Welcome back to Thought Broadcast. We're going to dive right into the second part of our two-part episode, Things I Wish Had Known Earlier in Training, featuring me, Noah Benepal, and Ava Carter, and Fiona Wilkes. This episode focuses on stage two and three and exams. We're not going to talk about EPAs because there's an entire podcast coming up about this one, hopefully next. So if you're listening for EPAs, hold on, there'll be a big one next time. But otherwise, hopefully this will be interesting and useful for any trainees in the city. Next on my list of things in stage two-ish is the psychotherapy written case. And I know we've actually done a much longer version of how to pass psychotherapy written case. Listen to that one for the long version, but for the short version and my take-homes from when I was recording that one with the experts, the particular one of the written case is about writing the intro as you go, which I did not do. So for the long case, I got my patient the start of stage two. We did about we actually ended up doing about 60 sessions, so that took me through until kind of middle of stage two. While we were in the middle of the psychotherapy or towards the end, I got pregnant. And so while I had planned to do my write-up before I had my kid, I did not get around to it. And so I then didn't end up doing my write-up until several years later. Which in and I hadn't been writing the intro and doing all of that background stuff as I went along and as well made it much harder. So I think that's one that I would like highly suggest that I'll but I'd definitely going back would be making more of an effort to to write her background and her history as I was going through.

I think I I did a sort of draft write-up just after I'd done it. But I think at that point I was also preparing for a few other exams and there was a lot going on. So then the final polished version probably took about another year. But I'd say that the sooner you can get it done, probably the better. Also allowing yourself the time to run it past multiple people because everyone will have a slightly different view or have slightly different suggestions or comments, and you don't have to take everything everyone says, but I think that would have been helpful. I failed it the first time and passed the second, and the second day definitely ran it past more people. That was helpful. Yeah.

I think it feeds in as well with the advice around this sort of talking about me, you being pregnant and coming back to it way later. Some of the best advice I got about everything else was if you don't have kids or you're planning kids, try and plan to get your exams passed before you have children, because trying to get any bit of assessment done with small children is an absolute nightmare. And similarly, I failed the long case, which is the only thing I failed. And it was the only thing that I've done while also trying to manage a toddler. Not that that was the main reason I failed, it wasn't, but it would have been a hell of a lot easier trying to organise it. Avery, anything that you would have done differently?

Well, I d I was lucky I didn't have kids. But it yeah, that's a huge one for men and women who have young bubs at home.

The advice I got was from a male supervisor who he was supervising when I just was early stages pregnant. I was thinking about doing CEQ and MEQ, and he was like, see, just get it, get it done, get it done, because he tried to do it, but he had two small children and it was just terrible and you have to quarantine time away from them, and no one wants to do that. So for everyone it's an issue, not just for women. Sorry, carry on.

No, no, no. Very good advice. I wrote up my psychotherapy case as I went along. I had a very excellent supervisor for my psychotherapy, and she gave me a lot of good advice on what to write, post-session, having good initial formulation and putting a lot of effort into that so that I then didn't have to rewrite it in a few years' time. And then just going along. So I treated it a little bit like going back to uni. That was my mentality because I didn't want to have to do it again. B I was aware that I I wanted to do an advanced training certificate and I wanted to have all of my basic training requirements completed by the time I entered stage three. My mentality going throughout training has always been stage three is is a mental hurdle for me, and I need to get everything done before then because I want to make the most of it. Because the background to that is that I couldn't do that when I was in dental school and make the most of that sort of advanced period in periodontics, which is the the subspecialty that I really enjoy, so I didn't want to to sort of redo that in in medical specialty training. So it was a lot of extra work, I think, in a way, at the same time as doing all the other things in stage two, um starting for the CQ and the MEQ and all those other things, and not everybody can do that, but that is how I thought about it. And if you have that opportunity and that privilege, because you don't have a lot of other carers' responsibilities, I think take it personally if if you can. Otherwise, the other really good advice I had from my supervisor was to write down your own reflections about your experiences with your patient throughout, because in the marking criteria, you have to think about how you changed a little bit as a I guess a psychotherapist in training. And I remember looking back and reflecting with my current supervisor who's not the supervisor for my PWC, but thinking, oh, okay. I thought very differently about psychotherapy when I first began, and four years later it's a very different experience. So that's actually quite a nice capstone, if you will, on the training experience as well, just from a personal nicety. But it also helped with the write-up too.

