Medical dramas such as Grey's Anatomy influence young people's career aspirations, creating unrealistic expectations. This article examines the gap between these portrayals and the reality of medical practice, highlighting challenges such as rigorous training and high stress. Using Italy's ‘numero chiuso’ (‘closed number’) system as a case study, it addresses the global issue of intense competition in medical school admissions. The article advocates for realistic education and better support to prepare future healthcare professionals.

Quality improvement (QI) is an evidence-based approach to analysing and improving healthcare systems. QI's success has led it to become a required competency expected of medical professionals in several countries. However, much of the QI literature to date has not focused on mental health. Moreover, many psychiatrists have no formal training in QI. To address this gap, this article introduces key QI concepts, including six dimensions of quality care, the Model for Improvement and plan–do–study–act cycles. Each QI concept is illustrated using a fictitious case study of an out-patient psychiatrist reducing chronic benzodiazepine use in their clinic.

Nidumolu et al’s article in BJPsych Advances illustrates how psychiatrists might use the key concepts of quality improvement (QI) to analyse and improve mental healthcare systems. This commentary on the article points out the importance of recognising the type of problem for which QI is best suited and the role of softer, relational approaches alongside the technical tools of improvement. It also highlights that QI can bring broader benefits to a team and organisation, including improvements in staff engagement and well-being. In mental health services, psychiatrists can play a key role in enabling and role-modelling this approach to problem-solving, as their extensive experience of leading multidisciplinary teams and shared decision-making with patients can be a great asset in QI.