Curriculum Redesign Project: The New Horizon

1:00
 Welcome everyone, we are going to be starting at 8 so hang in there or get yourself a glass of water and we'll be with you soon.

 3:13
 We'll give everyone another minute or so to join us, and then we'll begin.

 4:21
 You order.

 4:22
 Good afternoon and good evening, everyone, and welcome.

 4:26
 Thank you for joining us for today's webinar curriculum redesign project, The New Horizon.

 4:33
 My name is Georgia and I am Chair of the Binational Committee for Trainees in a Stage 3 Registrar of the Royal Australian and New Zealand College of Psychiatrists to formally open this event.

 4:47
 We acknowledge Aboriginal and Torres Strait Islander peoples as the First Nations in the Traditional owners and custodians of the lands and waters now known as Australia and Maori as Tangata Fenua in Altairoa, also known as New Zealand.

 5:04
 We recognise and value the traditional knowledge held by Aboriginal and Torres Strait Islander peoples and Maori.

 5:11
 We honour and respect the Elders, past and present, who weave their wisdom into all realms of life, spiritual, cultural, social, emotional and physical.

 5:23
 We recognise those with lived and living experience of a mental health condition, including community members and college members.

 5:32
 We affirm their ongoing contribution to the improvement of mental health care for all people.

 5:39
 I'm joining you this evening from the Manawa 2IN Altairoa, where I live and work.

 5:44
 And I would like to acknowledge the local EWI Branitani or Manawa 2 Brokawa and Naati Ko Fatter.

 5:52
 Anthony Llewellyn is going to talk us through the 1st slide, and then you'll be back to me for some housekeeping and further introductions.

 6:01
 Thanks, Georgia.

 6:02
 And good evening all from the worker lands in Newcastle.

 6:08
 I'm personally challenging myself to expand my my knowledge of the culture of the indigenous people, my lands.

 6:16
 And I wanted to share an interesting story about a local Aboriginal, Aboriginal leader, Biraban, who was present in the 1800s.

 6:28
 He was when as a boy, he was stolen from the region and taken down to Sydney and he worked in the office's quarters and he learnt, learnt the English culture, he learnt how to spell and read and write.

 6:42
 And then he returned to the region.

 6:43
 And the interesting thing is, it's interesting to me is that through his friendship with the local Anglican priest, Thrall Code, we actually developed one of the most comprehensive dictionaries and, and books around the language of the Aboriginal people.

 7:01
 So we, we do have a, quite a rich source of information about the, the original language in, in the Uavaco region in Newcastle.

 7:10
 And in fact the there's a centre named after Berabahn at the, the University of Newcastle.

 7:16
 But the interesting thing is that I think somewhere in this book he gets an acknowledgement, but he's not acknowledged as the author.

 7:22
 And he and Threlkor went through the region and they would often advocate for local Aboriginal people when they were getting in trouble with things like ports and etcetera.

 7:32
 So it's an interesting story and but also an acknowledgement that we should be acknowledging the contributions of the Indigenous people.

 7:41
 But thank you, George.

 7:44
 Thanks, Anthony.

 7:46
 Yeah, that's a a really interesting piece of of history.

 7:52
 So just some notes on housekeeping for this afternoon or evening session.

 7:57
 You won't have access to your microphone, camera or the chat box.

 8:02
 If you wish to ask a question during the session, please use the Q&A box in the toolbar below.

 8:08
 Please type them throughout the session and we will try to address as many as possible at the end.

 8:14
 Thank you to everyone who submitted their questions prior to the webinar.

 8:18
 Some of these will either be addressed in the talk or during the Q and AI will briefly acknowledge that There was an announcement earlier this week about the CEQ, which you may have some questions about.

 8:31
 Andy will very briefly speak to this, but it is not the purpose of today's webinar.

 8:38
 Also, just to remind you, today's session will be recorded.

 8:42
 You will receive an e-mail notification once the recording is available.

 8:47
 So now I'd like to introduce our speakers for this evening.

 8:51
 Doctor Anthony Llewellyn is the medical education specialist and fellow at the Royal Australian and New Zealand College of Psychiatrists.

 9:00
 Anthony's role is to support the education team and strategic educational initiatives and engagement with key stakeholders.

 9:08
 Anthony brings a wealth of experience from his previous roles such as Executive Medical Director at the Health Education and Training Institute, Hetty and as part of the H Net Psychiatry programme.

 9:22
 Anthony's leadership extends to his current position as Chair of PRE Vocational Accreditation for SA Met where he overseas accreditation processes for junior doctors.

 9:34
 Anthony brings a strong background in medical education, psychiatry coaching and accreditation.

 9:42
 We also have Professor Andrew Teodorsuk who practises as a consultant old age psychiatrist and is the Director of Medical Education at at Metro North Mental Health.

 9:55
 He is also an Adjunct Professor at the University of QLD.

 9:59
 He has a keen interest in interprofessional education, work based learning and well-being.

 10:06
 He has a well established track record with over 100 peer reviewed publications.

 10:11
 He has reviewed numerous awards in recognition of his teaching and research including the Principal Fellowship of the Higher Education Academy.

 10:22
 All right, over to you, Andy.

 10:26
 Well, thank you very much, Georgia for that very kind introduction.

 10:30
 I'm speaking to you again at the seminar series from Brisbane Meanjian.

 10:35
 And I like to acknowledge the Yagara and the terrible people who are the traditional custodians of the lands where we are here and pay respects to Aboriginal and Torres Strait Islander people in the audience as well.

