Welcome back to the Thought Broadcast, the trainee-led podcast from Australasian psychiatry. We have with us myself, Dr. Ed Miller, Dr. Arnor Benipol, Dr. Fiona Wilkes, Dr. Michael Waiteman, Dr. Andrew Amos, and joining us remotely are Dr. Alana Coburn and Dr. Michael Taran. And we're joining you physically from Congress 2024 in lovely Canberra. So good morning to you all and thanks for joining us here. Today we're going to be talking about Australasian Psychiatry's Editorial Subcommittee for Education and Training, which is also known as the Trainee and Early Career Group here at Australasian Psychiatry. And we're going to be talking about the aims and goals of our group and introduce and get to know our group members, particularly some of our newer members. Australasian Psychiatry is proactively committed to assisting psychiatric trainees and early career psychiatrists to develop vital collaborative research and academic skills and practices. And part of this commitment involves establishing the trainee and early career group. So the aim of this group is really to expose the trainees and early career psychiatrists within the group to a culture of research and academic practices and therefore increase the competence in these areas for the people within the group, but also through the work that's disseminated, our hope is really to increase the quality and rigour of psychiatric practice amongst trainees and early career psychiatrists in the community more broadly.

Thanks, Ed. So certainly one of our core beliefs as a group is that early career psychiatrists, trainees, and medical students all have the potential to make valuable contributions to psychiatric research. And one of the reasons that we're passionate about this is because we know that it's good for patient care. There's good evidence to show that health and training systems that provide opportunities for junior staff to participate in research help build cultures around this and they tend to achieve better outcomes for patients. Despite this, we know that not all specialist medical colleges in Australia and New Zealand have research projects or research-related assessments as part of their training process. Obviously, we do in psychiatry, which is a positive thing. But a lot of the training programs that do have research components lack adequate supervision or appropriate levels of research training. So we're hoping that we can help build up some extra resources in this space and help develop that for those in psychiatry. So we certainly feel that psychiatry trainees should be more exposed to research and academia and certainly support that wherever possible. Research can often be considered as something that is a tick-box thing to get through, research programme, or resume building exercise is a primary motivation to publish. We hope that that's not the case, and people will get into it, and exposure to research will build passion in this area. And part of that is about overcoming common barriers such as time restraints and limited opportunities. It's worth pointing out at this point that there have been a number of really significant contributions rather made by medical students and junior doctors over the years throughout medicine. So there are many ways that junior doctors with research aspirations can meaningfully contribute to the field. So a few examples of medical students and early career specialists who have made world-class research discoveries, are these that I'm about to talk about. So perhaps the most famous discovery by a medical student was a 1950s retrospective case-controlled study by Ernst Weinder, who showed that lung cancer was more likely to appear in men who smoked. Ernst was at the time a medical student at Washington University in St. Louis. Other examples are as medical students, Richard Pfeiffer discovered that Haemophilus influenzae caused the flu. Louis Provost worked alongside Jules Cottard to discover Provost syndrome. Julius Wagner Jaurig described the functions of the vagus nerve, and Wilhelm Reich contributed to the important second generation of psychoanalytic thought. And within our own college, in 2023, the Early Career Psychiatrist Award was given to Jason Jeggernathan for his work on quantifying facial dynamics in patients with melancholic depression. And Jenna Cheney won the Scholarly Project Award for investigating different diagnostic shortcuts psychiatrists make when assessing for early psychosis, which is some really interesting research projects that I'd encourage people to check out. Even within Australia, the most famous contribution to psychiatry was John Cade's discovery of the effectiveness of lithium. Despite being a relatively seasoned psychiatrist, he was operating out of a pantry in the Bundura Repatriation Hospital in Melbourne, which shows us that even those in the most unlikely of places can make great discoveries so long as their minds remain open and curious and they endeavour to report even the most seemingly straightforward clinical observations or case findings.

