Welcome to this episode of A Thought Broadcast, a trainee-led podcast from Australasian Psychiatry that aims to demystify the scholarly project and humanize the research experience. While we plan to cover many research, publication, and training-related topics in this series, this episode will be aimed squarely at achieving our primary aim of demystifying the scholarly project. We are lucky enough to be speaking with Associate Professor Jeremy Cooper, the chair of the Scholarly Project subcommittee with the RNZCP. We'd encourage anyone who missed the first episode of the Thought Broadcast, featuring our very own Brian Bowie, to go back and listen at your leisure via the Australasian Psychiatry website or your preferred podcast streaming service. Also, the training editorial team has collated all training and early career-related literature from Australasian psychiatry into one collection. This is a fantastic resource for anyone seeking information on topics ranging from mandatory learning goals such as the Scholarly Project, OSCI's, and the Psychotherapy Written Case, as well as more practically based information such as how to write a good formulation or manage your first years as a consultant. This collection is also available through the Australasian Psychiatry website. With us today, we have Director of Training in North Queensland and the perennial voice of the Australasian Psychiatry podcasting scene, Dr. Andrew Amos. Welcome back, Andrew. Whereabouts are you coming in from today?

Well, I'm sitting on my deck in Townsville overlooking the Ross River. I don't have any signs of fever or anything like that. It's a beautiful scene. I can see a pelican out my window, in fact. So I'm feeling very relaxed and uh glad to be here.

That sounds lovely. That sounds like a very nice place to be sitting. Uh and then the other member of our panel is Dr. Michael Waitem. So Michael is one of our associate trainee editors with the Australasian Psychiatry Journal, and he's a co-creator of the Thought Broadcast. This is his first time on the show. So, Michael, welcome. Can you please tell the audience where you're calling in from today?

Thanks, Ollie. Yes, very pleased to be a part of today's recording. Um I work with a rural and remote mental health service in South Australia, and I'm uh phoning in from a very wintry Adelaide today. So not quite as nice as Townsville, by the sounds of things. That's good.

Uh thanks so much, Michael. And look, my name is Ollie Robertson. I'm the trainee editor of Australasian Psychiatry. Uh, I'm completing my training at Barwyn Health in Victoria, and I'm uh recording today from Victoria's Surf Coast. And so it is our great pleasure to welcome you, Jeremy. Um I'm sure that most relevant to today's talk is your role in the chair of the Scholarly Project subcommittee. But um I'm sure that you're a man who wears many hats. Uh, and I'm about to commit a clinical sin by asking a compound question. But um, can you tell us where you're calling in from today and what does a normal day look like for you?

Oh, thanks very much, Ali. I'm calling in from a suburban Melbourne. I've just popped home in the hope that that will uh work better than being at the hospital. But uh I I work uh in eastern health in the eastern suburbs of Melbourne and uh work at uh Box Hill and Murunda Hospitals, so they're about 10Ks apart uh in the eastern part of Melbourne. So we have a catchment that goes right up into the Danongs and the into a sort of semi-rural hill area and then into sort of inner city areas like Mont Albert and Box Hill. So I move back and forth in the adult acute services and the CL service in those hospitals. So I've I've been interested in research. I'm not so much directly involved in research nowadays, but I have done done research and I'll talk about it if there's an opportunity later. What I have done in the past, but I do believe that um all of our fellows should have experience and knowledge of the principles of research and how to critically um analyse literature, the literature, and and therefore uh apply evidence-based uh practice to their for their patients. So uh, and um I think uh in the Australian and New Zealand College, um this is a great, great thing since 2012 to have this included as part of the regular training.

So I think before we get started, it's probably important that we cover a few sort of housekeeping things. And I thought um, Andy, maybe you'd like to just sort of explain what the role of the podcast is today, how it can sort of help uh trainees and supervisors and sort of how they should be using this resource.

Well, I think uh the podcast in the series is really useful for introducing the main areas of interest for the registrars, what resources might be available, to look at potential barriers that might prevent you from progressing. My personal feeling is that avoidance is a very large barrier. And so one of the best things that the podcast might do is to familiarize a lot of the ideas and the resources, overcome that initial uh anxiety that registrars have. The uh scholarly project is probably the part of your training that is going to be the least like all of the other parts. So a familiarisation um uh effort like this, I think, is going to be really useful for people.

