Training and Experiential Factors Associated With Transcranial Magnetic Stimulation Referral Readiness Among Psychiatric Providers.
5 affiliations
- 1College of Medicine/HCA Florida Capital Hospital Psychiatry, University of Central Florida, Tallahassee, Florida, USA.
- 2Boston Children's Hospital, Harvard University, Boston, MA, USA.
- 3Maclay School, Tallahassee, Florida, USA.
- 4Florida State University, Tallahassee, Florida, USA.
- 5University of California San Francisco, San Francisco, California, USA.
Abstract
Objective
Transcranial magnetic stimulation (TMS) is an established treatment for patients with treatment-resistant depression (TRD); however, barriers remain in clinical practice. This study examined how psychiatric clinicians view TMS and evaluated whether training exposure and prior experience were associated with their readiness to refer patients for treatment.Methods
We conducted a cross-sectional survey of psychiatric providers in Florida, including attending psychiatrists, psychiatry residents, and psychiatric nurse practitioners. The survey assessed beliefs about TMS effectiveness, comfort discussing and referring the treatment, familiarity with referral processes, and perceived barriers. Responses were dichotomized to reflect endorsement, and group differences were analyzed using chi-square or Fisher exact tests.Results
Ninety-four clinicians completed the survey. Conceptual endorsement of TMS was high, with more than 90% agreeing that it is an effective treatment for depression. Operational readiness was more variable, particularly for referral comfort, counseling confidence, and knowledge of referral pathways. Prior TMS training and prior TMS recommendation experience were associated with greater comfort referring patients, greater confidence counseling patients, and higher awareness of referral steps. Psychiatry residents reported lower referral-pathway awareness than attending psychiatrists. Insurance coverage and treatment costs were frequently reported barriers, and lack of training was a commonly endorsed modifiable barrier.Conclusions
While psychiatric providers widely accepted TMS conceptually, operational readiness to counsel and refer was more variable. Training exposure and prior TMS recommendation experience were associated with greater confidence, comfort, and familiarity with referral pathways, although causality cannot be inferred from this cross-sectional design. These findings suggest that efforts to improve utilization should emphasize building operational competence and confidence, along with clearer referral workflows and accessible system-level processes.
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BibTeX
@article{rahangdale2026training,
title = {{Training and Experiential Factors Associated With Transcranial Magnetic Stimulation Referral Readiness Among Psychiatric Providers.}},
author = {Aneesh Rahangdale and Lauren Ferraro and Gracyn Wood and Christopher Wadsworth and Eileen Venable},
journal = {Brain and behavior},
year = {2026},
month = oct,
doi = {10.1002/brb3.71876},
url = {https://europepmc.org/article/MED/42961169},
note = {CC BY},
}
RIS
TY - JOUR
TI - Training and Experiential Factors Associated With Transcranial Magnetic Stimulation Referral Readiness Among Psychiatric Providers.
AU - Aneesh Rahangdale
AU - Lauren Ferraro
AU - Gracyn Wood
AU - Christopher Wadsworth
AU - Eileen Venable
PY - 2026
DA - 2026/10/30
JO - Brain and behavior
DO - 10.1002/brb3.71876
UR - https://europepmc.org/article/MED/42961169
AB - Objective Transcranial magnetic stimulation (TMS) is an established treatment for patients with treatment-resistant depression (TRD); however, barriers remain in clinical practice. This study examined how psychiatric clinicians view TMS and evaluated whether training exposure and prior experience were associated with their readiness to refer patients for treatment.Methods We conducted a cross-sectional survey of psychiatric providers in Florida, including attending psychiatrists, psychiatry residents, and psychiatric nurse practitioners. The survey assessed beliefs about TMS effectiveness, comfort discussing and referring the treatment, familiarity with referral processes, and perceived barriers. Responses were dichotomized to reflect endorsement, and group differences were analyzed using chi-square or Fisher exact tests.Results Ninety-four clinicians completed the survey. Conceptual endorsement of TMS was high, with more than 90% agreeing that it is an effective treatment for depression. Operational readiness was more variable, particularly for referral comfort, counseling confidence, and knowledge of referral pathways. Prior TMS training and prior TMS recommendation experience were associated with greater comfort referring patients, greater confidence counseling patients, and higher awareness of referral steps. Psychiatry residents reported lower referral-pathway awareness than attending psychiatrists. Insurance coverage and treatment costs were frequently reported barriers, and lack of training was a commonly endorsed modifiable barrier.Conclusions While psychiatric providers widely accepted TMS conceptually, operational readiness to counsel and refer was more variable. Training exposure and prior TMS recommendation experience were associated with greater confidence, comfort, and familiarity with referral pathways, although causality cannot be inferred from this cross-sectional design. These findings suggest that efforts to improve utilization should emphasize building operational competence and confidence, along with clearer referral workflows and accessible system-level processes.
SN - 2162-3279
ER -