Thanks, Michael. So in terms of some of the roles and responsibilities of members of the Training Early Career Group, so what we do is we review articles for Australasian psychiatry and we try to review articles which are match our kind of stage or level of expertise. And we get help with this from the sort of senior editorial group to help us find appropriate articles. We write book reviews for Australasian psychiatry. We help, we run the this um podcast, The Thought Broadcast. So this is more or less entirely trainee run. We also function as a semi-kind of independent or autonomous research group ourselves where we write and publish articles relating to trainee matters or basically any um topic in psychiatry that is of interest to us. And that that is a way that we can practice our own research and collaborative skills. We present at local and national conferences. So we've presented at the RAN's ZCP Congress for the last two years in a row. And we we also participate in Australasian Psychiatry's annual general meeting. We're always looking for new ideas about how we could expand our research and academic interests within the group. So for example, in the December 2023 edition of Australasian Psychiatry was a trainee takeover edition where the majority of articles submitted to the journal were from trainees and with a cover art by a trainee and also an editorial written by trainees as well. So, like I mentioned, the the topics that we tend to focus on are topics around psychiatry training, psychiatry as a subspecialty, particularly for medical students who might read the journal and be inspired to take up psychiatry as a result. We're looking to focus on topics that disseminate knowledge around basic skills within psychiatry, topics that can help trainees with passing formal training requirements and expanding part of our portfolio is also focusing on early career psychiatrists and issues relevant to that group, such as well-being, which is an article that we published last year. So, what we're going to do now is just go around each group member and just sort of talk about each group member's interests and background and just to sort of give a bit of exposure to each person. So we'll start with Anor.

Hi, so my name is Anora Benny Paul. So I'm a stage three psychiatry trainee currently working in the Waikato in New Zealand, and I'm doing my advanced training in old age psychiatry. I've had the privilege of studying and working across Australia and New Zealand, even doing a few years of training right here in Canberra. My particular interests focus on dementia and the management of the behavioural and psychological symptoms of dementia, BPSD. And I think that intersects quite nicely with palliative care and pain management as well, because often pain can really increase those symptoms. So I'm looking towards doing some research with the palliative care team at my hospital around that. And then my other area of interest is developmental disorders. So autism, ADHD, and intellectual disabilities. And there is a reasonable amount of crossover with old age psychiatry and developmental disorders, actually, which is really interesting and I think under-researched.

I was thinking that's almost an oxymoron development and old age psychiatry, but I guess development is always happening across the lifespan. It doesn't necessarily mean early sort of life development.

So Exactly. And I think a lot of the research focuses on the sort of the child and adolescent period and then in young adulthood, but it's really neglected moving into older age when you start to get more physical health problems, mental health problems, or the sort of onset of neurocognitive disorders as well.

And also missed diagnoses, right? And I also work in old age psychiatry and I've seen women in their late 70s who've for their entire lives been told that they're lazy and stupid and just don't concentrate. And actually, no, you've just got ADHD. And then you start them on appropriate medication and their lives are totally changed. It doesn't, it doesn't stop. So that's awesome that you're looking into that more.

Okay, um, next we've got Fiona.

