So welcome back to the Thought Broadcast, the trainee-led podcast from Australasian Psychiatry. My name is Ed Miller and I also have with me Andrew Amos and Ash Nabasu. Today we're interviewing Ava Carter. Dr. Ava Carter is dual-qualified in dentistry and medicine and is currently the Consultation Liaison Advanced Trainee and Senior Psychiatric Registrar at Canberra Health Services in the Australian Capital Territory. She's been involved with the college since beginning her training and is the current trainee-appointed board director. Welcome very much, Ava.

Thanks so much, Ed, Asna and Andy. It's a real privilege to talk with you guys this afternoon and very excited to actually have a conversation about what this role is and a little bit about what I'm hoping to bring to the college.

So, Ava, I guess maybe a good place to start is if you can just I suppose tell us a little bit about yourself.

Yeah, of course. Well, I always like to start with the fact I'm a rural girl. Despite living in Canberra now, I come from a little town called Canungra, which is and no one knows where Canungra is, so I usually tell people about desert or qu or uh middle of Queensland, but Kanungra is a tiny little town, at least when I grew up, about an hour and a half, two hours inland from the middle of the Gold Coast. So there was about what 600, 700 people in it when I was growing up. So I know the direct impact of living rurally in an RA45 area and how difficult that can be. And essentially when I got to high school, I thought, well, you know, I want to do something for people, I want to change something, I want to, you know, engage with people that need help more. And I thought, well, what better way to do that than healthcare? And then I had to go and get braces. So I decided that dentistry was amazing, and I loved that awesome combination of science and biology and art and talking to people, combined with the fact that when you attempt to talk to people in dentistry, you often don't get to talk to them. You have a conversation with yourself half the time, the poor patient can't answer back. So I loved that combination and worked as a dentist for a number of years before moving to medicine. I felt that I wanted to do a little bit more. And you know, I'll be honest, the pathway to psychiatry for me was not clear. In fact, I went into psychiatry, or sorry, I went into med school thinking I'm gonna be a head and neck surgeon or a maxillofacial surgeon or ENT, you know, I'm gonna get in there, I'm gonna do trauma, that sort of stuff. And it really wasn't until my fourth year of medical school when I was exposed to what we call our PAM rotation here in Canberra, which is a psychiatry and addiction medicine. I got my rotation for the high dependency unit at the adult mental health unit, and I thought, just gonna get through it, I'm gonna do six weeks, you know, I'm gonna push through, handle this psychiatry, and then I'm gonna move on and go back to surgery. But it was a real learning curve for me. I spent the first 48 hours almost in shock by how impressive the psychiatry team was, you know, the social workers, the physios, the OTs, and that's not even the psychiatrists. I was very impressed with the registrar and the and the bosses, but this holistic wraparound approach to a person, whereas you know, I'd just seen a mouth and you know the head and neck previously. So I wasn't even thinking about what's going on in the mind. So just to be exposed to that, and then to see you know the incredible change that you can have on just not just treating someone for an illness or a disease or you know an operation, but the impact of the broader societal um network that person might have in their family, their community, their friends, and you know, psychiatry really spoke to me, and it was an absolute change from then on in, and I decided, you know, this is what I want to do. And since then, yeah, I've really been trying to find ways to to help people and engage with communities and different organizations that have that ability to have that broad impact on more than just one person, uh and try and sort of branch out from the singular uh mindset that I used to have. That's a little bit about me and sort of why I'm here now.

Thanks for sharing that, Ava, and hearing about your interest in advocacy and engaging with organizations, I think, leads us to asking about being the trainee board director and what led you to apply for that role.

