Welcome back to the Thought Podcast, the trainee-led podcast from Australasian Psychiatry. My name is Ed Miller, trainee editor for Australasian Psychiatry, and I'm joined by Andrew Amos and Ashna Basu. And this is the second part of a two-part series where we interview Ava Carter, the trainee-appointed board director for the college.

Can I ask, had you ever done a role like this before, or did you have any governance calls or are you going to undertake any of the AI CD courses?

Oh, that's a great question. As part of the terms of regulation for the position, uh you have to undertake the AI CD course, which I'm actually about to do next week. I've I've done the the 60 to 80 hours of preparation, and I think you've done it yourself, uh Ashna.

Yeah, those like big old binders, yeah.

It's it's enormous. It was very intimidating receiving that uh that package. I felt like I'd gone right back to high school for the ATAR or the OP school in Queensland. But uh I'm very excited to do the AI C D course next week. In terms of other sort of governance qualifications, I don't have anything formal otherwise, but I've spent many years doing work with the Canberra Regional Medical Education Council, which oversees accreditation for junior medical doctors. And that probably also has really influenced me in perhaps my decision to nominate for the board director role because you can see the power of governance and safe implementation of policy for junior doctors in large organisations and hospitals to enable the organisations to do what they want to do, which is work with doctors and train them well. So being a part of the accreditation committee and then the council, which is a ministerial sort of role, has really helped me broaden my experience within healthcare and the larger community. And I've done a little bit of work with the Medical Board of Australia through the Medical Training Survey and the Confederation of Postgraduate Medical Education Council, but that's only been in the last two or three years. So I feel still quite junior in that space because it's an incredibly broad role. So yeah, I've I've got um some experience, but in terms of formal qualifications, no, I don't have uh anything until the AICD.

Well, look, um from what I can see, you're you're uh as well qualified for the position that you've got as you possibly could be at this uh time. You're you know, there's still stuff um in front of you. But the reason people get into these positions, it seems to me, is that they generally, as you said, you want to do things that uh help people, basically. That's why people become doctors generally, and this is an opportunity to help with particular issues. Are there any big issues facing either the college or trainees in particular at the moment that you see as uh things that you could make a big contribution to over the next year or so?

I'd probably break that question down into two, because I think there's the things I can achieve in a year, well it's less than a year now, to be honest, and then there's the things facing the college and trainees within that. So, in terms of the things facing the college, I'll start with that one first, because that's a big list, but it's an important list, and I think it's one that the college has has taken on board and they've accepted all the recommendations and they're working towards achieving those goals. But the college wears many hats, and you know, it's of course focused on training and education, but it also represents psychiatrists and the work that psychiatrists and obviously psychiatry registrars do in providing mental health care of excellent quality and reproducibility to people in the community. So anything that impacts the community is impacting the college, and part of that uh is workforce and various reports. You know, I think this is really an important issue in terms of the Productivity Commission outlining we just don't have enough psychiatrists to meet the growing demand for mental health care in the community and the projections that the Productivity Commission uh provided also include other mental health care workers as well. So one of the biggest issues I see, and I think the a lot of the members see as well, is that the system's under pressure, it's immense pressure on people as individuals, but also from the RNs and CP as an organization. And we need reform and we need significant reform in this area, and the college is is working to look at that uh in terms of how that fits into, I guess, a patient community space. When we talk about a system under pressure, we're talking about people's experiences you know in the emergency department, seeking care, getting GP referrals, uh, looking at how they access psychiatrists and other people who can provide mental health care, and that continuity of care and ensuring its cost is reasonable and affordable, and and that's that's a major issue facing our college and and probably both nations. In answering the second part of your question, which is the things I would like to be involved with or change or introduce, you know, I've got less than a year left, and I've started started the ground running trying to understand my role and and how I can help. But I've always been a person that needs to be strategic but reasonable, with my goal always being, you know, what's the greater good? What can I do to help move things on a path that's that's going to be for the betterment of the whole of the community? And the two things that that I have sat down and had a hard think about always comes back to the TAC, which is the trainee advisory committee, and then communication strategy for trainees. So in terms of the TAC, um it's a very new committee. You know, we've only had a third meeting in August this year, and it's incredibly important that we understand what that is, how it's going to help trainees, why it's incredibly important in terms of a governance structure, and the ongoing need for it to continue to exist and be transparent and help improve the culture within our college. And I think that's that's something that I'm going to work hard to make clear to everyone and within my role as well as the board director for whoever takes my place afterwards, so that they can hit the ground running and they know what TAC is.