 10:50
 So as he mentioned, an announcement did go out earlier on this week regarding the CEQ exam.

 10:59
 This isn't the purpose really of the webinar, but we thought it'd be important just to say a little bit about it.

 11:07
 And we won't be answering questions in relation to it specifically.

 11:12
 But if you did have questions, do put them in the chat.

 11:15
 OK, So the key message went out, which was that the Board has approved that the March CEQ will be undertaken as a no disadvantage assessment.

 11:25
 I'd like to first of all recognise some of the distress that this has caused to the trainees, the SIMGS and Dots and the personal impacts on individuals.

 11:38
 If, if I think about it, the key element is managing uncertainty.

 11:43
 And therefore maybe today I'm going to try and give as much information as we can honestly provide, but we are limited as to what we can say today.

 11:52
 Just to set the context, the announcements around the CEQ came in the context of the intention to review the role of the CEQ.

 12:02
 It is a very important assessment exam and individual candidates are encouraged to consider their own circumstances on whether to sit the examination as it may be the last requirement for the fellowship.

 12:15
 It's encouraged that you consider to sit the exam to progress to fellowship.

 12:19
 That's to say, if your candidate's prepared, we would recommend sitting the exam to maximise the chances of progressing through the fellowship programme.

 12:28
 I do think it's important as well to recognise the educational value of the CEQ as an assessment.

 12:35
 In particular, critical thinking skills are an important part of important in the context of psychiatry training.

 12:44
 Lastly, I'll just finished about the the next steps, so further updates on potential changes.

 12:50
 An alternative will be provided in the coming months post the current diet of the CEQ in March.

 12:56
 This is as the college finalises consultation with stakeholder groups to explore approaches for learning CEQ related skills and knowledge.

 13:07
 There are extensive FAQs to provide further guidance on available information and these FAQs I believe have been updated and disseminated to trainees and Dots as well.

 13:19
 Lastly, I'd like to reflect that the announcement for No Disadvantage really reflects the College's efforts to be more trainee centred and to provide a safety net during transition.

 13:32
 We do appear, we do appreciate, as mentioned before, the uncertainty, but in communicating no disadvantage, the aim is very much to support trainees through this reform.

 13:45
 So that's probably all I'll say about the CEQ and thank you for giving us the opportunity to speak to that.

 13:53
 I'm really delighted, however, to now talk about this webinar series.

 13:57
 This is the second webinar that we've undertaken.

 13:59
 The first one was undertaken in November.

 14:03
 The aim of the webinar series was really to improve engagement with the membership on key aspects of education reform, and this is through a dialogical approach.

 14:15
 So one of the kind of observations that we have is that there's a need to improve the communication with a membership in this series are done dialogically.

 14:23
 And by that we mean we solicit questions in advance and we try and answer them as best as we can in an iterative fashion.

 14:31
 And we're intending to run these every two months and through that process really upskill the membership.

 14:38
 In the first webinar, which is available on the QR code there, which I'll encourage you to look at, we, we spoke about a few things we spoke about and the metaphor about the college's purpose and helping you on your education journey.

 14:53
 And we use the metaphor of a boat to say that going through the fellowship is akin to going through potentially, you know, choppy waters.

 15:02
 But the college's core purpose is to set the compass, set the direction, make sure that the committees aren't working at cross purposes.

 15:10
 And the other purpose is to set the sales right.

 15:14
 And by that what we mean is that we we believe that it's really important to develop education experiences and, and consider that nowadays in the context of competency based medical education, as you hear, the curriculum is really the workplace.

 15:31
 And therefore we're trying to maximise the amount of educational opportunities, whether it's free for assessment or otherwise, to improve your development in addition to develop deliver on the service.

 15:42
 And then the final part of that metaphor was in addition to the sales and the compass thinking about providing with strong anchors to hold you firm.

 15:50
 And these are the education principles of Co design and otherwise that we're touched on.

 15:56
 I then refer you to that webinar to learn a little bit more, but I think that's an important consideration as we go forward.

 16:02
 That was a metaphor that I presented.

 16:04
 And then Anthony came with a second metaphor, which was around the college has been landing a plane with lots of different kind of initiatives all landing at the same time.

 16:13
 And during that webinar, he spoke to various elements.

 16:16
 He spoke to the curriculum redesign.

 16:19
 That's the realignment which we're going to go into more detail about today.

 16:24
 He spoke around the clinical competency portfolio review and assessments and in particular the transition from high stakes to low stakes assessments as well as the expansion of assessments.

 16:37
 And then he spoke to the online examination roll out as well.

 16:43
 And then after that we spoke a little bit about in trustable professional activities.

 16:47
 And one of the core principles that we're trying to do in the education team is to simplify the education processes.

 16:54
 And we've actually brought, we're bringing down the amount of entrustable professional activities for about 150 down to about 15 or 16.

 17:02
 So really trying to sort of help add clarity on the purposes.

 17:07
 And then finally, we spoke about the FEC as well the formal education courses.

 17:12
 So that was the initial off the bat and navigating the membership seminar.

 17:17
 And I was pleased to see that the feedback was was good and positive as well and people appreciate the ability to engage.

 17:28
 I also wanted to today go over some of the assumptions that really underpin how we design education processes and the fellowship.

 17:36
 The first assumption that we make, and this is an important one and comes from the simulation centre in Harvard, is that everybody participating in the college training is intelligent, capable and cares about their best and wants to improve.

