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Raising awareness of Antibiotic Resistance and One Health in Cornish Key Stage 4 students

Antibiotic Resistance

Dr Aimee Murray, European Centre for Environment and Human Health.

Key points:

  • This piece is about how researchers can and have engaged with local schools. The researcher wanted to increase awareness about antibiotic resistance.
  • As a means of addressing this, the researcher and colleagues contributed to some GCSE classes in 14 secondary schools across Cornwall, devising a range of activities to encourage learning and reflection about microbes, and anti-bacterial resistance.


Antibiotic resistance occurs when bacteria become able to survive treatment with antibiotics. More and more bacteria are becoming resistant due to misuse and overuse of antibiotics, and as a result, infections are becoming increasingly difficult to treat. As antibiotics are used widely in medicine, for example in cancer treatment, surgery or during childbirth, antibiotic resistance is a threat to everyone. Urgent action is therefore needed. An important step is to increase public understanding of resistance, so we can all strive for change.

I work on the environmental dimension of antibiotic resistance as part of the European Centre for Environment and Human Health, based at the University of Exeter Penryn Campus. Our wider group considers the ‘One Health’ aspects of antibiotic resistance, so instead of focusing solely on antibiotic resistance in hospitals, we also look at how human activities can influence the evolution and spread of antibiotic resistance in the environment. For example, I study whether antibiotics or other manufactured chemicals released into rivers and streams via wastewater treatment plants could increase the numbers of resistant bacteria.

After attending a Cornwall Antimicrobial Resistance Group (CARG) meeting, I learned of efforts to engage with local schools about antibiotic resistance. Having grown up locally and keen to get involved with outreach, I thought I might be able to help by getting in touch with some of my old teachers. I met with Dr Jo Glasson (qualified vet and teacher) and this evolved into offering science lessons on antibiotic resistance and One Health to all state secondary schools in Cornwall.

Antibiotic resistance has recently been added the GCSE syllabus (Key Stage 4), so the lesson was offered to one class per school in either years 10 or 11 (aged 14 – 16 years). Of the 30 schools in Cornwall, 14 accepted. Post-graduates from Penryn and professionals from CARG were recruited to deliver the lesson. Jo was undertaking an MSc at the time and she worked on this project for her dissertation. Jo and I drew on the expertise of several members of the ECEHH to help with study design, and the Health and Environment Public Engagement group for feedback on questionnaires for students. The aim was to determine if student understanding of antibiotic resistance and One Health increased following our lesson, as well as establish which activities students enjoyed the most. Teacher questionnaires allowed us to collect professional opinions on the activities, to see if they could inform future lessons.

Students engaged in four activities. The first was a brief introduction to antibiotic resistance, in the form of a Public Health England video. The second was a simple laboratory colour change demonstration, to show effective antibiotic treatment. The third activity centred on the app Superbugs: The Game™. This game covers lots of important aspects of antibiotic resistance, such as bacteria being able to pass on their resistance genes to nearby bacteria (‘horizontal gene transfer’), the lack of new antibiotics being developed by the pharmaceutical industry, appropriate prescribing and length of treatment (aka, antibiotic stewardship). Students worked either alone or in small groups to try and improve their score after discussing all these factors. The final activity was a detective activity called ‘Outbreak’. Students were given an information sheet describing an outbreak of vomiting and diarrhoea and tasked with discovering the source of the outbreak. After reading the information, there was a class discussion and then further information was given until the outbreak was sourced. This incorporated many One Health aspects, such as antibiotic use in animals, transmission from different environments to humans and so on.

According to the questionnaire results, knowledge of antibiotic resistance and One Health increased significantly following the lesson. Students rated the Superbugs: The Game™ app and the detective activity the highest for increasing their understanding and for enjoyment. The majority of comments from teachers were highly positive as well. The game also ranked highly for teachers, suggesting this could be an effective teaching tool for future lessons or outreach activities.

A massive thank you to all the volunteers who helped deliver the sessions, and all the experts at the ECEHH who helped Jo and I with the study design and interpretation. Thanks must also go to the Royal Society of Biology for funding this project. I’m currently writing up our findings for publication, so watch this space.

»Find out more on the European Centre for Environment and Human Health website