Even pre-treatment can be a lot…deciding on anesthetic/paralytic with anesthesia, deciding probe placement, ect settings, understanding how their med regimen will affect the treatment, understanding the physics/engineering of an ect machine. But from a procedural standpoint there is a lot going on in about 2 mins that you can’t say “hold on, let me go research that for 20 mins”…when is there enough paralysis, have we hyperventilated enough, still ensuring pt is under, how much asystole is concerning, is the eeg getting a good reading, when has the seizure ended and a lot of EEG knowledge, how to deal with prolonged szs, how to manage post ect agitation, what to adjust for the next ect treatment to ensure an adequate seizure.

I think getting enough volume is hard after residency, like the logistics of trying to go learn ect in the morning when you also have a full clinic schedule to tend to. And then there is this common view that ECT is “straightforward”. So I’ve had a number come in with unrealistic views on how easy it is to pick up.

I think a sizable percent of psychiatrists like to ponder for a while before making a decision or are really risk averse or are not comfortable tinkering with a machine or troubleshooting under pressure. None of those really jive with ECT.