It's a good question. I had to ask myself that many times before applying. I was thinking about it for a long time. I obviously saw Pramudi journey through the inaugural role with the trainee-appointed board director, and I was incredibly impressed with how she handled what I imagined was a totally different role for both the college and both, you know, the trainees themselves, that different style of engagement with a body of members for a not-for-profit member organization that was, you know, in in part it became because of the Australian Medical Council's recommendations after the 2021 Aviovsky debacle. And so the way she was able to transition this role into something that's incredibly positive for trainees, as well as making sure that that she met all of her fiduciary and organisational responsibilities as a board director was impressive to me. So I thought, I wonder what I could bring to that and you know the way I think about things. And I've always thought about diversity, and I think this opportunity really gives us a a chance as trainees to see something a little different. And whilst the board director role is not a representation role, uh it does allow a different voice. And I've always seen, maybe not seen myself, but always like to think a bit like a switchboard. Uh and I know that sounds a bit odd and it sounds a bit a bit weird, but hear me out. So I really love hearing different inputs and different ideas and opportunities and voices from lots and lots of different parts of where we work, you know, our community, the world. And I see myself as this sort of switchboard that takes all these things in and lets them percolate and think about them. And I really want to direct them into the areas and sources of need that that need to have things, solutions, ideas put forward to them. And I like that ability to process and strategize and then be able to turn that into something that's actionable, something deliverable, something that can help make change, even if it's for the long term. I'm not necessarily someone who's focused on acute goals. I mean, that's always good, but the long-term change is incredibly important to me, and I think this position can help shape the future of the college and the the way that trainees will engage in the future is something that I've been really passionate about, having been the senior psychiatric registrar at Canberra Health Services. I mean, that's a different hat entirely, but you know, I've seen the impact that a positive culture that being able to evolve and change with the times can bring to trainees and to psychiatrists, and being able to connect those two things together is is part of the reason why I applied for the board position.

Well, look, that that's an amazing story, but uh I was I was wondering what sort of contact have you had already? I think the handover would have been between June and July, is that right, from Moody?

Uh 31st of May was when the handover occurred.

You've had a few months in the job, and and I imagine you've been to a few board meetings, and that's sort of the hidden.

I've had a uh I'll say I'm still getting uh still getting used to it, but I have had enough to to have a taste of it and be able to talk about it now. Yeah.

So what have you made of that structure and uh what what's your feeling about how the board works?

So I think it works incredibly collaboratively. The board is made up of eight psychiatrists and one of them's a trainee. Well, including one trainee, so nine of us. And essentially we have about eight to nine meetings a year. Occasionally there'll be uh an extra meeting that's really urgent uh if things arise, and the college is incredibly responsive. I think you we've seen that with the 2021 OSCI issues, and uh indeed there was uh an extra board meeting um to deal with some of those things recently as well, which I was a part of. The elected directors are elected by the fellowship um for a two-year term. I think the yes, a maximum of three years, sorry, uh three terms that someone can have. So essentially they can go for six years as an elected director, whereas the appointed director is a little bit different. It's a one-year term and it's appointed by the board, so obviously there's an application process. In terms of how the board works, it's a really fascinating job. And I'll admit, obviously, you go into any new position thinking this is my idea of it, and this will be how things will go. And I've been incredibly impressed with how willing and engaging the college and the board has been to take on a huge amount of different perspectives and be able to then process that and and try and and do the right thing and the best thing by the organization. And you know, I've really enjoyed being a part of it so far and being able to think about and strategize in and stretch my own mind uh in ways that that I hadn't thought possible before.

Well, getting your mind stretched is always a good thing. But my impression is that the the board is a bit of a portfolio, a series of portfolios. So each individual on the board has a particular area. I work, for example, with Mark Lawrence, uh, who is head of the membership engagement committee. I think there's finance and those other sorts of things. Have there been one or other of the board members you've had a bit more to do with on particular projects or anything like that?

