Attitudes to ECT – a nebulous concept with important implications

Kinnair et al ¹ raise some important points regarding training and teaching students on electroconvulsive therapy (ECT). Some of the questions used, particularly in assessing students' attitudes to ECT, have been used in similar studies ^2,3 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 absence of P-values, one cannot infer any significant differences between Groups A, B, C and D with regard to changes in knowledge of ECT. The relatively smaller sample sizes of these groups compared with the baseline sample would make a Type I error more likely, that is any differences seen could be due to chance.

Intuitively, one would expect either Group B or C to do better with their follow-up knowledge questions, simply based on constructivist theory (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, ⁴ as well as observing an ECT application (either live or a pre-recorded video), ⁵ so it is not surprising that Group B showed improved attitudes on two of the questions compared with 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 regard 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. ⁶ 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 regard to ECT.