So sorry, I've talked over anyway. Um my name's Freddie's. I'm a psychiatrist also a psychiatry of old-age uh advanced trainee here in Canberra. Um my uh research interests are similarly in um neurodegeneration. I suspect I'm gonna move a little bit more into delirium dementia prevention field, although I'm at the end of my training and I'm working out what that's gonna look like as I move into being in a consultant next year. Hooray, and and trying to work out how to manage clinical work and academic work and family life and all that kind of thing. Um, I got into psychiatry by a roundabout kind of way. Like I said, when you're talking about inspiring medical students to do psychiatry. Psychiatry was not in my plan at all. I was quite like when I was a younger child with my mum who's a GP, I was very rude to all of her GP friends about never being a GP. Thank you very much, Gross. And then I well became a doctor. I came into medicine wanting to do neurosurgery specifically and was very set on neurosurgery. But that was actually more from a having got to see deep brain stimulation. When I was doing my undergrad degree, my grandfather uh had Parkinson's uh disease and and died with Parkinson's dementia in my undergrad. I adored him, he was a wonderful man, and that really set into motion what I wanted to do and where I wanted to go, and I was lucky enough to see a wake-deep brain stimulation as an undergrad in a man with Parkinson's, not my granddad, um, but to see the change when you get the electrode in the right position in the brain and you turn it on and the Parkinsonian tremor just stops. And I was like, I want to do that, that's what I want to do. And so that's that's why I did medicine and that's how I started, and my medical elective was in functional neurosurgery in London, and I was absolutely this is what I'm gonna do. But A, the surgery for deep brain stimulation is actually pretty boring. Um, go figure. It's very mechanical. Here's some numbers, you plug it in, and then it's done. It's not all that exciting. Um but B, the other things that I was exposed to, and particularly this group that I went to in London, they were all about the research and they had neuropsychiatrists involved, and they did all of this amazing research into deep brain stimulation. They weren't just doing it, they were pushing the boundaries and working things out and really helping people. And so I saw a little bit of that, and then I did neurosurgery and I realised it wasn't for me. Um, but in the background, again, with being terribly rude to people about I'm never going to do that, that career choice. I'd started a PhD with the aim to get into neurosurgery, but three of my supervisors were neuropsychiatrists. And so when I realized neurosurgery wasn't for me, I looked around and realized that actually these neuropsychiatrists are pretty awesome. They're really lovely and really interesting, and they do all of this really interesting stuff. Maybe, maybe psychiatry would be a better fit. And so I switched. And I've got to say, I've never looked back. I'm really enjoying what I do, and I'm really excited about where it'll lead me.

Wonderful. You've seen the light, John Boss. So is it sort of that that biopsychosocial approach that was what attracted you to psychiatry? Is that part of what you were required?

Well, I think being able to be inquisitive and be interested and have lots of interests and ideas, and I think probably as well connection and and also, you know, psychiatrists were nice to me, which helps. And it certainly means that it I've been able to do things having switched that I wouldn't have done otherwise. I've got a toddler that was never in the plan when I was going to do surgery, it just wouldn't have been feasible.

So there'll be no healing with steel for you.

No.

Very good. Thanks, Fiona. Okay, next we've got Alana.

Hi, I'm Alana Covent. I'm the newest associate trainee editor for the team. I'm currently a stage three trainee doing advanced training in consultation liaison psychiatry and working in Victoria. I did my primary medical training back in the UK, but I've been in Australia for the last six years. So I guess in terms of my interest and what's drawn me to working with this team and particularly an interest around audio broadcasting. So I always had an interest in narrative and storytelling, which was what drew me to psychiatry as a subspecialty in the first place, um, starting from around fourth year of medical school and staying pretty drawn to it since then. I also have uh an interest in psychotherapy, so hoping to do advanced training once I've got my fellowship. Um I've been involved with some teaching through Unimelb over the last few years. I'm also an interest in the history of psychiatry more broadly. You might recognise my voice, some people from the Psych Review podcast. I'm one of the co-hosts along with my three esteemed colleagues. Um I have been doing that for the last uh three years or so. And yeah, that's I think been a really amazing time, a great team, and yeah, it's hard to meet to think about sort of scientists and communication more broadly, uh, how to condense and distill uh science topics and psychiatry topics specifically in a way that's palatable and understandable. And so hoping to bring some of that experience to working with this team. In terms of research, so I did some lab-based research back when I was a medical student, I've done a couple of QI projects, but really um yeah, my research career has been fairly uh dormant since then in terms of actually sort of actively being involved in research, but obviously reading and doing critique as part of the podcast for a number of years now. I'm currently involved in a project through completion of my scholarly project. So looking at the role of psychiatrists in abortion care, which is linking really nicely, I think, to my kind of broader interest in phenomenology and thinking about bodily symptoms or bodily symptomatic expression of distress, mental illness, and the mind, brain, body into a relationship more broadly. I'm really looking forward to working with the team and collaborating with them uh to help expand the audio broadcasting um of our work together. I think I've had a few ideas, but I'd love to do some episodes considering the history of psychiatry, what lessons that we've forgotten, what we can sort of continue to learn and what may be applicable in our work today. I guess more broadly thinking about the overlap between what has been or topics that may have classically been considered to be humanities or arts-based and psychiatry, so including things like ethics and philosophy, which I understand is a shared interest of some of the other members of the team. So yeah, looking forward to working with you all and what we can do together. Thanks.