Today's episode really is complimentary, it's not an official kind of assessment tool or anything like that. So um I hope that people can listen to this episode and then maybe go to the RANZCP website. Can you define what the scholarly project is from your point of view?

The scholarly project's an opportunity to do something with some scholarly rigor, it but it doesn't have to be research, it can be a clinical audit or a case series. But the concept is it would be at the level that could be considered for publication in a peer-reviewed journal. And and so that's really the level of rigor we want to aim at, which is a bit different to what some other uh training programs overseas do, but that's what we've got.

Jeremy, um so how how would you say an understanding of the scholarly process contributes to clinical practice?

So so hopefully in every trainee's day-to-day life, when they propose a formulation or a management plan for a patient, they they they might be quizzed on what the evidence base for that their decisions may be, and and um, and or they might find themselves involved in cases that are unusual or obscure or situations that are unusual or they haven't experienced before, and we would want them to be able to interrogate the literature where it's where there might be useful information, but to do it in a rigorous way.

I suppose the other part of the training program where these skills are tested is in the multiple choice exam with the critical analysis problem. I wonder if you have any thoughts about how this assessment task complements that um part of the examination process?

Yeah, yeah, right, Michael. Depending which of the um, we'll touch on the different types of scholarly projects that you can choose, but particularly the ones to do with literature review or the original research ones, you know, that would be very closely related to what you're being tested for in the MCQ. So things like understanding statistics and uh understanding bias and you know um these sorts of issues would could well be questions in that part of the written exam process. And um, but you'd be honing in on particular ones in more detail if you choose to do a scholarly project in one of those areas.

What are some of the common approaches people take in your experience?

There are actually four types of projects that are outlined and a description of each one and what its criteria are. There is a fifth one, which is um uh other projects. So there's a quality assurance project or clinical audit, uh, which which can be um well, I would expect it to be done to a level which could be published in a suitable journal, like the Australasian psychiatry does publish um audits and quality assurance projects frequently. Um it could be a systematic and critical literature review. That might be something very rigorous and um analytical, like a meta-analysis, but it could also be a narrative literature review depending on the topic uh and the and the extent of um research already available to be reviewed. It can be original and empirical research, which could be either qualitative or quantitative, or a combination of the two, uh, or it could be a case series. Um so uh and then and as I say, then there's other another category. Yeah, can you remember any projects in that sort of other category that were sort of coming out of left field that um that got through that you can remember or um I think uh you one one that comes to mind was um a review of all of the different mental health acts around Australia, you know, and and comparing and contrasting them. And the and so the the um it was really um more a legal document, um, you know, legal legal a piece of legal legal scholarly work, you know, and uh and the traditions of how you cite papers and how you present information is different to what we traditionally use in uh biomedical journals that we mainly read. Uh that's one that comes to mind. So but it was you we certainly couldn't argue it wasn't relevant to psychiatry, so we we ever was in agreement it was suitable, um, but it did need a reading it through a different lens, if you like.

Jeremy, there's there's certainly a huge variation between the different types of project. Um I'm not sure if this is the same at the national level, but as Director of Training in North Queensland, there seems to be a huge bias towards a systematic review. Do you have any inkling as to why that might be? Is it the same at the national level?

Um look, I I do know um that unfortunately some trainees leave the scholarly project to last. You know, a literature review, it's all in the bag, everything's there you need. You can do it if you just um burn the midnight oil, you can knock over a literature review in a few weeks, you know, because you can just go home and get on the computer and do it. Um but that's that being said, if you you can do things like clinical audits or original research using um uh existing patient records, you know, most hospitals now using electronic records, so again, you can you can um find a sample that you already know you have once you've uh done the necessary investigations and the similar principle uh can apply. But um but if you're recruiting people prospectively, there's always inherent risks of delays or difficulties in reaching your um you know your your target um number for your study.

So with literature reviews being the most common, are there other approaches that in your experience have been found to be more risky that um perhaps harder to execute?

