Welcome to another episode of the Thought Broadcast, the trainee-led podcast from Australasian Psychiatry. Today we have a special episode. It's our pleasure to welcome uh Dr. Pramudi Gudnaratni. She is the first board representative with the Royal Australian and New Zealand College of Psychiatrist coming from the trainee group. We were hoping to cover a number of topics in this episode, but the underlying message is that we are trying to enhance the degree of communication between the RENZCP and the trainee group who it represents. My name is Ollie Robertson. I'm the uh trainee editor of Australasian Psychiatry, and I'm joined today by our regular panel. We have our uh deputy editor of the journal, Andrew Amos. Welcome, Andrew. Hi g'day Oli, good to be here. And then we also have uh Michael Waiteman, uh, our associate trainee editor. How are you, Michael?

Hey Oli, good thanks.

And then we're also joined by our other associate trainee editor, Brian Bowie. Welcome, Brian.

Thanks, Oli. And uh hi to everyone.

Well, our last and most important introduction, Pramudi. Welcome to the show.

Hi, everyone. Thank you so much uh for having me.

Pramodi, uh the listeners uh would love to hear a bit more about you. Can you tell us um at what stage of training you're in, where you're living and where you're working at the moment?

Yeah, sure. Um so I'm currently working in Sydney and I'm doing a fellowship year in intellectual disability and neuropsychiatry. Um it's a partly clinical, partly research term, and it's sort of spread across three different health networks in Sydney. Um, and I'm you know really loving it. Um, this is an area of psychiatry that I'm really passionate about. So it's proving to be, you know, a really wonderful, I guess, capstone um year to finish off my training. But I have taken a bit of a circuitous route through training, uh, so balancing work in public health um along with sort of the usual psychiatry rotations.

Ah, yes, that sounds like a busy schedule, but it sounds like you're well engaged, so that's fantastic. It's been a short time since you were uh announced as our trainee board member. Just had our uh annual conference, the uh May Congress uh in Sydney, and your presence was felt. I know that Michael and myself both attended one of your talks, which was fantastic. Can you just tell us a bit about how you thought to apply to become to become a member of the board and what the process was like going through that?

Yeah, sure. So I suppose my journey to the board uh is probably a bit different to most people who've had, I guess, years of experience in college activities and committees. Um, so I've always had an interest in understanding sort of systems and governance structures, I guess with my public health background. Um, and I've I've had various experiences, you know, outside of the college in these areas. So I've worked as a consultant for the World Health Organization in Geneva, um, as a registrar to the chief psychiatrist in the New South Wales Ministry of Health, and I've sort of founded or co-founded a private neuropsychiatry practice. But I guess like most people, um there's sort of a million and one potential areas where we can sort of direct our efforts. And I suppose the college hadn't really been on my radar as such, but the event that really changed that for me uh was being a candidate in the November OSCI, which we all know now sort of crashed and burned in a fairly spectacular fashion. And while that was, you know, a horrible experience, um, and certainly I personally felt it at the time. But if you know, if there is kind of a silver lining to that event, um, I think it would be that it brought together a whole lot of really passionate people to the field, whether it's registrars and fellows, um, and it really focused kind of attention onto kind of the college and processes. And I think it was also sort of a catalyst for a lot of change, or at least it accelerated change that may have already, you know, been in the works within the college. And obviously including a trainee on the board was one of the you know the major pieces of reform that was introduced in the aftermath of the November exam. And I think the fact that the board sort of chose to appoint me, um, I guess a relative outsider to sort of the traditional college machinery, um, I think that shows an openness to sort of fresh perspectives and ideas. So I guess that's a little bit of a timeline, I suppose, for how I came to kind of becoming interested in the college and the activities and wanting to be on the board. But maybe more importantly, I think there's sort of a range of issues that have really drawn me to want to sort of, you know, pursue this role. And so training is obviously, I guess, a really huge motivating factor. And so the listeners might be aware that uh the college is currently in the process of redesigning the training pathway, and the last sort of major reform was in 2012 when the sort of 2012 training pathway was launched, and so it seemed like now was a really great time, you know, perhaps a once-in-a-decade opportunity to be able to have a say in what the next sort of iteration of our training program could look like. So I think that was a really big motivating factor.

