{"id":224,"date":"2016-04-04T17:23:32","date_gmt":"2016-04-04T17:23:32","guid":{"rendered":"http:\/\/cusjc.ca\/ect\/?page_id=224"},"modified":"2016-04-10T23:43:23","modified_gmt":"2016-04-10T23:43:23","slug":"training","status":"publish","type":"page","link":"https:\/\/cusjc.ca\/ect\/training\/","title":{"rendered":"Learning by doing"},"content":{"rendered":"

[et_pb_section admin_label=”section” background_image=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/Training-ECT.jpg” transparent_background=”off” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”row”][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#f2f2f2″ allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][\/et_pb_column][et_pb_column type=”4_4″][et_pb_post_title admin_label=”Post Title” title=”on” meta=”on” author=”off” date=”off” categories=”on” comments=”on” featured_image=”on” featured_placement=”below” parallax_effect=”on” parallax_method=”on” text_orientation=”left” text_color=”dark” text_background=”off” text_bg_color=”rgba(255,255,255,0.9)” module_bg_color=”rgba(255,255,255,0)” title_font=”PT Serif|on|||” title_all_caps=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title_font_size=”36px”] [\/et_pb_post_title][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=”Row”][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n

On a rainy Sunday morning in January, 16 psychiatrists from across the world gathered in a small lecture room at the University of Ottawa Skills and Simulation Centre<\/a>.<\/p>\n

The largest simulation centre in Canada, “the SIM lab,” is equipped with state-of-the-art medical machinery, fostering hands on educational opportunities for healthcare professionals in all fields of medicine.<\/p>\n

With different clinical backgrounds and varying levels of experience, the psychiatrists all have one thing in common, they are determined to increase their skills in the administration of Electroconvulsive Therapy and they hope to do so through Dr. Kiran Rabheru<\/a>‘s hands-on course.<\/p>\n

On this particular morning, most of the SIM lab is closed off, with the exception of about half a dozen procedure rooms towards the back of the facility.<\/p>\n

Equipped with surgical exam tables and machines to monitor both the heart and brain, the room is reminiscent of one you would see while watching TV shows such as Grey\u2019s Anatomy<\/em> or ER.<\/em><\/p>\n

But one thing is different.<\/p>\n

Lying on the bed \u2014 as a stand-in for an actual patient \u2014 is a life-like mannequin.<\/p>\n

Rabheru, a geriatric psychiatrist at The Ottawa Hospital and a member of the CANECTS group, is leading the way when it comes to finding cutting-edge techniques to train psychiatrists in ECT.<\/p>\n

Once every year since 2011, he\u2019s organized a one-day intensive training program in which practising psychiatrists can re-certify their skills in Electroconvulsive Therapy.\u00a0 In addition to receiving lecture-based training, clinicians get to practise administering ECT on state-of-the-art dummies, known as \u201chigh-fidelity mannequins<\/a>.\u201d \u00a0Rabheru said that to his knowledge, his centre is the only one in the world to offer this type of simulation-based course.<\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_2″][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/DSCN1201.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Dr. Kiran Rabheru (centre) accompanied by staff of the University of Ottawa Skills and Simulation Lab (Photo courtesy of Kiran Rabheru)” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c”] [\/et_pb_blurb][et_pb_image admin_label=”Image” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/DSCN1203.jpg”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”Trainees practice delivering ECT on high-fidelity mannequins (Photo courtesy of Kiran Rabheru)” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c”] [\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_code admin_label=”Code”]<iframe width=”560″ height=”315″ src=”https:\/\/www.youtube.com\/embed\/14iDkcQuiWM?rel=0″ frameborder=”0″ allowfullscreen><\/iframe>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#f2f2f2″ allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_4″][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n

A key finding of the 2006 CANECTS survey was that ECT training for psychiatry residents is an area of concern.<\/p>\n

The results revealed that more than half of responding centres had no formal ECT training program for psychiatry residents.\u00a0 At the treatment centres that did report offering ECT training, teaching methods varied significantly, with some facilities assigning required readings and others requiring their residents to observe a minimum number of ECT treatments.<\/p>\n

Vast variations in training across the country is problematic.\u00a0 Without formal and uniform learning, psychiatrists may not be able to acquire the skills or confidence needed to properly administer ECT.\u00a0 This may discourage practitioners from offering the treatment altogether, and this could result in the underutilization of ECT.\u00a0 Ultimately, the patient would be the one to suffer.<\/p>\n

