SPEAKER_03 0:03

Welcome back to the Thought Broadcast, the trainee-led podcast from Australasian Psychiatry. We have with us myself, Dr. Ed Miller, Dr. Arnour Benapal, Dr. Andrew Amos, and Dr. Michael Waiteman. Morning everyone.

SPEAKER_00 0:16

Morning Ed, how's it going? It's good to be here, Ed.

SPEAKER_02 0:18

Hi, Ed. Morning.

unknown 0:19

Hi. Hi, Ed.

SPEAKER_03 0:21

And we're joining you from Congress 2024 in lovely Canberra. So today we're going to be talking about supervision in psychiatry. And that's because the roles of RNZCP trainees and fellows require navigating really complex professional, organisational, interpersonal roles, as well as a whole myriad of different clinical expectations and relationships. So adequate training, self-care, and continuing professional development are central to maintaining professional standards in psychiatry. And like most medical subspecialties, supervision in psychiatry has roots in the apprenticeship model, whereby a junior trainee learns directly through teaching, observation, and feedback from a more senior practitioner. In psychiatry, supervision has also been influenced by the traditional psychoanalytic dyad. The RNZCP emphasizes the central role that supervision has in psychiatry training and practice, but the supervision concept has actually received relatively scant research attention, and it's not really an entity that has a unified or single definition. There's actually at least six main different types of supervision that are available to both junior and senior RANZCP practitioners, and these include clinical supervision, reflective practice groups, peer groups, mentoring and external supervision, psychotherapy supervision, and research and scholarly project supervision. What we're going to do in this podcast is outline these different types of supervision and try to give a contrast between their different aims and outcomes.

SPEAKER_02 2:06

So looking to the actual process of clinical supervision itself, the RANZCP mandates that all trainees receive at least one hour per week, and that's two hours for the stage one trainees, of one-on-one supervision with their primary supervisor, along with another four hours of additional clinical supervision. So clinical supervision is vital to the training and assessment of trainees. However, it can paint with a very broad brush, so it covers many different perspectives and many different intended outcomes. I'm just going to talk through a complete list of the expected roles of clinical supervisors as described by the college. And I warn you, it's a lot. So to start with, they ask that clinical supervisors and trainees are familiar with the core information, inclusive of the college regulations and the curriculum, the code of ethics, and the procedures of the competency-based fellowship program. So they ask that both parties understand the basic requirements for the role and be committed to education and training. That a supervisor provides an initial orientation to the training program for first-year trainees at their institution. That they provide leadership and modelling, monitor and observe trainees with patients, peers, and other medical staff on a regular basis. That they encourage trainees to consider a patient support network, so that's family and carers, as part of the patient's treatment and recovery. They ask trainees to reflect constructively on the work that they do and the work that they present in supervision, as well as discussing the trainees' performance with the director of training if that's required. Strategies to overcome any weaknesses in performance with a trainee concerned can be discussed. And it allows the supervisor to pick up any problems that need early remediation in consultation with the director of training. They ask that supervisors ensure the availability to participate in the trainee's formative work-based assessments of the WBAs as required. And as part of that, that they sign off a trainee's in trustable professional activities, EPAs, only when they are confident that the trainee can conduct an activity with distant supervision. They're responsible for completing a trainee's formative midterm in training assessment, the ITA, and to provide feedback to the trainee at this time, as well as completing the trainee's summative end of rotation report and assisting the trainee in ensuring that it reaches the college within 60 days. A supervisor is asked to be interested and supportive of the trainee, to understand the educational aims and the objectives for the specific training rotation, to attend reliably and be available for clinical consultation, as well as to attend a supervisor's peer review group three times a year and present at one of these meetings, at a minimum, or at a meeting of medical staff where supervision is discussed.

SPEAKER_03 5:18

That's a lot of different roles. I was just thinking, while you were talking, how many supervisors would know the core information in each EPA requirement? Because just in my own experience, I would think that that's not that common for a supervisor to have the experience to know exactly what each EPA kind of entails. So that would be an interesting.

