Hello and welcome back to the Thought Broadcast, the trainee-focused podcast from Australasian Psychiatry. On today's episode, we will be discussing trainee experiences in trainee advocacy, the realities of the challenges and triumphs, and a little bit of a call to action for registrars who may be interested in the trainee advocacy space. My name is Michael Tarran, and I am an editorial committee member of Australasian Psychiatry. I'm also the chair of the rural subcommittee of the Western Australian Association for Psychiatry Trainees, or WAAPT. Joining me today as host is one of our regular voices, Dr. Ed Miller, who's the trainee editor at Australasian Psychiatry. Welcome, Ed. Great to have you. Our guests today are Dr. Matt Davidson, the immediate past chair of the WAAPT. Welcome, Matt.

Thanks for having me.

And Dr. Dave Townsend, who is currently the chair of the WAABT. Welcome, Dave. Thanks, Michael. Both Matt and Dave have been heavily involved in trainee advocacy in WA across both the metropolitan and rural training zones. Thanks to Matt and Dave for joining us today. To start with, it would be great to hear a little bit about yourselves and your roles in the WAAPT.

So I originally started my training in the Metropolitan Training Program in WA. And then I went across to the rural training program when that started, when I was in my second year, so start of stage two. It was about halfway through the year, I think I joined the WAAPT just through a general invite. They needed a rural representative. And at the time, I think I'd just moved up to the Pilbara, so half a million square kilometre space, and I was the only trainee up there. But I'm also on the rural site trainees committee as the social and well-being rep, so I sort of was in touch with lots of people that way. And I think that the opportunity to pass on their voices was seen, and I was a conduit for that, so that's how I got involved, and just started going along to meetings that were held once a month on a Thursday night, and it was just nice to sit and listen.

Yeah, and I guess from my background, I've done a few different advocacy things, both as a med student and in psych training. So I used to be on the old TRC as a non-jurisdictional rep, and then when I moved to WA from New South Wales, which is where I first started training in Newcastle, I wanted to get involved with the APT because it's always interested me to get involved with advocacy, and so I I joined and um that was a couple of years ago now, and was the vice chair for a long time, supporting Jared Paul, who was the chair before Matt, and then Matt when he was in the chair role. Yeah, I've also got an interest in rural psychiatry, so I was keen to try and get that started and get involved with the APT and sort of get that rural voice out there, and then as it's evolved, also become involved in supporting a lot of Metro trainees as well.

For those who who don't know, which would have been me a couple of years ago, what is the WA APT or what are APTs in general? Can you give us an overview of what it is and how it operates?

Yeah, uh so the WA APT has been around for about 20 years. It's been uh an actual registered association in WA for about a decade. And about 20 years ago, even longer, I think they originally started with an APT in Victoria. And so the associations of psychiatry trainees were the original representative bodies for psychiatry trainees, and they sat outside the college. There wasn't a separate committee of any sort in the college. And it kind of grew up around Congress, and over many years, as technology evolved, they kind of became less of a face-to-face meeting at Congress to talk about what to fix in the training program, and more of a local support program. And so there were APTs in pretty much all the states and jurisdictions and and New Zealand. And then about 10, 15 years ago, I think the college sort of worked with the APTs to incorporate them back into the college. And that's how the TRC or the Trainee Representative Committee was formed. And it was basically the college saying, We see what you're doing is valuable, and we'll give you some financial supports and secretarial support to bring everyone together for these meetings and create a sort of more formal structure within the college for trainee representation, not just at the committee level, but also then for having trainee representatives on different committees like the EC, the Education Committee, Accreditation Committee, and and different parts of the college from there.

So it sounds like the colleges recognize that the trainee committees are really important. Why is that?

