Table 1 Stages employed in the contest

Organising a steering committee

The purpose of the steering committee was to provide guidance and outline an overall framework for contest execution. We convened a steering committee composed of ten individuals from five countries that met periodically through 60-min teleconference meetings over the duration of the contest to discuss design, organisation, and implementation. Members included experts in medicine, public health, infectious diseases, and medical education, as well as representatives from partner organisations who helped with contest promotion and dissemination

Engaging the community to contribute

The contest was officially launched on April 15, 2019. The website provided detailed information on the contest, including the purpose, categories of participation, rules, steering committee members, and partner organisations. In order to foster creativity and avoid cognitive fixation, we did not provide examples of entries. Promotional information was disseminated through social media (Instagram and Twitter), blog posts, email, and personal contacts. Emails were sent to relevant entities and individuals, including medical student interest groups at multiple institutions (such as interest groups in internal medicine, infectious diseases, and global public health), researchers, and medical specialists across multiple countries. We promoted the contest using Figure 1^® and Ding Xiang Yuan (DXY). Both are digital platforms that bring together medical students, healthcare providers, and other healthcare-oriented professionals to share, distribute, and comment on medical cases. [18] DXY is China's largest online healthcare community, with more than four million registered users. On DXY’s main platform website, we paid for four banner advertisements and one push notification to registered users, which reached 16,323 individuals and had 99 unique opens. We also created an official Figure 1^®profile to facilitate contest promotion and developed a promotional infographic that was distributed via the Figure 1^® app and made using Canva, an online graphic-design tool

In order to encourage participation on Figure 1^®, we posted two MCQs on their platform. Each question focused on correct antibiotic treatment options based on presenting symptoms. As of November 9, 2019, the first promotional MCQ received 31 user-comments and 13,762 views and the second MCQ received 54 user-comments and 17,429 views. Promotion was also conducted through the official Figure 1^® app email account

Finally, we promoted the contest through one in-person event. Contest flyers were distributed at an AMR-focused conference in Belfast, United Kingdom where over 150 healthcare professionals working in the field of antimicrobial resistance and infection prevention and control convened

We analysed metrics from both Figure 1^® and the contest website. Figure 1® metrics showed that there were 85 comments, 107 saves, and 31,191 views from both promotional MCQs. Email analytics from the Figure 1^® official email account suggest that details regarding the contest were disseminated to a high number of individuals. This first email had 764 opens, 491 unique opens, and 50 clicks. A digest email that consisted of both AMR contest and Figure 1^® app content and was then sent to primary care physicians, nurses, and medical students. This email had 13,485 email opens, 8979 unique clicks, and 74 clicks on AMR contest content. A third email was sent on May 22, 2019 specifically asking Figure 1^® users to contribute AMR related MCQs. This email had 19,298 opens, 12,243 unique opens, and 6781 clicks

Using online analytical tools, official contest website metrics were obtained between April 30 and June 9, for a total of 41 days. During this period, the website received 578 total clicks, for an average of 14.1 clicks per day, or 98.7 clicks per week. By reviewing IP addresses, it was determined that website clicks originated from 36 different countries

Receiving and evaluating contributions

Participants were given the option to submit their entries through a digital form made using Qualtrics^© Survey Software (Qualtrics, Provo, UT) or upload their entry through either the Figure 1^® app or DXY, provided that they previously had a platform account. Individuals could submit multiple entries. In addition to entries, we collected the following sociodemographic details regarding participants: name, institution, and country. We asked participants to specify a target audience for their entry (general and primary care physicians, medical students, pharmacists, infectious disease specialists, nurses, etc.) and identify any AMR learning objective(s) that were addressed, whether it be in regards to background, prevention, diagnosis, or treatment of AMR (Table 2). Consent was sought from participants regarding the modification and use of solicited entries for learning purposes, along with records of proper citation of external sources, and documentation of patient confidentiality

Eligibility was determined based on pre-specified criteria: that the entry focused on AMR, was in English, and was in the correct format (as either a MCQ accompanied by answers, an infographic accompanied by brief explanatory captions, or an image). After determining eligibility, entries were transferred to evaluators for phase 1 judging. Evaluation was conducted by three clinical experts who were identified by the steering committee. Their participation as a judge was voluntary

During phase 1, each judge awarded every entry an individual score between 1 and 10 based on predetermined criteria. Predetermined evaluation criteria included adherence to the required format, contribution to existing learning resources, relevance and effectiveness in enhancing awareness and understanding of AMR, and focus on one or more of four AMR learning objectives (Table 2). The three individual scores were then averaged to determine one single score. Comments and revisions to further improve and develop finalist entries were sent to participants

Recognising finalists

The eight finalists with mean scores of 6.0 or greater were awarded a total of 1000 USD in prize money through Amazon gift cards and cash. Entries were awarded differing cash prize amounts based on the strength of the submission. All submitters were awarded a commendation certificate in recognition of their participation. The judges also received a thank you letter

Sharing solutions

After further review by expert judges, entries were shared with the public. The MCQs were arranged into a slide deck and included as an additional study material to an AMR learning module that was developed through a similar challenge contest in 2018 [18] Nine MCQs were selected by Figure 1^® to be shared on their platform via posts, reaching a total of 68 comments, 126 saves, and 81,928 views. Three finalist infographics were published as posters on F1000Research, a life sciences-focused digital publishing platform

We asked participants to identify a target audience for their entry. Target audiences identified by submitters included medical students, general practitioners and physicians, internal medicine specialists, infectious disease specialists, microbiologists, prescribers in low- and middle-income countries, junior doctors, and nurses. Submitters also identified veterinary practitioners and farmers as a target audience due to the increasing prevalence of antibiotics in agriculture practices and raising livestock