Stigmatization towards electro convulsive therapy: Impact of practical teaching on medical and nursing students

BACKGROUND

This study explored the impact of theoretical and practical teaching on electro convulsive therapy (ECT) on medical and nursing students' stigmatizing attitudes towards ECT and representations of it.

METHOD

Fourth-year medical students and nursing students answered questions from the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and from the Mental Illness: Clinicians' Attitudes version 2 (MICA v2) scale. The questionnaires were completed before and after observing a 3-hour practical training session in the ECT unit. The endpoint was the impact of practical training as assessed by MICA and QuAKE scores. Multivariate analyses were used to explore the impact of practical training on MICA and QuAKE total scores.

RESULTS

Stigmatizing attitudes and representations of both medical and nursing students towards ECT were reduced after practical training (β=-4.43 [95% CI -6.15; -2.70] p=0.0001). The impact was greater in medical students (β=-8.03; 95% CI [-10.71; -5.43], P=0.0001) than in nursing students (β=-2.77; 95% CI [-4.98; to 0.44], P=0.02). Gender, psychiatric history in close persons, and having already followed a psychiatric/ECT course had no independent impact on stigmatizing attitudes towards ECT and representations of it.

CONCLUSION

Practical training in ECT should be given to all health professionals to improve access to it.

A Qualitative Exploration of Gaps and Challenges in Knowledge and Practices of Electroconvulsive Therapy by Key Personnel in Public and Private Mental Health Units in Kenya

Background: Evidence-based research for electroconvulsive therapy (ECT) practice in Kenya is scarce. This has seemingly stifled knowledge with regard to ECT practice among key personnel in the country. Research shows that evidence-based guidelines not only harmonize clinical practice in a certain region but also improve health outcomes and quality of clinical decisions made by key personnel. This study aimed at assessing knowledge and administration of ECT by key personnel in psychiatric units in Kenya. Method: This is a qualitative study targeting multiple stakeholders in mental health facilities. The study was undertaken in three counties: Nairobi, Nakuru and Eldoret. Snowballing sampling method was used to interview 33 targeted respondents who work in ECT departments or actively interacted with the procedure in both private and public facilities. Researcher-designed respondent profile questionnaire and interview guides focusing on knowledge, practice and barriers in delivery of ECT were used as tools. Data collected were transcribed from the audio recordings. Thematic and content analyses of these semi-structured interviews were carried out based on the patterns that were noted across the data collected. The interviews were read by the research team and re-read to highlight the core ideas. Findings were presented in form of themes, which were illustrated along with representative verbatim quotations. Results: Overall, the key personnel were knowledgeable about ECT in different stages of the procedure, but we noticed methodological incongruence in their practice with regard to the pre-ECT preparation, stimulus dose calculation adequacy of seizure and in the procedure for dose adjustment of psychotropic medication before and after ECT sessions. The identified barriers to the uptake of evidence-based practice were lack of infrastructure, inadequate funding, lack of adequate training and negative perception by patients, relatives and even some participants. Conclusion: Though key personnel in this study showed that they had knowledge on ECT administration, lack of standard guidelines on ECT practice led to lack of standardized training on the procedure hence the methodological incongruence. Inadequate infrastructure, knowledge and negative perception towards the procedure seemed to interfere with uptake of ECT as an intervention. Recommendations: The study makes the following recommendations: adoption of a guideline by psychiatrists, intense training on ECT, specialized training for nurses in ECT and dose calculation for psychiatrists and registrars. Funding should be made available for new ECT machines. Lastly, education and awareness creation should be done about ECT to help deal with negative perception towards the intervention.

Effectiveness of an Educational Intervention on Medical Students' Knowledge About and Attitude Towards Electroconvulsive Therapy

OBJECTIVE

This study was done to determine the effectiveness of a lecture and exposure to electroconvulsive therapy (ECT) followed by interaction with patient, on medical students' knowledge about and attitude towards electroconvulsive therapy.

METHODS

A questionnaire was administered to second year medical students to determine their baseline knowledge about and attitude towards electroconvulsive therapy. Following this, they underwent two educational interventions, a lecture on ECT and exposure to the procedure and interaction with the patient and relative, and their knowledge and attitude were reassessed after each intervention using the same questionnaire.

RESULTS

Eighty-one students completed all the three assessments. Students' knowledge about ECT at baseline was minimal (mean 3.58 out of 12). Their knowledge increased significantly after the lecture (mean 10.3), and there was further increase following exposure to the procedure and subsequent interaction with the patient and relative (mean 11.1). At baseline, students had an overall negative attitude towards ECT. There was significant improvement on all attitude items following the lecture. Exposure to the procedure resulted in further improvement in attitude regarding whether ECT is a cruel treatment and has to be used as a last resort.

CONCLUSIONS

Exposure to ECT in lecture and clinical scenarios followed by interaction with the patient should be included in the undergraduate medical curriculum to improve students' knowledge and attitude about this safe, effective, and potentially lifesaving treatment modality.