Welcome to Thought Broadcast, the Australasian psychiatry podcast made by trainees for trainees. Today we are going to continue our discussion around the failed audiovisual OSCI and the alternative pathways now underway for psychiatry trainees in Australia and New Zealand. For background, please refer to our previous episode with Dr. Nick O'Connor entitled Examining the Examiner. Our guest today is Dr. Skye Kinder, a powerful advocate for the well-being of junior doctors, amongst many other pursuits. Skye's efforts have earned her many accolades, including being named Young Victorian and Young Australian of the Year in 2019. Skye has been central to discussions following the OSCE cancellation this November, and we are sure you will gain much from her insights. But before we introduce Skye, let's welcome our panel. Today we have an all-trainee panel. So we have our two associate trainee editors, Michael Waiteman and Brian Bowie. Welcome, Michael.

Hi Olli, great to be here.

Good to have you here and welcome Brian. Thanks, Ali. Nice to be here. So, Sky, welcome. Would you be able to tell us a little bit about who you are in work and life at the moment?

Yeah, thanks, Ollie, and thanks everyone for having me. That's an interesting question. I suppose I'll just keep it to the 30-second overview, which is that I'm obviously a trainee. Until recently, I was actually one of the non-jurisdictional representatives on the trainee representative committee for the college. And I suppose that's how I've been involved in a lot of the work that we might be discussing today. But otherwise, um, just like everyone else trying to get through my exams and uh advocating for things that I think are important as well.

So, look, I mean, part of the reason we've brought you on the show is that we know that you've got some um you've been you've been really central to the to the audiovisual OSCI cancellation and um and the discussions that have followed afterwards. So I suppose our first question would be that you know, what's your perception of how the cancellation of the OSCI has impacted on trainees who are affected?

Yeah, it's an interesting question. And I suppose uh the way that I think about it is that there are two things happening in parallel. So there's the crisis of the exam itself, you know, the fact that people haven't been able to sit the exam, some people for, you know, the majority of the past two years, in fact, and particularly thinking about New South Wales trainees when I talk about that, but other people around the country and binationally as well. Uh, and the fact that, you know, there's this ongoing uncertainty around fellowship pathways for lots of people, even people who weren't sitting that particular exam, who now have questions around what the pathway is going to be like for them and whether the examinations that they're planning to sit are even going to happen or reliably sort of be conducted. And then I suppose there's a second, as I would see it, a second um issue that's unfolding, uh, which the examination crisis has brought to a head, which is a member engagement crisis with the college. And by member engagement crisis, I'm talking specifically about trainees and I would say sim Gs as well, although I don't, you know, profess to speak on behalf of SIMGs because I'm not one of them. Uh, but certainly they have even less opportunity than us actually to speak at things like this, and in fact, which is part of the problem. But uh this sort of long-standing uh grumbling issue with how the college uh engages with trainees and values trainee feedback or or does not value trainee feedback as the case might be, and how that then actually precipitates issues like what happened with the exam crises.

Just to follow on the theme of the back half of your answer, from what I understand, um there has been some engagement during the process of creating the alternative assessment pathways. Can you comment on that at all?

Yeah, so that so there is a task force. Um now the task force is being headed up by President-elect Elizabeth Moore, and there are a number of trainees that are involved in providing representation on that task force, including uh representatives from the TRC itself, but also actually representatives who aren't part of the TRC but might be active in uh other representative groups, like the Association of Psychiatry Trainee State uh based groups, for example. And, you know, my I don't personally sit on that task force, but my understanding is that the trainee engagement has rapidly increased as part of that in a really appropriate and positive way. But I suppose, you know, again, I think one of the challenges here is, you know, if we just look at this as one issue in one moment of time rather than the bigger pattern that's actually playing out and the bigger issues with training engagement, I think we actually risk repeating, you know, you know, yes, we have good engagement now in this particular task force about this particular OSCI, but actually there's lots of assessments, you know, and there's lots of things that the college is responsible for. And how do we actually increase training engagement across all of those domains to make sure that this doesn't repeat itself again in future?

