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Electroconvulsive therapy: medical students' attitudes and knowledge

  • Daniel Kinnair (a1), Sheila Dawson (a1) and Roshan Perera (a1)
Abstract
Aims and method

With increasing numbers of students and falling numbers of individuals receiving electroconvulsive therapy (ECT) it has been difficult to timetable all students to witness ECT, and it has been suggested that this experience may be dispensed with. However, we wondered how the experience of witnessing ECT might enhance students' knowledge and, just as importantly, challenge negative perceptions of ECT. We surveyed students' attitudes and knowledge at the beginning and the end of their 8-week attachment in psychiatry.

Results

There appears to be a clear benefit in terms of knowledge and positive attitudinal change for students who both witness ECT and receive a lecture on the subject.

Clinical implications

Direct observation of ECT can challenge and affect attitudes in ways a lecture may not. Any changes to the provision of ECT teaching for medical students, including replacing witnessing ECT, needs to be carefully developed and assessed.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Daniel Kinnair (Daniel.Kinnair@leicspart.nhs.uk)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Benbow, SM. Patients' views on electroconvulsive therapy on completion of a course of treatment. Convuls Ther 1988; 4: 146–52.
2 Rose, DS, Wykes, TH, Bindman, JP, Fleischmann, PS. Information, consent and perceived coercion: patients' perspectives on electroconvulsive therapy. Br J Psychiatry 2005; 186: 54–9.
3 Benbow, SM. Medical students and electroconvulsive therapy: their knowledge and attitudes. Convuls Ther 1990; 6: 32–7.
4 Clothier, JL, Freeman, T, Snow, L. Medical students attitudes and knowledge about ECT. J ECT 2001; 17: 99101.
5 Papakosta, VM, Zervas, IM, Pehlivanidis, A, Papadimitriou, GN, Papakostas, YG. A survey of the attitudes of Greek medical students towards ECT. J ECT 2005; 21: 162–4.
6 Poster, E, Baxter, LR, Hammon, CL. Nursing students' perception of electroconvulsive therapy: impact of instruction with an electroconvulsive therapy videotape. Convuls Ther 1985; 1: 277–82.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Electroconvulsive therapy: medical students' attitudes and knowledge

  • Daniel Kinnair (a1), Sheila Dawson (a1) and Roshan Perera (a1)
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eLetters

Attitudes to ECT � a nebulous concept with important implications

Schalk W. du Toit, Specialty Registrar ST6 General Adult Psychiatry
08 March 2010

The study by Kinnair et al raises some important points to consider with regards to training and teaching students on ECT. Some of the questions used, particularly in assessing students’ attitudes to ECT, havebeen used in similar studies (1), (2) and would therefore carry some face validity. Clearly it is important to consider the sequence of teaching events in any instructional design of a teaching block, however I would disagree with some of the authors’ conclusions. With such a descriptive study design, the use of binary variables (yes/no answers) and the absenceof P-values, one cannot infer any significant differences between Groups A, B, C and D with regards to changes in knowledge of ECT. The relative smaller sample sizes of these groups compared with the baseline sample size, would make a Type I error more likely, i.e. any differences seen could be due to a chance-effect.

Intuitively, one would expect either Group B or C doing better with their follow-up knowledge questions, simply based on constructivism theories (i.e. building on previously attained knowledge). In Group B a certain amount of knowledge will be acquired from simply watching an ECT procedure. The authors did not state how soon after the lecture and/or witnessed ECT event, students were asked to complete the questionnaire. One cannot therefore assume a limited benefit (in terms of knowledge obtained) from watching ECT before receiving a lecture, as this could equally be due to having the lecture closer to the questionnaire.

I find the absence of any tables to explain the results of their attitudes questions, somewhat disappointing. Previous research in this area has shown that medical students’ attitudes to ECT can be improved by receiving a didactic lecture on ECT (3), as well as observing an ECT application (either live or a pre-recorded video) (4), so it is not surprising that Group B showed improved attitudes on two of the questions compared to Group D. It would have been interesting to know how many of those students who had seen either One Flew over the Cuckoo’s Nest or Beautiful Mind belonged to Groups A or D, which could explain the different response with regards to question 10 – “I would agree to have ECT if I was depressed”.

Better knowledge of ECT, particularly self-perceived knowledge, does not necessarily imply better attitudes to ECT (5). If we want to attract more students to our profession, further research in this area is essential to help unveil some of the secrets behind students’ negative perceptions, attitudes and prejudices with regards to ECT.

Declaration of interest: None

References:

(1)Clothier JL, Freeman T, Snow L. Medical student attitudes and knowledge about ECT. J.ECT 2001 Jun; 17(2):99-101

(2)Abbas M, Mashrai N, Mohanna M. Knowledge of and attitudes toward electroconvulsive therapy of medical students in the United kingdom, Egypt, and Iraq: a transcultural perspective. J.ECT 2007 Dec; 23(4):260-264.

(3)Papakosta VM, Zervas IM, Pehlivanidis A, Papadimitriou GN, Papakostas YG. A survey of the attitudes of Greek medical students toward electroconvulsive therapy. J.ECT 2005 Sep;21(3):162-164.

(4)Warnell RL, Duk AD, Christison GW, Haviland MG. Teaching electroconvulsive therapy to medical students: effects of instructional method on knowledge and attitudes. Acad.Psychiatry. 2005 Nov-Dec; 29(5):433-436.

(5)Gazdag G, Kocsis-Ficzere N, Tolna J. Hungarian medical students' knowledge about and attitudes toward electroconvulsive therapy. J.ECT 2005Jun; 21(2):96-99.
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Conflict of interest: None Declared

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