper-based

1, 2, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20

KAR (4.3–42.3)

KAMP (61.9–94.3)

CRCV [OTHCV (20.7–74.5)]

NT (41.5)

ABG (27.3–68.9)

PHC (71.7)

NE

Abbo et al. [16]

2013

United States

4th

317

2012

Online

1,2,4,5,8,9,10,11,12,13,15,16,17,18,19

KAR (21–57)

KAMP (32–91)

CRCV [RTICV (87), UTICV (45), OTHCV (59)]

TB (46)

MJ (55)

NT (41–90)

ABG (29–49)

PHC (3)

OHSP (54–80)

NE

Huang et al. [13] (last year)

2013

China

Last year

241

Unknown

Paper-based

1, 2, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 19, 20

KAMP (31.0–93.5)

NE

NE

Ibia et al. [11]

2005

United States

Senior students

989

1999–2000

Paper-based

1, 2, 4, 5, 8, 10, 11, 12, 15, 16, 17, 18

CRCV [RTICV (24.3–65.6), OTHCV (38.6–90.9)]

NE

FL (7.1–21.4)

CC (15.1)

OHSP (15.8–26.1)

Other courses

          

Hu et al. [30]

2018

China

All

1819

2015

Online

1, 2, 4, 5, 6, 10, 11, 12, 15, 16, 17, 18, 19, 20

NE

NE

NE

Harakeh et al. [19]

2015

Saudi Arabia

All

1042

2013

Interview

1, 2, 4, 5, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20

KAMP (48.2–93.7)

NT (41.2)

OHSP (43.6)

OTHS (47.2)

NE

Minen et al. [12]

2010

United States

All

304

Unknown

Online

1, 2, 4, 8, 9, 10, 11, 12, 15, 16, 17, 18, 19

NE

TB (53.3)

MJ (18.8–38.5)

NT (4.3–60.2)

ABG (18.4–33.2)

PHC (63.5)

OHSP (58.9–63.5)

NE

Hoque et al. [24]

2016

Bangladesh

3th, 4th, 5th

107

2015

Paper-based

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 14, 15, 16, 17, 18, 19, 20

NE

NE

NE

Haque et al. [22]

2016

Malaysia

3rd, 4th, 5th

142

2015

Paper-based

2, 8, 9, 10, 13, 16, 17, 18, 19, 20

KAR (35–49)

ABG (45)

NE

Padmanabha et al. [28]

2018

India

2nd

142

2016

Paper-based

1, 2, 5, 4, 11, 15, 16, 17, 18, 20

NE

NE

NE

Sharma et al. [20]

2015

India

2nd

120

2014

Paper-based

1, 2, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 19, 20

CRCV (29.2–87.5)

NE

NE

Khan et al. [15]

2013

India

2th

97

Unknown

Paper-based

1, 2, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 18, 19, 20

KAMP (32–77.3)

NE

NE

Huang et al. [13] (1st year)

2013

China

1st year

262

Unknown

Paper-based

1, 2, 4, 8, 9, 10, 11, 12, 13, 15, 16, 17, 19, 20

KAMP (23.1–88.2)

NE

NE

Authors

Results

Attitudes

(%)

Behaviour

(%)

Beliefs

Antibiotic resistance as a problem

(%)

Overused antibiotics

(%)

Contributors to resistance

(%)

Others

(%)

Last courses

      

Sanchez-Fabra et al. [32]

NE

NE

NE

PPAB (24.3 -94.8)

ABRE

(40.6)

NE

Rusic et al. [31]

FC (84.6)

OUG (82.1)

INH (47.7)

TMBS (83.3)

TLD (89.7)

IUAB (80.8–88.5)

LSU (83.3)

PICM (88.5)

PPAB (44.9 74.4)

RSP [OPR (48.7–79.5)]

ABRE (74.4–83.3)

NE

Dutt et al. [29]

NE

NE

TMP (53.9)

IUAB (42.1–78.9)

LSU (65.8)

NE

NE

SSM (76.4)

SMRTI (48.7)

ICU (28.9–50)

Weier et al. [27]

NE

NE

TLT (75.2)

TLD (91.9)

IUAB (95.3–96.6)

PPAB (67)

CABK (38.8–89.7)

NE

NE

Tayyab et al. [26]

WP (97)

NP (84)

TH (61)

NE

NE

NE

NE

SSM (41)

SMRTI (82)

ICU (14–78)

Wasserman et al. [25]

NP (87)

TH (61)

OUN (92)

OUTH (63)

TMBS (88)

IUAB (98)

PHH (62)

PPAB (13–87)

RSP [ABDP (13)]

ABRE (90–95)

NE

Chuenchom et al. [23]

NP (84.6)

TH (75.4)

OUN (98.2)

OUTH (94.3)

INH (85.3)

TMBS (99.1)

PHH (99.6)

PPAB (87.2–99.7)

CABK (71.4)

RSP [ABDP (99.1)]

ABRE (98.9–99.8)

NE

Yang et al. [21]

NP (91.6)

TH (85.0)

OUN (84.8)

OUTH (39.4)

INH (24.6)

TMBS (32.5)

IUAB (92.3)

PICM (70.9)

PPAB (25.6–54.1)

RSP [ABDP (76.9)]

ABRE (85.9–90.4)

NE

Dyar et al. [18]

NP (92)