What is some uh goal that you're hoping to achieve uh uh you know being in your position for the next 12 months and you know, and and what your what are your strategy to get to your goal, uh Brahmudi?

So I think a lot of my goals have probably been driven by kind of the initial suppose consultation process with the different um register organizations, and I guess a couple of things have come up, and I and I guess it really aligns with my own kind of views around things that I you know feel are important to do as well. So I guess the first kind of big issue that essentially every single trainee I've spoken to has voiced concerns around is sort of training. Um, and you can probably you know break that down into two areas. So, firstly, I guess as the college um kind of transitions into whatever the next sort of iteration of the training pathway is, um I guess there's a lot of concerns around what will that look like. And so I think having, you know, as education is being part of my portfolio, you know, I'm really hoping that I can be actively engaged with that process. Um, and in the middle of June, there's a face-to-face uh consultation meeting where all of the Association of Psychiatry Trainee presidents have been invited to Melbourne as well as sort of TRC representative. So there's kind of a really true consultation process going on in order to look at the first, I guess, draft of that new training pathway. Um, and so I think by you know bringing registrars together and you know actively being engaged in those meetings, I'm hoping that that's something that you know I can you know uh be part of. Um and then at the second kind of part of the um training issues, I guess, um, is kind of managing the transition from now to that new training pathway. So I guess you know that's a it's a real issue for current registrars who are trying to plan their training. Um, and also I guess there's some ongoing kind of um unanswered questions around uh especially the second half of this year, um, where you know we're not sure whether there's going to be an OSCI or an alternative assessment pathway. Um and so I think um that's something that's you know high priority uh for trainees, but also for the college and the board is to try and you know iron those things out. And you know, one of the things I'm really keen for, and I know the board is as well, is to try and communicate with trainees in as timely a manner as possible around these issues. So I think those trainee issues, training issues, sorry, um is is a really kind of big piece of work. And then the other kind of issue that's come up is around voting rights for trainees. And I think you know it's a really complicated issue. Most of the trainees that I've spoken to kind of we've had to rank sort of issues, would probably say training itself is probably the most important, given that it kind of is the most tangible thing that we as trainees experience is you know, the assessments that we have to do. But I do think that you know, registrars having uh uh a more formalized kind of voice in terms of voting is something that is important. Interestingly, there was a presentation at Congress where a survey was done of what the fellowship thought of that. And I guess that uh survey suggested was that if you know this went to a vote with the fellowship at the moment, it probably wouldn't pass. And so um I think there are a lot of you know conversations that need to happen around, you know, what does it actually mean? And I guess as with any referendum, the drive for change is a lot harder, and you're you know battling against the drive towards conservatism. So I think uh timing that referendum for trainee rights is really important. Um, and um I think there's you know a fair bit of groundwork, it seems, that needs to be done before that can potentially go to a referendum. Um, and so I think having those conversations, um making, I guess, the fellowship aware that this is an issue, um, I think is really important. Um, my personal view is that I think that um trainees should be given a voting right. I think there's a lot of evidence to suggest that, you know, autonomy, having a sense of kind of agency and inclusion improves well-being, improves job satisfaction, and I think it's a really meaningful way to show that the college, you know, values and wants to meaningfully engage with the registrar voice. So I personally am for it, but I think in order to kind of bring the fellowship along, there's probably more work to be done in that space.

It's certainly not going to be, uh, at least having spoken with you on this episode and just before it, it's not going to be a ceremonial position. I understand that you've been very busy uh communicating with various state representatives over the past few weeks in preparation to achieve some of the goals that you've outlined. Can you tell us a bit about that and then afterwards um sort of hand over to the panel to ask you further questions?