Great, thanks, Alana. So next we've got um Michael Turan.

Hi, my name's Michael. Uh I'm logging in from Albany, which is uh located in the southwest of Western Australia. So I'm logging in remotely, I'm not in Canberra, I'm currently sitting on uh Menang Nungar land. I'm a stage 2.2 uh psychiatry trainee in the WA Rural Psychiatry Training Program. Uh I guess I found psychiatry like many people in a little bit of a roundabout way. It was never something that was on my radar. Uh indeed, entering medicine wasn't something that I was actually overtly interested in. It was just something that I did after high school and then came out as a junior doctor and realized that the work in medicine wasn't really what I was cut out for. I had uh quite a hard experience as a junior doctor, and like others have said so far, I found psychiatry initially because it was a rotation where people were actually nice to me, they treated me as a human, as a person, uh, and it was also something where there was no shift work, which fit quite nicely with life. But as I started to work a little bit more in psychiatry, I realized that compared to the rest of medicine, I found that it really suited the way that I liked to approach medicine and thinking about people rather than kind of ordering a test to find out what something is, ordering an MRI or an X-ray or a blood test to diagnose something, that it's really around the formulation and thinking about all the factors across the life course. And the fact that we knew relatively little in psychiatry compared to the rest of medicine, in the sense of kind of relocating pathology and things like that, really kind of sparked an interest that I initially fostered at uni but had kind of lost through burnout as a junior doctor in research and uh coming into psychiatry training kind of reignited that interest in research. I've picked up an eclectic mix of research projects, and uh, I was trying to think while others were talking what kind of intersects them all. And I think that uh while some are looking at substances, some are looking at indigenous mental health, the intersection is really kind of an interest in systems and systems development from kind of the point of view of how uh the healthcare system can uh better provide mental health care to clients in the most appropriate way, and how we can innovate in that space.

Thanks very much, Michael. And now I've got Michael Waitman.

Thanks, Ed. Yeah, so uh regular listeners might already know me from previous podcasts. I've been involved for a few years now. Currently, I'm an early career psychiatrist based in uh South Australia. I work for the Rural and Remote Mental Health Service and also do some part-time academic work for the University of Adelaide. I yeah, first got involved with the journal a few years back as an associate trainee editor, um, really enjoyed the role working with the group and have been fortunate enough to continue on as an early career psychiatrist now on the general editorial committee. My uh interests are in medical education and teaching. Through my academic role, I've been involved in uh curriculum redesign for the psychiatry component of the Adelaide medical degree and really enjoyed doing that, and that links sort of well with the goals of our group with um psychiatry training as well. From a research point of view, I've uh published in Social Cognition in mood disorders in the past, and uh in future, I'm quite fascinated by artificial intelligence and how that might impact on psychiatry and psychiatry training, and that's an area that I'm quite interested in getting involved with as time moves forward.

Most listeners will probably know me reasonably well. I'm Andrew Amos, deputy editor of Australasian Psychiatry. At the moment, most of my focus is on research, so I'm doing artificial intelligence work where I'm trying to suck all of the information out of uh the uh indexing database PubMed and then shape it into an information map of everything in medicine and psychiatry in particular, and then put it into a form that's useful for curriculum development. Uh other areas of interest include changes to the assessment program in uh the RNZCP and gender medicine. So I've been it's been fantastic fantastic working with Ed and Michael over the last few years, and wonderful to welcome Fiona, Arnur, Alana, and Michael to the team.