SPEAKER_01 5:42

And even with Ockers, in in my experience, from rotation to rotation, different supervisors do it differently, even though there's a very prescribed uh set of guidelines for it. So yeah, I suspect you're right that a lot of supervisors don't have familiarity with the format.

SPEAKER_03 5:57

And also I think with that Ocker kind of statement, that how EPAs are viewed by your supervisor also changes because I've had some supervisors that take you know EPAs and doing the WPBAs very, very seriously, and others that see it just as a kind of addendum to your workplace kind of experience, and it's not that sort of important, and both might be true, but it's quite difficult going from one supervisor to the other and then knowing how that each one's going to view it.

SPEAKER_00 6:26

I have been a director of training, and my observation is that there's a large variation through the work life, the trajectory of the career as well. So you probably rely a lot more on process early in your career as a supervisor, and then as you become more comfortable, the process of entrusting a registrar becomes a bit more clear. Because of course, it's it's absolutely not just the things that you're doing in those sessions that allow you to entrust a professional activity, you're going to have other observed activities outside. What the EPA structure does is it gives you a framework within which to integrate all of that knowledge. And I think the list that Anu has just listed, those are all the things that potentially may happen. A lot of them are going to be innate in a supervisor, and you may not even be consciously aware of them at all times. But the EPA process then gives you a way of integrating all of this information and not only changing what the registrar does, but then what the supervisor does in response to the registrar. It's actually a fairly cool process to observe in others over time.

SPEAKER_03 7:25

I think so. I think I've kind of viewed the whole sort of training process and doing a WPBA more as a process rather than doing the actual assessment in the WPBA. So it's for me, it's always reflective of, well, the supervisor's seen me handle a bunch of different complex cases, so they know that I can, you know, do my job. So doing the WPBA is more of a reflection of that rather than sitting down and actually assessing me, you know, sort of in that moment doing the WPBA.

SPEAKER_02 7:52

And I just wanted to say, in addition to what we've been talking about, that first sort of few weeks with a new supervisor, I think, is really important as you learn about how they supervise, they learn how best to supervise you, and then you sort of meet at a a sort of middle ground that you proceed from. So every relationship, I guess, in that sense will be different.

SPEAKER_00 8:13

People can't see it, but I'm nodding in furious agreement. The supervision relationships that tend to run into trouble are the ones that didn't do that planning at the beginning. Because it is a process. You want to familiarise yourself with the partner that you have for that process and review as you're going through.

SPEAKER_02 8:28

So coming back to the practice of good clinical supervision, one of the many reasons that we want this to be happening on a regular basis is that it can help to protect trainee burnout, particularly in those early phases of training. As we've discussed, this practice can be highly variable and can sometimes have unclear goals based on limited evidence of the effectiveness of supervision. It can also be poorly understood, particularly by trainees. One survey found that the supervision objectives were often not clearly defined at the beginning of the rotation, and that the lack of structure, set times, flexibility, and frequent changes in the supervisor were barriers to a safe and supportive learning environment. Another survey of trainees from 2012 found that less than half thought their clinical supervisors were supportive of the role of the trainee in medical student teaching, and they thought that the supervisors did not discuss their teaching in the supervision.

SPEAKER_00 9:26

Thanks, Enora. I'm going to talk about the impact of supervision on assessments, which is of course one of the focus points for registrars. We really want to get through exams. And there is a feeling that this is a responsibility of the supervisor. Some supervisors feel differently, of course. The change in the RENZCP's assessment model in 2012 shifted the focus of supervision to assessment over supportive or mentoring elements of supervision. So proposed changes to the assessment model in 2024 are likely to continue this trend as they replace high-stakes exams with workplace-based assessments. And these will then form the basis of decisions about training progression. So this presents clinical supervisors with potentially an even more complex set of competing responsibilities. So what used to be more pastoral support now might have that pressure. It has been said, for example, that if you replace high-stakes exams and then start using low-stakes processes to replace those exams, they then become high-stakes processes. So it's a complicated situation, and some supervisors have felt burdened by that. So look, the responsibilities then for supervisors will include professional development aspects, such as fostering resilience, well-being, and an understanding of professional boundaries, and may include facilitating an understanding of therapeutic relationships and psychodynamic aspects of the work while ensuring safe and effective clinical teaching and training, alongside additional assessment and pastoral developmental and leadership roles. So quite a mouthful there and quite a big set of tasks for supervisors. Look, a potential workaround to this dilemma in the Australian context can be found in the Royal College of Psychiatrists, RC Psych, training in the United Kingdom, where an educational supervisor is appointed that's separate from the clinical supervisor in order to externalise the monitoring of a trainee's educational progress. So you're literally removing that conflict in the responsibility, and potentially each of those different people can focus on that one aspect of the trainee's trajectory through training.