Yeah, um, so I've been on the job for about two weeks now. So uh my main sort of two portfolios are education and member engagement, and I'm you know really happy about that. So I guess it's probably important to sort of clarify that the board director position, I guess it's not a representative role. Um, and I guess the obligation of every board director is towards the college as a whole. Um so that of course includes uh fellows and trainees, but I guess it's not to represent the interests of any particular group. And my opinion is that it's important to kind of maintain that because it means that the trainee member is a full board member that they have an equal seat at the table and um with full voting rights. Um I think you know it's not a tokenistic position and that's important to maintain. But I guess the mechanism for how this position was created was using a clause in the constitution, um, which allowed the board to appoint up to two additional members. Um, so they don't necessarily have to be fellows. It could be a trainee, it could be a member of the public, um, in order to fill, I guess, like an identified skills gap on the board. And so naturally, I guess the skills gap that the trainee board member would fill would be around trainee issues. Uh, so while I recognize that my job is not as a representative, um, I did feel that in order to sort of meaningfully fill that skills gap, I would need to sort of consult widely with trainees. I can obviously bring my own perspective as a trainee, uh, but I'm really mindful that my experience of training doesn't necessarily reflect the experiences of all trainees. And so the first thing I've done over the last sort of two weeks has been to reach out to all the different trainee representatives. So the current, I guess, trainee representation landscape across Australia and New Zealand is pretty fragmented. So most of the larger states around Australia have kind of state-based associations of psychiatry trainees which don't have any sort of official links with the college itself. And then sort of other, you know, usually more smaller states in Australia and in New Zealand as well. There might be kind of a registrar representative who's not associated with an association necessarily. And then, of course, there's the trainee representative committee or the TRC, which is embedded within the college itself. And trainees on this committee sit on a range of college committees and sort of provide a trainee voice on those committees. And I guess in the aftermath of the OSCI, there was some fracturing of this committee with a large number of trainees resigning. Uh, so overall, it's a pretty complex picture, I guess, of all the different sort of trainee representative bodies. But so far I've managed to speak to, I guess, almost every single state-based representative and the chair of the TRC. And I felt that that was a really important thing to do to be able to sort of reach out and kind of understand what the issues were that were facing trainees. And next week uh we're hoping to sort of convene a meeting with all of these representatives, or as many as possible. It's a fairly large group of people kind of spreading the time zones from New Zealand to Western Australia. So we're hoping to capture as many people as we can, and then potentially this can become kind of an ongoing forum. And by and large, I think I've had a really positive experience with these sort of initial individual discussions, and I'm hoping that we can have a really productive discussion together as a group of trainees as well. And of course, you know, we're not always going to agree. Um, trainees like any other group kind of aren't a homogenous entity. So I think, you know, apart from learning the ropes with my new portfolios and trying to digest, I suppose, a whole lot of new acronyms that the college is throwing my way, I thought that starting with trainee engagement uh was an important first step.

It's fantastic to hear you've been so proactive from e hitting the ground running and starting to speak with a lot of stakeholders already. I guess if there are trainees out there who might be listening to this podcast who have issues that they're really passionate about or they want some advocacy on, what's the best way for them to get their voice heard? Is it still to speak to the local associations and feed up through that chain, or are there other ways that you might suggest for them to get involved in these conversations?

Yeah, I I think I mean, I guess that's part of what I'm hoping that we can do when we get together as kind of a trainee forum is to try and kind of delineate some of the different roles that we have because I think there's potentially a lot of overlap as well as sort of different things that we do. So I think for trainees who want um, you know, who have issues that they would like to feed back to the college, I guess the trainee representative committee is one group that's you know potentially you know available to speak to. There's also all the state-based apps as well, and particularly when it comes to service-based local issues, it seems that the apps do an amazing job at being able to kind of navigate some of those issues. And I'm yet to get uh RNZCP email, but I'm sure once that's up on the website, um you're more than welcome to contact me as well. And if you know if I'm able to help, I'm you know more than willing to do that or at least to point in the right direction.

