A game for teaching antimicrobial mechanisms of action

Figures & data

Table

Practice points

Alternative teaching tools have proved to enhance students’ interest and knowledge of the formal contents and interpretation skills. Students have difficulty in correlating Basic Microbiology (i.e. bacterial cytology) with applied aspects of mechanisms of action of antimicrobial agents and microbial resistance. The game could be applied to any undergraduate course in the field of Healthy Sciences, and is intended to be applied to students that are at the beginning of their courses.

Figure 1. Game board.

Figure 2. Red cards containing a clinical case, the microorganism that was isolated and its susceptibility profile to the antibiotics.

Figure 3. Yellow cards with questions concerning the mechanism of action of antimicrobial agents and microbial resistance.

Table 1.  Pre-test and post-test

Mark if the statement is true (T), false (F) or if you do not know the answer (?):	T	F	?
1. Gram-negative bacteria are normally more resistant to antimicrobial agents than gram-positive ones due to the presence of an outer membrane, which hinders the entry of antibiotics.
2. Antimicrobial agents do not induce bacterial resistance to other antibiotics that have not been prescribed to the patient.
3. Vancomycin is prescribed for the treatment of infections caused by multiresistant gram-positive bacteria, including the ones caused by methicillin-resistant Staphylococcus aureus (MRSA).
4. Sulfonamides do not act upon mammal cells due to the fact that these cells do not synthesize folic acid, which must be provided through feeding.
5. The prescription of bactericidal or bacteriostatic antibiotics achieves the same results: Clearance of infection. Thus, the information concerning the bactericidal or bacteriostatic status of the antimicrobial agent is irrelevant in clinical practice.
6. The most common type of resistance to aminoglycosides is the production of β-lactamases.
7. The isolation of Pseudomonas aeruginosa as cause of sepsis is worrying because this bacterium is naturally resistant to several antimicrobial agents.
8. Bacterial resistance to tetracycline is disseminated probably due to the excessive prescription of this agent in the past.
9. The joint use of sulfonamides and trimethoprim is not advisable because these agents compete for the same target in the bacterial cell.
10. Aminoglycosides are efficient against obligate anaerobic bacteria.

Table 2.  Students’ answers to the evaluation questionnaire about the activity

	Medicine (n=42)^a		Pharmacy (n=36)		Total (n=78)
	Yes	No	Yes	No	Yes	No
1. Is the game interesting?	39	3	36	0	75	3
2. Did the game help you better understand the content of the discipline?	38	4	35	1	73	5
3. Is this content difficult?	30	11	21	14	51	25
4. Was the content studied previously?	10	32	5	30	15	62
5. Do you think the game improved your knowledge about the issue?	41	1	35	1	76	2
6. Was the recommended literature appropriate?	36	1	25	3	61	4
7. Was the design of the game clear?	41	1	35	1	76	2
8. Did the activity encourage clinical thinking?	33	8	35	1	68	9
9. Do you consider the game an important way of enhancing learning?	36	5	35	1	71	6

Medicine

Pharmacy

Total

10. How do you classify the activity? (E=excellent; G=good; R=regular; P=poor)

E 20

G 20

R 2

P 0

E 27

G 8

R 1

P 0

E 47

G 28

R 3

P 0

Notes: Whenever the number of answers did not correspond to the n for the group analyzed, this means that some questions were not answered by the student.

^aTwo students did not answer the questionnaire.

Table 3.  Average number of answers on the pre-test and post-test for Medicine and Pharmacy students

	Mean (standard deviation)
	Medicine	Pharmacy
Pre-test
Right answers	5.59 (2.1)^a	5.06 (1.3)^a
Wrong answers	1.02 (1.1)^b	1.06 (1.1)^b
Do not know	3.39 (2.3)^c	3.89 (1.6)^c
Post-test
Right answers	7.43 (1.5)^d	7.64 (1.4)^d
Wrong answers	1.36 (1.1)^b	1.33 (0.9)^b
Do not know	1.20 (1.3)^e	1.03 (1.1)^e

Scores marked with the same letters mean they are not significantly different (p < 0.001).