Table 3 Students’ approach to case interpretation

Systematic approach

Critical thinking

3.1. “For empiric therapy, it has to be initiated as soon as possible because it is usually time-sensitive. Empiric therapy would be started within 48 hours according to the prescriber on call, but then after 48 hours, any additional dosing required has to be approved by the ID team, which I think is a good approach to optimize empiric therapy first, and then move on to the definitive therapy after the culture results are out.” – Participant 18

Three factor approach:

Patient-Drug-Bug

3.2. “First of all, we have to look at the patient, drug and organism factors. The patient has a recurrent urinary tract infection and pyelonephritis, going to the organism, the patient has E.coli but resistant to meropenem, which she is started on empirically, so we can now narrow down to something that covers E.coli.” – Participant 10

3.3. “The patient had a history of MRSA, and now he is having a central line skin infection that could be caused again by MRSA. Vancomycin covers MRSA. I think Vancomycin is a good option for this patient.” – Participant 17

Elimination approach based on sensitivity results and allergy assessment

3.4. “Third generation cephalosporins is fine for this patient as she cannot take trimethoprim/ sulfamethoxazole because of her sulfa allergy.” – Participant 5

3.5. “I think I would investigate the sulfa allergy further and if she doesn’t have a true allergy, I would go with trimethoprim/sulfamethoxazole because the organism is sensitive to it and is an oral option. I would step down to oral therapy as soon as she stabilizes.” – Participant 18

Evidence/Clinical-based decisions

3.6. “I can look into the Sanford guide or the local Hamad Medical Corporation guidelines to double check my recommendation.” – Participant 11

3.7. “I would consider general guidelines for my recommendation like the ones from CDC. Also, I will check the local antibiogram.” – Participant 10

Non-systematic approach

Disturbed thought process

3.8. “So I will go with giving trimethoprim. Oh no, she is allergic to sulfa. So then I will go with trimethoprim. Oh God why do I keep going back to trimethoprim?” – Participant 2

Knowledge deficit/Misinterpretation of questions

3.9. “I do not know now what the treatment of UTI is. I do not have idea right now. This one I do not recall at all” – Participant 20

Lapses and slips (lack of focus)

3.10. “She is taking meropenem, and the report shows it is sensitive, so mmmm, I think I will keep it” – Participant 19

Incertitude

3.11. “I am not sure how do we actually take effective considerations into account” – Participant 16

3.12. “I know that it is a good choice to give Bactrim for the patient, and I know also that cephalosporins can be used. So one of them, I am not sure. OK, maybe I'll go with Bactrim” – Participant 7