Well, I don't want to answer for the college, but I I guess from my point of view, my perception is that they see them as a way of road testing ideas, trying to get some of that feedback and avoid pitfalls before rolling something out. I think the trainee perspective is important. Certainly from my point of view, I think we have as trainees and as a trainee body helped the college evolve and become more trainee responsive, become more considerate of the realistic lives of trainees and their needs and welfare, and really pushed a lot of different things over the years that the college really needed to improve. I mean, originally the APTs were the oldest and uh first trainee representative uh committee of any specialty in Australia. And the AMC actually based their whole classification and accreditation of medical programs for trainee representation around the APTs and that model. Um so w we used to be really, really innovative in that space, and that I think was acknowledged by the college and wanted to bring it inside.

And I'd like to think that the college acknowledged that we are the future of the college as well. Trainees aren't trainees forever. We spend a lot longer as fellows of the college, and to not hear our voice now is detrimental to the future of the college. And I think that can be seen because once you become a fellow, you don't forget what training is like, unless you have to suppress that memory. So I think that hearing the voice of the trainees sets the college up to be a more responsive college in the future to its fellows.

Is there a difference between an APT that's incorporated within the college compared to one that sits outside and separate to the college?

There is. So I guess the APTs that exist now are still independent. So they're kind of like the state or jurisdiction-based committee for trainees, and not all jurisdictions have them, like Northern Territory, ACT, TASI don't have them. They just have a rep who then goes up on behalf of those trainees to that college by national committee. But the actual APTs are still separate. So the WA one, there's one in New South Wales, NAPT, there's VAPT in Victorian APT. South Australia and Queensland have them as well. And yeah, so I think some of them are actually associated as independent organizations. Some are more informal and sort of base around the committee and meet, and some have got formal support from their BTCs and the like, or from their branch committees. And yeah, it just varies in each state and jurisdiction. But that kind of gives an opportunity for the APT to be a bit independent and maybe speak out in a way that an internal committee can't.

How does that connection between the APTs and the TRC, the trainee representative committee, work?

Well, it's actually evolved recently. So the after the A. V. OSCI sort of situation that happened a few years ago, the TRC changed and became two separate bodies. So it became the Binational Committee for Trainees, or BCT, which is the most confusing name possible considering we also have BTCs, so the branch training committees. So for stage ones who are getting confused and cross-eyed from that, apologies for that. So the BCT or the Binational Committee for Trainees has the jurisdictional reps from each of the jurisdictions that the college covers. And that's kind of the main representative body within the college. And then there is also now the trainee advisory council, which is actually chaired by the trainee board director. So that's been Ava in the last couple of years.

Another question I had was what are the key projects or initiatives from I guess you guys can't speak on behalf of other APTs, but possibly within WA and also possibly from a rural perspective that that you guys are working on at the moment?

I guess some of the key things that we do. The APT is pure advocacy. So someone approaches us and we are there representing them. I know in my experience, once I became the chair, I was approached by a lot of people in distress about a few very specific issues, and then they were reluctant to take it further themselves, and they wanted that support. They wanted someone to go in on their behalf, partly to keep them de-identified because that they were concerned about any repercussions to not just training but their career if they spoke out about certain things. And I guess as an association, we have a protective element. We go in and say this is the views of people approaching us. We're not there with an agenda, we're there as advocates. I think that what all APTs do, and I think we've had to have a really fine balance of it in WA, but we've given the right of rebuttal. So when someone has come to us, we are going to advocate for them, but you want to make sure they've done all the appropriate channels first. We shouldn't be the first port of call. We can be a supporting element when they do go to that first appropriate step. We can be there with them. But if they've exhausted all those options, then it becomes part of us to go yet. And then often what happens, I think, is we collect all this information because people are coming to us. And these problems aren't in isolation. So the APT represents broader issues. So if one, two, three people are having a problem, it's probably broader if 10, 12, 15 people are having a similar issue. In WA with a across both training programs, roughly 150 trainees. If you've got 15 trainees coming to you with an issue, that's 10% of your cohort. I'd say it's probably even beyond that. That's just the people willing to speak up. So I think that's the power of the APT. You go in as an advocate, you go there to build. Nothing is perfect, no association is perfect. But I think what we're doing is pure. So we are stepping forward to say, this is what our members are saying, this is what trainees are saying, and we're going to represent them. We can't represent the views of 150 individuals because there's going to be 150 individual views, but we can bring that collective justice and uh value to any aerial issue that comes our way.

