• Colleen Lewy, C Wayne Sells, Jennifer Gilhooly, and Robert McKelvey.
• Psychiatry at Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., GH249, Portland, OR 97239-3098, USA. lewyc@ohsu.edu
• Acad Psychiatry. 2009 Sep 1; 33 (5): 389-93.

ObjectiveThe authors aim to determine whether pediatric residents used DSM-IV criteria to diagnose major depressive disorder and how this related to residents' confidence in diagnosis and treatment skills before and after clinical training with depressed adolescents.MethodsPediatric residents evaluated two different standardized patients portraying major depressive disorder before and after learning about adolescent depression. Residents' interactions with standardized patients were observed, and checklists containing DSM-IV criteria for major depressive disorder and other pertinent information, such as comorbidities, were completed for each interaction. After the encounter, residents completed a survey asking about the "patient's" diagnosis and the residents' confidence in their clinical skills.ResultsResidents assessed significantly more checklist items in the second encounter with a standardized patient. Residents' confidence in treatment was significantly higher after the rotation, while confidence in diagnostic skills was unchanged, remaining high. Even after the rotation, residents did not use all DSM-IV criteria for major depressive disorder in their diagnoses.ConclusionMajor depressive disorder is a common adolescent psychiatric disorder. Pediatricians must be equipped with appropriate interpersonal and diagnostic skills to detect this and other psychiatric disorders. Standardized patients represent one useful way to teach and assess these skills. This study suggests that residents' interpersonal and diagnostic skills can improve with practice. Although resident scores improved, post-encounter checklists showed that residents were still not asking all the necessary questions for a DSM-IV diagnosis, concluding prematurely that the standardized patients had major depressive disorder before satisfying all diagnostic criteria. The majority did not consider other depressive conditions or comorbid disorders.

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