Sky, do you have some thoughts about what would be some good steps forward for the college to take to try and address some of those concerns?

Yeah, it's it's a really interesting question. I personally uh you know got involved with the TRC because I'm actually really passionate about, you know, being involved with the college and creating change for you know other trainees. And uh, you know, I suppose myself as well, none of us are completely um, you know, d devoid of that conflict of interest being trainees. But uh I suppose one of the challenges that I've personally found with the TRC structure relates to um communication, uh specifically with the TRC and then from the TRC to trainees. There are a lot of uh, you know, sort of regulation's not the right word, but I suppose it sort of encompasses the sentiment of what there is, whereby, you know, as TRC representatives, you know, you can't freely share a lot of the information that you are aware of as a result of being in part, you know, part of these committees. And you know, that has a two-pronged uh, you know, impact, which is, I mean, trainees don't know what's happening is the first thing. Uh, and then secondly, actually, trainees assume that they're not being represented in these forums is the second thing that happens, you know, and and um, you know, we've gotten reports from lots of people uh, you know, over the past few months saying, look, I don't even know how to find out who the trainee representatives are, and people saying that they're contacting the college asking who the trainee reps are so that they can provide feedback to the trainee reps and being told, well, we can't provide you with that person's contact information because it's confidential. You know, so just all of these issues about how how do we actually even communicate the problems, you know, that we can all see in front of us. And how do we communicate the solutions? Because as part of this, I think what a lot of us have seen, certainly what I've seen, is that a lot of trainees have a lot of answers to some of the challenges that the college is facing. You know, there are a lot of trainees as part of this process who came forward and said, I actually have run platforms similar to what you're trying to run as part of businesses that I'm part of outside of, you know, my training, you know, workplace. And, you know, I would actually have uh, you know, insights that perhaps could be beneficial for the college. Uh, but but you know, where does that information go? How does that information get communicated? And how does it actually end up in these committees that people are being represented on? And then even if it does end up there, how does it then get fed back to them that that's even happened? And and all of those things are a big problem.

Sky, you've talked a bit about your role on the TRC. Um, can you give us some background to the recent resignations that occurred from a large proportion of that committee?

Yeah, so um, unfortunately, myself and eight other TRC members, so nine of us in total did choose to resign in the wake of the OSCE failure. Uh, but you know, again, and I don't speak for the other people who signed the resignation letter because we all came to that point uh on our own journeys. And I suppose each of them may have their own particular set of reasons as to how they ended up there. But I suppose the overall sentiment of how we ended up there was an overwhelming sense of frustration with the fact that we felt as though we were attending an enormous number of meetings, in fact, you know, many, many hours that most trainees wouldn't be aware of. Um, and we didn't feel as though the feedback that we were providing was being meaningfully integrated into the decisions. You know, it was starting for certainly myself to feel as though we were really tokenistic in our role. And actually the the fact that there was trainee representation in a lot of these discussions was being fed back to bodies like the AMC to say, well, you know, you know, don't worry, um we're engaging the trainees around these issues. And we started to, certainly for myself, this was how I started to feel, feel complicit in what was happening because we knew that actually the feedback we were providing wasn't necessarily being integrated in the way that we wanted to see it integrated. But yet our presence in those conversations was being used to justify, you know, the decisions that were being made. And it was this real sort of, you know, catch-22 for us. And so I suppose, uh, certainly for myself, um, and I do expect that this would be what the other members would say is that um, you know, the the resignation was an opportunity to actually take a stand against that um and to really make it clear that we did not want to be complicit in what was going on. And also, to be honest, it was an opportunity to bring to light issues that, as I said, were not able to be communicated in any other way. You know, it was a point of significant frustration to us that we couldn't even really share with the trainee body, you know, what was happening. So this was our opportunity on our terms to put forward what we believed was really happening in the dark, you know, behind the scenes in the college.

Yeah, that sounds like a really challenging situation to have been a part of and a very courageous decision to resign. Has there been any um official acknowledgement or outcome from that point onwards?

