Anesthesiological training and certification for psychiatrists practising unmodified ECT

Sir,

In response to the joint position statement and guideline on the practice of unmodified ECT that was issued by the Indian Association of Private Psychiatry, the Indian Psychiatric Society, and the Indian Association of Biological Psychiatry,[1] Kellner et al.,[2] propose that practitioners of unmodified ECT be trained and certified in the procedures related to the administration of anesthesia to uncomplicated cases, and in the management of crises should these arise. This proposal is laudable, in principle. In practice, two important questions arise: Who will provide the certification, and would the certification be considered valid in a court of law.

With regard to the first question, it is possible for a medical institution or a psychiatric association to conduct workshops that provide the necessary training. The institution or association could afterwards certify that the participants attended the workshops and, perhaps, demonstrated the practical skills required for the administration of anesthesia to uncomplicated cases taken up for ECT. An important caveat, however, is that it may not be possible to learn intubation skills in such a workshop, and this may limit the value of such a workshop.

With regard to the second question, there is no assurance that a court of law would consider such training adequate should a medicolegal situation arise. Given that at least two years of training in anesthesia are required to lead to a degree in anesthesia, a court may deem two days of training insufficient for competence in the context of ECT even though, decades earlier, psychiatrists had themselves regularly administered short-term anesthesia for ECT.[3]

Which is better: A suboptimal form of ECT or an optimal form of ECT associated with potentially suboptimal anesthesiological practice? The experience of decades suggests the latter.[1,3] Whereas the Medical Council of India will not recognize the short-term training and certification suggested by Kellner et al.,[2] some statutory support for such certification could be obtained if national psychiatric associations were to endorse it, much as was done for the administration of unmodified ECT in rare circumstances.[1]