 17:51
 This is really important.

 17:52
 What we're saying is that we think that trainees have got a growth mindset and we're working with trainees to work forward to look at learning development.

 18:01
 So that's the first assumption.

 18:03
 The second one is that the core purpose of education, and you may not think this is the core purpose, but actually it is, is to improve patient outcomes through high quality patients, psychiatric care and learning processes and upskilling.

 18:18
 So we're trying to design education processes that ultimately will benefit the patients and that's why we've adopted competency based medical education.

 18:28
 The next principle is that we're scrutinising the assessments and we believe that they should be fit for purpose.

 18:34
 All assessments are a balance.

 18:36
 It's no perfect assessment, but all assessments are a balance between reliability, validity, authenticity and education impact.

 18:45
 And and by education impact we mean what the trainees do to prepare and the impact on their learning in the run up to the exam.

 18:54
 So we take that lens and we also think that all the assessments need to balance each other and be considered as an integrated programme.

 19:01
 As such, the 4th principle that we have is that supervisors need the correct tools to support and implement.

 19:10
 And what does that mean?

 19:11
 Well, if we believe that training and learning needs to happen close to the patient in the workplace, they need to have tools that they can align to their practises which don't get in the way of service but actually make service easier.

 19:25
 And in that regard, so we're looking at designing tools which actually are helpful.

 19:31
 An example of that is, you know, a tool which potentially could be initiated if one has remediation needs or otherwise to support.

 19:40
 And so the supervisor can get objective evidence about how a trainee is to do that.

 19:46
 And then finally, and this is the most important assumption and it goes back to some of the messaging that I was talking to in the CEQ, the CEQ update, we believe trainee well-being is absolutely paramount.

 19:57
 And why is that?

 19:58
 Well, the reason is that.

 20:00
 Without being well as a trainee you cannot learn and this reflects really the kind of direction of education change over the last 10 to 15 years as we try and promote both at an individual and a systems level trainee well-being.

 20:15
 So that relates to the burden of assessment as well.

 20:18
 OK, So those are the five key assumptions and in education we talk a lot about assumptions.

 20:22
 Now, the title of today's talk is the curriculum framework, What, Why, When and How.

 20:28
 And this builds on the previous webinar that I've briefly spoke to Navigating the Curriculum.

 20:35
 And in essence, the purpose today is not to give you all the fine detail, not to tell you what conditions are more important than other conditions and that level, but actually to give you a broad overview because we're going to invite, you know, stakeholder feedback.

 20:50
 And by providing this overview, setting the scene, framing the framework, so to speak, it's possible to actually have a good dialogue and Co design together.

 21:00
 So that's really what we're going to do.

 21:02
 And I'm really delighted that Anthony Llewellyn is going to, you know, deliver the main, the main course, if you like, of today's seminar in a moment.

 21:12
 But before we do that, I just thought I'd just cover a little bit about the curriculum.

 21:17
 OK.

 21:17
 Anthony, next slide please.

 21:23
 At the last seminar, I made the point that the way that we look at education is changing in the way that we might do clinical practise is changing.

 21:31
 And and certainly many years ago when I was at medical school, the curriculum was considered in a different way.

 21:37
 But now we have more contemporary ways of looking at the curriculum and we're particularly wedded to the ideas of Janet Grant and colleagues in particular.

 21:46
 So when you think about a curriculum, and this is important in understanding why and what we're making the changes that we're doing, we think of the curriculum as a real broad umbrella term.

 21:57
 And basically it's all of the education experiences within a programme of learning.

 22:02
 So what does that mean?

 22:03
 It means the outcomes, what we hope the learner will be able to do at the end of the curriculum of the programme of learning.

 22:10
 And that's the objectives and and what we hope the programme achieves.

 22:15
 That's the aims.

 22:17
 Critically, it includes also the learning activities, how learners will learn.

 22:22
 So if we're going to learn cultural safety outcome, using yarning circles as a pedagogical approach is an example of learning activities that are suitable.

 22:33
 The curriculum also importantly covers a syllabus and perhaps that's what you and I previously thought was the curriculum.

 22:39
 The syllabus is that long list of content that needs to be learnt and that's particularly important, but it's probably not the most important part of the curriculum.

 22:50
 And then finally, the assessments.

 22:52
 So why do we do assessments?

 22:54
 We do assessments for two reasons.

 22:55
 One to determine and examine what's been learnt and then the second one is to shape future learning and that's this AFL concept assessment for learning.

 23:07
 So the assessment in itself is a learning exercise to drive forward and promote future engagement.

 23:17
 So, you know, I'll give you an example of that just this week, one of our trainees here did an excellent journal club covering a paper which explored a approach to improving cultural safety.

 23:31
 We did a brief informal assessment and then materials to read up further about were given to drive future learning.

 23:38
 So those are the components of the curriculum, the four components, the outcomes, the learning activities, the syllabus and the assessment.

 23:46
 Moving on, how do what do we know about programmes of learning well, curriculum success or actually making a difference to improve skills, to improve patient care?

 23:56
 And Anthony, can we just have the Miller's pyramid please?

 24:01
 Rests on very sound education theory and paradigms.

 24:05
 The approach of competency based medical education is the one that we are following.

 24:10
 This is the one that has been followed across the whole education ecosystem from the pre vocational space to the vocational space to medical schools.

 24:19
 I'll just talk you through Miller's pyramid.

 24:21
 You'd all seen as pyramid, but every time you learn about it, you can learn something different.

