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Comparison of Traditional Didactic Seminar to High-Fidelity Simulation for Teaching Electroconvulsive Therapy Technique to Psychiatry Trainees

Rabheru, Kiran MD, CCFP, FRCPC, DABPN*†; Wiens, Andrew MD, BMedSc*‡§; Ramprasad, Bismil MBBS, MD*†; Bourgon, Luc MD*†; Antochi, Ruxandra MD*†; Hamstra, Stanley J. PhD§∥¶

doi: 10.1097/YCT.0b013e318290f9fb
Original Studies

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.

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From the *Department of Psychiatry, University of Ottawa; †Department of Psychiatry, The Ottawa Hospital; ‡Royal Ottawa Mental Health Centre; §University of Ottawa Skills and Simulation Centre; ∥Departments of Medicine, Surgery, and Anesthesia, University of Ottawa; and ¶Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Received for publication December 13, 2012; accepted March 4, 2013.

Reprints: Kiran Rabheru, MD, CCFP, FRCPC, DABPN, Geriatric Psychiatry & ECT Service, The Ottawa Hospital, 501 Smyth St, Ottawa, Ontario, Canada K1H 8L6 (e-mail:

This work was awarded Best Oral Presentation at the Academy for Innovation in Medical Education annual research day, Ottawa, Ontario, Canada, March 23, 2012.

Dr Rabheru is on the advisory board for Astra Zeneca, Lundbeck, and Bristol Meyers and has received honoraria for speaking for those companies. Dr Hamstra has received honoraria for speaking for Laerdal. For the remaining authors, no conflicts of interest were declared.

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© 2013 by Lippincott Williams & Wilkins