What sort of things might listeners out there be able to bring to you guys for help with?

I think one that's I can talk about historically that's happened in WA was I had a lot of people approach me about being bullied in their training posts and through different people and just how to manage that, whether it was someone on their ward, whether something to do with training, whether it was as a supervisor, and how they were to cope with that, and then trying to find a pathway forward for them. In WA, we went to our branch training committee and said, This is happening. What's the appropriate forum to redirect these people? There was almost some disbelief that it existed. And I had suggested that because I had quite a number of people come forward, it was probably bigger than they realized. And there was a request for evidence that this was happening. So we undertook a survey of all our members. We had about a third of WA trainees respond, which was a huge uh amount. Never, we'd never had that many responses before. And there was a significant proportion of trainees, more than half, that had reported bullying. So it just demonstrated that this was a really big problem. And we were very considered in our approach to this because it was a lot of information to hold, and there were risks associated with keeping that. I at the time spoke with lawyers because the information that we had was quite intense and knowing what to do with that, so I sought that legal advice. And then based on that, we approached all the appropriate people. So we approached the WA, AMA, the BTC, the health department, and the integrity unit within the health department and said, this is what is happening, gave them their heads up that this document is going to come and it's not a good look. But we're doing this because obviously harms are happening. And I know the results actually did distress people when they saw the level of bullying that was going on in WA. And I think some people were not happy that it had been exposed. But the APT can't be blamed for exposing harms that are occurring. That's where advocates were showing this is a harm that's occurring, we're not responsible for it. But keeping our heads in the sand is not doing anyone any benefit either. And I it did trigger change in WA, started the ball rolling on lots of things that have been happening here. So that's one of the things that's that we have done and can be seen and this sort of public knowledge.

That sounds really significant and like a really big piece of work, actually, I can imagine.

Yeah, it was a lot of very careful work, both in the design of the survey and also in how we process the data. And you know, we had a whole team of trainees doing it, which was brilliant. So, you know, we had to really carefully de-identify things, and we got a lot of legal advice and and industrial relations advice around how to do that. Because we are a separate association, we are a legal entity if we're not protected by being within the college. And we found out that, you know, we had responsibilities of if we hold on to this information and don't distribute it, and then something were to happen, you know, someone were to do something drastic, then we would have some liability because we didn't raise the alarm that there was a problem. So knowing that, had to find the way to do it in the most sensitive and careful way possible so that we're not inflaming the situation. So we had to break up answers so that no one could possibly be be identified by the sort of inferring things from what they'd said. We had to de-identify service names, individuals, organizations, everything, so that we could give a flavor of what was happening, but not cause anyone any reputational damage, because ultimately it was about fixing the system, not about targeting any particular organization or provider or individual.

One of the things that came out afterwards as well was once we'd released this information and we provided all trainees with a copy of the report, is that trainees came forward saying they didn't complete the survey out of fear that it wouldn't be de-identified correctly, but having seen it, were really proud that the APT had done this and then started sharing their stories and saying that if they had their time again, they would have filled in the survey. And I think it got a lot of buy-in then from trainees. They saw that we were advocating for them. Here's an issue that's been going on for a long time for some people. And there were some fellows that came forward and said, I read it, this happened to me when I was a trainee. I'm really glad that there are people representing and advocating for the current trainees in this sphere. It was reassuring because that we knew there would be consequences and there was that element of fear, but it's like that Harry Potter sort of thing. Sometimes you have to do what's right, not what is easy. And that's sort of where we were sitting. It wasn't an easy thing to do, but it was the right thing to do. And I know that does sit uncomfortably with people. Like we wrestled with it ourselves, the committee, we took it to a vote because we knew the ramifications that could come from it. But on reflection, despite all the sort of fallouts that did occur, it was the right thing to do, and I'm comfortable with it. And I'm glad my name's part of it.

