Milestone map
Milestone map
3 milestones
Construct a bacteriology knowledge map by class and clinical significance
3–4 weeks
Produce a comprehensive knowledge map of medically significant bacteria organised by Gram staining result, morphology, and clinical significance. Cover the core bacteria in each group: Gram-positive cocci (Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae, Enterococcus), Gram-negative rods (E. coli, Klebsiella, Pseudomonas, Salmonella, H. pylori), Gram-negative cocci (Neisseria meningitidis, N. gonorrhoeae), anaerobes (Clostridium, Bacteroides), and atypicals (Mycobacterium tuberculosis, Chlamydia, Mycoplasma). For each organism, your map must capture: Gram stain + morphology, pathogen mechanism, clinically significant infection(s), diagnostic method, and first-line treatment.
Proof required
Submit your bacteriology knowledge map (format: table, concept map, or annotated diagram) with all organisms listed above, each mapped across all 5 dimensions. Present to a qualified examiner who can test recall on any organism.
What gets checked
- All major organism groups are represented — a map limited to only 5 or 6 organisms is not a bacteriology knowledge map.
- Each organism is mapped across all 5 dimensions — missing 'diagnostic method' or 'treatment' for some organisms is a common shortcut.
- Pathogen mechanism is specific — 'causes infection' is not a mechanism; 'Staph aureus produces toxins that cause tissue necrosis via protein A and panton-valentine leukocidin' is.
Common mistakes
- Map produced by copying textbook tables without understanding — the examiner test in the proof prompt will detect this.
- Atypical bacteria omitted — M. tuberculosis, Chlamydia, and Mycoplasma are frequently overlooked because they don't Gram stain conventionally.
- Treatment section that lists drug classes without specific first-line agents for each organism.
Resources
Foundationstart here
Depthgo deeper
Masteryfor the dedicated
What a verifier looks for
- Test recall: name any organism from the map and ask the student to give all 5 dimensions without looking — this is the proof prompt requirement.
- Ask for the first-line treatment for MRSA — a common exam question that tests treatment knowledge.
- Ask what an atypical bacterium is and why it doesn't Gram stain — tests understanding of the category, not just the list.
Map antimicrobial resistance mechanisms and stewardship principles
1–2 weeks
Produce a structured document (2–3 pages) covering: the four major mechanisms of antimicrobial resistance (enzymatic degradation, target modification, efflux pumps, reduced permeability), a specific clinical example of each mechanism with the relevant organism and drug class, and a summary of antimicrobial stewardship principles as applied in a hospital or community setting — why stewardship matters, the specific behaviours it targets, and what clinical guidelines govern prescribing in your jurisdiction (e.g. NICE antimicrobial prescribing guidelines, local formulary).
Proof required
Submit your 2–3 page resistance mechanisms and stewardship document with all four resistance mechanisms mapped to specific organisms and drug classes, and antimicrobial stewardship guidelines cited.
What gets checked
- All four resistance mechanisms are present with a specific clinical example — beta-lactamase production (enzymatic), MRSA PBP2a (target modification), Pseudomonas efflux pump MexAB-OprM (efflux), and reduced outer membrane porins in Klebsiella (permeability) are canonical examples.
- Stewardship principles are specific — 'prescribe antibiotics responsibly' is not a stewardship principle; 'narrow-spectrum agent selected on basis of culture results before broad-spectrum empirical treatment is continued beyond 72 hours' is.
- Clinical guidelines cited are specific to your jurisdiction — not generalised statements.
Common mistakes
- Resistance mechanism section that describes only beta-lactamase because it is the most familiar — all four mechanisms must be covered.
- Stewardship section that is aspirational rather than procedural — what specifically happens in clinical practice.
- No citation of specific clinical guidelines — 'I follow guidelines' without naming them.
Resources
Foundationstart here
Depthgo deeper
What a verifier looks for
- Ask the student to name a clinical example of each resistance mechanism — tests understanding beyond the category names.
- Ask what they would do if a patient's culture result came back after 48 hours of empirical broad-spectrum antibiotics — tests stewardship in practice.
- Ask which antimicrobial stewardship guideline governs prescribing in their clinical setting.
Pass a timed bacteriology examination under qualified observation
2–4 weeks (study + examination)
Sit a timed bacteriology examination (minimum 40 questions, 60 minutes) covering organism identification, antimicrobial sensitivity patterns, clinical presentation correlation, and resistance mechanisms. The examination must be administered by a microbiologist, infectious disease physician, pharmacist with clinical microbiology experience, or medical educator. You must achieve at least 75% to pass. This examination is specifically designed to test recall and application under timed conditions — preparation materials may be reviewed beforehand but not used during the exam.
Proof required
Submit your examination paper (or a 10-question sample provided by the examiner after the exam), your score (75% minimum), and the examiner's signed attestation confirming the exam was completed without notes in a timed setting.
What gets checked
- Examiner has clinical microbiology, infectious disease, or equivalent expertise.
- Score is 75% or above — no rounding up from 74%.
- Exam includes all four question types (organism identification, sensitivity patterns, clinical correlation, resistance mechanisms).
Common mistakes
- Examiner without microbiology or infectious disease background — a general nurse or peer student cannot administer this exam.
- Exam that tests only identification without sensitivity patterns and clinical correlation.
- Open-book exam — the timed closed-book requirement is the core of this milestone.
Resources
Foundationstart here
What a verifier looks for
- Confirm the exam was closed-book and timed — the examiner must attest to these conditions.
- Ask the student to review their incorrect answers and explain what the correct answer should have been.
- Verify the examiner has clinical microbiology or infectious disease expertise.