Yeah, same. It was a I wasn't expecting to enjoy it as much as I did, but I know the process I think was great. Oh, I loved it. Would I do it again? Probably not, but it was really good when I did it. I think the other thing as well with the first time was I just didn't look at the marking criteria, which was stupid. I just had a whole pile of other people said it passed and I based it on that, but I turns out I totally missed the point the first time around. And so, as you know, you were saying, giving yourself more time to do it, because I was like, ah, it's fine, I'll just do it to the deadline because it's how I do everything. It's it will get put in at the very last minute and it'll be fine. Turns out it wasn't fine. Give yourself more time for this one because it's very different to anything else that you've probably ever written or dealt with before, because you know, most of us come from science-y backgrounds and used to writing scientific reports, but that's not the point of this at all. It's much more of that reflective kind of process. So definitely look at the marking criteria.

They have been changed. Anybody who's submitting at the moment will be marked on their original, whatever criteria was out at the time, uh, and then the new one has been proved. So it's actually a I think a benefit for both trainees and supervisors because it separates a few of the criteria that were bunched together and helps separate that skill in mastering each of the headings. And I agree, whilst it's a different style of report writing, I think it's both formal and informal. Even though it's it's written as a formal report, that lovely reflective piece is really important because we again, like with supervision, you don't get the opportunity to do it in many other circumstances. So, really, as frustrating as it can be, take that and roll with it because you will grow as a psychiatrist, I feel, through doing it. I might be wrong, but I know I did. And then also it does have a lot of objectivity to it in the form of analysing someone's mental state, their use of phenomenology, making sure that's consistent, and their ability to formulate and follow that process where it makes sense and and that you can see the growth of the patient throughout. So it's it's one of those reflectively informal, formal pieces that as the trainee editor of our journals, I don't think it's similar to your more objective articles, but I think there is benefit to doing it. But I am psychotherapy inclined, so I am very biased.

And when I when I reformulated it as more of a creative writing exercise, that was fine. But yes, as someone with a PhD who then failed this bloody written submission, I was very annoyed. But it's fine, it was just an expensive draft. Alright, so that's I think that's probably written in case things we would change. What about exam prep, managing exams? I guess we've talked a little bit already about how we organise that. Anything else that you'd do differently, any advice that you've got or been given that's been useful?

I think with the MCQ exam, aiming to do that in your second year, that one it takes a lot of preparation because it's a lot of sort of rote learning. But again, there's not as much of that like reflective kind of deep learning. Like you can kind of study on the go. There are a few question banks out there, you just do endless questions and you can kind of fit that in around your day. So that one isn't necessarily as uh scary or threatening as the other exams, I guess. It's sort of more med school kind of style. So if you can get it over with, just get it over with.

And I use the BMJ on examination app, which had been recommended to me, which I found really useful. But at that stage, those questions tied up really well. I mean, I don't know whether they've changed much.

For the the syllabus for the MCQ?

Yeah, the qu exam questions. Is it still can you still just get an app and do those questions and then pass it, or have they changed?

I would say the the formulation of questions to the MCQ is is consistent throughout the last five years. I used BMJ myself and found that really helpful, but I found it helpful not so much for content of phenomenology and forensics and CAMS and all of those um subgenres, but actually more for the statistical analysis. I thought BMJ was excellent. I didn't do any of the prep courses. I just went nuts with fish and with all the other textbooks and just utilized those. But I know a lot of people find the prep courses particularly helpful. They're not endorsed by the college and they're not run by the college. But there are example questions and other things that you can access on the college's website to assist. But certainly peer study was very helpful for me, uh, mostly in pointing out my own deficits where I thought, you know, I'll pretty good at that. Nope. Yeah, my CAMS and forensic knowledge was certainly lacking, I can say that, but it definitely benefited from group learning.

