Comparison of traditional didactic seminar to high-fidelity simulation for teaching electroconvulsive therapy technique to psychiatry trainees

Abstract

Objectives: Traditional training of electroconvulsive therapy (ECT) consists of a combination of didactic and hands-on demonstrations using ECT equipment. Our goal was to explore the potential of a high-fidelity patient simulator (HPS) to train these skills. To our knowledge, this is the first time an HPS has been used for skills training in psychiatry.

Methods: Nineteen psychiatry residents participated in this randomized controlled trial to compare traditional training (n = 9) versus training using an HPS (n = 10). Two blinded raters assessed performance using a newly developed checklist and global rating scale for this task (ECT-OSATS) (Objective Structured Assessment of Technical Skills). Residents also completed a pretest-posttest knowledge test and confidence survey.

Results: Residents in the HPS group performed significantly better in terms of ECT-OSATS when compared with the control group (P < 0.001). All 10 of the HPS group received a "pass" rating following training, whereas only 1 of the 9 control group received a "pass" rating. There were no significant group differences in posttest confidence (P = 0.21) or total knowledge gain scores from pretest to posttest (P = 0.36).

Conclusions: The level of clinical skill acquired by trainees in psychiatry for performing ECT is significantly superior using HPS- based training, in contrast to the domains of knowledge and confidence, which appear to be equally imparted using either training modality. The acquisition of skills in administering ECT seems to be an independent variable in relation to a clinician's level of knowledge and confidence in performing ECT.