Yeah, Mark's fantastic. Um, but I'm not part of the membership engagement committee. I'm on the CRGC, the Clinical Risk and Governance Committee with Mel Turner, she's fantastic. And I'm also on the Education Um and Examinations Committee with Nick O'Connor. And I thought it was really when a board is formed or a new member comes on, for any board, it's important to sort of reallocate portfolios and people get involved with different things depending on their interests. But I thought it was really important to be part of these two committees, the CRGC and the education, because they're key elements to a training experience. The education is obviously part of why you know we're with the college, we're learning to be psychiatrists, and uh being involved in that was was incredibly important to me and as it was to Pramodi. And then I'm also personally very interested in clinical risk and governance, and I think it's important to any organisation to be able to think about different risks and and the way we govern ourselves and and the impact that has on the broader community from different perspectives. So that's why I wanted to join the CRGC. So I'm a member of those committees, but the committee that I chair is called the TAC, which is the Trainee Advisory Committee, and that one was formed as again a part of the AMC recommendations, and its role is to help advise the Binational Committee for Trainees, the BCT, which then reports to the board. So it brings about this incredible group of psychiatry registrars, so registrars that aren't just part of the college. So we we have members from lots of different organisations, such as the ADHD network or the Veterans Association Network, to help bring different perspectives, not just within the college, so that we can get together as the TAC and then help the BCT understand what the major issues for trainees across Australia and New Zealand are, so that the BCT can then go to the board and make recommendations. And that's an experience that we know we met a few weeks ago in Adelaide, the TAC, and and I have to say that I was really humbled by how much knowledge there is within the trainee cohort. You know, you think that when you go to a meeting, you know, you'll meet lots of people and they'll be and they'll be incredible. But when you actually meet them in person and online and you hear their stories and you hear what they've gone through and what they want to achieve and what they want to see done, you just have to sit back and go, okay, we've got some really special people here. We want to hear their voice and and let's get that started. Uh so I've been you know on a high since our last TAC meeting. You know, it's been absolutely fantastic. Uh, and I think we're gonna do some some really good work.

Thanks, Ava. That's that's been that's been really helpful. And one thing that I've always wondered, um, and I think maybe a few people do, is kind of the inner workings of the college at a kind of higher leadership model is kind of a little bit mysterious sometimes. I just think that's probably because people don't actually get to go and see kind of physically what you do. Could you just give us a little bit of an insight, I suppose, and you have already about the sort of leadership model and how it all kind of fits together at that higher kind of board level and whether that's similar or how different or similar that is to other large organisations?

You know, it's a good question, and I didn't really know what it looked like either until you sort of get to the table, as they say. In terms of medical colleges, I think it's easier to to translocate how our college looks in comparison to other medical colleges because we are a not-for-profit member-driven organisation, so we're going to be a bit different to, you know, a listed public company or something like that. So medical colleges generally have a president who's almost always a very, very senior fellow and elected by the college membership. I mean, we saw our new president elect uh Dr. Asta Toma and the process that she went through and all the other candidates went through in terms of the election more recently. And then the president of each medical college is a director of the council of presidents of medical colleges, I believe it's called. And so they themselves meet uh fairly regularly, as I understand it, to discuss the major issues that are going on for all the medical colleges. So, you know, I and I didn't know this until doing this position and hearing that they all meet together, you know, the college of surgeons, for example, and ophthalmologists and everyone gets together to talk about the presiding issues for the community and the their own colleges for the year and whatever's happening in the community at that time. So it's quite heartening that they actually all talk and and liaise with each other, I think anyway. In terms of the composition though, in terms of the leadership, that can differ quite widely. However, consistently medical college leadership is made up of college members, and we know that in our board as well. Uh even as a trainee as a as a member, all of us are in the RANZCP in some way. And we um are obviously a little bit different because we have an appointed trainee director, myself and previously Pramodi, but sometimes other organisations will have independent directors as well. But everybody on on our board has very specific and as well as generalized experience either in finance, governance, policy, engagement, and more generally sort of leadership and specific knowledge of psychiatry and the different sectors within psychiatry and mental health care. That's important to be able to govern the organization as a whole. Does that answer a little bit uh about how the the leadership model works?

It does. I actually didn't know that there's kind of like a higher level in terms of colleges collaborating at that level. That that's really interesting to know.

It's good. It's I I find that really warming actually that they all connect in liaise.

So that concludes the first part of this two-part series discussing Ava Carter and her role on the board of the college. Join us in the next episode of the Thought Broadcast podcast for the second part of this interview. Thanks to our producers David Bill and Nishtakuma, Shady Dave for our intro music, Sidoni Prentice for our artwork, and of course Australasian psychiatry for the opportunity.