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Effects of a Depression Education Program on Residents’ Knowledge, Attitudes, and Clinical Skills

From the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California; Division of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; Department of Obstetrics and Gynecology, Kaiser Permanente Medical Center, San Francisco, California; Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; and Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, Oregon.

Address reprint requests to: Lee A. Learman, MD, PhD, San Francisco General Hospital, Department of Obstetrics and Gynecology, 1001 Potrero Street, Room 6D-9, San Francisco, CA 94110; E-mail: learmanl{at}obgyn.ucsf.edu.

OBJECTIVE: To determine whether an interactive educational program would improve obstetrics and gynecology residents’ knowledge, attitudes, confidence, and skills in caring for depressed patients.

METHODS: We recruited 74 residents from eight residency programs to attend the Depression Education Program, which consists of a 1-hour lecture and two 2-hour workshops combining discussion, diagnosis and treatment tools, critique of a videotape, practice with feedback, and audio-tape self-assessment. Before and after the program, participants 1) completed a questionnaire measuring knowledge, attitudes, and reported actions taken with a recent depressed patient; 2) received a standardized patient visit; and 3) kept lists of patients they suspected were depressed. Clinic patients completed a depression screening questionnaire. To assess improvement, we used paired t tests, Mc-Nemar ² tests, and multivariate models adjusting for training site.

RESULTS: The education program led to 3-month improvements in participants’ reported use of formal diagnostic criteria (38% before, 66% after; P = .004), clinical actions documented for suspected depression (P = .035), and perceived self-efficacy in depression care (P < .001). Perceived preparedness to diagnose depression, treat with medications, and comanage with a mental health practitioner improved (P < .05 for each). Small improvements in clinical behaviors with standardized patients and clinic-based depression detection rates were not statistically significant.

CONCLUSION: The Depression Education Program improved residents’ knowledge, confidence, and reported clinical actions with depressed patients, but did not improve most objectively assessed outcomes.

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