Quality Improvement Training Varies Widely Across Canadian Psychiatry Residencies, Survey Finds

Quality improvement, the disciplined, data-driven practice of systematically making health care better, has quietly become one of the most consequential skills a modern physician can possess. Yet a new national survey suggests that psychiatry residents in Canada are receiving strikingly uneven preparation in this domain. A study published in Academic Psychiatry examined the state of quality improvement education across all seventeen Canadian general psychiatry residency programs and found that while most responding programs offer some form of training, the depth, structure, and consistency of that training vary enormously, and a small but significant fraction of programs provide essentially nothing at all.

The research, led by Kamini Vasudev of the Schulich School of Medicine and Dentistry at Western University, together with James Ross, Arlene G. MacDougall, Emma Kalapun, and Tara A. Burra of the University of Toronto, set out to answer a deceptively simple question: what are Canadian psychiatry residents actually being taught about improving the systems in which they will practice? In 2024, the team distributed a Qualtrics survey to all seventeen Canadian psychiatry residency programs, asking program directors to confirm whether their program had a quality improvement curriculum and, if so, to describe its content and their experiences delivering it. To triangulate the survey data, the researchers also reviewed the websites of every program for any mention of quality improvement education.

The response rate alone tells part of the story. Twelve of the seventeen programs, or 70.6 percent, replied to the survey. Among those twelve, eight, or 66.7 percent, indicated that they deliver a quality improvement curriculum. But only five of those eight, representing 41.7 percent of respondents, shared a structured curriculum when asked, while the remaining three did not provide one. Four programs, a full third of respondents, reported that they do not deliver a quality improvement curriculum at all. Two of those four teach introductory quality improvement content, with one program sharing PowerPoint slides from a lecture, and the other two reported the complete absence of any formalized quality improvement curriculum or related materials.

The picture darkens further when the five non-responding programs are considered. The researchers turned to the public websites of these programs as a proxy for what they might offer. Only one of the five mentions quality improvement work on its psychiatry residency website, and even that reference appears as a possible elective nonclinical rotation. The remaining four programs have no mention of quality improvement anywhere on their websites. Taken together, the survey and website review paint a portrait of a national training landscape in which a psychiatry resident’s exposure to quality improvement depends heavily on where they happen to train, ranging from structured curricula with shared materials, to a single introductory lecture, to nothing whatsoever.

Why does this matter so much? The technical answer lies in what quality improvement actually is. Unlike clinical research, which seeks to generate generalizable knowledge, quality improvement applies iterative cycles of measurement and change, often formalized as the Plan-Do-Study-Act cycle, to local systems of care. Practitioners identify a gap between current performance and a desired standard, define measurable outcomes, analyze the processes and contextual forces driving the gap, intervene, remeasure, and adjust. The skill set draws on epidemiology, data literacy, human factors engineering, and implementation science. It is the mechanism by which health systems convert good intentions into reliably better care, and it is increasingly embedded in the accreditation architecture of medical education on both sides of the border.

In Canada, the Royal College of Physicians and Surgeons of Canada requires psychiatry residents to demonstrate competencies in quality improvement under the CanMEDS framework, which positions the physician not only as a medical expert but also as a scholar, leader, and health advocate. The framework’s 2015 iteration explicitly elevated the role of physicians as agents of system-level improvement. In the United States, the Accreditation Council for Graduate Medical Education embeds quality improvement and patient safety requirements in its Common Program Requirements and in specialty-specific milestones. A 2018 content analysis of twenty-six sets of ACGME milestones, cited in the study, concluded that every graduating resident needs foundational knowledge in quality improvement and patient safety. The Association of American Medical Colleges has likewise published competencies in quality improvement and patient safety spanning the entire learning continuum, and recent cross-specialty analyses of entrustable professional activity guides have asked whether quality and safety are adequately represented in the tasks trainees must be trusted to perform.

