Resident Training Curriculum in Adolescent Depression and Suicide Screening

Routine screening of adolescents for depression and suicide risk is now considered best clinical practice. However, due to a lack of training, many physicians do not engage in screening. The goal of this curriculum is to improve learner knowledge of and comfort in adolescent depression and suicide risk assessment and management. This curriculum was designed for use with pediatric and internal medicine–pediatric residents during their adolescent medicine rotation but could easily be adapted for use with other learners in different settings. The didactic session typically takes 60-90 minutes to complete. In addition to a teaching PowerPoint that provides instruction in both the assessment and management of adolescent depression and suicide risk, the curriculum also includes a suicide assessment and management protocol. This protocol outlines an algorithm that assists in distinguishing between individuals at high and low risk of suicide. The algorithm enables clinicians to determine the most appropriate management plan based on the assessed level of suicide risk. Outcome measures indicate that the majority of residents improved their self-perceived knowledge and comfort in assessing and managing depression and suicide risk, with an average of 61.7% of residents moving from the novice to the proficient group at the conclusion of the rotation. These results reflect learners obtaining 4 weeks of supervised clinical experience after the didactic session. Please see the end of the Educational Summary Report for author-supplied information and links to peer-reviewed digital content associated with this publication. Introduction With the lifetime prevalence of a depressive disorder for adolescents through age 18 estimated to be as high as 20%1 and suicide being the second leading cause of death in the United States for individuals aged 15-24,2 screening for these conditions has become a highly recommended best clinical practice.3-5 In 2009 the US Preventive Services Task Force issued a recommendation that adolescents aged 12-18 seen in primary care medical settings complete a universal screening for major depressive disorder.6 The American Academy of Pediatrics recently extended the recommended screening ages to 11-21.4 Despite the pervasiveness of adolescent depression and suicide and the strong recommendation to screen for these conditions, many physicians do not engage in screening due to a self-reported lack of confidence, skills, and knowledge,7 as well as lack of orientation to psychosocial aspects of medical care.8 In a systematic review, Zuckerbrot and Jensen concluded that most physicians do not systematically screen for depression and that the recognition of adolescent depression in primary care would greatly improve with physician training and consistent use of depression rating scales.9 A recent survey of pediatric residency program directors indicated a general lack of focus on mental health training in pediatric residency programs, resulting in resident knowledge and skill deficits10 and, ultimately, substandard patient care. This curriculum was created in response to these empirically identified needs. The curriculum has been taught for the past 3 years to pediatric and internal medicine–pediatric residents during their adolescent medicine rotation at a large midwestern medical school. It consists of a 60to 90-minute didactic session followed by supervised clinical practice during the 4-week rotation. The overall goal of the curriculum is to improve learner knowledge and comfort in adolescent depression and suicide assessment and management. Stanley A, Chelvakumar G, Cody P, et al. Resident training curriculum in adolescent depression and suicide screening. MedEdPORTAL Publications. 2016;12:10361. http://dx.doi.org/10.15766/mep_2374-8265.10361 Published: March 21, 2016