Diagnostics and antimicrobial resistance: A clinical case challenge contest
Creators: name: Eneyi E. Kpokiri
name: Budak, Jehan Z.
name: Chang, Christina C.
name: Ong, Jason J.
name: Mabilat, Claude
name: Peeling, Rosanna W.
name: Duin, David Van
name: Tucker, Joseph D.
Publisher: name: F1000 Research Limited
Year: 2019

description: Antimicrobial resistance (AMR) is a serious public health problem around the world. Enhanced AMR training, especially related to clinical diagnostics, is needed at many medical schools. We used an open clinical case challenge contest to solicit clinical cases on antimicrobial resistance and clinical diagnostics. The aim of the challenge contest was to identify clinical cases in order to develop educational resources to support use of clinical diagnostics in antimicrobial stewardship. We received 25 clinical cases from nine countries. Three cases were selected as finalists and developed into an open access learning module on clinical diagnostics and AMR. This work suggests how crowdsourcing and challenge contests might be used in order to generate open access content for medical training.<br><br>Our crowdsourcing approach focused on developing a diagnostics/AMR educational resource for medical students and physicians. The goal of the call was to encourage medical students, trainees, physicians, and others to collect or write clinical cases that will be used to develop open access educational materials. Online learning tools such as shared study tools, online videos, problem-based learning cases and downloaded question banks are increasingly being utilized by medical students for revision or learning new information.The contest also aimed to increase interests and awareness in the role of diagnostics in the management of resistant bacterial cases.<br><br>We set up a global steering committee comprised of 19 individuals from six WHO regions (seven women and twelve men). The steering committee included experts in laboratory science, medicine, public health, health communications, and medical education. Members were selected based on sex, geographic region, and expertise. The call for submissions was launched and kept open for a period of six weeks. This call was disseminated through social media channels (including Facebook, Twitter and YouTube), partner organizations, professional association mailing lists, and in-person events. The call for participation was translated into the six official languages of the WHO, but only entries in English were accepted. Links to a one-minute promotional video and a website developed for the contest were shared as part of the strategies to disseminate the call for entries. The website received an average of 117-page views each week. Banners and posters were also printed and displayed in some hospitals and medical schools to create awareness about the contest. At the end of the call, all cases received were screened for eligibility by two steering committee members and then sent to four physician judges for evaluation using pre-specified judging criteria. Judges included infectious disease fellows and residents. Eligibility criteria include clinical cases focusing diagnostics and AMR, written in English, less than 2000 words in length, and includes at least one image. The selected judges were neither part of the steering committee nor involved in the design of the call. In the first round of judging, each case was scored between 1 and 10 by the judges. Criteria set for judging the cases include focus on diagnostics and AMR, relevance to medical teaching and capacity to enhance appropriate antibiotic use.<br> <br>We received 25 clinical case entries from nine countries. Peru had the highest number of entries (10), followed by the US (6), Nigeria (4), China (3), Australia (1), Canada (1), Ethiopia (1), Paraguay (1), and Zambia (1). After screening, 23 cases were eligible for the first round of judging; two entries were excluded for not being relevant to the subject of the call. Nineteen were original cases written by participants, and four were adapted from already published literature. All cases were submitted alongside a signed declaration of patients’ consent from the authors. The cases described clinical presentations of drug resistant organisms and the role of diagnostics in their management.<br> <br>Out of the 23 eligible cases, three cases emerged as finalists. All three finalist cases were summarized and developed into an online diagnostics/AMR interactive learning module using Articulate Storyline (version 3, United States). The purpose of the learning module is to increase understanding of diagnostics and AMR in adult and paediatric medicine.The module could be used as CME for physicians or integrated into medical curricula. The module was tested among six individuals in five locations. <br>Crowdsourcing provides several advantages in the development of medical training materials compared to conventional approaches, including duration of time needed, cost, and global coverage. Our challenge was able to solicit over twenty cases in less than two months, faster than the development process for traditional medical education resources. The costs incurred in organizing the challenge contest were less compared to having experts develop clinical cases. Finally, the global composition of our steering committee and case contributors allowed us to develop a resource that may be relevant in diverse global settings.<br>However, our crowdsourcing contest had some limitations that warrant consideration. This contest received fewer clinical cases compared to other crowdsourcing contests. The low number of cases may have been related to the lack of official partnerships with larger conferences or professional associations, the relatively high requirements in the guidelines for submissions, and the timing of the call. Our call for cases coincided with a similar call for clinical cases on infectious diseases from the IDSA. Despite the overall low number of submissions, we received sufficiently strong cases to create the learning module and develop new open access clinical cases.<br>We describe how we used crowdsourcing to develop learning materials for medical education. This expands on the limited literature suggesting how crowdsourcing could improve medical curriculum resources. Crowdsourcing may be used by medical educators to develop new content or to update existing teaching materials. This pilot suggests the need for more formal evaluation.<br><br>The authors wish to acknowledge the support of Mark Miller, Isabelle Canaiux, Gros Marie-Francoise, Brian Schwartz, and Rajesh Tim Gandhi. The diagnostics/AMR challenge contest Steering Committee, the London School of Hygiene and Tropical Medicine International Diagnostics Centre, University of California San Francisco, Partners ID Images , Social Entrepreneurship to Spur Health (SESH Global) and the authors of our clinical cases.<br><br>The challenge contest was supported by an unrestricted educational grant from bioMérieux.