OPEN ACCESSMarch 2, 2015

Scott Green: Depression after a Heart Attack


    This standardized patient case and workshop was developed as part of a small-group curriculum for preclinical medical students. The session is intended to be used with preclinical or early clinical learners to give students practice obtaining a chronic disease history while simultaneously recognizing and treating depression after a myocardial infarction. Depression is an under-recognized medical condition after a patient experiences a myocardial infarction. Practitioners often mistakenly overlook depression as a “normal response” after myocardial infarction. Evidence suggests that patients who are depressed after having a myocardial infarction suffer worse outcomes. Specifically, depressed patients postmyocardial infarction experience more social problems over the first year, are slower to return to work, and report more stress than their non-depressed counterparts. Additionally, depressed patients after myocardial infarction are at increased risk for subsequent cardiac events, including reinfarction and rehospitalization, compared with those without depression. This standardized patient case and workshop provide an active learning environment using a standardized patient to teach about depression in the setting of chronic cardiovascular disease. Students practice a patient-centered approach to taking a history with a focus on hospital follow-up and the impact of a chronic disease on psychological functioning. Although our evaluation data is limited to student and facilitator feedback, students are expected to demonstrate the patient care and communication skills utilized in this workshop during an observed structured clinical encounter.

    Educational Objectives

    By the end of this case, learners will be able to:

    1. Utilize a patient-centered interviewing approach in a patient with chronic heart disease.

    2. Practice the collection of a relevant history in a patient with chronic heart disease.

    3. Discuss the impact of disease on a patient's psychological and behavioral functioning.

    4. Counsel a patient on the comorbid conditions of depressed mood.