Against this regulatory backdrop, the Canadian findings read as a gap between mandate and reality. The study’s authors argue that action is needed to provide quality improvement education to all residents, not only to meet certification requirements but also to address unmet societal mental health care needs. That second rationale is not rhetorical decoration. Mental health care in Canada, as in much of the world, faces chronic access problems, long wait times, and well-documented variability in the quality of care delivered. Research cited in the paper has documented changing practice patterns among Ontario psychiatrists with implications for access, and international work has emphasized that measuring and improving the quality of mental health care is a global priority. Youth mental health, in particular, has been described by Canadian researchers as deserving top priority in health care planning. When the system charged with training the next generation of psychiatrists leaves a third of its trainees without formal quality improvement education, it forfeits a powerful lever for addressing those systemic failures.

The study also situates itself within a substantial literature on how quality improvement should be taught, and why teaching it well is difficult. Realist reviews of quality improvement curricula in undergraduate and postgraduate medical education have identified the characteristics of successful programs, including experiential learning, protected time, faculty mentorship, and integration with real clinical projects rather than classroom abstraction alone. Systematic reviews have repeatedly found that lecture-based teaching produces knowledge gains but that durable skill development requires residents to actually conduct improvement projects within their clinical environments. Prior studies in psychiatry specifically have tested various models: a prospective cohort study found that an experiential quality improvement training program during residency improved residents’ confidence and knowledge; work on residents-as-teachers showed gains in quality improvement knowledge and skills; and a 2021 study identified barriers to resident engagement in quality improvement initiatives in psychiatry, including time pressures, competing clinical demands, and a perceived lack of relevance. More recent contributions have developed and evaluated dedicated quality improvement curricula for psychiatry residents, contextualized quality improvement and systems-based practice within psychiatric clinical teaching settings, and even created novel leadership roles, such as patient safety and quality improvement resident representatives, to improve peer engagement with root cause analyses.

What the new Canadian survey adds to this literature is a national baseline, and the baseline is sobering. The authors describe considerable variability in postgraduate quality improvement education practices across Canadian psychiatry programs, a diplomatic phrasing for a system in which some residents graduate having led data-informed improvement projects and others graduate having never encountered the discipline beyond, at best, a single lecture. The methodological approach, combining direct survey of program directors with systematic website review, has inherent limitations that the authors implicitly acknowledge: program directors’ self-reports may not capture informal teaching, and website silence does not prove curricular absence, as the non-responding programs could not be directly assessed. Still, the convergence of the two data sources, with two responding programs reporting a complete absence of formalized quality improvement education and four non-responding programs showing no online trace of it, suggests the variability is real rather than an artifact of measurement.

The implications extend beyond Canada’s borders. Psychiatry residency programs in the United Kingdom operate under Royal College of Psychiatrists curricula, and American programs face ACGME requirements, yet the Canadian experience suggests that formal requirements do not automatically translate into uniform implementation. The study’s authors, who have themselves published a primer on applying quality improvement to clinical practice for psychiatrists and an evaluation of a quality improvement module for psychiatry residents, frame the solution as a matter of both compliance and mission. Certification bodies can demand competence, but the deeper argument is that psychiatrists equipped with quality improvement skills are better positioned to close the persistent gaps in mental health care that no individual clinician, however skilled, can fix alone. As health systems worldwide grapple with rising mental health needs and constrained resources, the finding that a third of Canadian psychiatry programs report no formal quality improvement curriculum is less a bureaucratic footnote than a warning about how the specialty’s future workforce will, or will not, be prepared to improve the systems it inherits.

Subject of Research: The status of quality improvement education in Canadian psychiatry residency programs

Article Title: Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada

Article References: Vasudev, K., Ross, J., MacDougall, A. G., Kalapun, E., & Burra, T. A. (2026). Status of Quality Improvement Curricula in Psychiatry Residency Programs Across Canada. Academic Psychiatry. https://doi.org/10.1007/s40596-026-02432-7

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02432-7

Keywords: quality improvement, psychiatry residency, medical education, Canada, curriculum, patient safety, CanMEDS, graduate medical education, program directors, mental health care, survey study, Royal College