Yeah, I used the MRC Psych question banks, so that's the British ones. And then I think I I had PsychSean as well. And PycSene was really good for the statistics bit. They had a number of questions, and I think that was pretty much what I based my statistics bit on, and then that was fine. So it's just whatever works for you, I guess.

What about for the other exams with MEQ and the CEQ? And similarly with the group study, I found that really useful, particularly for getting because we you know had a study group and we'd get together every week and we'd practice and we'd practice writing it and writing stuff for time. And I think shout out to Arjun who organized my study group. I don't think I would have passed those exams had I not been involved in them. But did you guys do any other preps or courses or anything else for those ones?

I think I had psych scene for both of them. I think it was useful for the MEQ exam just to have more sort of example questions. And ultimately my study for that was just doing questions, and I wish that I had practiced doing questions to time, because I really only did that maybe the week leading up to the actual exam, and that was the most time-pressured exam I have ever had in my life. So now I tell people do it timed from the very start, and that way you'll get used to what it's actually like under that time pressure. So for the CEQ exam, I used Professor Marie Bismarck's essays, and those were absolutely fantastic. She has a number of essays that she had, you know, written as examples herself. So I basically just went through those and then compared the essay that I had written to what she had written and saw if they kind of vaguely matched, and that was fun.

I think she's responsible for just about everyone at Canberra Health Services passing the CEQ. I was advised to use her stuff. It was so useful. I advise other people. Yeah.

Highly recommend.

Ava, what about you?

I did similarly. I used those uh excellent essays that uh Marie's got on on her website. And I I started studying at the beginning of year two because I wanted to take it at the end of year two of stage two. That's right, yes. So end of year two I took it. I know. Sorry. Because I was still finishing the PWC, so I finished that in.

For anyone listening, don't go by API's standard. She is exceptional.

No. No, don't do that. Don't do that. But I I gave myself six months because again, I think I had that I don't know enough syndrome, which I think we all have as doctors, I'm not supposed to say. But it was helpful because it took a bit of pressure off me knowing I had six months. I still had I timed myself with the essays, I'm still scarred by Gamsat. I did really pathetically in the in that written section, so I probably put a lot more effort than I needed to into that. But it also was very helpful because I enjoyed the historical and the ethical learning and the critical analysis. But again, I do think this is an exam that that if you're not English first speaking, I know the formal standpoint, so I'll remove myself from my conflict of interest there. But I do think that is an area where people should think about if they don't have English as first language and and consider coaching and other things. But we know that there is significant discussion about the CEQ changing, so watch this space, but it's probably not going to happen for a little while. But the TAC and the BCT are certainly talking about that as well as the Education Committee. But I I would hope that no one changes their trajectory of studying for that exam based on what I've just said then.

Yes, I share your opinions, Ava, about that particular exam. I enjoyed it, but I did high school English in Australia, and I don't have dyslexia or other things which may make it more difficult. And so for me it was fine, but there are a huge proportion of our colleagues where it's a much more challenging exam. Alright. Anything else that you guys would change? Any other tips, tricks for any of the exam stuff?

I mean you don't have to do the MEQ and the CQ at the same time. You can do them separately. They used to be coupled together, but now they've decoupled, so if you don't want to study for both, don't.

I did them at the same time. I think I was trying to do an Ava and just get things over and done with so that I could enjoy the end. And I'm glad that I did. But it's a lot, and especially if you've got kids, I can imagine that would just do one at a time.

It's a lot, isn't it?

