New way to educate doctors on recognizing and treating depression

An international team of educational researchers, including CAMH’s Dr. Sagar Parikh, has recently published the findings of a major randomized controlled trial to test a new way to educate doctors on recognizing and treating depression.  The study, published in a series of articles in the journal Family Practice in 2008 and in press in the Canadian Journal of Psychiatry, involved scientists from Iran, Sweden, and Finland.  The results show striking benefits to tailoring education for doctors on depression by using a specialized theory of how doctors learn.

Family physicians in Iran, like their Canadian colleagues, frequently treat depression but are faced many challenges.  Both recognition of the illness, and its treatment, are inadequate amongst physicians in Iran.  Continuing medical education (CME, accredited and standardized educational activities) is one method used to enhance physicians’ skill, and CME is compulsory in Iran. But this education method has largely failed to improve professional practice and patients’ health, and there is no formal CME course for depression in Iran.  This has created a need to increase the knowledge and skills of family physicians around diagnosing and treating depression.

In an earlier study Dr. Parikh explained that even sophisticated CME formats used with capable learners are not enough to change a physician’s performance, in part because the learner is not ready to change.  In this new study, the first known of its kind, Dr. Parikh worked with an international group of educational researchers and psychiatrists to determine if tailored education formats impacted physicians’ readiness to change their medical behaviour (i.e. performance).

Using an original theoretical model of how doctors learn -- the Modified Prochaska Questionnaire (MPQ) that identified three stages of behavioural change, attitude, intention and action, developed in part by Dr. Parikh -- the research team identified which stage of change participating physicians were in. They were then grouped according to their identified stage and randomly assigned to either the intervention group or the control group.  The control group received standard CME.  However, in the intervention group participants were matched to a method of learning that fit their needs, based on the results from MPQ.   For example, participants in the attitude stage were identified as having an awareness of the problem (i.e. benefits of effective diagnosis and treatment of depression) but had no commitment to take action.  The desired outcome for this group, which would allow them to move to the next stage of change, was improved understanding of diagnosing depression.  Therefore physicians in this group participated in interactive education methods such as lectures, videos and discussions focused on diagnosing depression.

This randomized control trial involving 192 family physicians revealed that significantly more participants in the intervention group (59 percent) moved to a higher stage of readiness to change, compared to just 12 percent in the control group.   These results support the assumption that educational formats tailored to different stages of learning can help family physicians not only become more aware of problems, but also motivate them to learn more on a given subject and change their behaviour. In the case of this study, the desired change ultimately is starting to use better methods to diagnose and treat depression.

This model could be used to enhance CME programs in Iran, and is may be applicable to physicians in other parts of the world.  This enhanced education may help people living with depression receive better care and treatment for their illness.

In recognition of his work on this project, Dr. Parikh received the 2008 Dave Davis Continuing Education & Professional Development Research Award from the University of Toronto.  This award recognizes an outstanding completed research project in continuing education and professional development in the Faculty of Medicine.

 

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