 24:25
 So the idea is that at the end of a curriculum we would like our learners to be able to do and to be.

 24:34
 So we need to design activities of learning at various different levels, activities of learning and assessment in terms of, you know, the syllabus, the what, knowing how, showing how doing that's a higher level and being just to say a little bit about the doing.

 24:52
 So that happens in the clinical workplace and that's why we have the assessments and authentic, authentic places.

 25:01
 So that's the purpose of WBAS.

 25:04
 You know, we all know people who are very good and we can actually assess them in the in the curriculum workplace itself.

 25:11
 The beings really interesting actually.

 25:13
 So the being is this is the highest level of learning and this is to do with you develop the identity of being a consultant psychiatrist.

 25:21
 And that's where we want to go.

 25:23
 Why is that important?

 25:24
 Well, that's important because in essence, being and having an identity is linked to accountability.

 25:32
 So there's a very famous theorist that Anthony might have heard of called Etienne Wenger, and he was saying that accountability is the flip side of identity.

 25:42
 So if we if we develop the identity as a psychiatrist, we are more accountable as well.

 25:47
 But the take home message from this slide is that curriculum success depends a lot on having the right education theory and following it.

 25:55
 So let's just move on to the college.

 25:57
 So the AMC have asked the college for a framework.

 26:01
 The AMC are our regulators and they determine how we set about our education processes to achieve standards.

 26:08
 And they've asked for each specialist medical programme to have a framework, which is what we're going to talk about today.

 26:14
 And we're going to invite dialogue around organised specific programme and graduate outcomes.

 26:20
 And this framework's essential for guiding education processes.

 26:25
 So the framework in essence is the map of outcomes and learning experiences.

 26:31
 And this is the one that we've actually used here at the the college.

 26:35
 So we've actually developed programme outcomes and graduate outcomes that map onto Miller's pyramid.

 26:40
 So if you could just do the slide there.

 26:43
 So our set of competencies and outcomes, we have programme outcomes, which Anthony's going to talk about in detail in a moment.

 26:50
 And this is what we want fellows to be able to do, IE the higher level learning processes and graduate outcomes, which are the skills and knowledge that we want fellows to acquire as well.

 27:03
 So you'll see that they're a bit lower down in Miller's Pyramid.

 27:06
 And then there's a syllabus which will be assessed by our MCQS and other approaches as well too.

 27:12
 So we've, we've used Miller's Pyramid to guide the, the framework that we're going to show you today.

 27:18
 We can go forward, Anthony.

 27:19
 Thanks.

 27:19
 A few other principles.

 27:22
 And first of all, it's really important to consider that no assessment on its own deemed someone as competent or not competent.

 27:30
 What is required is a holistic, broader, integrated view of assessments.

 27:36
 And by that process, at the end of the the programme of learning, the curriculum, we will say that a trainee is competent as such.

 27:44
 So it's the suite, the balance of the assessments that counts.

 27:47
 Second principle I was mentioning before was the importance of using assessment as a guide for learning and, and one of the things we're going to try and do is upscale and feedback so as we can do feedback in a way that promotes further learning.

 28:01
 The other aspect in terms of assessment is that it's becoming increasingly clear what makes a difference when you're being assessed isn't whether you've got a three or A4 or A5.

 28:11
 We forget that what actually makes a massive difference is getting the narrative words in relation to the feedback and driving future.

 28:20
 So when you're getting your assessments as a trainee from a supervisor, ask for narrative.

 28:25
 And when you're a supervisor doing the assessment, fill out as much qualitative aspect as you can.

 28:31
 And then the third critical principle was that validity or how well we purport to deliver what we wish to educationally depends on how well an assessment is undertaken.

 28:43
 And This is why it's critical that going forward, there's ongoing supervisor and trainee development in undertaking and using these tools of learning as well.

 28:53
 So that's a key aspect.

 28:55
 This is a really busy slide which Anthony spoke to last time and it basically gives you the kind of outline or the future fellowship programme.

 29:05
 Not going to go into it in detail, just to say that the yellow points are what we're going to focus on today.

 29:09
 That's the graduate outcomes and the programme outcomes as well.

 29:14
 But Anthony might speak a bit more to that later.

 29:17
 And finally, I'm going to end by talking a little bit about the priorities and this is aligns to other priorities at the present moment in education.

 29:25
 And first of all, we intend to deliver the best psychiatry training and programmes across the career.

 29:32
 And we want to in a sense up skill training so that understand it's important to sort of develop skills for lifelong learning and that's important to mid career and retirement to we also want the college to be adaptive and contemporary in the use of its high standard assessments.

 29:50
 So we are, for example, in my working group, the EPA working group, we're using education theory for medical teacher and otherwise to use contemporary approaches to learning.

 30:00
 And then also this is a key purpose of medical education is to have that social accountability agenda.

 30:06
 We're trying to meet the needs of the community.

 30:09
 So next slide.

 30:12
 These are detailed in the strategic plan.

 30:15
 So we're trying to engage in particular and improving access and equity by engaging with stakeholders.

 30:23
 And an example of that is Anthony engaged with 20-30 groups in developing the Epas.

 30:29
 We're trying to elevate the voices of people with lived experience, which is absolutely critical, and also improve outcomes for Maori and Aboriginal and Torres Strait Islander peoples by building on the cultural safety learnings in the pre vocational space as well.

 30:45
 So this is really last time I spoke to you at the seminar.