Anything in particular you devise for stage three? One of mine is I really like stage three. I like the advanced training. I think it's great. This is a kind of feeling like I'm coming into myself as a psychiatrist and working out what I want to do and getting towards that. So one of my bits of advice is hanging in there in the first three stages and getting through the other stuff so you can get to what you enjoy and work out what you want to do going forward. I also, having been in the training program for a while when we went in, probably would have gone it's not gone back to full time. So I started when I got back from that leaf, I came back at 0.6 and then I kind of slowly edged up 0.7, 0.8, 0.9, went to full time. I probably would have ramped that up a little bit quicker, I think, um if given my time again, just because I'm so sick of waiting out my time now on it. And the the more that you drag that on, then the longer at the other end that it means that you've got to finish out your training time. So I'm hanging out for March 18, but had I thought about it earlier, I probably would have maybe a month earlier pushed up a bit, and that actually makes a difference. Um so if you can and you wanted to think about that, it might be useful. But then everyone's in different spots and everyone has different responsibilities. I'm very lucky in that I'm very well supported by my husband and both sets of grandparents and daycare's and and and I would have been in a position to go back to increased hours earlier than I did. And I say like this not as a proponent of full-time. I'm just waiting to finish my body training and go back to part-time because part-time's excellent. But I I want to do that as a psychiatrist, not as a trainee. What about you guys? Have you thought about anything else that you'd advise?

I think as you said, it's nice working more in your area of interest and not having to get rotated around things that you might not be that interested in or areas that you don't actually see yourself working in. I mean, the experience is valuable wherever you work, but it's nice being where you're feeling really passionate and feeling that you want to learn everything. That's really great. And I think at least I found the more senior that I've gotten, it's trying to think a bigger picture and think about team dynamics and think about leadership and think about my own decision-making sort of process and try to put myself more in the consultants' shoes while you've still got so much support around you. You can make mistakes, you can ask questions, but try to take on a bit more responsibility. I found that really valuable.

And I think with you say with the rotations and getting to do more what you're interested in, that's a big shout-out for doing an advanced training certificate, isn't it? Because I may have to put you in what you want to do and you don't just get put into whatever gaps they need to fill. So when I was thinking about doing the advanced training certificate, you know, you can do it as a fellow if you want. Well, certainly the PLA certificate isn't all that much extra, and you're already having to sign stuff off anyway. So I'd highly recommend thinking about advanced training certificates if you have any interest in things. What about you, Ava?

I can't really add to what Anua said. I think it's a very excellent answer. I think the only thing I'm perhaps that's useful to remember is that a lot of us don't know what we want to do when we enter stage three or in those last few months to years. And that's okay. I don't think there's any problem with that. And in fact, I may be doing CL now, but I might not be doing CL in a decade. I might be doing something else entirely. So I think it's also okay to to not do an advanced training certificate and to just move around and explore different health services, different types of specialties, and if you can, and not everybody has this luxury, if you like outpatients or you like CL but you don't want to do the advanced training, or like older persons but don't want to do the advanced training. Some services have those outpatient clinics that you can organise to do half a day or a day in once a month or once every two weeks or three weeks because they often need senior registrars in stage three to assist with those community-based services. I know we have that in intellectual disability in lots of different services because it's not an advanced certificate, so they often have stage threes from all over the place doing them in terms of what you know, it could just be general adult, but they might not be doing any AT at all. So see what's on offer and and just go explore.

And I think you can definitely have a chat with your director of training about what is interesting to you and what sort of areas you'd like to work in or you know, experiences you'd like to have. And my experience has been that they've been really open to that. They're excited for you to learn, they're excited for you to become the best psychiatrist you can be. So people will generally be quite flexible about where you want to be or or what experiences you want to have.

Cool. Well, thank you. Or I think on that note, maybe we'll leave it for today. But thank you, folks, so much for joining me and for chatting. I hope it's been hopefully useful for anyone listening if in part. Thank you. As we're finishing, I'd also like to acknowledge Joe Rose Feita and Mishda Kuma from the College who have given us such excellent support in producing the show. We're also thankful to Australasian Psychiatry for giving the opportunity to create these podcasts, as well as Sidoni Prentiss for our artwork and Shady Dave for our music. We encourage listeners to rate the podcast on whichever app you're accessed, as well as promoting it to other readers and supervisors if you find it useful. We also do love getting feedback, um, and as I kind of flagged earlier, if anyone were interested in doing this kind of stuff, please do reach out. The best place to do that is probably at the thoughtbroadcast.podcast at ranscp.org or through the Australasian Psychiatry X slash that used to be Twitter account. That's all for now. My name is Jenny Wilkes, and we'll catch you next time.