Cool, thanks Andrew. And just to sort of finish with myself, so yeah, listeners might also kind of recognise my voice from a large number of podcasts over the last so 12 months. So I have been trainee editor of Australia's psychiatry for the last 12 months. I've really, really enjoyed this role. I first started being interested in psychiatry um as a final year medical student, actually. So prior to that point, I absolutely hated psychiatry and um didn't didn't really want to have anything to do with it. And in my final year of medical school, I happened to do a rotation in child and adolescent psychiatry with a really inspirational child psychiatrist, Ben Wells, from um Adelaide, who was, yeah, I found really, really interesting and really, I think ignited passion for psychiatry um in me. And I was interested in psychoanalysis. I started reading, reading Freud, and I've got one interesting anecdote where I was in a um oncology rotation after that point, sitting in an outpatient room. And the way that this sort of um department operated was the I was with the consultant, and the consultant would see patients sort of in and out for the appointments, and I'd more or less be sitting um in the back corner of the room, so basically doing nothing, I suppose, just observing. And uh during one break, I had started reading Freud on my tablet sort of computer that I had, and the consultant came in and said, What are you reading there? And I said, Freud. And he basically just turned away from me, went back looking at the computer screen, didn't talk to me again for the remainder of the rotation. Um, so I've yeah, I I realised pretty pretty soon after that. Well, some aspects of psychiatry, I suppose, a little bit niche, and there's a particular stereotype, I suppose, or perspective that other medical doctors may have towards psychiatrists. But as I've gone on, I've really loved learning about the intersection between the mind and brain. So I'm really interested in neuropsychoanalysis and the philosophical aspect about mind and brain. I love all those sort of technical, sort of uh intellectual perspectives on psychiatry, on human nature, these sorts of things. The majority of the research I've done to date has been actually in school-based mental health interventions. So I spent some time in the UK doing a research master's on school-based mental health interventions, and then I did a second master's in theoretical neuropsychoanalysis to kind of scratch the itch that I had that I still have around those things that I mentioned earlier. And I'm now actually based in Auckland in uh New Zealand. I'm in the latter, very latter stages of training, sub-specialising in child and adolescent psychiatry and looking to potentially do possibly an inpatient consultant role in child and adolescent psychiatry and tying that in, hopefully more with psychosis, schizophrenia, mood disorders. I'm also really interested in quality and service improvement projects. So research that has real practical sort of implications for the service and the way that different um components within the service interact. And I've also got an interest in teaching and training. So teaching medical students at the University of Auckland, um, obviously doing this group is a really strong passion of mine as well. So I'm really, really passionate about giving back and demystifying research in academia, I think, and making it more accessible. Um, because I think that actually improves quality of service and patient outcome. So it kind of ticks all those boxes in terms of things that I'm really passionate about.

Can you tell us more about theoretical neuropsychoanalysis?

Uh yeah, so that was the masters that I did at UCL, so University College London. So that that was the course. So there's actually it's actually a sort of a field that is growing in awareness, in in scope. And I think it's it's really about breaking down this traditional Descartes view that there is a difference between the mind and the physical brain. And so there's lots of really interesting research. And so one field of this is actually effective neuroscience, and what's the difference between subjective experience and biological predisposition, and how do those two elements interact in the field of say emotions and effective experience?

So can I ask a curly one, Ed? Of course, Andrew. Uh are you familiar with the Neuralink process where Elon Musk's company is starting to insert electrodes that allow uh people who essentially numb from the neck down to control computers with literally from their mind. So an interface between mind and machine. Does this have have implications for the philosoph philosophy of consciousness and phenomenology?

Yeah, I have seen that sort of stuff, and that that's absolutely amazing, isn't it? That people can control I I think someone was playing Tetris with their brain, I think it was. And with this sort of massive uh you know, supercomputer attached to their head. But you know, so I'm sure in you know 50 years or a hundred years, you know, what people are are going to be able to do with their mind is going to be on a kind of science fiction you know level.

There was a paper in I think Nature about six months ago about using fMRI to decode what people were saying as well. I don't know whether you guys saw that, but it it wasn't quite you know, you had to had to think a sentence and then they get they would try and, I assume, through AI, run it through processes to get the AI to say what are they what are they thinking of.