 30:49
 We spoke about the different content and promoting cultural safety is a really important area that we'll talk more about.

 30:55
 We're also engaging and trying to listen and, and respond openly and, and transparently as much as we can and, and to support our our members in terms of their health and well-being and their connections.

 31:06
 So in this context, we can go to the next slide.

 31:10
 There are a few areas we listened to at the last webinar.

 31:14
 We've put on further development sessions.

 31:17
 There is a pre Congress workshop called CBME 101 which is aimed at trainees so you can learn the fundamentals of CBME.

 31:27
 There's a supervisor workshop and a handbook which is led by doctor Shane Gill.

 31:31
 And we've got a symposium at the Congress which I encourage you to come to when we're going to hear from external speakers called Show Me the Evidence.

 31:39
 And that's really about sort of understanding kind of how the education was change.

 31:45
 There's OCA and IOCCA training, which is on the horizon.

 31:49
 We do, we heard from asking questions that there's a need for more resources, infographics and webinars as well.

 31:56
 So we're adapting the processes really to try and upskill as much as we can too.

 32:01
 OK, Georgia.

 32:02
 OK, Anthony, how are we going?

 32:04
 Good.

 32:08
 Can I hand over to you Amster now and to to talk to us now about the curriculum framework?

 32:13
 Over to you.

 32:14
 Thanks, Andy.

 32:15
 Thanks, Georgia.

 32:16
 So we've just got a quick poll.

 32:17
 We're going to pop up and we'd be interested to get people's thoughts on the question of what and what you've already heard from Andy and what you know, Which of the following are the most important factors in designing an effective curriculum?

 32:34
 I'll just pop that up and I would acknowledge we've got quite a few questions in the Q&A already which we will try and get to most of them, some interesting ones there.

 32:47
 I don't know whether people are just lifting their hand, that sometimes happens on Zoom, but I've noticed a few people raising their hand as well.

 32:53
 We would just encourage you if you've got a question to put it in the in the chat.

 33:00
 I'll just give people a few more moments to vote.

 33:16
 About 32% looks like people are finished voting.

 33:26
 If they were intending to, we might just share the results then.

 33:30
 Thanks, Jess.

 33:32
 Do that.

 33:36
 Well, actually I look also, it looks like it's continuously sharing from what I can see here.

 33:40
 So interesting results.

 33:44
 I guess you know, from what you've heard already, you could probably argue that all are important on that list.

 33:49
 It looks like practical application wins and I think it would be.

 33:56
 It's worth noting that that sentiment is very much in line with the, the what the board has asked the education team to think about in implementing change management.

 34:08
 We did present to them a number of issues late last year is a part of a deep dive session.

 34:14
 And they asked us to, to, to do some, some more work or to outline to them how, you know, they understood the changes that they were happening and the, the need for the changes.

 34:26
 But how can they be done practically and how can they be done in a sustainable way.

 34:30
 So interesting results there.

 34:35
 So I think can I, I think I can close that by the looks of it, but thank you for voting on that.

 34:45
 Maybe leave Jazz to to stop the share there.

 34:57
 OK, So I'm sure you're interested to find out what's happening with the curriculum framework.

 35:03
 That's what we're here for tonight.

 35:05
 So I will try and go through this as briefly and efficiently as possible so we can get to your questions.

 35:13
 The first thing to acknowledge is that at some point before 2012, I'm not entirely sure.

 35:19
 Looking through the of the documents, a curriculum was designed for the current fellowship programme.

 35:26
 And So what does that mean?

 35:28
 Well, we've got a curriculum framework that is around 15 years old and so many of you would be familiar with this diagram.

 35:43
 The many, a lot of you probably aren't aren't aware of the origin of this diagram and why it's called the Cam meds diagram, but you can actually see that on the picture.

 35:52
 So, so the the Royal College in Canada, interesting college.

 35:58
 It's basically the omnibus college for all specialities apart from general practise.

 36:03
 And they've been very kind to the Australian and New Zealand colleges over the years and lots of other parts of the world in sharing their expertise and knowledge.

 36:12
 I think because of the nature of their, their college being, you know, a, a multi specialty college, it's given them an advantage to think about what goes into being a good doctor, whether that's a psychiatrist, a surgeon, a General practitioner, what have you.

 36:28
 And they, in the, in the 90s, they developed some works looking, you know, by basically going out to lots of groups and reviewing literature and developing consensus and came up with this roles framework, which you will recognise through the college documents.

 36:44
 And it, it, it's a very high level conceptualization of the roles which are sit above the actual competencies that we want a specialist to be able to demonstrate.

 36:55
 I think one, one thing to acknowledge here is that sometimes it feels a bit like a Superman, superwoman model, you know, that you have to be excellent at everything.

 37:04
 And I think we, you know, I think there's a level of competency in each of these roles, but we still want diversity and we want, you know, high level communicators, we want high level scholars, etcetera.

 37:15
 So there's there's a role for all these roles within within especially as well.

 37:22
 So that's been our guiding point for the new for the 2012 programme.

 37:26
 And so what's happened around that?

 37:28
 Essentially not much since it's been developed in for 2012.

 37:34
 The literature or the the reports that I've looked at show that the framework the has been updated with minor updates till 2016.

 37:44
 Whereas lots has been happening in the medical education space within the college and outside the college.

 37:49
 And lots has been happening in relation to psychiatric practise, you know, thing things like the treatment for ADHD, for example, or trans transgender issues, etcetera.