SPEAKER_03 11:36

I experienced that when I was training in the UK and I thought that was a really good way of doing it. But one of the problems with that is that every clinical supervisor will also be an educational supervisor for another trainee. So it's still for the supervisor, it's still a lot of work. It's just quite nice for the trainee not to have to have that sort of conflict of interest from their direct kind of clinical supervisor as well.

SPEAKER_01 12:02

And also getting two perspectives, two different psychiatrists that they can work with and bounce ideas from, that would be a benefit to the trainee as well.

SPEAKER_00 12:08

Well, one of the big tension points in the college approaching the 2024 changes was the level of resourcing required. So having two different roles may be better for the trainee, but it may not be feasible for all workplaces, for example. So I've worked a lot in regional and rural Australia, and there often isn't even the opportunity for the you know the full attention of a single supervisor. We've tried to address this with things like telepsychiatry and so on, but at the moment we we haven't quite reached that level of resourcing.

SPEAKER_03 12:39

So just to summarise, um, clinical supervision. So clinical supervision is usually individual, it's based on the traditional apprenticeship model. There's often this dual role of the supervisor having both a supportive and assessing role. Uh it's a mandatory part of training, but there's high heterogeneity in the method of supervision, and it's only short term in that it changes every six months.

SPEAKER_01 13:02

Thanks, Ed. So the next category of supervision that we're going to talk about is reflective practice groups. So these are groups where practitioners participate in non-judgmental clinical reflection as facilitated by a trained supervisor, and probably the best example of this category are ballant groups. So, interestingly, again to compare to the UK, in the UK training program, ballant groups are a mandatory weekly component of the training programme. Of course, that's not the case locally here. Nevertheless, many local training branches do offer these groups, uh, and they can also be privately arranged for psychiatrists for CPD purposes as well. Ballant groups typically meet between weekly and monthly and usually have around five to ten participants in them. The format of these ballant groups is they typically centre around a participant presenting an account of a perplexing or troubling patient encounter which elicited a strong emotional response in that practitioner. And then the other members of the group consider the emotional experience of both the doctor and the patient without a focus on the technical explanations or giving advice. The aim really is for the participants to be able to explore the dynamics that might be involved in the interaction and which might also play out in the group that's discussing this particular patient as well. So looking at things such as parallel processes, transference, counter-transference reactions, identification, projective identification, these kind of things. And the goal of these groups is really intended to help the participants understand their own experiences and also their patients' experiences, which is a really valuable perspective. And it can also help deepen understanding of complex psychodynamic aspects of cases as well, which can help the participants with emotional well-being and preventing burnout as well. So they're really valuable groups if you have an opportunity to participate in one.

SPEAKER_03 14:55

And in my experience, I've had um rotations where I've had balent groups and also where I haven't had balance groups, and I think that the balance groups really add something to the training experience, both for the sort of technical aspects of the Balient process, but also getting to know your colleagues and workmates and seeing a different side of them. I think it really helps with that. I think one problem with balance groups is that in rotations where we've tried to get a balance group started, is you need to get someone that has balent group training, which actually isn't, in my experience, a common thing.

SPEAKER_00 15:32

It's highly specific to the region. So the Gold Coast has got a whole slew of them. But what about New Zealand? Have you heard of it?