Yeah, Michael, I think the main ones we have problems with are the audits and the um the quality assurance projects or clinical audits, and that might be to the um you know the the the regulations we've set out, you know, but partly to blame because it is quite ambitious that it was hoping it's hoping the candidate can do a clinical audit cycle. So that involves identifying a problem. Let's say it's um, you know, uh, are we giving nicotine replacement to inpatients in our service, and then you know, establishing whether what the what our guidelines say we're meant to do, and then um checking the level of how often it's happening, and then some intervention to see if we say we find it isn't what it should be, you know, that a lot of people aren't being offered nicotine replacement, so then we should make some intervention. It might be putting up billboards and talking to staff and you know, raising it in ward meetings and things, and then we do another survey to see have we have we improved or fixed the problem. And not many people manage to achieve that full audit uh cycle. But certainly I've seen some excellent examples of it being done. But it's often to do with um, again, a bit like the literature review problem being overly ambitious. People get a bit carried away with what they think they can achieve through a clinical audit cycle and then they get lost part of the way along. So, what I have suggested to people on some occasions is they're partway in, they're asking quite a novel, interesting, complex question, um, and it might be more suited for original research than it is for an audit cycle. So sometimes I suggest people go back to their branch training committee and uh and request that it be changed in its category to um original research.

Thank you. Yeah, and I suppose starting early in training as well will be another way to get around not having time to do the full cycle.

Yes, that's right. On that, um Jeremy, I mean, it can be quite intimidating, I think, for some um trainees when they're coming in if they haven't got any experience to find a supervisor and understand maybe how to approach someone who's got particular interests or experience doing a type of study. I mean, have you got any um sort of tips not only for the trainees to find a supervisor, but maybe for health services in the way that they can engage the trainees and also um whoever is doing research, whether it be academics or just clinician researchers on the site and how they can work to kind of engage each other?

So I think uh so some supervisors will have ideas or projects or areas of expertise that they can invite the trainee to join, and and I think trainees need to think about that because it might not be exactly what they had in mind, but it may lead to opportunities to get in, get to learn the ropes with research and get um get some momentum going, and then they can move once they've got the research skills into areas of greater interest to them personally. Um whereas other supervisors have you know pet subjects or areas of interest which may not be related to the uh candidate's interest. But um if they if they're offering that that backup and that support and that system, you know, I think they should think about it seriously. But if they're sort of um just wanting them to do something because they're interested in but don't want to do it themselves, that's not such a good reason to sacrifice a candidate to spend a long time on if they haven't thought through. There isn't that um that you know that that infrastructure because um what we don't want to see is pro is candidates spend a lot of time on a project that can't be completed or hasn't got the support it needs to be finished.

Jeremy, I I might put a plug in here for the regional training hubs. I'm a director of training in North Queensland, and the universities have uh have uh relationships with their local hospital sites. So Cairns, Townsville, Mackay, uh with James Cook University, University of Queensland, with Toowoomba down in South uh South West Southeast Queensland, and around Australia there's I think now 16 regional training hubs. So if you are in a regional training setting, it would be really good to get uh involved in those sort of networks which can provide that sort of academic supervision in addition to your consultant.

I think um Jeremy, you were hinting before maybe some uh some common pitfalls or or things that people tend to run into when they're getting towards the end of their project, and you had some maybe some words of wisdom for people in that position.

Before starting on the project, um what I really encourage trainees to do is take the opportunity to present their idea, to um pitch their idea to different audiences to get it sort of knocked down and you know um beaten up. So if you're doing a PhD or a doctorate or a master's you know thesis, then traditional universities is you you know you pitch your idea to a to a uh usually there's um sessions organised by universities where you have to come along and you know present what you're proposing to do, and then people who might have done some work like that or something in a related area or different people, different expertise in the room can point out um pitfalls or problems. Um so there's an analogy you can use for a research project, which is like building a house. Um, and if you think about it, I mean most people have been involved in a house renovation or building a house or know someone who has. So, you know, there's a there's a process of you know deciding what kind of house you're gonna build and getting all the relevant permits and deciding whether you can afford it and how long it's gonna take and so on. Is it suitable for the site? All those sort of things, and then um then then um then there's the so that's all that kind of before you you know you dig a hole, you is getting all the documentation and plans in place to to make sure it's gonna be a successful project, then the foundations, you know, and then then this the structure goes on and then all the finishing touches, and finally you get to move in. But um, but it's thinking on those terms of the foundations are terribly important. If you don't get the foundations right, it's not gonna you know the house isn't gonna work, you know, and and getting all that um pl pre-planning done. So I think it's quite a good analogy. Um, so maybe maybe a scholarly project's not a house, maybe it's a granny flat or a bungalow, you know, it's just a small house, but um, but the same principles apply. You can still spend a lot of time building a granny flat, and you don't want to build one that's gonna you know not work out. So I think it it's the it's the way to look at it. It's some it's going through a stepwise process. So you really want to make sure you're building a granny flat in the right bot in the garden, and um, you know, that its foundations are secure and I'm not gonna flood. Um it's the same sort of idea, just putting more time into planning rather than rushing in and starting it, and and and again getting the right builder and the right architect, the you know, the right sort of supervision, you know, to help you get the project done. It's a it's a kind of a way of thinking about it.