 38:00
 You know, they weren't as you know as huge topics and areas.

 38:07
 TMS would be another one I guess like I'm sure you can think of a lots of things that have altered since that framework was put in place.

 38:15
 So that's a bit of a problem.

 38:16
 We've got an outdated curriculum framework which as you saw from that high level diagram really is underpinning all our other educational programmes.

 38:24
 And it is important that our framework sets up the rest of the curriculum, the learning experiences, the rotations, the learning programme, the formal education, the assessments, the Wbas, the exams, etcetera, for success.

 38:41
 And you know, unsurprisingly, because of the emergent knowledge and practise and also, you know, where we were back then, there are gaps around things like being more in tune.

 38:54
 And there's a question about how we being more in tune with the needs of those with lived experience.

 38:59
 Well, we are deliberately building more of that into the curriculum framework to support that.

 39:08
 Similar with non acute psychiatry and similar with wanting to achieve more around cultural competency and cultural safety.

 39:18
 And then another thing that often happens when your framework is a bit old.

 39:21
 The other things have changed in the programme and does it also all necessarily align or map back directly?

 39:28
 And I think there's some concern and evidence that that is not the case anymore.

 39:32
 So one of the things that we will need to do once we've actually agreed on our curriculum framework is to go back and then map it to our existing learning experiences, assessments, exams, etcetera, and make sure that that does align and, and perhaps potentially have to make some other some further adjustments if necessary.

 39:49
 But this is a process of, of engaging in dialogue and giving you information and leading you down the journey of what might be able to happen so that you can prepare for some of these things.

 40:03
 There are the Australian Medical Council does have concerns around our curriculum framework.

 40:09
 The other thing to note is this is a complex project.

 40:11
 There's a lot, there are lots of complex projects happening on within education at the moment, but.

 40:17
 This project had a lot has lots of interdependencies because it is the framework.

 40:22
 So other projects are dependent on its timelines as well.

 40:26
 And then I think the big question that we need to also resolve as part of this process is how do we prevent it from sitting there again for 15 years?

 40:36
 Because like we've had example questions in the chat already or the Q and I should say already about how are we factoring in things like AI into the curriculum framework?

 40:44
 Well, I would answer that question by saying, by the time that this is implemented in 2028, we won't be talking about AI.

 40:50
 We'll be talking about other things like AI agents.

 40:52
 We'll be talking about the fact that most of us will have will pay a subscription fee for all these bots online to be doing all these tasks for us, which might well include go off and write me a talk about best practise in bipolar disorder management in an inpatient setting.

 41:11
 So again, we need to think about how can our curriculum framework be agile enough and adjustable regularly to keep pace with contemporary practise and needs.

 41:23
 And also the syllabus of what we we'll be calling the knowledge base also is dynamic.

 41:29
 The challenge there being not to just keep adding things in, but also removing things so that we don't crowd the curriculum too much.

 41:38
 So I'd like to see that we have a process that we are probably annually reviewing knowledge base thinking, getting going to the question from David about how how can the the college engage with the education committee about these issues, seeking annual views about things that are missing, working out how to put put new things onto the syllabus and even adjusting the framework more regularly as needed.

 42:03
 So the impact is significant.

 42:05
 It impacts all parts of training.

 42:08
 And as I said, we need to take the care to align it with other elements.

 42:11
 And that requires time and also one of the big considerations here with all our pieces of work.

 42:18
 But the curriculum, you may not think that the curriculum framework has lots of IT implications, but if you think about it currently that our roles framework, it's underpinning the the Ida forms that we do with trainees.

 42:31
 So actually we need our IT system, our in train to be able to show us how the curriculum framework is being delivered through all the other elements of the curriculum.

 42:43
 So there are sort of IT challenges as well in delivering Boo.

 42:49
 I've mentioned that there are there are a number of AMC conditions.

 42:53
 I'm not going to dwell on that.

 42:55
 When you get to read the the two papers on the draught programme, outcomes and graduate outcomes and roles, as well as how we've got here so far, which we're endeavouring to get to release in the not too distant future.

 43:10
 You understand how we're having, how we're trying to incorporate some of the AMC conditions as well.

 43:17
 So how have we gone about this redesign?

 43:19
 So we have partnered engaged with the Australian Council for Education Research as part of that project.

 43:27
 We have deliberately included the need to address all the AMC conditions in the project.

 43:35
 And once we've completed our framework work, we will be working again with ISA to do that mapping exercise.

 43:42
 We anticipate that we'll start sometime in the second-half of this year.

 43:49
 We've already given, yeah, got some consultation from key stakeholder groups, a community collaboration committee, which represents lived experience and carers, as well as two Indigenous committees to Kanahara and Aboriginal Prostate Islander committee and A and a couple of other committees.

 44:07
 Just to get some because those committees, particularly we were very mindful that some of the curriculum changes that we need needed there early input.

 44:16
 And we're now at the point where we're doing our broad consultation around this.

 44:20
 What that will look like, It's not going to look like me going around 20 to 30 odd committees like I did with the EPA project.

 44:29
 It's going to look more like there will be the documents on our web page for you to read a survey which you as an individual can complete and, or a committee could complete.

 44:42
 And you can also provide your own, you know, will there be some, some questions to, to consider.

 44:47
 But obviously we're open for any form of feedback from the in relation to the framework, emphasising that where we are is in terms of a draught product.

 44:57
 And that opportunity would be for all members of the college, but also for all members of the community.

