Gaining a comprehensive understanding of antimicrobial resistance in dental education: a mixed methods study protocol

Antimicrobial resistance (AMR) is one of the most pressing global health challenges of the 21st century, driven in part by suboptimal prescription of antibiotics. Most antibiotic use worldwide occurs in outpatient settings, including dental practice, where dentists account for approximately 5-11% of all prescriptions. Educational environments play a critical role in shaping prescribing behaviors early in professional development, and interventions implemented during undergraduate training are more effective at changing clinical practice than those introduced later in clinical careers. However, research on how dental curricula, institutional culture, and stakeholder perspectives influence antimicrobial stewardship education is limited. Therefore, this study proposes a comprehensive evaluation of antibiotic prescribing practices and AMR education across all dental schools in Québec, Canada.

Using a convergent mixed methods design, the project integrates quantitative and qualitative approaches to examine knowledge, attitudes, prescribing patterns, and educational content about antibiotics and AMR. Quantitative components include a cross-sectional survey of dental students and a retrospective analysis of antibiotic prescriptions within undergraduate clinics. Qualitative components include focus groups with students and interviews with clinical instructors and academic administrators, guided by the Health Belief Model and the Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR) model. A curricular document analysis will further explore how antimicrobial stewardship principles are taught and implemented across institutions. Findings will be integrated through a mixed methods matrix to identify convergences, gaps, and opportunities for educational change.

This work advances current research by moving beyond traditional survey-based assessments toward a holistic, multi-stakeholder understanding of antibiotic prescribing in dental education. By linking student and educator insights with clinical practice data, the study aims to generate actionable knowledge to aid curriculum developers, clinical practitioners, and policy shapers to optimize antibiotic use and mitigate antimicrobial resistance.

https://cihr-irsc.gc.ca/e/193.html, # PJT183763.