Feasibility and utility of short-course fellowship training in brain stimulation techniques: Perspective of the trainee and trainer.

Abstract

Byline: Sujita. Kar, Urvakhsh. Mehta, Ganesan. Venkatasubramanian, Jagadisha. Thirthalli, Bangalore. Gangadhar 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.[sup][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.[sup][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. …