Scoping review: Antimicrobial resistance (AMR) stewardship competency and competency assessment tools

Background: Antibiotic resistance (AMR) is a worldwide health problem. Antimicrobial stewardship (AMS) promotes and monitors the appropriate use of this medication. Literatures exist on AMR/AMS competency model and its interventions but a comprehensive overview is lacking. Objective: Our review aims to systematically explore and map the existing literature on AMR/AMS competency model among healthcare professionals. It also seeks to examine and investigate competency assessment tools. Methods: A scoping review was conducted in two bibliographic databases in 2013-2023 and supplemented by manual searches. Two independent reviewers screened and characterized the reviews, with a third reviewer verifying any disagreements. The review included full-access English articles on AMR/AMS competency and interventions for healthcare professionals. A competency model and intervention were synthesized and proposed. Infectious disease specialists validated the final competency model. Results: Seventeen articles met the AMR stewardship competency inclusion criteria. Following expert consultation, seven domains were identified : Domain One: antimicrobials and antimicrobial resistance, Domain Two: the diagnosis of infection, Domain Three: antimicrobial use & and prescribe, Domain Four: antimicrobial stewardship, antimicrobial stewardship principles, Domain Five: infection prevention and control, Domain Six: surveillance and interprofessional collaborative practice, and Domain Seven: person-centered care. We identified 34 articles that met the criteria for inclusion in our competency assessment tools. Additionally, we used the EPOC taxonomy to categorize five intervention types. These included enabling interventions (such as education or guidelines on antibiotic use), restrictive interventions (which require expert approval prior to the use of certain antibiotics), structural interventions (which involve the introduction of a new diagnostic test or clinical algorithm to guide prescriptions), bundle interventions (which include a combination of different interventions), and others, representing 39%, 6%, 15%, 39% and 6% respectively. Moreover, the outcomes were categorized into three groups; group one, knowledge, attitude, and belief; group two, prescription rate and behavior; and group three, others, representing 33%, 60%, and 6%, respectively. Conclusion: Our AMR/AMS competency comprises seven domains, key elements, and interventions. Additionally, we have explored how to measure proficiency. Our findings can contribute to the improvement of the AMR competence framework and support ongoing intervention efforts in the field.