You've touched on some of the challenges there, Dave and Matt. But I wonder what are the challenges that you have both encountered while working with the WA APT. And I wonder whether it's had an impact on your training because it sounds like a lot of time.

Yeah, I mean, there's no doubt that it's had an impact on myself and my family doing this sort of work. The last couple of years have been pretty hard in WA. It's required a lot of work. And it's also required a lot of commitment from the whole committee, but not even that beyond the committee to other trainees. It feels like we're inundated with surveys in WA. Like we've just actually changed to doing an annual survey for the APT so that we're not swamping our own members with all these different surveys and things. But yeah, the amount of time has been huge. But I would also say that it's an unusual situation in WA. There are significant changes happening, and there's a lot of different organizations involved, and there's an entire restructure of training in the state happening at both the health service level, state government level, and with input from the college accreditation committees and the like. So it's been a pretty extraordinary situation, and that that has resulted in an extraordinary amount of work because everyone wants our feedback and everyone wants our input and the input of trainees. And yeah, it's taken its toll. It's been many sleepless nights and all nights working and those sort of things. But like Matt mentioned, you know, when you get those responses from trainees who say, you know, I experienced these things, and it was really validating or reassuring to see these surveys come out and see the way that the advocacy has happened, that really helps. It helps to reassure you that what you're doing has value. It's hard, but it's important. I guess the other thing to point out is that, you know, WA is in a weird situation at the moment, but this is not what all APTs are like. And it's not even what our APT should be like and what we want it to be like. We, you know, it's also about running events and that sort of stuff. Uh, but I think Matt needs to talk about the impact it's had for him because um I've only been chair for a short time, but yeah, Matt was chair for a considerable period, and Jared and Shannon and other people in WA were before. And it takes its toll on everyone because it's a big job.

Yep. I'll start off by saying I think there's a history lesson in taking on the role. So a lot of people go like, oh, why are the APT doing this? What are you doing? And when I stepped in, I didn't fully understand what had been going on. And when you take something on and you get all this information, the historical information, like why something is done the way it is, and why it was appropriate at the time and why it's not appropriate anymore, and then having to point out issues and say, look, no one's doing anything wrong, but it's no longer right, and disrupting the status quo a little bit, and lots of people who aren't involved and don't see all these things, we were definitely in a privileged position because we get this information, and having to then hold that knowing, like I've been given all this information about historical stuff, about current things, about what the future plans are, and I can't share it. So then having to justify why you have made a decision or why you have represented the APT in some way and go, I would love to tell you this. And I would argue that over the last 18 months, we've had the most open and transparent APT in WA that we've ever had. Uh I started a communication newsletter to trainees called The Mental Note that Dave has continued, and we just tell trainees what's going on. We try to put the social things in that as well, but you can't tell them everything because you were told not to, and you've still got trainees that want to know in the now. Even with the recent communication about the CEQ, I had people contacting me as the previous chair going, Matt, what's going on? What would you do with the CEQ? What are you going to do? What's happening? What can the APT do? There was a lot of distress around that. And I think the communication on that has been poor, and I don't think anyone would disagree with that. But you have all this context that people don't have. And so holding that, and you feel like you're doing a disservice to people, and you feel guilty about it. I cannot give enough to this role. I've got to study, I've got to meet my own training needs, I've also got family and friends that I want to contribute to. I want to also have a life, go and watch a Marvel movie, read a book, take a day off. You want to do all those things. And so then you feel guilty about it because there's so much that can be done. There is the work is endless. And our committee isn't full. And I think even if it was, the work would be endless and relentless, but it's worthy of doing.

Might be a good time to talk about some of the fun social activities that you guys also seem to organize.