 45:02
 And we really think it's critical if there was one key piece of work that we were delivering from education, the college that needs to have good community engagement.

 45:12
 It is our curriculum framework.

 45:14
 So there will be a significant period of time where essentially these documents will be open to community consultation.

 45:25
 So we've had a project group, we've been taking a CVME approach, we've used Canmed's roles as a starting point.

 45:35
 There was a question about, you know, where's the evidence around this and why are we doing things at other colleges and no one else is doing around the world?

 45:42
 Every college has, Yeah, well the majority of specialty medical colleges around the world or postgraduate medical education programmes adopt A competency based medical education framework when designing their curriculum.

 45:58
 That is the cutting edge at the moment.

 46:01
 It is something that the Australian Medical Council has said should happen.

 46:07
 So you'll, when you get to a, a little picture section at the end, which is be the fun part of tonight, you'll see that other colleges are doing what we do.

 46:14
 So we're not out of step at all with that.

 46:17
 So I've used that as a starting point, but we have looked at other curricular both within Australia and New Zealand and, and the, the curricula with the College of Psychiatry in the UK and, you know, picked up on ideas from there and looked at what were our, our existing framework says it is a redesign.

 46:35
 It's not a complete restructure starting from scratch.

 46:40
 We we're, we're evolving in a sense and we've now got some draught programme outcomes and graduate outcomes to share for consultation.

 46:52
 Some of the other things that we've done as part of this work is to be mindful of the emerging concepts.

 46:57
 Again, we've had questions about cultural safety, digital health, etcetera.

 47:02
 This is something that the CAN Meds group in Canada are considering.

 47:06
 They are endeavouring to, they, they update their framework about every 10 years.

 47:10
 They are endeavouring to have a new version in 26.

 47:14
 And these are the 11 emerging concepts.

 47:16
 So we're trying to sort of think about what Hameds might look like in a future document as well and, and pick up on some of these concepts.

 47:27
 Some other key documents that we've looked at are the very excellent Victorian Psychiatrist Leadership Framework, which the the college has endorsed and and a very key document.

 47:39
 I would recommend people read go and read this.

 47:44
 Perhaps we might even be able to post a link to this in the chat if one of the team members could grab it.

 47:50
 Is the cultural safety training plan for vocational medicine in Etero.

 47:56
 The college has endorsed this.

 47:58
 This is a council of medical colleges.

 48:00
 Endorsed documents.

 48:01
 So this is the key document that we are endorsing not just for New Zealand trainees, but for Australian and New Zealand trainees.

 48:10
 It has four proficiencies essentially competencies outlined in it.

 48:14
 So that forms the heart of our new cultural safety role going forward.

 48:20
 So again, we're, we are actually pulling on best evidence from other, other, other areas to redesign and reimagine this curriculum framework.

 48:32
 So we have initial draught of programme outcomes and graduate outcomes in a framework that's now being delivered.

 48:38
 These are the programme outcomes.

 48:41
 I would say at this point, it's certainly not my intent to show you through all the documents we have.

 48:50
 I think it's 38, sorry, there are now 8 roles about 38 P competencies in 140 enabling competencies.

 48:59
 So clearly we are not going to run through each of them tonight and you know, get your feedback.

 49:03
 It's and clearly that's why it's probably not going to be useful for me to go to various committees and seek feedback either because you need to be able to, you need to read the document and consider it and, and jot down your thoughts and, and philtre them through that way.

 49:17
 So I think that's where we're, we intend to head with consultation.

 49:23
 Here's just one example what a programme outcome might look like.

 49:26
 So this is the intent, as Andrew said, is that this is what we want our graduates to be able to do.

 49:33
 So the first one is exhibit excellence and equity and in person standard psychiatric care.

 49:40
 And it's you can see it's a very high level.

 49:43
 And one of the tricks here is to not not put too many words in there, but capture all the important things.

 49:49
 So that's, you know, that's our aim, that's our vision.

 49:52
 If you like, underneath that we then have our roles, which you'll be familiar with.

 49:58
 So here's an example of how the roles then cascade down to key competencies and then enabling competencies.

 50:04
 So it will be particularly the enabling competencies that we need to make sure map across the curriculum.

 50:14
 And you can kind of think of these, there's kind of an intellectual argument here as to whether the enabling competencies is a learning outcome or not.

 50:25
 But certainly this is where we would derive our learning outcomes from.

 50:31
 And then we have graduate outcomes, which, as I said, fit under the roles.

 50:35
 So here's an example of one outcome that sits under and then the sub competencies that sit under psychiatric and medical expert.

 50:44
 So the other practise psychiatry with a commitment to delivering high quality evidence based person centred care with being a whole lot of sort of sub points.

 50:55
 So I'm just going to run you through some of the key high level changes that there are.

 50:59
 Two big ones.

 51:01
 One is to change.

 51:02
 It may seem subtle, but we we're suggesting change the word health advocate to advocate.

 51:09
 The reason being is that many people who consider these documents often find that this is the role that is less least understood or hard for people to engage with.

 51:20
 So we want to try and make it a more accessible role, but the other thing is to also recognise that psychiatrists advocate outside of health for improved mental health outcomes and, and a lot of things that we need to advocate for really about, you know, societal change and policy shifts, etcetera, that then, you know, education and equity issues, etcetera.

 51:45
 So, so that's one thing that that will be somewhat different in the new framework.

 51:52
 And then the other big piece is around cultural safety.

