Sir,
Brain stimulation techniques have been used for the management of various psychiatric disorders over several decades. After the introduction of electroconvulsive therapy (ECT) for therapeutic purpose in the early part of the twentieth century, a lot of developments have happened in the ECT techniques. At the same time, several other innovative brain stimulation techniques such as deep brain stimulation, transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation, and magnetic seizure therapy have been introduced to the arena of psychiatry. However, these techniques are available in few highly developed psychiatric setups of resource-poor countries and many mental health professionals remain deprived of training in these conventional and innovative brain stimulation techniques.
With exhaustive research in this area, the near future is likely to witness greater clinical applications of both invasive and noninvasive brain stimulation techniques. However, the paucity of training and exposure in resource-poor settings certainly limits the utility of these applications in a universal manner by all mental health professionals.[1] A survey on psychiatric trainees revealed that inadequate training and supervision resulted in lower confidence and lesser ability to administer ECT in clinical settings.[2] This observation can be extended to the areas of other brain-stimulation techniques in India, given the lack of focused training programs on advanced brain-stimulation applications.
Recently (in the year 2015), the Indian Psychiatric Society has started sponsoring early career psychiatrists for short course Fellowship programs anywhere within the country. One of the authors (SKK) got an opportunity to avail the travel fellowship training in “Brain Stimulation Techniques” from the National Institute of Mental Health And Neurosciences, Bengaluru. The 2-week training program had included observation of different therapeutic procedures (ECT, TMS, and tDCS), hands-on training under the supervision of experts (other authors), and exposure to the potential research avenues in this area. In addition, there were also opportunities to train MD residents (through didactic lectures) under the supervision of experts. The trainee found the experience to be very useful - encompassing domains of clinical and research applications. The trainee felt confident in using the TMS technique in routine treatment, as well as in research. It also helped the trainee in training the postgraduate residents of his institute. However, it was also felt that remaining more focused and choosing a specific brain stimulation technique would have been more useful in such a time-bound training program as each of the brain-stimulation techniques is broad in their clinical application and conceptually different. Focusing on a particular technique might have facilitated in-depth learning on that specific procedure.
The supervising team found the experience enriching and heartening. The training experience would have been better if it were to be conducted in smaller groups. This would certainly enhance peer learning and experience sharing.[3] Supervisor's and trainer's role in mentoring the trainees is always crucial. Decisive feedback of the supervisors is an important element of training, which helps in improving the skill of the trainee.[4] Similarly, the trainee's feedback to supervisors is also extremely crucial to enable better training in the future. Sharing of the experience of training by trainees and trainers helps in designing and strengthening the training process as there is no formal training curriculum in the resource-scarce countries.[5] Given the challenges of an overburdened mental health care setup in developing countries supported by scarce workforce having long training programs will be challenging for both the trainee, as well as the trainer. In this context, such short course training fellowships are indeed suitable and may be supported on a larger scale by professional bodies, governmental and nongovernmental agencies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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