SPEAKER_03 15:38

Yeah, that's that was the issue to try to get someone with balance training, and then to actually get training, to undertake the training is quite a convoluted and costly process.

SPEAKER_00 15:47

I think it is to get the pure form bailant, but uh when I was a registrar, we actually put on what were called modified bailant groups. So we had a supervisor that was very familiar with the form. We modified it in various ways, including inviting non-doctors into the group, and that was a valuable training experience. So the trainees led those sessions, and as you say, very valuable learning experience. The dynamics within Allied Health and Medicame really interesting ways.

SPEAKER_02 16:13

Yeah, and where I am in New Zealand and the Y Cuttor, we have bailent groups built into our teaching program. So maybe every month or two we meet for those as well as separate reflective practice groups, which are really valuable.

SPEAKER_03 16:26

So to summarise reflective practice groups, they're they're group based, they're psychodynamically informed, there should really be a clear methodology to the process. They're not mandatory though in RANZCP training. They can be short to long term, depending on the context, and they may have a cost involved. And they're also something that any grade of psychiatrist from trainee to consultant can participate in.

SPEAKER_01 16:49

Great, thanks Ed. So another type of group supervision is a peer group. Now, this is a category that's perhaps more relevant for psychiatrists than for trainees, as peer groups are part of the mandatory annual CPD requirements for psychiatrists. But often in some training networks, senior trainees will be included in these groups as well. Peer groups typically meet on a regular basis, often monthly, but can be more frequently than that if required. They consist of between sort of five to ten psychiatrists, often of differing clinical stages or differing sub-specialties as well, to get broader kind of perspectives into the group. As well as contributing to CPD, a peer group offers perspective sharing between professional equals with tasks such as exploring complex cases, management decisions, and also sharing current trends in research or practice. And these are really valuable spaces for psychiatrists to learn from each other in a safe place, to be able to discuss conundrums from their clinical practice and get perspectives that can be really valuable in helping them manage through this. And I guess the value of having a peer in the group is that it provides a supportive and encouraging environment from others to understand the complexities and the vicissitudes of the role. There are some peer groups as well that can focus on a particular theme or subspecialty that might be of particular value for the participants. For example, I'm in an Indigenous psychiatry peer group because that has a lot of relevance for my work in rural and remote psychiatry in South Australia and helping me understand some of the unique factors in looking after Aboriginal patients. So I get a lot of value out of that with like-minded specialists there as well.

SPEAKER_03 18:23

Are they all psychiatrists or are they a group with people from different perspectives or roles within Indigenous mental health?

SPEAKER_01 18:30

The current membership is all psychiatrists, but I know that in the past it has been broader with other people like that as well. And yeah, it'd be great to have more people join in future if possible.

SPEAKER_03 18:40

So thanks, Michael. So just to summarise, peer groups, so they're a group-based type of supervision, often with a mix of junior and senior colleagues from within the same grade. They meet regularly and count towards CPD with a mix of collegiate, clinical, and supporting roles. They're often long-term. They may have a cost involved and are usually at a consultant level.