I guess this was something that Skye Kinder talked about when we had her on the podcast um a little while back when she was on the trainee representative committee. She was wanting to talk to a lot of issues to trainees, but there were restrictions about what was in confidence of what could be communicated. And I'm wondering if that's something that is potentially going to be in your role as well, and if there's any sort of advice that you've been given or strategies you have about making sure you can sort of walk that tight rope of being able to maintain communication but not sort of breach the confidentiality requirements of being on the board. I imagine that's a pretty difficult position to be in.

Yeah, so I guess my understanding of kind of the confidentiality um side of the role is that it's kind of similar, I suppose, to our day-to-day confidentiality that we have in kind of practicing medicine, in that you know, there are sensitive issues to do with specific individuals that might come up to the board level or to the various committees. And when it comes to those personal issues, then of course confidentiality has to be maintained. But outside of that, in terms of a lot of the kind of normal day-to-day communication or things that are being discussed, I guess, in the meetings, um unless something's you know specifically highlighted as being confidential, I haven't faced that um issue.

As far as the assessments go, it it is a big topic. Things are going to change. We don't yet know what that's going to look like, but as you say, there's going to be quite a lot of consultation over the next little while. When you were talking about it, and um having heard as a director of training, many other registrars express great dissatisfaction with what happened in November, I'm a bit of a contrarian and I I often wonder: is there anything about the current way of doing things that we shouldn't throw out? Is there any baby that we don't want to throw out with the bathwater while we're changing things? So the the main proposal for the change is to move from a very high-stakes examination to more frequent but less high-stakes experiences, if you like, more like ochers or things like that. Can you um sense any feeling within the registrar community as to whether they prefer one or other of these?

I guess we have a system where we have a whole lot of you know workplace-based, competency-based assessments, and there is just an enormous sort of burden of paperwork around that. And then on top of that, we also have these high-stakes examinations, and we have six externally assessed assessments. And so we kind of are in the situation where we sort of have both competency-based and examinations, and we kind of have an incredible workload from both. And so I think there's going to be a lot of uh teasing out that needs to happen in terms of the college and how we can, I guess rather than hedging bets both ways, how we might be able to try and look at, you know, uh a more kind of unified way to be able to assess trainees that reduces some of that burden of both paperwork and externally based assessments. And I guess it's important to talk about each individual assessment, but I think looking at the overall kind of structure of our training, I think there is a lot of questions around which things have to stay and which things have to go. And yeah, I'm hoping that, and and I guess there is just so many viewpoints on this. It's not like there is, I guess, a single correct path. There's just so many opinions, and I think that's across, I suppose, the literature as well as across kind of people's personal experiences of examinations, and so I think yeah, there's a lot of work to do. Uh, and I'm not sure that I have kind of a direct answer on that.

Primeidi, going back uh to your other issue that you've raised is something that you're like sorry, something that you're quite interested in being a part of changing. What are some of the detracting arguments against getting voting rights within the trainee group?

I I'm not sure that the trainees themselves, I don't think I've met trainees that think that we shouldn't have voting rights. Um so I mean I think there are a lot of trainees who are maybe apathetic towards it. I guess uh, you know, there's lots of trainees, um, and I think myself included really, um, in kind of the initial stages of my training, probably kind of viewed the college as being, you know, an organization that provided these external assessments. I did them, and I hadn't really had a lot of involvement with the with the college at you know that stage of my training, and I think there are heaps of uh you know trainees out there that would be in a similar situation. So I don't think that every trainee is sort of gung-ho wadding training uh voting rights. And I think that that probably is a reason why we should give trainees voting rights because I think it's a way to kind of engage people is by allowing them to have a voice, you know, in these issues. If they didn't, uh you know, if there's if there's an opportunity to actually kind of exercise your view or your vote or what's the point of getting involved anyway. So so I think maybe in terms of the um arguments against it, I struggle to kind of think about what exactly they might be, but if I'm gonna hazard a guess, I would say that it's probably just I guess conservatism around kind of not wanting things to change and keeping the status quo, and maybe some fears around, you know, what would happen if trainees, you know, got the vote. Would we sort of overhaul the system? Would we be able to band together and you know drive changes that maybe uh the fellows don't want? But I I really, in my view, fellows and trainees, we're all kind of part of the same team. We all probably have aligning viewpoints on a lot of things, and we're all going to be, you know, psychiatrists one day. So I'm not sure that I kind of buy into the us and them rhetoric around trainees versus fellows, and I kind of see us all as being colleagues. Some of us are just further along that journey than others. Um, and so I think maybe there is fear and kind of a conservative attitude, but hopefully with more conversations we can try and debunk some of those things.

