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EMPIRIC
Antimicrobial Fantasy Draft

Antimicrobial stewardship, as a team sport. A live, phone-based game where resident teams treat real cases on the projector — and the scoring rewards exactly the reasoning we're trying to build.

~30–45 min · any group size · phones + a projector · one facilitator · nothing to install
Why it matters
Residents learn antibiotics as a list. We want them to think in systems.

Naming drugs is easy; using them well is the hard part — and it's exactly where habits form early and stick. EMPIRIC makes the good habits the way to win.

Empiric overkill

Reaching for the broadest agent "to be safe" — the reflex that drives resistance, cost, and C. diff.

Slow to de-escalate

Cultures come back and the regimen doesn't change. Narrowing on data is a learned discipline.

Cost & harm blind spots

Price, duration, and C. diff risk rarely enter the bedside calculus — until they're made visible.

What residents practice
Three learning objectives — each built into the scoring

The game isn't a quiz bolted onto trivia. Its mechanics are the objectives: to win, a team has to reason the way we teach.

1
Antibiotics have roles, not just names

Teams draft a bench of agents grouped by role — antipseudomonal β-lactam, atypical coverage, MRSA, anaerobes, urinary. A live "cover the field" checklist forces the question every good empiric plan answers: what am I actually covering? They read a real local antibiogram to draft, not a memorized list.

The board — your local antibiogram

Local antibiogram

draft to cover the field
CRO
FEP
MEM
CIP
SXT
VAN
DOX
E. coli
92
96
99
77
81
E. coli (ESBL)
0
0
++
±
67
S. aureus (MRSA)
0
0
0
0
78
++
92
P. aeruginosa
0
90
94
78
≥90 / ++ 80 / + ± <50 / 0
Numbers = local %S. Letters = Sanford grade. Draft to cover the bugs you'll actually face.
2
Start broad, then narrow as data comes in

Day 0 is an empiric bet under uncertainty. When cultures return, the board reveals the susceptibility and teams must de-escalate to the narrowest agent that still covers. The single biggest reward in the game is landing on "narrowest effective" — de-escalation is the winning move, not an afterthought.

The board — cultures back, de-escalate
⚄ Final cultures back — susceptibility · E. coli (ESBL)
this isolate's resistance
82 / 100
susceptibleresistant
Nitrofurantoin 90% S
susceptible ✓
Ciprofloxacin 77% S
resistant ✗
De-escalate to nitrofurantoin — narrowest and cheapest agent that covers.
3
Cost-conscious, stewardship-minded care

Every regimen accrues cost per day, and broad or prolonged therapy quietly raises a C. diff roll at the end of each case. Overkill wins the moment and loses the game. Residents feel the downstream cost of "just in case" — the harm that's usually invisible at the bedside.

The board — end-of-case scoring
Gram Stainers+43
Clinical points+45
Case cost$56 (−2)
C. diff rollP 4% · rolled 71 → safe
narrowest effective therapy ✓+15
right level of care ✓+10
A rival team that carpet-bombed the same case scored just +18 total — same cure, dragged down by cost and a C. diff hit.
How it works
The whole game in 30 seconds
📽️

Projector

The shared story: the patient, the cultures, the reveal, the live standings.

📱

Phones

Each team's console. A rotating captain submits the team's call — everyone debates it.

🎛️

Facilitator

You. Open a case, advance the days, hit "Score & reveal." That's the whole job.

Teams draft a bench of antibiotics, then treat a case that unfolds over several days. Each day they choose a disposition (discharge / admit / ICU) and a regimen (which drugs, IV or oral). Picks auto-save on the phone; the facilitator advances and the board scores every team at once. Then the next case. Highest total after the last case wins.

8 cases span the bread-and-butter of inpatient ID — cystitis, pyelonephritis, pneumonia, cellulitis, S. aureus bacteremia, febrile neutropenia, meningitis — each grounded in IDSA and institutional guidelines and a local antibiogram.

A team's phone — the decision
✓ Disposition: dischargeadmit or discharge?
✓ Submitted — Nitrofurantoin (PO)
Case spend
$14
C. diff hazard
0.10
Choose your regimen
✓ Nitrofurantoin PO$14
Ciprofloxacin PO$9
Meropenem IV$140
How it's scored
The leaderboard rewards stewardship, not carpet-bombing

Scoring is transparent and guideline-anchored. Teams see exactly why each day earned or lost points — the feedback that makes the reasoning stick.

Points for

Narrowest effective therapy+15
Correct de-escalation once cultures return+15
Appropriate empiric coverage+10
Right level of care (disposition)+10

Points off

Overbroad — it worked, but it was overkill−5
Inadequate — missed the bug−15 to −20
Can't complete outpatient (e.g. IV on discharge)−15
Cost, and a C. diff hit at case close− / roll

Final score = clinical points − cost − C. diff. A team can cover every bug and still lose to one that treated narrow, cheap, and clean.

Why it works
Engaging on the surface, rigorous underneath
🗣️
Active & social. Teams argue the plan out loud — the discussion is where the learning happens, not a lecture.
Immediate, specific feedback. Every choice is scored with a clinical reason on the spot — the fastest way to correct a habit.
📚
Guideline-grounded. Cases and answers are built on IDSA & institutional CPGs and a real local antibiogram.
🛡️
Red-teamed for concordance. The scoring engine was exhaustively audited so guideline-correct care never gets penalized by chance.
What you'd need
Drop it into a noon conference. Zero setup.
⏱️
30–45 min

Fits a noon conference or an academic half-day slot.

📱
Phones + a screen

Web-based. Residents scan a QR code — nothing to install.

👥
Any group size

Split the room into teams of 2–5. Scales from 6 to 60.

🆓
One facilitator

You run it from one screen. Free to use.

What's next
A single-player mode — for solo, self-paced learning

The live team game teaches in a room. We're now building a single-player version so any learner can work through the same cases on their own time — and so the game can double as a multi-site education study.

Live team game
shipped
Solo practice
building now
Research mode
next
Multi-site study
after review
Asynchronous practice. The same cases and the same teaching feedback after every decision — one learner, at their own pace. No room, no facilitator, no scheduled conference.
🔀
Two modes. Practice keeps nothing and needs no sign-up. Research is a consented, standardized run — every learner faces the same fixed case form. Anyone who doesn't consent still gets the full teaching tool.
📊
De-identified by design. Every decision is already scored with a clinical reason; solo mode saves that as an anonymous performance record — empiric appropriateness, de-escalation, narrowness, disposition, safety. No names or PII; a self-generated code links pre-test → play → post-test.
🌐
Built to pool across sites. Each program runs the same frozen build and exports de-identified data to one coordinating site, so results compare cleanly. We're looking for programs to help expand the dataset.
In development. Any data collection begins only after the required QI-vs-research and IRB review — the teaching tool works today regardless.
Play a case, then let's run one together.

Try a case yourself in two minutes. Then — whether you'd pilot it at a resident conference, bring the solo mode to your learners, or join the multi-site study — let's talk.

No account, no install — it runs in any browser.
EMPIRIC · Antimicrobial Fantasy Draft
A resident-built teaching game for antimicrobial stewardship · Internal Medicine Residency
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