SPEAKER_00 19:01

Okay, thanks, uh thanks, Ed, thanks, Michael. I'll be talking about mentoring and external supervision. So mentors and external supervisors both offer individual supervision, but uh mentors are generally referred to as teachers, advisors or career coaches, and they'll be good at listening and talking in confidence with the mentee. Usually mentors and mentees meet fortnightly to monthly. Sometimes, when more professional guidance is needed, they'll meet more often, and at other times they'll meet less frequently when things are going smoothly. So, common subjects for this type of relationship are training, managing work-life balance, issues with supervision. Very important part is uh the career goals and plans. So, very helpful to talk through with a mentor where you're going, where you're trying to end up, and uh the little adventures you might have along the way. So, suggestions about professional development opportunities and uh can be helpful for getting into those sorts of professional networks that are useful for developing a career. So uh mentors will often also affirm the mentees' strengths and interests and provide encouragement uh when that is needed. There's limited research available that providing evidence on the effectiveness of mentoring, but it can help with burnout, and it's thought to be particularly effective for senior trainees who are planning for the transition to fellowship. This is one of those areas probably haven't done a lot of research because the ethics and the methodology are a little bit tricky. The things that are discussed in the mentor-mentee relationship often are so specific to that individual they don't necessarily translate well to other people, and people are a bit reluctant to engage in research. I think that that's understandable. And it's also one of those situations where it's just you don't actually require evidence in the way that you do for a treatment. It's part of the professional discretion of each of those professionals to judge this is useful for me as a mentee, and for the mentor, I find it fulfilling to engage in this relationship. So, look, barriers to effective mentoring include times when the mentor is being too critical. This is something I've recognised in myself. I I love being hyper-critical, which works well in a research situation, but not necessarily when you're dealing with living human beings and uh who may be having difficult times. Other barriers can include mentors who try to solve mentees' problems for them rather than help them find the solutions for themselves, mentors who interfere with the psychodynamics of rotation supervision through processes such as splitting. So just harking back to the idea of having educational and and uh clinical supervisors, this might be another uh situation where that would be difficult. If you've got two different supervisors, splitting then becomes more of a possibility. But certainly something that can happen when you have a mentor that's providing different advice than other supervision relationships. And finally, blurring of boundaries between professional, social, and other relationships. This is particularly a problem in regional and rural where often there are a few options for supervisors and mentors. And it's one of the reasons that the college has set up their mentoring program across Australia and I think New Zealand, in fact. So you might find a mentor through seniority, you might find them through shared interests. COVID, paradoxically, has actually helped with that process, making the selection process much more broad. Alright, external supervision then refers to a trainee or a psychiatrist regularly seeing a senior colleague outside of their workplace for support and guidance with complex clinical organisational or workplace issues or upskilling in a specific area. I don't know that we specifically talked about this in the article, but this has been thought to be fairly uh important for young female registrars and uh early career psychiatrists.

SPEAKER_03 22:54

I've got my own external supervisor that I've kind of envisioned to help me from the final year of my training and then navigate that into my kind of first few years as an early career psychiatrist. So I think and so far it's been really, really helpful. Yeah.

SPEAKER_00 23:09

Well, one of the interesting things, the mentors love it as well. It's quite different from the clinical supervision role and often a lot more rewarding because you're developing that longer trajectory of career, and it's almost like watching a favoured colleague bloom into the fullness of their own career. So, look, given the seniority difference between mentors and mentees, the the uh role includes uh both mentoring and supportive aspects, and it may focus more on the supervisees' emotional experience of their role, alongside facilitating career choices and direction. And as discussed before, those are likely to have a different level at different parts of the uh trajectory.

SPEAKER_03 23:46

Thanks, Andrew. So just to summarise mentoring and external supervision, so they're both individual types of supervision which are informal and optional and non-intimidating because there's no assessment aspect to them. They're based primarily on the person's experience and not so much training. But although some mentor training can be acquired, they're usually short to medium term and often at sort of a registrale early career consultant level.

SPEAKER_02 24:11

So now coming to psychotherapy supervision. As a RANZCP trainee, the psychotherapy written case forms quite a significant aspect of our assessment. This supervision is most commonly conducted on an individual basis, but can also happen in groups of up to five trainees with three co-supervisors. Group supervision is more common in regional locations where it might be more difficult to find a supervisor, and has been deemed effective by trainees. When it comes to the psychotherapy skills training, this has traditionally followed an apprenticeship model, wherein trainees develop their own competency by practising and discussing the practice of their psychotherapy with a supervisor, with minimal direct observation of the therapy process. Many training sites can't consistently provide access to an accredited psychotherapy supervisor from within the workplace setting, which leads to trainees seeking external supervisors. And I know again sometimes this happens over telehealth. Trainees undertaking the advanced training certificate in psychotherapy require ongoing psychotherapy supervision, the frequency and length of which is dependent on the modality of psychotherapy training undertaken and involves discussing and formulating aspects of the case based on the psychotherapeutic principles being taught. The college doesn't mandate private, sort of personal psychotherapy at any point during one's career, but some professionals who choose to do this may find it beneficial. But of course, this requires an ongoing time and cost commitment.