Promethea, I agree entirely with all those points about why it's an important issue for trainees to get voting rights. My recollection of the two main themes from that survey that you referenced before was one, like you said, a lot of fellows were concerned that trainees might use the rights to water down training requirements, like voting for you know candidates or policies that might sort of make assessments easier. I'm not sure how realistic that is as an argument, but that was one concern. I think the other one was also about there was a range of viewpoints about how much time as a member of the college someone should have before they get voting rights. Some people thought they should be, you know, 12 months, some people short stage three, some people thought fellowship before someone should be able to vote. And they thought that, you know, I guess maybe someone who's not had much experience of psychiatry or the college might not warrant a vote. So those I think were the main pushbacks that I recall. And yeah, I mean, not that I agree with either of those particular viewpoints, but I suppose, yeah, that's a bit of a starting point, maybe, for sort of trying to advocate for why it's important to change things.

Can I give the Machiavellian Fellows perspective on this? My feeling is that uh within the college and uh within the fellow community in particular, there's there's uh an acknowledgement that voting is actually not a very common activity. And if you have an organised group, they can have a really dominant voice. If you have an organised group of voters who will vote, you can actually have an outsized impact. And I think there are some uh some of the fellows at least think that that might happen if we extend, because it's very likely, I would think, that there are going to be certain groups within the registrar population that will organise that will have specific agendas, and there's a lot of fear around that. I think it's an expansion of the conservative point that you've made, but uh there's certainly a lot of fear around it.

Has anyone got any other questions they wanted to ask or comments um Pramudhi you'd like to make or anything you feel like you've missed?

Yeah, I'm just gonna ask Pramudhi, just with the way this is set up, um, like it sounds like you've given a 12-month appointment and it's at the discretion of the board. And I I just the concern that I have is whether that's going to become a permanent thing, whether the board could say in 12 months' time, great, we've had a trainee on, we don't need another one, kind of thing. And I'm just wondering if there's an opportunity to try and make this a you know a permanent change, that the board will always have a trainee representative, and if there's a sort of mechanism to try and make sure that this is something that trainees can keep for for good.

My understanding of that is that that the the plan is that it'll continue. So I haven't heard otherwise. I understand your point in that it's within the mechanism that it's currently kind of being supported, there is, you know, the board, it's at the board's discretion. So I think there'd need to be some sort of constitutional change again in order to be able to sort of permanently enshrine, I suppose, a trainee voice on the board. But as far as I, you know, my dealings with the current board, I don't think there is any kind of plans that this would be a one-term thing.

Certainly on the committees that I'm on, that's the way it's been discussed. I'd be very surprised if they didn't continue with it. Fantastic.

Feels like we've only just started talking for Moody and getting to know you, but there's always the opportunity to come back on the Thor broadcast in the future and keep these lines of communication open. We will wrap up the show now. So I'd like to thank our panel, Michael, Andy, and Brian. Thanks for coming on and sharing the time with us.

Thanks, Oli. My pleasure.

Thanks, Oli. And uh, of course, Pramudi, thank you so much for your time. We really appreciate it. And we uh can all tell that you're absolutely suited to the role and you're gonna do a fantastic job. So we're really happy that you're um you know up there and doing what you're doing. So thanks so much.

Oh, thanks so much for having me, guys.

Of course, we have to thank our production team. Um, we've got all of our stars at the RNZCP who make these podcasts happen. David, uh Joe Rose, and Nishhtar, thank you so much for your time today. Thank you to Doni Prentice for our artwork and Shady Dave for our music, and thanks to Australasian psychiatry for the opportunity.