TH (79)

FC (98)

NE

TMP (95)

TMBS (96)

TLT (55)

TLD (68)

LSU (76)

PHH (42)

PICM (67)

CABK (40–92)

RSP [OPR (66)]

RSP [ABDP (60–89)]

ABRE (67–92)

NE

Dyar et al. [17]

NP (94)

TH (69)

FC (96)

NE

TMP (98)

TMBS (92)

TLT (60)

TLD (63)

LSU (75)

PHH (55)

PICM (80)

CABK (33–97)

RSP [OPR (63)]

RSP [ABDP (26)]

ABRE (79)

NE

Thriemer et al. [14]

WP (85.5)

NP (92.9)

FC (67.4)

NE

TMP (69.0)

TLD (82.1–89.7)

IUAB (83.2)

PICM (64.1)

CABK (85.7)

NE

NE

Abbo et al. [16]

NP (98)

TH (97)

OUN (94)

OUTH (65)

INH (70)

TMBS (95)

IUAB (97)

PICM (83)

PPAB (31–63)

RSP [ABDP (20)]

ABRE (79–90)

NE

Huang et al. [13] (last year)

NP (82.6)

OUG (91.7)

TMP (81.4)

NE

ABRE (74.5–87.0)

SMRTI (14.5–56.4)

Ibia et al. [11]

NE

NE

NE

NE

NE

NE

Other courses

      

Hu et al. [30]

NE

NE

NE

NE

NE

SSM (27.0)

SMRTI (30.7–55.6)

Harakeh et al. [19]

NE

NE

INH (95.0)

NE

NE

SSM (49)

SMRTI (61.8)

Minen et al. [12]

NE

OUG (79.5)

OUTH (36.5)

NE

NE

ABRE (65.8)

NE

Hoque et al.[24]

NP (99)

TH (59)

NE

TMP (67.3)

TMBS (66.4)

TLT (54.2)

TLD (54.2)

LSU (65.5)

PHH (60.7)

PICM (81.3)

CABK (64.5–77.5)

RSP [OPR (87)]

RSP [ABDP (32.7)]

NE

NE

Haque et al. [22]

NP (83)

TH (63)

FC (42)

NE

TMP (88)

TMBS (86)

TLT (72)

TLD (56)

LSU (75)

PHH (49)

PICM (78)

CABK (53.6–80.3)

RSP [ABDP (23)]

ABRE (88)

NE

Padmanabha et al. [28]

NE

NE

INH (59.0)

TMBS (36.7)

TLT (47.5)

TLD (38.9)

IUAB (35.3–49.6)

LSU (48.9)

PHH (33.1)

NE

NE

NE

Sharma et al. [20]

NE

OUG (99.2)

TMP (96.7)

TLT (100)

IUAB (100)

CABK (7.5–93.3)

RSP [ABDP (72.5)]

ABRE (98)

NE

Khan et al. [15]

WP (90.7)

NP (88.7)

TH (68)

NE

TMP (78.3)

TMBS (69)

TLT (49.5)

TLD (58.0)

IUAB (56.7)

LSU (54.6)

PICM (39.0)

RSP [OPR (53.6)]

NE

SSM (7.2)

SMRTI (56–59.8)

ICU (13.4–69)

Huang et al. [13] (1st year)

NP (67.2)

OUG (87.2)

TMP (72.9)

NE

ABRE (61.1–89.3)

SMRTI (6.4–20.6)

  1. aIn some studies, this is measured via different items. The response range for the items comprising this construct is shown
  2. NE, not explored. KAR, knowledge about antimicrobial resistance (% students with correct knowledge). KAMP, knowledge about antibiotic use and prescription (% students with correct knowledge). CRCV, correct responses in clinical vignettes (% students with correct knowledge). RTICV, respiratory tract infection clinical vignettes. UTICV, urinary tract infection clinical vignettes. OTHCV, other clinical vignettes. FL, formal lectures. TB, textbooks. MJ, medical journals. CC, clinical cases and clinical rotation. NT, new technologies. ABG, antibiotic guidelines. PHC, pharmaceutical companies. OHSP, other house staff physicians. OTHS, other sources. WP, perception about antibiotic resistance as a worldwide problem. NP, perception of antibiotic resistance as a national problem. TH, perception of antibiotic resistance as a problem at their teaching hospital. FC, perception of antibiotic resistance as a problem in their future career. OUG, overused, generally. OUN, overused, nationally. OUTH, overused at teaching hospitals. INH, inherent in the use of antibiotics. TMP, too many antibiotic prescriptions. TMBS, too many broad-spectrum antibiotics used. TLT, too long treatment. TLD, too low dosage or treatment not completed. IUAB, inappropriate use of antibiotics. LSU, excessive use in livestock. PHH, poor hand hygiene. PICM, poor infection control measures. PPAB, medical students’ perceptions of preparedness in antimicrobial resistance. CABK, confidence in antibiotic knowledge or antibiotic prescription. RSP, responsibility. ABDP, perception of development of new antibiotics. OPR, own professional responsibility. ABRE, attitude to integrating more training in or education about antibiotics and resistance. SSM, students’ self-medication with antibiotics. SMRTI, self-medication with antibiotics for respiratory tract infections. ICU, incorrect use of antibiotics
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Antimicrobial Resistance & Infection Control

ISSN: 2047-2994

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