ANNUAL FEATURE: IN PROGRESS: REPORTS OF NEW APPROACHES IN MEDICAL EDUCATION: CURRICULUM: Clinical Science Education
Objective: To design and evaluate the effectiveness of a curriculum on depression for third-year medical students in a required four-week internal medicine primary care clerkship.
Description: Depression is often not recognized and when recognized is often inadequately treated. Under-recognition occurs for a variety of reasons. Many depressed patients present with one or multiple somatic complaints. Associated cofactors such as alcohol abuse or a history of childhood sexual abuse often go unrecognized. Depression in the elderly may be diagnosed as dementia. Adolescent depression often manifests itself as poor school performance or as an eating disorder. Therefore, depression is emphasized in our new curriculum, which is being introduced in the fall of 2001.
The instruction format is based on a four-hour workshop using four standardized patient (SP) cases. Each SP case depicts an important aspect of depression, including adolescent and geriatric issues. Examples of these cases are a 15-year-old boy with poor school grades who presents because “my mother made me come,” a 30-year-old woman complaining of headaches who was sexually abused as a child, and a 65-year-old man with insomnia and fatigue. Each of eight students individually rotates through the four SP stations. A faculty member facilitates a discussion on depression based on the SP cases, using an Instructor Depression Reference. The students are provided a Student Depression Guide for reference.
Depression is one of the seven topics taught during the year. Because of time constraints, only four of the seven topics are taught in the workshop format each rotation: Preventive Medicine and Screening and three of the other six topics. Thus we are able to evaluate the effectiveness of the Depression Workshop and of five of the other workshops. The remaining three and one half weeks of the clerkship are spent at various clinical sites.
Evaluation will consist of a 100-item multiple-choice test (30% of final grade), preceptor's evaluations (40%), the clerkship director's critique of chart notes (10%), and an eight-station SP examination (20%). Six to eight of the 100 questions are about depression. The SP examination includes one depression case that is different from the four SP cases used in the workshop. Summative evaluation of the Depression Workshop includes comparing the performance on the SP exam of students who have participated in the workshop (50% of the students) with that of those who have not done so. Higher scores by the participating students would suggest that the workshop teaches skills beyond those gained from clinical experiences or assigned reading. Similarly, performances on the examination questions on depression will be compared to assess knowledge gain.
Discussion: It is essential that we develop and implement an effective curriculum that teaches medical students the knowledge and clinical skills to care for patients with depression. The SP workshop on depression is a way to assure that all students who participate in the workshop receive similar clinical instruction. The design of the evaluation will provide a means to assess the workshop's effectiveness and provide opportunities to modify the curriculum.
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