I mean, do you look at the TAC as, let's say, a bit of a pipeline for bringing on other trainees that might be interested in developing leadership skills and those sorts of things?

I think so. I think the TAC's a fantastic opportunity for trainees to get involved with the college, to get their voice heard, um, but also not just their voice, to be able to take and elevate the voices of other trainees from their jurisdiction, their region, and then go, this is what I've condensed, and these are the key priority areas we need to address, be able to take that then to the BCT and the board. I'd highly recommend uh any trainee to look at the college and the wider community representation roles they can they can get as part of their leadership and management.

I hope I'm not talking out of school here, but I think you've been talking with Ed about having a page in the college journal uh with each issue. Um and one of the things, being on the membership engagement committee, it's always been difficult to get feedback from broad swathes of the uh the membership, both psychiatrists and trainees. And I wonder whether that sort of feedback loop where you have an organization like TAC and then you have a mouthpiece like being in the journal every every uh couple of months, that's a good way of getting feedback from a broader group of people. Have you thought about those sorts of feedback loops and how you might generate that sort of feedback for the college?

We have. I think it's you know, this column we're doing in Australasian psychiatry, it's it's pretty exciting. Um, it's not something that I've seen done before uh in terms of other journals, and I think it's really unique and it's going to bring a bit more transparency uh to what both my role is and uh a little bit more information to to trainees who might not always be you know necessarily interested in looking at all the emails and and the website. So I think it offers a different form of communication.

But in terms of Have you picked out any high impact topics for the first couple?

So we're really looking at the chat. And then the other things we're going to talk about is the other forms of communication in terms of in-train, app development, other online platforms that the college could use longer term to engage with trainees as we're moving in the digital space, which I think is incredibly important. Uh and then also, you know, Indigenous and Maori training, uh, cultural competency and safety, and just highlighting that as a really important area that's often not for what many reasons, uh, not necessarily on front line, and I think it needs to be.

Yeah, no indeed. Look, Ashna, I think, is our now ahead of social media for Australasian psychiatry. So maybe um Ashner, you can be involved in some of those feedback loops.

Absolutely. I actually have some more questions, still very much um maybe on the TAC side of things. But I remember there was a lot of controversy around the TAC's predecessor, the trainee representative committee, I think it was. And I'd just love to hear about how the TAC has like evolved from those concerns or how this committee is more meaningful than the previous one.

Well, I think the TAC evolved because of the AMC recommendations, and it's I wouldn't say that the TAC is more meaningful than the trainee representative committee, which was the TRC. But I think what the TAC brings is the ability to consolidate the ideas of all these non-college trainee representatives. So you've got everybody from the college, but you've also got all these other voices, which is incredibly important for diversity and transparency and equity for our training within Australia and New Zealand. So the TAC is able to take all those ideas, bring it to the BCT, which is all our jurisdictional representatives, and then sort of meld that into actionables and deliverables for the board. Does that help answer the question? Or have I missed a bit?

Yeah, yeah. No, I think so. And is the TAC bound to the same non-disclosure obligations that the TRC was?

So the I think you're talking about yeah, the deed of undertaking.

I just remember that the people that were like, you know, remember when all those trainees resigned? Yeah. That's part of their rationale for resigning was that they felt they couldn't go back to trainees and feedback what they had heard. Can we talk about what you think are, you know, I guess while you're not a representative on the board, you are bringing that trainee voice. What do you think are the things that trainees are most concerned about, or what have people asked you to raise to the board?