Yeah, I mean, I guess one of the good things about APTs is they are representative of their jurisdiction. The WA one at the moment has had to focus a lot of energy around the redesign. South Australia or in Victoria, where there are less significant things going on, they're able to put more energy into some other things, like you know, they have really great social events and educational events, you know, they do their uh psychotherapy cinema nights and all these sort of things. They do subspecialty uh advanced training information nights. Or information for how to do the psychotherapy case. In New South Wales, they have always had fantastic post-exam events and the like, but in with what's been going on in their state, have suddenly had to transition to a lot of more industrial stuff and a lot of interaction with the college because of the loss of supervisors in a lot of different services and all the changes happening at the strikes. You know, we've acknowledged as a committee and probably the last three or four months in particular that we need to balance back out again this year and really want people who are excited about running social events and educational events and doing support and well-being activities for trainees because that's really important too. Some of the stuff that Matt's been doing in rural WA around well-being has been really cool and really innovative because it's like two and a half million square kilometres that training zone covers for less than 40 trainees. So trying to find ways of having social activities when you can't exactly fly everyone together has been pretty fascinating to watch. But I think yeah, he's done really well with it.

Yeah, so I send out a newsletter to the rural trainees called The Chill Pill. There's always a competition in there. I write a story, that's that's something that's happened in my life, often embarrassing, so people feel better about themselves. I like I'm an avid reader, so I put a book review sort of in and recommendation. There's always a site cartoon. I have the warped, which is the WA Rural Site Trainees, so because we're warped, we have the Warped pub quiz, which is about every month, and it's 20 questions, really sort of simple general knowledge stuff, and people can come online on a Wednesday night, but anyone can be involved. So we make sure their families are involved as well, and they just need to write down their answers. And the tenth question of each round is always like show me something. So it's like a pair of socks, you know, an ironing board. So people are running around their house trying to find these things. But if it's a family, then trainees that have got kids are often getting the kids when it comes to question 10, they send them off at the doorways ready to run and find whatever it is. And so it's been a lot of fun doing that and trying to come up with ways to get people involved in things. So we have also like a photography competition. So every couple of weeks there's something new going on in rural. I mean, it would be great if we could bring that into like all of WA as well. So that's something that we'd probably like to do.

How have you balanced that huge time commitment that working with the APT is with your own self-care and work, family? Have you found that balance?

I can't speak from that, but I can say that I've done it poorly. Yeah, it's it's really hard. I have taken leave at times just to give myself a bit of headspace and to recover. Um I have had to prioritize exercise and getting out and going for walks and walking my dog. I've had to put really secure boundaries around personal time and relationship time with my wife. I'm lucky that I live in a really beautiful part of the world with a lot of bushland around me so I can walk outside and see the sunset over the water and just recharge and and repair some of the wounds that can happen. And I think it's also important to have your support networks around you as well and be okay with like speaking up and saying, no, I'm I'm not coping, I need a break, or can someone else go to this meeting because I just can't do it? And I've realized that for me, running a big organization like the APT and the different moving parts is not something that comes naturally to me. I have a very probably more analytical brain, so I I like sort of looking at all these disparate things and bringing them together. Um, but trying to coordinate things like that, uh, I'm not a juggler, so I find it hard to do that.

I think I can say that we may not always achieve what we want to achieve or we may not please everybody, but it is well-intentioned. And sometimes when you get the criticism or the feedback, you know, and it can be constructive criticism, saying, next time do this, or this didn't work, or we didn't like this, you take it really personally because this is not a paid position. We are doing this out of the off our own back. So like I welcome the feedback and stuff, but sometimes you just think of when I've read like an email like with someone who's not happy about APT stuff, and he's like, actually, it's not APT, this is a college thing, or this was a BTC thing, but it's directed at you, trying to not take things personally. Yeah, I understand this person is just distressed and they're venting and you just happen to be the target. Um, and then trying to self-care and in that field is sometimes you will just vent to someone else completely outside of it. So I'm lucky I've got really close friends who work across different fields, and they're very good at just listening and not having to go, oh, this is how you'd fix it. I think that's been a really big thing in self-care. So I love to go droning. I'm trying to get out every weekend, sometimes after work, and I take my drone out and take some photos somewhere in the middle of nowhere, down by the beach, but you don't really realize how much you've given over to these roles and how much self-care you do need until you sort of get that to those points sometimes where you feel a bit burnt out. I know the night before the August exams last year, we were writing the bullying survey. Like even up until 10 o'clock the night before exams, there was still stuff being done in hindsight. I had to resit the exam, probably not a good idea. And so, you know, that's a $1,500 learning curve. But it was still probably the right thing to do to get that done for everybody.