Um That's an interesting question. And I say that because there's been no public acknowledgement that it's occurred, uh, which is surprising to me because having nine members of your representative trainee uh committee resign is is pretty unheard of uh across any of the specialty colleges, and certainly in the history of our college, I've uh I to my knowledge, um, from speaking with people who have been in the college for much longer than I have, you know, this is not something that has occurred before. And uh I think it to be to be honest, was a really dark day for us as a trainee body, and and you know, it was really very representative of where we felt that things were at. And so for it to not be publicly acknowledged still to this day, several weeks on, that that has even occurred, um, you know, I do think that that is a problem. Uh, because I think, you know, if you're not acknowledging publicly that something's occurred, then how can you be uh, you know, assuming you're part of the responsibility for the things that led to that um event for, you know, occurring in the first place? Privately, we have had an opportunity, the nine of us, to meet uh with the board. And um, we were given a half hour of board time to discuss uh some of the things that we were concerned about. And certainly other college committees have made some time available to hear from a number of us. I've certainly personally been able to speak at a local uh branch trainee committee level and also um as part of the member engagement committee, which is a board constituent committee. And I know that a number of the other resigning members have had similar opportunities. Uh, but uh, you know, I think that what we all want to see is change and commitment to change. And if you're not willing to acknowledge publicly that there is a problem, then I am cautious about how committed to change one can really be.

Sky, you spoke about the uh dissatisfaction with uh the college's response in uh to the resignation of multiple TRC members. If the college was to respond in a way that would give you confidence, what would that look like, do you think?

To be honest, I think a lot of the ways that um the college could have responded that would have given us confidence were quite simple, to be honest. And they would look like um, for example, a statement saying publicly, it wasn't good enough that this happened. And we really apologise because we actually really do understand and appreciate the level of distress that's been caused. We have caused you harm by this failure occurring, and we are committed to making sure that this never happens again. Similarly, with the TRC resignation, you know, I think that the college could have come out and said, you know, it's a dark day for us that nine uh, you know, if I may say so myself, you know, hardworking and committed trainee representatives felt that they needed to resign, uh, that they felt that there was no other way for them to represent their peers than by having to actually step away from their posts. That's really disappointing that that things have had to get to this point. We understand that that's probably been a really tough decision for them, and we're actually committed to better understanding why it was that they felt that they needed to make that decision and to working with them and the remaining TRC members to institute meaningful reform to ensure that trainees do feel like they're being heard. I think making these sort of public statements that are that are really quite simple, and I think part of what we do every day as psychiatrists, right? You know, it's the open disclosure, it's the validating the fact that something has happened, and it's committing to actually, you know, taking steps to ensure that they won't happen again in a in a way that is publicly accountable. You know, these are things that we we do all the time in our professional work. I think those things would have inspired confidence.

You know, Sky, one of the things that um came up in the letter and uh was mentioned as a as a serious deficit was the fact that the trainee representative committee does not have any sway or or official um position on the board. Do you think there's going to be any movement there?

I would hope so. I that that is my genuine hope is that as a result of uh you know this unfortunate series of events and even you know the unfortunate events that led to the group of us resigning in the way that we did, my hope, genuinely, is that the college will implement changes that are meaningful. And some of those changes would be uh, you know, certainly having a trainee on the board is a is a good first step. To be honest, you know, do I think that's going to fundamentally change lots of the cultural problems that we have with trainee member engagement? Personally, no, I don't. I think it needs to happen because I think it's representative of a commitment towards working towards that bigger picture. I don't think it in and of itself is the solution. Uh, I think actually, fundamentally, we need voting rights. And I think there's no better time actually to put to the fellowship a vote than there is right now, because we've had fellows reaching out to us from across the country asking us what we can do for you and for the trainees that that are impacted by what's happening. And there are a lot of fellows out there who I think would be really willing to support us in our bid for membership voting rights. And that's where I think we can actually start to have uh more say because at the end of the day, you know, the college is a business and the board responds to its members. And if we can't vote, then we have no role tangibly to require the board to do everything to do anything. And that's what we said in our letter. You know, if it was up to us, the nine of us would have put forward a vote of no confidence uh in the management. You know, that's what we detailed in the letter. We don't have the capacity to do that. So until we actually have a membership status that means that the board actually has to be responsive to the things that we want in terms of a governance and organizational structure. I'm not sure that we're going to get the change that we want. I, as part of the board meeting that I did attend recently with the other resigning members, asked the board, you know, what the barriers would be in terms of, for example, immediately assigning uh, you know, a trainee to the board, because there is a clause in our constitution that says that somebody can be co-opted for special skills uh at any time that's required. And so that could happen without any, you know, reasonable delay. And also what would prevent them from calling a special meeting to put the um trainee membership issue to a vote. Uh and I suppose we were assured that the board will continue to look into that. But you know, again, I think uh the time for hearing trainee feedback has passed and the time for action is now, and what we all need to see is a genuine public commitment to moving forward uh and to a healing process that we actually all need to go through.

