Psychiatric Residency Education in ECT Lacking: New Study From Canada
Senior Residents' Perceived Competence in Evidence-Based Treatments for Major Depressive Disorder.
Acad Psychiatry. 2022 Mar 4. doi: 10.1007/s40596-022-01605-4. Online ahead of print. PMID: 35246813
The abstract is copied below:Objective: The current study aims to assess the self-reported competence of graduating psychiatry residents in Canada to provide pharmacotherapy and psychotherapy for major depressive disorder as recommended in national practice guidelines.
Methods: Canadian psychiatry residents who participated in an optional national review course to prepare for licensing were anonymously surveyed regarding their experience and competence in providing treatments recommended by the 2016 Canadian Network for Mood and Anxiety Treatments guidelines.
Results: The majority (89%, 130/146) reported competence in ≥ 5 medication monotherapies (e.g., selective serotonin/norepinephrine reuptake inhibitors, bupropion, mirtazapine) and ≥ 3 adjuncts (e.g., mirtazapine, second-generation antipsychotics). While 76% expressed interest in practicing multiple psychotherapeutic modalities, only 47% reported self-assessed competence in delivering multiple modalities. Only 42% reported pharmacological competence (≥ 5 monotherapies, ≥ 3 adjuncts) and competence in ≥ 2 psychotherapies. Only 9% reported competence in offering medication, psychotherapy, and electroconvulsive therapy. Less than two-thirds endorsed sufficient didactic teaching (58%) or supervision in pharmacotherapy (50%) for treatment-resistant depression.
Conclusions: Canadian psychiatry residents report competence in prescribing many first-line medications. However, only a minority report competence in prescribing medications and competence in psychotherapies and/or electroconvulsive therapy. Given known biases in assessments by self-report, real-world competence may be even lower. This study identifies gaps between national practice guidelines and the comfort of the emerging psychiatric workforce in delivering recommended treatments. These gaps in resident competence may lead to under-use of effective treatments for depression. Residency programs should consider how to improve resident competence in providing the full range of evidence-based treatments for depression.
Keywords: Clinical guidelines; Graduate medical education; Major depressive disorder; Pharmacotherapy; Psychotherapy.
Methods: Canadian psychiatry residents who participated in an optional national review course to prepare for licensing were anonymously surveyed regarding their experience and competence in providing treatments recommended by the 2016 Canadian Network for Mood and Anxiety Treatments guidelines.
Results: The majority (89%, 130/146) reported competence in ≥ 5 medication monotherapies (e.g., selective serotonin/norepinephrine reuptake inhibitors, bupropion, mirtazapine) and ≥ 3 adjuncts (e.g., mirtazapine, second-generation antipsychotics). While 76% expressed interest in practicing multiple psychotherapeutic modalities, only 47% reported self-assessed competence in delivering multiple modalities. Only 42% reported pharmacological competence (≥ 5 monotherapies, ≥ 3 adjuncts) and competence in ≥ 2 psychotherapies. Only 9% reported competence in offering medication, psychotherapy, and electroconvulsive therapy. Less than two-thirds endorsed sufficient didactic teaching (58%) or supervision in pharmacotherapy (50%) for treatment-resistant depression.
Conclusions: Canadian psychiatry residents report competence in prescribing many first-line medications. However, only a minority report competence in prescribing medications and competence in psychotherapies and/or electroconvulsive therapy. Given known biases in assessments by self-report, real-world competence may be even lower. This study identifies gaps between national practice guidelines and the comfort of the emerging psychiatric workforce in delivering recommended treatments. These gaps in resident competence may lead to under-use of effective treatments for depression. Residency programs should consider how to improve resident competence in providing the full range of evidence-based treatments for depression.
Keywords: Clinical guidelines; Graduate medical education; Major depressive disorder; Pharmacotherapy; Psychotherapy.
While the full text of this article is not yet available to me, I doubt the details will change the main point of blogging about this survey: psychiatric residency education in ECT is woefully lacking. These limited data are from Canada (big country, few people) but they are likely very similar in the US and many other countries. There is an urgent need to train the next generation of ECT providers, and train them comprehensively; I worry that so-called "interventional psychiatry" modules will give short shrift to ECT, which requires much more in-depth training than brain stimulation techniques.
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