PSYU-4078 - Quality Improvement (QI) in the Department of Psychiatry

PSYU-4078 - Quality Improvement (QI) in the Department of Psychiatry

Elective Title: Quality Improvement (QI) in the Department of Psychiatry
Course Number: PSYU-4078
Elective Type: research Duration/Weeks: 4 weeks Max Enrollment: 2
Prerequisites: Successful completion of Year 2
Additional Requirements: Must have approval by Dr. Shotwell prior to enrollment to discuss proposed QI Project. An R-Form and a Request for IRB Determination of Non-Regulatory Activity Form must be submitted at least 60 days prior to start of the elective.
Responsible Faculty Director: Joseph Shotwell, MD Periods Offered: 1, 3-13 including holiday period 8 
Coordinator: Jessica Prescott Other Faculty:
Location to Report on First Day:
Faculty will email student prior to 1st day to arrange for either virtual or in person orientation.

This elective will help students recognize the importance of quality improvement projects in maintaining high quality and evidence-based treatments in clinical practice.

1. Understand the role of the Institutional Review Board (IRB) in regulating research activities.
2. Identify areas of psychiatric practice that might benefit from a QI project.
3. Learn about providing evidence-based care in the clinical setting.
4. Develop a QI project with a goal of improving a practice or process within the Department of Psychiatry.
5. Communicate findings of the QI project back to psychiatry residents, fellows, and faculty members with a goal of directly affecting institutional practice.

Description of course activities
Students will contact Dr. Shotwell with a proposal for a QI project prior to enrolling in the research elective.

At least 60 days prior to the start of the elective, the student will need to complete an R-Form and a Request for IRB Determination of Non-Regulatory Activity Form to ensure institutional compliance regarding the proposed activity. (Instructions Below)

1. Go to
2. Click Research Elective form Link (RFORM).
3. Log in with your UTMB Login.
4. Click "Add a New Request."
5. Complete the R-Form in its entirety.

Request for IRB Determination of Non-Regulatory Activity Form:
1. Email Dr. Shotwell ( and he will provide you a copy of the form.
2. Complete the form and send it to for approval.

Students will conduct their QI project primarily through retrospective chart review (unless otherwise approved). Once the QI project has been completed, the student will either 1) organize the findings in a poster and present the findings to the departmental QI committee or 2) summarize the QI project in written format to be dispersed to Department of Psychiatry faculty and staff. Findings of the study are expected to directly affect institutional practice and identify corrective action(s) needed to improve quality of care. When recommending changes to clinical workflow, students will reference evidence-based treatment recommendations from reputable resources.

Type of students who would benefit from the course
Any student who values the importance of providing equitable and high-quality care to all patients regardless of variables present in the clinical setting.

Weekly Schedule
  Clinical Activities (estimated schedule)  
Day of Week   AM   PM

 Average number of patients seen per week: 0 (no direct patient care)
 Call Schedule:

Research Activities (estimated schedule)
Activity Hours per Week
Faculty Contact-Time 1-2
Self-Directed Study
Data-Collection/Analysis 40
Other Student should plan to be available from M-F from 8am to 5pm. There will be no direct patient care involved in the elective. Students will spend ~40 hrs/week developing their QI project, collecting and analyzing data, and organizing their findings into either a poster or written presentation.

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
    Residents, fellows, and faculty members in the Department of Psychiatry
  B. Frequency / Duration of Presentation(s)?
    1 presentation during the elective.
  C. Format - What guidelines are set for the student's presentation?
    Oral presentation/Project summarized in poster format.
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    1 write up during the elective.
  B. Format - What guidelines are set for the student's written work?
    Summarize findings of QI project in written form.
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
    d. References should be included when providing practice recommendations.
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
    student-selected topic
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.