I think that's a really good point about the voting rights guy. I remember when I first became a trainee, there was a college-wide vote around that shortly after then, and unfortunately that time it wasn't passed. Um but hopefully, as you say, this could be a catalyst to revisit that and and hopefully have a different outcome this time around.

Yeah, absolutely. And I I think um a lot of people do, when you talk about trainee voting rights, go back to the fact that it was put to a vote a number of years ago, and and almost uh I've seen that be used as a bit of a barrier in conversations with people. Well, we put it to a vote and it didn't get up, but clearly times have changed, and I think actually the fellowship's response to trainees and what the fellowship even wants out of the college, although I don't speak for fellows, is continuing to evolve. And so I think we shouldn't sell ourselves short that our fellows wouldn't come to us in our time of need and and back us in in this really potentially meaningful change that's on the table.

Sky, we we've we've heard now um in great detail what the alternative assessment pathway is gonna look like, and it's been approved by the AMC. Uh, reviews are underway. Um, people have been marked on their OSCI performances over the two stations for those who were lucky enough to be able to do it. Can you make any comments on whether or not you feel like the alternative pathways are going to be adequate? Um, if there's any glaring issues that you can identify?

Look, I suppose, you know, where we're at is trying to make the best out of what has been a very bad situation for a lot of people. And so, you know, in terms of satisfactory outcomes, there are always going to be things moving forward that are not satisfactory because really the only satisfactory outcome was that the OSCI proceeded as it was supposed to, and people were able to sit as they were supposed to. Or perhaps in my view, the only satisfactory outcome would be that we actually uh radically overhaul all of our assessments and move towards workplace-based assessments uh in line with the ACER review. Uh, but that's a that's a topic for a different time. Uh, but I suppose what we're dealing with now is all of the nuance, right? Because we've got trainees coming forward and saying things like, well, you know, I'm a young mother and I actually cancelled my registration for the OSCI because I knew it was going to be a disaster, and I did so only a couple of weeks out, and I just didn't want the stress, you know, on top of me and my young family. Why am I not allowed to access the alternate pathway compared to somebody who went through with sitting on the day? And these are questions that are going to have to be grappled with. And I think that there are going to be a number of unsatisfactory outcomes because this is just a wholly unsatisfactory situation that we find ourselves in. Do I think, though, that there are a lot of people trying to do their best to make the best out of the situation? Yes, I do. And, you know, as I mentioned earlier, we actually have seen a real commitment to hearing trainees as part of this process, as part of this task force that's involved. And I think that that is really positive. The question for me is, you know, this has happened, we're trying to make the best out of it. But what are the things that we can do to implement now to make sure that this doesn't happen again? And again, it comes back to all of this stuff around cultural change in terms of ongoing uh valuing of trainee feedback, not just once, not just in a crisis when things are really bad and when things are hitting the media, but ongoing and sustained trainee engagement.

Thank you for bringing up, you know, being woman in training Boschition. You know, I think definitely bring a lot of uh additional difficulty in a family, things like that. Uh, you know, and yourself, you have a lot of haps, you know, you you do a lot of things uh as well at training. Can you comment on you know the difficulty of being uh you know woman in the training Bushician?