Yeah. And I feel like you do often have lots of ideas and then it's like it's pruning them back and trying to pick the best one and the one that's most likely to succeed. Because at the end of the day, you want to, we're all busy, you want to get through, you want to get the job done and do it do it well and feel sort of satisfied by the job that you do, but you also don't want to fall into the trap of doing something that's not um not going to be successful.

So yeah, and hope and and and hopefully they'll that'll be interesting and it'll be fulfilling and it'll be fun as well, because research can really be fun, you know, and I hope it will be, and I as I really hope it it they have a successful experience and want to do more after they've got their fellowship, you know, and and that we we build up the the the level of um uh of sort of literacy and research in our fellows in in the years to come. And hopefully the the scholarly project plays its part in doing that. But um so it's important into topics you're interested in, but but to be practical at the same time.

I think um Michael was in the same boat as myself. We we both got through the scholarly project by exemption, and um I know that some people do choose to go down that pathway. Um, I suppose before we get into more specifics, what are your thoughts on on that as a pathway? And um do you have any advice for trainees looking at that um option?

So there's a little bit of controversy within our committee um in that um you know, there's one point of view that if the ultimate goal ought to be to produce a piece of work that could be published in a in a peer-reviewed relevant journal, you know, let's say Australian psychiatry, for instance. And there's another view that some things that might get published are not at the standard that we have set in our college as a scholarly project. And so what we can do sometimes is people can provide additional information, you know, about what they've done, which isn't covered in the article, especially some articles, some journals require very short articles.

For trainees who may have published something in another domain of medicine during their career to date, how directly does that need to relate to psychiatry for it to meet the criteria for the scholarly project?

And sometimes there's debate as to the relevance to psychiatry, um, and um it depends if it's so some things might be relevant to old age psychiatry or to CL psychiatry or forensic psychiatry that the main body of psychiatrists might not be sure is is sufficiently relevant. Um so that um and we don't really define relevant to psychiatry, it's kind of it's just in the in the gift of the committee to really decide that, but we do have discussion sometimes as to what's uh relevant, and we try to be as broad as we can, but at the same time, I mean I'm thinking of one person submitted an article that was about some very high-tech part of MRI scanning, you know, about the the technological aspects of how the machine worked or something, and you know, we do use MRI machines in psychiatry to do brain imaging, but it was a bit too it was really radiology in those other. So it's great that people have got so you know, it's really good we get people from very diverse backgrounds joining psychiatry nowadays, and they add a lot to it, but for this particular task, it it needs to have the the subject matter of the project needs to have sufficient relevance to psychiatry uh to to um to reach muster. Absolutely right again, uh both with exemption and also with um the projects. If people some some trainees are coming up with really interesting new questions, and I think um you know, we really don't want to discourage that. You know, it's harder to do things that are new because you've inventing it as you go along. But you do need good supervisors to help you and to make sure you don't get lost, you know.

Yeah, I mean I think that's a nice place to to finish, maybe, is um that you know we're trying to we're trying to push innovation and get get as much out of the talented cohort that we've got in the college and all the trainees out there.

So and all the diversity that our trainees have, you know, they've all got different ideas and see different things, you know, and and see different problems and different questions that that um you know perhaps the um generation before them haven't thought about or didn't look at.

Yeah, and the more questions we can ask, the more answers we might find. So it's all all good stuff. Great. Well, thank you so much, Jeremy, for coming on uh the Thought Broadcast. We can't, yeah, really can't thank you enough. There was um your insights were uh I'm sure going to be incredibly valuable for all the trainees out there and and supervisors who were looking to try and um create a fun and creative, innovative, and successful uh scholarly project. I'd like to just say a quick thank you to David Beale for his support in the recording of today's discussion and his ongoing guidance in the creation of this series. And also, if you did enjoy our introduction to music, it was produced by an artist named Shadi Dave and is available through open source platforms. The links will be available on our bio and website. So we look forward to uh seeing you on our next episode. Um thanks, Andy, thanks, Jeremy, thanks, Michael.

Thanks, Ollie.

Thank you, thank you.