SPEAKER_03 25:51

Thanks, Anoua. So just to summarise psychotherapy supervision, so it can be individual or group supervision as it relates to the PWC case. People undertaking psychotherapy, advanced training or practicing psychotherapists do require ongoing individual supervision. It's based on psychodynamic principles, so there is some methodology to it, although that's heavily influenced by one's individual style and practice. Usually they're weekly or fortnightly and are medium to longer term and may have a cost involved.

SPEAKER_01 26:19

Another important category of supervision is research supervision, which for trainees is most likely going to be relevant for their scholarly project. Most research supervisors for trainees are the trainees' primary clinical supervisor or perhaps another psychiatrist in their service who has an academic interest. However, certainly seeking out a primary or a secondary supervisor from a university department of psychiatry can be really beneficial for the trainee, not just for their project, but also around networking and career development benefits as well. When selecting a supervisor, it's really important for the trainee to think about a few things. In particular, finding a supervisor who meets their or shares their research interests so that they will be able to provide that expertise on their topic of choice, but also finding someone who has compatibility in their both personality and professional approaches to help the whole process go smoother. At the early career and trainee stage, academic supervision usually falls into more of a mentoring kind of relationship. Obviously, the supervisor has the expertise and the trainee is trying to learn from that. And yeah, it's more sort of an educational component to this type of supervision. Particularly at the beginning of this supervision relationship, the focus uh needs to be on establishing mutual aims and goals of the research. What are they setting out to do? And this can include important things such as the uh the time frame of the research and all the different milestones along the way, the expected outcomes of the project, including if there are going to be publications at the end and how that's going to be navigated, and also receiving assistance around developing the research skills through the project, such as formulating research questions, choosing the correct methodology, going through ethics applications if necessary, the process of data collection analysis, and then also receiving feedback at the write-up stage as well. So there's a lot of input that supervisors can provide throughout this process, and finding someone who's got the experience and skills to do that will make a huge difference for the trainee. One bit of advice is that it may be helpful to put together a written supervisory agreement at this at the start and to discuss any potential issues from the outset of supervision.

SPEAKER_03 28:31

I think particularly if your scholarly project supervisor is your direct clinical sort of supervisor as well. Um I've I've found that research supervisors, so these are non-scholarly project related supervisors, have been the some of the most helpful and supportive sort of relationships that I've had in psychiatry. And I think that's a large part due to the fact that it's all voluntary. So there's no ulterior motive to the relationship, really, other than you kind of want to learn about research and and you want to you know either create new knowledge or or discover something or learn something. And so there's always a real a real focus on that and being supportive and learning. And like I said, it's there's no sort of ulterior motive necessarily because it's just you volunteering your time and them volunteering their time purely just out of a an interest and educational sort of perspective.

SPEAKER_01 29:22

Academics are always delighted to have an extra pair of hands to do work and projects that are needing a bit of extra momentum.

SPEAKER_03 29:28

So thanks, Michael. So just to summarise research and scholarly project um supervision, it's usually either individual or networked. There's often a clear aim, methodology, and process to the supervision. Um, it does require a high level of training, particularly on the supervisor's part. And it can be a steep learning curve for the trainee and could potentially be perceived as being critical once you become familiar with the sort of the language of research and academia, but it's highly rewarding when it's done well and can be short or long term.