Yeah, it's I think really um great that you have all chosen uh, you know, to highlight the specific impacts that these issues are having on female trainees because there are a lot of impacts for reasons that I should hope would be no surprise to anyone listening, you know, working in medicine, working in psychiatry, we should all really be aware of the gendered impacts of the workplace on everyone. And uh female trainee psychiatrists are no exception because at the end of the day, when we take our psychiatry trainee hat off, we're still women and we're still facing all of those things in society that are problems for every other woman in every other workplace, on top of uh these particular issues with this exam. But I think one of the big things that I've heard a lot from female trainees that have reached out to me is the impacts uh that this process has been having on them as often carers. You know, we we all know um that women. Men are more likely to be in caring roles. And a lot of female psychiatry trainees have caring responsibilities, whether that's for family members, for partners who are unwell, for children. And the other side of that same coin is women who are thinking about pregnancy. You know, this is a problem for female trainees across every single college. We all have to think about when we're going to try and engage in family planning and, you know, how we can try and get pregnant around certain milestones in terms of examinations. And when there's such a level of uncertainty about whether or not exams are even going to go ahead, you know, female trainees are not infrequently faced with this question of, well, do I try and get pregnant now or do I not? Is the exam going to go ahead? Is it not? If I put it off and then the exam doesn't even happen, have I just lost a lot of time where I could have been trying to get pregnant or be pregnant or taking maternity leave and all of those things that I need to juggle around my career that our male peers don't necessarily need to think about to the same extent as what we do. And so the the additional stress and you know burden that's actually put on female trainees through this, I don't think can be understated. And I am aware that a group of female trainees have actually uh sorry, a group of um female trainees and fellows have written to the college to try and highlight the extra layer of distress that that a lot of females, uh, female trainees are facing.

I think what you're getting at is that I mean there's um so much pressure around trying to plan one's life around training, and the and the and the planning is just so much more acute for um our female colleagues. And then there is this ripple effect that goes out into their families with their partners and their other kids and their kids if they've got kids or you know, relatives or whatever, and it's just there's so much um riding on being able to know that if you're going to commit months to sitting an examination, you want to be able to sit it when you think you're gonna be able to sit it.

Mentioned before about workplace-based assessments being a model that you prefer uh more for assessments. I suppose one of the reasons would be that it would help perhaps address some of these issues with the major exams that we currently have.

Yeah, I mean, look, lots of people have lots of views around what assessments should or shouldn't be in the college. I I don't think that it would be um, you know, reasonable to suggest that everybody uh, you know, is on board with a move towards workplace-based assessments. Certainly they're not, otherwise we'd already be there, of course. Uh, but for me, you know, if what we're saying is um that, you know, through your work you should be able to develop the skills of being a psychiatrist, then to me it makes sense that the assessments should also be able to be incorporated within that. And I really just think that the model of having annual, stressful, life-altering, one-time only examinations, I think it was archaic even before the pandemic hit, to be honest. I think it's a hangover of medicine that we need to move away from across, you know, any specialty, to be honest, not just in psychiatry. But now with the pandemic and the ongoing uncertainty, new COVID variants that are inevitably going to keep cropping up, you know, the fact that this is the model that we're working off just makes no sense to me from a workforce perspective. It just makes no sense. And, you know, what we're seeing now is people taking time off to try and sit these exams, and then because the exam didn't go ahead, they've used up their study leave and now they can't apply for leave to sit other dates and all of these sorts of, you know, issues that have actual tangible impacts on our patients if we actually can't get registrars on the ground doing their job on the day-to-day because they're having to faff around in the background with leave, you know, and applying for leave and they're not applying for leave, and all of those sorts of cover arrangements that occur as a result of those things. So there are real world implications to us maintaining what I think is a very sort of archaic model. And, you know, my view would very much be that it, you know, it's time for the college to really radically rethink a lot of things. And this is an opportunity for the college to do that. This has been a real disaster. You know, I don't think anyone would say that it wasn't. And that's not to be disparaging, that's just a fact, I think it would be fair to say. Uh, but out of every disaster is an opportunity to think about the pathway forward. And member engagement is one of them, uh, but assessments is another one.