There's a reasonably long history with that, and they're actually quite good at getting visual parts of the brain because they are topically organized. But the Neuralink is is a direct physical connection which is much finer granularly. So I think as Ed says, it's going to develop in leaps and bounds over the next little while. I think it's really interesting in terms of uh blurring the boundaries of consciousness, and it's gonna have big implications. I mean, obviously for people who have broken necks and so on, but for the rest of us as well.

Yeah, I and that's it's just super um interesting, isn't it? And so going back to this you know split between mind and brain and discartes and then how that split off psychotherapy from kind of biological psychiatry, but now we're seeing a return back to say psychedelic or psychopharmacologically assisted psychotherapy. So even that it there's more recognition that that you know you can interact with someone's mind through interacting with their brain, and you can also interact with someone's brain through talking that has a specific methodology and structure to it as well. So, and and there are so many implications across multiple different sort of fields as as well as you know, important ethical implications from that. So it's it's all yeah, really interesting.

One one final uh diversion from me. I think artificial intelligence is probably going to change our view of consciousness largely because a lot of these large language models look like they have intelligence, but all they are is pattern recognition. One of the problems with understanding, we don't actually know what human consciousness is, so how can we be sure that it's not exactly the same thing that's happening in these supercomputers?

Can I jump in with a comment? Uh I find it interesting that we we all have kind of vastly different experiences that have led us all to psychiatry and to this group, but then it sounds like even things that we share in common, there's this vast diverseness and interest, which to me just kind of demonstrates one of the things that I love about kind of psychiatry and working in psychiatry is this kind of diversity of interests that you kind of anyone can foster. And I just find it really interesting listening to everyone's stories and kind of hearing about the common threads, but then the things that were different, and how you know some people are interested in artificial intelligence, others are interested in areas of dementia and that all these experiences kind of mixed together, and I think that's then reflecting on my own practice in psychiatry, what I like about seeing patients as everyone kind of has their own journey.

Absolutely, and that's what's been really lovely about Congress.

I'm sorry you couldn't make it uh with us, Michael, but there's the the diversity of the Congress presentations has been exactly the same. There's been all of this wonderful stuff on history of psychiatry, there's been great trauma stuff. I don't think there's been all that much AI this time around, has there?

But Well Elizabeth Moore gave a talk over course. And there uh there were a couple of other items on the programme.

Okay, so that just about wraps up things for this podcast. We've just talked a little bit about our belief that fostering a culture of research from early on in a doctor's training, including you know, starting in medical school, you know, we all have different perspectives and different views. I think you know ultimately we're thinking about how this impacts on patient care, you know, and innovation and better outcomes for patients and the services that we work in. And there's lots of examples of junior doctors and medical students who have made really meaningful scientific advancements, and that's still happening today, as evidenced by the all the RA and ZCP awards. And this group that we're running here is just one um opportunity to increase research exposure amongst the members here and also hopefully more broadly, such as through disseminating this podcast.

And just on that, Ed, it'll be fantastic for listeners to get in touch and let us know and what they think about our podcast, what topics they're interested in, what we could do in the future. We've had people in the past who have reached out to us and have been guests on the podcast as well. So it'd be fantastic to have more people get in contact as well. And I think people can do that either through contacting us individually, there's a journal Twitter account, and we do have an email address which is thethoughtbroadcast.podcast at ranzcp.org as well.

Yeah, thanks for that, Michael. I think that's a really important point that we're really keen to hear what people think and to get your your feedback and input as well. So thanks. So that concludes this podcast on Australasian Psychiatry's trainee and early career group. Many thanks to Arnor, Fiona, Michael Taran, Michael Waiteman, Alana, and Andrew for your input.

Thank you. Thank you.

Thanks, Ed. Many many thanks to our producers David Bill and Nishta Kuma, Shady Dave for our intro music, Sidoni Prentiss for our artwork, and of course Australasian psychiatry for the opportunity.