And I think one other thing to add is that I know when I've been feeling tired, I then just look at Ava Carter and Georgia Ramsden, who's the chair of their ECT. Um, because you know, being on the board of the college or being the chair of these big binational committees, that's even more of a commitment. And they attend many meetings and they're involved in many different initiatives. And I I still don't quite understand how none of these positions are actually acknowledged as part of training. There's no actual credit for it. There's no uh component. I mean, maybe leadership and management, but that's like in stage three. But even then that doesn't really count.

You can do way less and still tick that box. Absolutely.

You don't do it for that, for sure. But um, it's always amazed me that these huge uh roles that the college depends on. Like they depend on these trainees and the people running these committees for the input of trainees. That there's no formal acknowledgement of that or credit for that as part of training. There's a lot of gratitude and acknowledgement from the leaders of the college for the work and a lot of thanks for it. I I've always been surprised by that, you know, that someone like Ava who's on the board, she doesn't even get 0.5 allocated of her current training term or something like that. It's on top of a full clinical load unless you choose to delay or prolong your training. Yeah, that's that's one area I think could do with some improvement and would make it a bit easier to be able to manage this, because then if you did have some dedicated FTE, you wouldn't have to do it all after hours and it wouldn't have such a drastic impact on families and uh our own private time. And that that may be something to look at in the future.

Obviously, you're talking from the perspective of being the chair and having quite a large time commitment. But how how could a trainee who's just looking to get involved and dip their toe in get involved? And what could that look like?

I think many hands make light work. So especially with the social stuff, if you get involved and you're like, oh yeah, I'm part of this, and you've got three or four people doing it, those three or four people can easily drag ten people along to a social event with them, and then you you've actually got something decent. So I think the social element is the best way to get your toe in. It's a fun job, there's not a lot of commitment to it. You don't have to go to a lot of meetings and you get to spend the kitty, which is always nice when you're spending other people's money. You get to bring people together, and there's a certain joy in that. So I think that's the best way to start. That would be my advice getting in on that, because if you get into that social stuff and you and you enjoy people and you know, we're in psychiatry for a reason, then that's probably the best way to start.

I think also reaching out, like if you've got a particular interest, whether it's academic stuff and research or social events or in policy development or in advocacy, or you're interested in something that your APT doesn't do, but you approach them and sort of put it out there as something that you might want to do and do it under their banner, because all of the APTs are keen for anyone to get involved. And it doesn't have to be such a drastic impact on your your life and study. It can be just attending the committee meeting every month and and whatever time you have spare to work on different things.

All right. This is all that we have time for for today. So we'll need to bring this discussion to a close. I'd like to thank you both, Matt and Dave, for coming onto the podcast today to discuss your work with the WAAPT. If anyone listening is interested, you can get involved with your local APT. Or the college also sends out calls for interest in trainee representative positions on various committees. And I encourage anyone listening to keep an eye out for these positions and to apply for them if they're interested. I'd also like to thank you, Ed, for joining me as host today. Thanks very much, Michael. We'd also like to acknowledge Nishta Kumar from the College, who gives us so much support in producing and editing the show. We are also thankful to Australasian Sicatri for the opportunity to make these podcasts, as well as Sidoni Prentice for our artwork and Shady Day for our music. We encourage our listeners to rate the podcast on whichever app you have accessed it on, as well as promoting it to other registrars or supervisors. We always love getting feedback or suggestions for further episodes, including volunteers interested in being a guest. You can get in touch by email at thethoughtbroadcast.org. That's all for now. My name's Michael Tarran. Thanks for listening, and we'll catch you next time.