Addressing a Shocking Omission: Development of an ECT Skeleton Curriculum for Adult Psychiatry Residency Programs
DOI: Pending DOI
Synopsis
Electroconvulsive therapy (ECT) is one of the most effective psychiatric treatments, but inclusion in psychiatry residency training is highly variable. The International Society for ECT and Neurostimulation convened a Subcommittee for Curriculum Development, with members ranging from current psychiatry residents to senior experts in the field. A “Skeleton Curriculum” draft was developed, with twin goals to establish Minimum Standards for ECT residency education and to build a Repository of content for easy implementation by residencies. Partnerships were cultivated with organizations focused on neuromodulation education to ensure consistency and avoid redundancy. Next steps include development of lectures for the Repository, in consultation with residency program stakeholders.
Background
Electroconvulsive therapy (ECT) remains one of the most effective treatments in psychiatry, serving as the gold standard of treatment for major depression and catatonia and with established efficacy in management of bipolar disorder and primary psychotic disorders [1]. Yet, ECT access in the US remains limited, with only 10% of hospitals offering this treatment, with substantial regional variability [2]. This may in part relate to gaps in ECT training. Guidelines only require residents to demonstrate knowledge of “indications for and uses of electroconvulsive and neuromodulation therapies,” with no other training requirements specified [3]. Psychiatry residency programs can vary significantly in their ECT exposures, from a single didactic lecture to required residency rotations with additional elective track offerings in neuromodulation. It is unsurprising that a survey of US ECT providers found 30% had trained in the same 12 residency programs [4].
Limitations in ECT residency training and ECT clinical availability form a “domino effect,” where absence of clinical ECT providers limit comprehensiveness of residency training, perpetuating limitations in ECT providers and clinical ECT services. Offering a structured guideline with expert resources for ECT education could help break this cycle.
Methods
The Education Committee of the International Society for ECT and Neurostimulation (ISEN) proposed the development of a Residency “Skeleton Curriculum,” an outline of minimum standards for didactic topics and clinical exposures related to ECT appropriate for inclusion by a residency training program, with a broader repository of resources for faculty to implement in their residency programs. Model open-source psychiatry curricula developed by the National Curriculum for Reproductive Psychiatry [5] and the National Neuroscience Curriculum Initiative [6] served as prototypes for the proposed ECT Skeleton Curriculum. Core principles for curriculum development were established, including incorporation of multiple perspectives; involvement of trainee, clinician, and educator stakeholders; and open access with emphasis on easy implementation at a residency program level.
Results
Initial targets for training were informed by the recommendations of the American Psychiatric Association’s Task Force Report on ECT1 and integrated insights from existing curricula for ECT from multiple US residency programs. A prepared draft was reviewed with the ISEN Education Committee, and a Curriculum Subcommittee was spun off to further develop the curriculum outline. Subcommittee members were recruited to include members at diverse stages of practice, from residents through senior ECT practitioners, while also including colleagues from other disciplines. Partnerships were established with other organizations developing curricula for brain stimulation including the Interventional Psychiatry Consortium [7] and the Brain Stimulation Society (BraSS) [8] to share resources and promote alignment in educational goals.
The Subcommittee co-chairs met to review the drafted Skeleton Curriculum, dividing it into a Minimum Standards outline and an Advanced ECT Focus Track outline. Initial meetings with the Subcommittee focused on developing consensus for the Minimum Standards outline and assigning lecture topics to develop. Interventional Psychiatry Consortium and BraSS were engaged to review the Minimum Standards outline.
Discussion
Over the last year, representatives from ISEN’s Education Committee have drafted and reviewed a curriculum of ECT-related topics intended for psychiatry residency programs, convened a group to refine curriculum goals and develop content for dissemination, and established partnerships with other organizations working on education in the interventional psychiatry space. Intended next steps include finalization of the curriculum structure and building a repository of lectures and videos for each curriculum topic, as well as collaboration with residency stakeholders in the American Association of Directors of Psychiatry Residency Training (AADPRT) to promote feasibility of implementation at the residency level.
Disclosures
None of the listed authors have relevant disclosures.
References
1. American Psychiatric Association, ed. The Practice of Electroconvulsive Therapy: Recommendations for Treatment, Training, and Privileging. Third edition. American Psychiatric Association; 2025.
2. Case BG, Bertollo DN, Laska EM, et al. Declining Use of Electroconvulsive Therapy in United States General Hospitals. Biological Psychiatry. 2013;73(2):119-126. doi:10.1016/j.biopsych.2012.09.005
3. ACGME Program Requirements for Graduate Medical Education in Psychiatry. 2026. https://www.acgme.org/globalassets/pfassets/programrequirements/2026-prs/400_psychiatry_2026.pdf
4. Wilkinson ST, Kitay BM, Harper A, et al. Barriers to the Implementation of Electroconvulsive Therapy (ECT): Results From a Nationwide Survey of ECT Practitioners. PS. 2021;72(7):752-757. doi:10.1176/appi.ps.202000387
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