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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