[\/et_pb_text][\/et_pb_column][et_pb_column type=”1_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_code admin_label=”Code”]<iframe width=”560″ height=”315″ src=”https:\/\/www.youtube.com\/embed\/pdIKdfKTNa8?rel=0″ frameborder=”0″ allowfullscreen><\/iframe>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#f2f2f2″ allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_2″][et_pb_image admin_label=”Image” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/DSCN1252.jpg”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”The simulation lab’s procedure room looks identical to an actual ECT suite (Photo courtesy of Kiran Rabheru)” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c”] [\/et_pb_blurb][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/Training-from-the-viewpoint-of-the-SIM-room.jpg” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” title=”A technician sitting behind a one-way mirror controls the mannequin’s movements through a computer (Photo courtesy of Kiran Rabheru)” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c”] [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n

In order to standardize ECT training in Canada, Rabheru is leading the development of a set of standards\u00a0specifically for ECT teaching.\u00a0 His proposed training standards will be part of a larger document written by CANECTS, consisting of clinical practice guidelines covering multiple areas relevant to ECT, such as treatment and facilities, equipment, dosing, electrode placement, among others.\u00a0 A draft version of the guidelines has been penned, and is currently in the peer-review stage.\u00a0 The hope is that once finalized, ECT centres across the country will voluntarily comply.<\/p>\n

Dr. Rabheru said that the training guidelines will stipulate that every person performing ECT should undergo a proper skills-based training course, followed by regular practice of the procedure.\u00a0 Furthermore, a minimum number of annual ECT treatments will be recommended as part of the standards for practising psychiatrists to maintain their skill level, but the exact number has yet to be decided.<\/p>\n

While Dr. Rabheru said he\u2019s proud of the CANECTS team\u2019s work, he added that the group unfortunately doesn\u2019t have the authority to mandate ECT training.<\/p>\n

He said that if the Royal College of Physicians and Surgeons<\/a>, Canada\u2019s national professional association that oversees the education of specialists, adopts CANECTS\u2019 training standards, there will be more support for skills-based teaching in Canada.<\/p>\n

One of the responsibilities of the Royal College is to accredit residency programs in medical schools across the country.\u00a0 With the College\u2019s stamp of approval, psychiatry training programs could be altered to require hands on learning for ECT.\u00a0 This would ensure that residents across the country receive the tools necessary to be able to deliver ECT in a high-quality way.<\/p>\n

Dr. Rabheru said that the current lack of clear training guidelines means that psychiatry trainees could potentially go through their entire residency program without ever having to administer a single ECT treatment.<\/p>\n

The rules for ECT delivery, he said, should be similar to those for any other surgical procedure.\u00a0 For example, he explained that an obstetrician has to do 50 or 100 deliveries per year to be able to maintain his or her privileges.<\/p>\n

\u201cWhile at this point there\u2019s no science behind it, to maintain your bare minimum skills, you need to do at least between 30 and 50 ECT treatments a year, so on average one or two a week,\u201d said Rabheru.<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_code admin_label=”Code”]<iframe width=”560″ height=”315″ src=”https:\/\/www.youtube.com\/embed\/4TDfxSYbJBY?rel=0″ frameborder=”0″ allowfullscreen><\/iframe>[\/et_pb_code][\/et_pb_column][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#f2f2f2″ allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_2″][et_pb_image admin_label=”Image” src=”http:\/\/cusjc.ca\/ect\/wp-content\/uploads\/2016\/03\/Training-Dr.-Rabheru-demonstrating.png” show_in_lightbox=”off” url_new_window=”off” use_overlay=”off” animation=”left” sticky=”off” align=”left” force_fullwidth=”off” always_center_on_mobile=”on” use_border_color=”off” border_color=”#ffffff” border_style=”solid”] [\/et_pb_image][et_pb_blurb admin_label=”Blurb” title=”Dr. Rabheru preps the patient for the procedure (Photo courtesy of The Ottawa Hospital)” url_new_window=”off” use_icon=”off” icon_color=”#7EBEC5″ use_circle=”off” circle_color=”#7EBEC5″ use_circle_border=”off” circle_border_color=”#7EBEC5″ icon_placement=”top” animation=”top” background_layout=”light” text_orientation=”left” use_icon_font_size=”off” use_border_color=”off” border_color=”#ffffff” border_style=”solid” header_font=”PT Sans|on|||” header_font_size=”16″ header_text_color=”#4c4c4c”] [\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n

In today\u2019s operating environment, ECT learning varies depending on where you do your training.\u00a0 For example, Rabheru explained that if you train at a cutting edge centre where ECT is practised in an academic setting, you\u2019ll do book learning as well as hands-on training.\u00a0 In that case, the experience you receive would be no different than training that exists for other surgical procedures in which you learn incrementally and gradually become more independent.<\/p>\n

