A Quality Improvement Initiative to Improve Psychiatry Trainees' Knowledge and Confidence in Levels of Care

To evaluate a brief educational intervention designed to improve psychiatry residents' confidence and knowledge in making level-of-care (LOC) decisions for patients in crisis.

Psychiatry residents at Tufts Medical Center participated in a quality improvement initiative consisting of a self-guided didactic session and a structured decision-making tool outlining inpatient, intermediate, and community-based LOC options. Residents completed pre- and post-intervention surveys assessing self-reported confidence and objective knowledge. Data were analyzed using paired Wilcoxon signed-rank tests.

The intervention was associated with increased residents' overall confidence in LOC decision-making. The largest gains occurred in less familiar intermediate and community-based settings, such as crisis stabilization units and partial hospitalization programs. Residents reported greater awareness of alternatives beyond inpatient admission or discharge, and objective knowledge scores showed consistent improvement across domains.

This quality improvement initiative was associated with increased psychiatry trainees' knowledge and confidence in navigating LOC decisions. This initiative highlighted a potential educational gap in our program and suggests that brief, structured curricula may help increase familiarity with intermediate care options.