Family Medicine Clerkship

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Depression

OVERVIEW

One in four people will experience depression over his/her lifetime. Family physicians frequently encounter patients presenting with symptoms of depression. Family physicians must make the initial diagnosis and manage patients with depression. They must manage the pharmacotherapy, perform counseling, and know when to refer. They need to collaborate appropriately with psychologists, therapists, and other health professionals to manage this disease and must understand depression as a component of other acute and chronic diseases.

TOPIC LEARNING GOALS AND OBJECTIVES

  (Organized by ACGME Competencies)

Patient Care

GOAL: Students will accurately assess signs and symptoms of depression.

OBJECTIVES: Students will be able to:

• Perform a focused history to elicit signs and symptoms of depression.
• Rule out other causes of symptoms of depression, such as hypothyroidism, using history, physical examination, and laboratory testing.
• Screen for depression in patients with chronic illnesses that place the patient at higher risk for developing major depressive disorder.
• Describe the role of a family physician in management of depression.

GOAL: Students will appropriately discuss depression with patients.

OBJECTIVES: Students will be able to:

• Conduct a patient-centered discussion to help the patient understand the signs and symptoms of depression.
• Convey to patients the treatment options and goals of treatment, including pharmacotherapy and counseling.
• Assess risk of suicide and contract for patient safety.
• Anticipate patient resistance to treatment, including beliefs about medication use and counseling.

GOAL: Students will be sensitive to individual and cultural differences in their development of treatment plans.

OBJECTIVES: Students will be able to:

• Elicit cultural and family perspective on mental health diagnosis and treatment.
• Discuss with patients and families the environmental and lifestyle issues related to depression, including stress, alcohol use, and family support.
• Develop treatment plans in the context of each patient's life and environment.

Medical Knowledge

GOAL: Students will understand the significance of depression in health promotion and disease prevention.

OBJECTIVES: Students will be able to:

• Discuss the epidemiology of depression, including racial, gender, and socioeconomic status differences.
• Discuss USPSTF guidelines for screening for depression.

GOAL: Students will understand the pathophysiology and risks of untreated depression.

OBJECTIVES: Students will be able to:

• Describe diagnostic criteria for depression.
• Discuss and defend the initial evaluation of a patient with a new diagnosis of depression.
• Discuss the neurological and biochemical causes of depression.
• Describe the risks of untreated depression, including suicide, family instability, and economic hardship.

GOAL: Students will understand the rationale for treatment plans for depression.

OBJECTIVES: Students will be able to:

• Describe the appropriate therapy for depression.
• Discuss the evidence for the role of lifestyle changes, especially regular exercise, decreased alcohol and drug use, relaxation techniques, stress management.
• Discuss the pharmacological mechanism of action and efficacy, side effects, and cost effectiveness of commonly used medications.

Practice-Based Learning and Improvement

GOAL: Students will understand the role of screening for depression in practice and community settings.

OBJECTIVES: Students will be able to:

• Analyze how the assigned clerkship site monitors management of depression, including such factors as appropriate use of pharmacotherapy, appropriate follow-up time, and use of contract for patient safety.
• Consider the impact of family, environment, and community on adherence to treatment plans and lifestyle changes.
• Describe the comorbidities of depression and how these dual diagnoses are monitored in clerkship site.

GOAL: Students will bring best current evidence to the point of clinical care.

OBJECTIVES: Students will be able to:

• Identify gaps in their own knowledge and frame appropriate clinical questions regarding depression.
• Use best evidence to answer clinical questions about depression.

Interpersonal and Communication Skills

GOAL: Students will understand the importance of effective communication with patients and families in the management of depression.

OBJECTIVES: Students will be able to:

• Discuss the initial diagnosis of depression with the patient and family (as appropriate).
• Develop long-term treatment plans for patients with depression.
• Include patients and families, as appropriate, in the development of treatment plans.
• Demonstrate effective listening skills and empathy to improve diagnosis and management of depression.
• Recognize nonverbal cues as signs of depression.

Professionalism

GOAL: Students will demonstrate the ability to care for patients with depression from diverse backgrounds and at different points in their illness.

OBJECTIVES: Students will be able to:

• Demonstrate sensitivity and responsiveness with patients who are not adhering to treatment plans.
• Reflect on personal frustrations when patients are not adherent to plans or not improving.
• Demonstrate understanding of the relationship of depression to culture, age, gender, and disabilities.
• Give examples of situations that dictate violation of patient information confidentiality in the care of patients with mental illness, such as depression.

Systems-Based Practice

GOAL: Students will understand the impact of health care systems and environment on the management of depression.

OBJECTIVES: Students will be able to:

• Describe cost-effective strategies for treatment of depression using different formularies and modalities.
• Analyze barriers to effective integrated treatment of depression.
• Imagine care plans that would highlight collaboration with behavioral scientists, pharmacologists, therapists, social workers, and community agency representatives in the effective treatment of depression.

EDUCATIONAL METHODS AND RESOURCES

Published Material

• DSM IV
  
• Giving Patients Hope: Ending Depression. Monograph. AAFP.
  Order DVD or VHS

Web Sites

• National Institute for Mental Health (NIMH)
  http://www.nimh.nih.gov
  
• American Psychiatric Association
  http://www.psych.org
  
• National Mental Health Association
  http://www.nmha.org
  
• National Foundation for Depressive Illness
  http://www.depression.org

Contact People

• STFM Group on Behavioral Science
  The Group on Behavioral Science serves as a forum for the discussion, collaboration, and communication on issues relevant to behavioral sciences within family medicine. The group is most interested in promoting the integration of behavioral science teaching within the total curriculum of family medicine education. Currently, the group is focused on developing a document that will outline behavioral science objectives and effective methods for teaching these concepts.

ASSESSMENT STRATEGIES

Standardized Patient Cases

• Adolescent patient with depression case, Doctoring course, UCLA
  
• Adult patient with depression case, UT San Antonio
  
• Case, Contact: Caryl Heaton, DO

General Assessment Strategies

• ACGME toolbox

Lead Author: Lauren Oshman, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales, PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton, DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD, Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore, MD, Richard Usatine, MD

Family Medicine Curriculum Resource (FMCR) Project HRSA Contract 240-00-0107.

For questions or comments, please contact Webmaster or Ardis Davis

This page last updated November 6, 2004