P-1: Waterloo Regional Campus Psychotherapy Program Process Review
Dr. Amanda Ritsma
Jasmine Tsang MD*,
Amanda Ritsma MD*, Madeleine Wootton MD,
Ewa Talikowska-Szymczak MD
Department of Psychiatry and Behavioural Neuroscience
As a resident body, it has been recognized that the psychotherapy training program at the Waterloo Regional Campus is designed in such a way that residents are often unaware of their next steps in the process, have difficulty finding patients, and struggle with the administrative burden of the process, resulting in prolongation of the time it takes for them to complete their psychotherapy requirements. Our overall goal was to create a more streamlined and efficient process for completing psychotherapy training at the Waterloo Regional Campus.
To do this we thoroughly reviewed the current structure of the psychotherapy program in five different facets and gradually introduced (or advocated for where necessary) solutions to arising problems identified. Iterative plan-do-study-act (PDSA) cycles included: PDSA#1: gathered input from WRC resident body about their experience; PDSA#2: connected with the Hamilton campus psychotherapy centre to learn about and compare their processes to our own; PDSA#3: divided the psychotherapy program into five major components of the completion process - identifying potential supervisors, finding a patient, screening patients, registering patients at a location, and identifying an MD backup; PDSA#4: further investigated the specific problem areas & obstacles within each part of the process; PDSA#5: identified & implemented solutions to simple problems identified; PDSA#6: presented to administration the problems identified, which were outside of the control of the resident body and offered suggestions and/or potential solutions.
The main issues identified included; telephone/VC supervision not permitted, unclear guidelines on the provision of medical back-up and back-up limited by site, ineffective patient referral process, lack of standardized patient screening, lack of clarity with regards to registering patients, and lack of secure documentation storage system. Overall, the training process was found to be largely resident-dependent and yet this process lacks clarity from the perspective of the residents. Solutions implemented included: creating a process map for each psychotherapy modality, a secure cabinet for documentation storage which was placed in the resident office, creating a document to outline the steps involved in registering a patient at each particular site, and a centralized electronic spreadsheet which was created to facilitate a more stream-lined referral process. Recommendations made to program administration included: allowing for VC/telephone supervision at the distributed site and for this to be reflected in policy, providing clear guidance on the requirements and responsibilities of the MD back-up, and considering adoption of a standardized screening approach for psychotherapy patients, which could be used across both sites.
We were able to identify where the most significant difficulties lay in each of the five key facets of psychotherapy training. We were also successful in implementing simple solutions as well as proposing relevant administrative recommendations that have the potential to significantly improve the resident experience in psychotherapy at the Waterloo Regional Campus.