And no, and no one, I'm not, and I'm sure you're not saying it, and no one's saying it's easy. I mean, it's like I think to try and decide on how to um assess people for competency in the training program is really difficult. And it's amazing the different opinions you get when I've canvassed this conversation with some of the group of trainees in my own service. Like the opinions are so varied, and um, people really feel strongly about their uh the way that they feel like it should be done. Um and you can sort of just imagine that then you take that up to um the level of the college and they're trying to have conversations about it. It must be it's a hard task to try and figure this stuff out.

Yeah, absolutely, absolutely. And there are a lot of people in the college, you know, that are doing really good work and are really trying to make meaningful change and uh continue to nudge us, you know, into whatever the future college might look like. But um I suppose at the end of the day, and and you know, this is how I view things, you know, um the college is a company. Uh companies put out products, our company hasn't put out a product, you know, successfully for some time now, really, if we're being honest about it, um, uh, in terms of the number of OSCIS that have been cancelled at the last minute, the number of OSCIS that have been rescheduled at the last minute, the OSCI that's failed most recently. Uh, and you know, boards are accountable to that. And so if we just come back to sort of basic governance, you know, we are all as trainees paying a significant amount of money to participate in the college and to receive a certain product. And if that product can't be delivered, then it's very reasonable that we ask questions as to why why not. That doesn't diminish the fact that there are a lot of really difficult decisions that have to be made, and that doesn't diminish the fact that a lot of people are doing really good work, but at the end of the day, that is something that we are entitled to, and we shouldn't feel empowered to ask that question because we are consumers of this product, and and you know, we are actually uh in terms of the power differential very much on the the the less empowered uh side of things at the moment.

I just have another question. I think last episode, you know, we talked about learning from auto college, either, you know, um nationally or overseas about how to better, you know, engage with the training, how better communicate, and how to be more transparent. Um I just want to know if you would know if there's anything like any example that you know we can highlight to say that you know that there's definitely that example that we can learn from other colleges.

I mean, my view is actually that this is our opportunity to show other colleges how they can learn from us. You know, we are very good at many things. And I think, you know, in the same way that we take a strengths-based approach in our actual day-to-day clinical work, we need to take a step back and look at what our strengths are as a community of psychiatrists and then implement that in the way that we engage with trainees and actually show all of the other colleges the way that it can be done really successfully in a very uh, you know, um, uh I don't want to say patient-centered because we're not patients, but you know, trainee-centric uh sort of a way. So, you know, do I think that do I think that there is another college that has the perfect example of how this is done right at this moment in time? No, I don't. I actually think that all of the colleges, probably to a greater or lesser extent, have exactly the same problems that we're grappling with at the moment. But what I do think is that this is an opportunity and that we have a lot of trainees who have a lot of ideas. Now that can be a problem because as we've talked about before, how do you integrate all of those ideas? Uh, but we're we're certainly not short of ways that we could meaningfully make change, and this is our opportunity to do that.

Sky, thank you so much for coming on the podcast. Um, it was a really thought-provoking conversation, and I mean I know that you've really got us thinking, and hopefully we can um use this as a way of communicating with trainees in in an as transparent a way as possible and and get this message out there because it is really important to be having these conversations um in the light of all the things that have been going on recently. So thank you so much.

Yeah, thank you so much for for having me and listening to my diatribe.

Not at all, no. And uh thank you, Michael, and thank you, Brian. Thank you very much.

Really good discussion. So I think it'll be another good podcast.

And I would like to say thank you to our deputy editor, Andrew Amos, who is uh working in production today, um, in place of David Beale, and also to Sidoni Prentice for our logo and Shaddy Day for our intro and outro music. Uh, we will be speaking to you uh in approximately one month's time. If you would like to rate us and leave us a review on any of the streaming platforms, that would be fantastic. Thank you.