SPEAKER_00 29:58

Oh, thanks. Ed look, I'm just going to do a scan of some of the other types of supervision that we covered in the article with just a brief description of each. Remote supervision then is unique to rural and remote workers who can't access the different kinds of in-person contact due to the distance and the work workforce limitations, as we've already discussed. It's conducted over teleconference or video link, and that has advantages and disadvantages. So it means that you can access bespoke psychotherapy supervisors, for example, but it may require adaptation to use. Psychotherapy is probably a good example. You get a lot of feedback, of course, from looking or being in a room with someone and reading, you know, all of all of their uh nonverbal cues. But of course, a lot of our work these days is done over telehealth as well. So, you know, there are swings and roundabouts, as with everything. Structured supervision then is a form of group supervision that's offered by uh certain district health boards in New Zealand. This is where trainees are offered to meet with either a single or a rotating supervisor, and that will enable them to discuss systemic and structural issues relating to their practice. So, for example, things like being on call and uh after-hours issues, and then important things that are often not done all that well, uh so things like mental health acts and other system processes. Look, this is certainly not limited to New Zealand. I've seen this across Australia as well. Uh, Townsville, for example, does this particularly well. Focus on first-year trainees to get them up to speed with the aspects of being a doctor, being a uh psychiatrist in particular, uh, that they may not have known. The uh specialist international medical graduates uh have their own form of supervision. So these are candidates who have started their training overseas, some of them, in fact, have completed their training overseas, but are then required to undertake a bit more uh service in Australia before they uh gain the full rights of fellowship. So uh SIMG candidates have additional supervision needs, and these are listed in the RNZZB committee for CMG Education Guidelines. They have quite different pathways to fellowship, including the types of assessment they do, the sorts of work they do, and they have a lot of pressures that uh registrars don't have to worry about. Things like literally, am I going to be allowed to stay in the country if it takes me longer to do my exams, that sort of thing.

SPEAKER_03 32:24

So I think it's quite complicated for them. I think you're right, they probably don't get enough credit for what what they have to sort of go through. And if you look at the guidelines, there's a lot of information in there, and it depends on you know which country someone's come from, what stage of training, and yeah.

SPEAKER_00 32:37

Look, I think there's a general wish within the college to make things as smooth as possible. It it may be taken out of our hands. There's news now that the uh the federal government is going to be developing what they call an expedited pathway to fellowship for uh sim Gs. It's not exactly clear what that would be, but there's a little bit of apprehension within the college that we might lose control of the process but then be responsible for the results. Another type of supervision is service user supervision. This is a setup where additional supervision is provided by a service user and it's aimed at helping trainees develop a recovery-focused perspective. And then finally, educational supervisor, which I think we briefly mentioned, which is a role in the RC psych training pathway that's separate from the clinical supervisor role of the RNZCP. It aims to externalise the support and monitor educational progress as separate from the clinical supervisor and assessment role. And the educational supervisor works with individual trainees to facilitate an individual learning plan, to develop curriculum competencies, and is responsible for up to four trainees. So they meet uh four to six times per year with each one.

SPEAKER_03 33:46

Thanks, Andrew. So just to kind of wrap things up, psychiatric supervision has continuously evolved over time, but its roots are still principally grounded in the apprenticeship model, with the clinical supervisor role really remaining central to this. But within that role, there are often several competing aims. So the changes to the college's examination process seem to be likely to significantly impact the clinical supervisor role. And so there's a potential for other supportive elements to be delivered through other modalities such as the balin groups. Clinical supervisors might also benefit from additional training to help them balance and juggle all these completing needs, particularly with the changes to assessments. And so, really, we've just summarised in this podcast all the different aims and features of the current mix of supervision modalities available to RANZCP trainees and fellows. And hopefully that's been helpful and can make this process just a little bit easier to understand and to navigate.

SPEAKER_01 34:46

Mike just had a quick plug for our article that we put together in Australasian psychiatry, which covers in a bit more detail some of the things that we've talked about today. So if anyone is interested in learning more, it's called Defining the Passage of Wisdom: a Taxonomy of Supervision for RAN, Z C P Trainees and Fellows. It's worth checking out.

SPEAKER_00 35:02

I think it's got a bit of history, but it's also got references to useful other documents that describe these things in more detail.

SPEAKER_03 35:08

So that concludes this podcast on psychiatric supervision. Many thanks to Arnoua, Michael, and Andrew for your input. Thanks also to our producers David Bill and Nishta Kuma, Shady Dave for our intro music, Sidoni Prentice for our artwork, and of course Australia psychiatry for the opportunity.