While Rabheru\u2019s own ECT training program at the University of Ottawa follows this approach, many of the smaller centres, particularly ones in remote and rural areas, simply do not have enough resources to be able to offer the same level of training.<\/p>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#4c4c4c” allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”4_4″][et_pb_code admin_label=”Code”]<iframe width=”560″ height=”315″ src=”https:\/\/www.youtube.com\/embed\/PMwQ1oLZEeM?rel=0″ frameborder=”0″ allowfullscreen><\/iframe>[\/et_pb_code][\/et_pb_column][et_pb_column type=”4_4″][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section admin_label=”Section” fullwidth=”off” specialty=”off” transparent_background=”off” background_color=”#f2f2f2″ allow_player_pause=”off” inner_shadow=”off” parallax=”off” parallax_method=”off” padding_mobile=”off” make_fullwidth=”off” use_custom_width=”off” width_unit=”on” make_equal=”off” use_custom_gutter=”off”][et_pb_row admin_label=”Row”][et_pb_column type=”1_4″][\/et_pb_column][et_pb_column type=”1_2″][et_pb_text admin_label=”Text” background_layout=”light” text_orientation=”left” text_font=”Open Sans||||” text_font_size=”16″ text_text_color=”#000000″ use_border_color=”off” border_color=”#ffffff” border_style=”solid”]<\/p>\n

In the past, ECT has traditionally been taught using didactic methods, such as lectures and directed readings.\u00a0 Often, a few stations with ECT machines and different equipment would be set up so students could get more of an idea of what a typical procedure looks like.\u00a0 The idea behind this type of training was that students would then go back to their respective facilities and get some practice with real-life patients, under supervision.\u00a0 However, the problem with this method was that no one ever measured to see how effective it really was.<\/p>\n

\n\n\t\t
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\n\t\t\t\tPeople across North America are looking at how to replicate our SIM lab. There\u2019s a high level of interest in this type of training. \u2013 Dr. Kiran Rabheru<\/span>\n\t\t\t\t\n\t\t\t<\/div>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\n
\n

A few years ago, with the help of a team of investigators, Rabheru led the research on this very subject.\u00a0 He split his class of psychiatric residents into two teams and taught half of them using traditional didactic methods and the other half using practical methods in the simulation lab on mannequins.\u00a0 Those who trained with the dummies were allowed to practise their skills for as long as they wanted.\u00a0 After the teaching was complete, both groups underwent a standardized test that measured three different domains: knowledge, confidence and skills.\u00a0 The study revealed that while both groups had an equal level of knowledge and confidence, the group that received the simulation-based training had a much higher skill level.\u00a0 Rabheru said that while none of the traditionally trained residents passed the skills-based station, 100 per cent of the simulation-based cohort passed and actually did very well.\u00a0 As a result, patients of psychiatrists who received the hands-on training had better outcomes and lower risks of cognitive side effects.<\/p>\n

This finding is significant, because it rejects decades of assumptions about ECT training.\u00a0 It is also particularly worrisome because it points to the fact that many trainees may have graduated from psychiatric residency programs without knowing how to administer ECT safely and effectively.\u00a0 Patients could potentially be put in harms way if they are treated by a clinician lacking the necessary skills to properly deliver ECT.<\/p>\n

\u201cFor the first time, we were able to demonstrate that simulation-based training actually has a huge effect on the level of skills, which makes total sense when you think about it,\u201d said Rabheru.\u00a0 \u201cIt was nice to see it being demonstrated in a proper scientific trial.\u201d<\/p>\n

Rabheru said he\u2019s hopeful that the new training guidelines will encourage other hospitals around Canada and the world to open their own ECT simulation centres and embrace hands-on training.<\/p>\n

\u201cPeople across North America are looking at how to replicate our SIM lab,\u201d he said. \u201cThere\u2019s a high level of interest in this type of training.\u201d<\/p>\n

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On a rainy Sunday morning in January, 16 psychiatrists from across the world gathered in a small lecture room at the University of Ottawa Skills and Simulation Centre. The largest simulation centre in Canada, “the SIM lab,” is equipped with state-of-the-art medical machinery, fostering hands on educational opportunities for healthcare professionals in all fields of […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-224","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/224","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/comments?post=224"}],"version-history":[{"count":75,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/224\/revisions"}],"predecessor-version":[{"id":891,"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/pages\/224\/revisions\/891"}],"wp:attachment":[{"href":"https:\/\/cusjc.ca\/ect\/wp-json\/wp\/v2\/media?parent=224"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}