No, that's a really good question. And it's one that that I have to always keep the forefront of my mind as well. Well, having you know, I'm probably quite lucky that we're having this podcast after the attack has met because I've had direct communication with uh the people that help me do my job. Uh they're the people that that really um inform me. But I've had a lot of communication with lots of trainees across Australia and New Zealand over the last few months, and the I would say distilling it down, we've got four things that are real priority areas. Obviously, there's things that I want, but those things have to come second to what the majority, what the community wants. And the first one's education, training, and assessment, and trainees really want to be involved in that process, and the college wants to be involved in the process of getting the trainees involved. So helping shape how that looks in the future is a key aspect to my role at the moment, uh, and engaging the the education committee and working with Nick O'Connor on the board is part of a passion of mine because it's I know it's what the trainees want from my role. The second is indigenous and and Maori cultural competency. That has been a really key issue, and making sure that the college is is listening to that, which they are, but bringing that voice up and elevating it and making sure it's clear and heard is part of um what the trainees want to see and is also what I'm gonna bring moving forwards to the next BCT meeting and obviously the the TAC meetings onwards. And then I think communications is always a tricky topic, isn't it? Because it can come in so many forms, whether it's verbal or or online or in social media. But in terms of what the trainees want from it, from the college in particular, is clearer communication in newsletters, that training in newsletter platform, how in train works, and discussions about how the the digital space is going to look for trainees over the next few years. And we have it's actually really uh impressive. The the group behind the college, um, so the the digital team, the IT team, the executive managers all involved in this are incredibly passionate about making this work. So we've got uh an acute plan, and I'm working with a few trainees in particular on how we design that strategic space. And we've got a few acute ideas that I can help get done in the next tenure of my position, but we're also working on a longer-term plan because I think it's important to address acute concerns now. But what's perhaps even more important, at least to me, is that we set things in foundation so that we can move forwards and keep going after I'm gone. And then obviously the fourth thing, and this again I could talk to you for days, so I won't continue too much longer, but is voting rights for trainees. And just because it's fourth does not mean it's not important, but I like to end with the the strongest point, and voting rights for trainees is uh an incredibly important issue and one we um we will continue to look at in the TAC and the BCT and the board continues to look at as well.

I wanted to ask you about well-being as well. I know this you're obviously doing lots of things, and I'm sure everybody's got different things that they potentially want you to do, but given the sort of workforce issues that are that's facing the college sort of more systemically, and the impact that that may have on trainee burnout um and well-being, are you thinking about doing anything in that kind of well-being and retention space?

It's a fantastic question. And you know, I didn't have it in the in the four sort of key pillars or priority areas that trainees want from me because it's it's a complete uh pillar on its own. Incredibly important area that has so many subheadings to it. But we are working on it, and I'm working with some of the executives uh and non-executives in the college to really define what well-being looks like for trainees and trying to figure out where it is that we've gone in the past and where we actually need to go in the future because the trainee space is changing. The way we train has changed dramatically post-COVID. I mean, I can't really say post-COVID, we're still in COVID, despite the fact we're not recording as many PCRs. But the way we're engaging with training has been flipped on its head 180 since the introduction of hybrid models. So looking after trainees in the well-being space has changed. In terms of what we're doing right now, the college has it's got a an EAP program, which is for members and trainees as well as their families, actually. And I think this is probably an area we haven't communicated very well to people. Perhaps if we would need to keep doing that, but it's a free service, and trainees, members, and family members get four free sessions on things like burnout, stress at work, bullying and harassment, alcohol, substances, pretty much a nutrition diet, whatever you need to talk about, you can talk about it. And it's the fact that it's free and funded by the college, I think is says something about where the college wants to go in this space. But additionally, and I think this is incredibly important, particularly for people who are worried about transparency, is that the college doesn't get any data at all on who it is or which family member or what state you're in. All they know is that people have used it and they get the number. So they get the N, but they get nothing else. So it is incredibly confidential. And we've seen that when I last spoke to the college about this, it was 11 or 12 members that have accessed it so far. And it's only opened in the last few weeks, about the last month. So for us, I think that's a pretty good uptake. And if we keep talking about it, we keep uh destigmatizing this area, I think we can we can do a lot of great work with it as time goes on.

Well, Ava, thanks so much for your time for coming on and just being so generous with your time and your ideas and your plans for your tenure. So yeah, on the on behalf of the Thought Broadcast, just like to say thank you again for this opportunity to talk with you.

My absolute pleasure. Thank you for having me.

Thanks to our producers, David Bill, and Yoshikuma, Shady Dave for our intro music, Sadoni Preference for our artwork, and of course Australia Sarry for the opportunity.