 51:55
 We, we may not have quite landed on the right wording here yet because all the other roles are being an advocate, being a scholar.

 52:04
 You, as has been pointed out, it's grammatically incorrect to say that you are a cultural safety.

 52:10
 So perhaps we need to just wake that a little bit, but in but the point being here is that we wanted we have, we, we feel it's important that we introduce a new role specifically focused on aspects of cultural safety, competence and responsivity, picking up those ambitions from the the vocational training safety plan.

 52:31
 And this does challenge the college to be, we are actually seen as a leader by Indigenous groups, but they continue to be a leader in this space and find common ground with our Indigenous people.

 52:44
 As I said, we're driving much of this from what's already in the existing document, but adding in a fifth role, which is about the need for psychiatrist to be involved in managing cultural load.

 52:59
 And we've come up with a little potential framework for this, which has an acronym attached to it around the concept of humility, eliminating racism, accountability, reflection, and transformative action.

 53:11
 Again, you will see if you if you read that cultural safety training plan, you'll see that reflected there as well.

 53:18
 So what are the next steps?

 53:21
 So 2025 we, we're sort of this is I guess you can see this is soft launch if you like.

 53:28
 We need to present the work to the education committee with our consult consultation plan.

 53:34
 And then we're hoping probably around April, May, we will actually launch the key documents off the website with open consultation with an invitation to all members to read and engage and complete the survey, all committees as well and and the public.

 53:51
 And we've got a large list of other stakeholder groups such as government, colleges, mental health advocacy, etcetera that we will be putting an open invitation to provide comment and feedback on these documents the rest of the year.

 54:09
 Looks like us basically then, you know, analysing that feedback, hopefully then developing the final framework model.

 54:20
 We also want to we also need to show the the new knowledge base.

 54:26
 We're not doing both at the same time because I think the, my feeling is that the knowledge base is quite dense.

 54:33
 And so we, we need to sort of first get the framework agreed on and then it's, it'll be easier for, for those to comment on the syllabus knowledge base.

 54:43
 It also needs a little bit more work before we release that.

 54:47
 You can see there are other things that need to happen in 2025 and you can see why we have been saying that it's probably not going to be till 2028 that we move to this new framework.

 55:00
 Now that's giving a lot of time so that people, you know, obviously can adjust to the change, but it does come with these downsides.

 55:11
 And one thing that we want to look at and consider is are there certain elements of the new framework that are that are, you know, important to try and bring in a bit earlier and can we do that?

 55:21
 And obviously one of the key ones would be around cultural safety as the role.

 55:27
 And so these are sort of questions that we will be asking when we go out to consultation.

 55:31
 So you can start thinking about these, but you know, we're very much, again, I want to emphasise these are draught documents.

 55:39
 We, we expect that the final framework will change and we do want considered feedback.

 55:48
 I know a number of fellows have said to me that they don't feel that the, the current framework and the current knowledge base reflects contemporary psychiatry practise.

 55:59
 I have put the question back, well, what does that look like?

 56:02
 And I'm very interested in understanding your views around that.

 56:07
 And certainly I'm going to say I, the education team, are very interested in understanding your views around that.

 56:15
 So before we get to the Q&A, as I said, there is a little bit of a fun bit for tonight if you like.

 56:24
 As as I mentioned, most colleges in Australia and New Zealand have adopted a version of the Cam EDS framework.

 56:33
 We've taken some inspiration from some of them.

 56:36
 You might recognise some of these inspiration a bit later when I show you some of our draught concepts for our roles diagram.

 56:43
 This is the College of Physicians.

 56:44
 So here's an example.

 56:46
 You see medical expert, communicator, leader, manager there.

 56:51
 But you see that many colleges over time have added things in.

 56:55
 This is 1 college that is added in cultural safety and they've actually put the patient in the in the middle there as well, which is interesting, as have the Royal Australasian College of Surgeons patient centred care in the middle.

 57:10
 I would expect that this might be something that looks different for care meds as well.

 57:15
 Again, you can see they've added a few other things like judgement and technical expertise in there.

 57:21
 This is the College of Ophthalmologists, which I find interesting because you have to really stare, stare at it to read it.

 57:27
 And then here's the version of the Australasian College of Dermatologists as well.

 57:33
 But there's a few sort of examples of how other colleges have done it.

 57:38
 These are some concepts that our communications team has been very helpful in in, in working out for us.

 57:45
 And we will have a poll.

 57:48
 We're interested in your feedback in terms of what you like best and also if you want to put in the Q&A some comments about things you like about one or other, that would be perfectly OK as well.

 58:00
 So here's option A.

 58:02
 This you can, as you see, looks a little bit like the Royal, the College of Physicians.

 58:07
 These are all college RANZCPI should say college branded colours.

 58:13
 I can reassure you.

 58:15
 Here's another version which it looks like a bit like a sunrise.

 58:19
 I guess another one which is a bit closer to the sort of can meds petals and then finally one kind of looks like an atom or something, I guess.

 58:33
 Yeah.

 58:35
 So that options ABC and DI might get just to start the poll and I'll go back and just cycle through the options for you again.

 58:54
 All right, We've got option A there.

 58:59
 There's option B, option C, then option D Do that one more time for people, Option A, option B, Option C, then option D.

 59:55
 Or we can leave the poll up for a bit longer, but I can see that over half of you evaded already.

 1:00:02
 So that's the poll question.

 1:00:06
 So yeah, we might share the results.

 1:00:10
 So it looks like option A is a clear winner, which is consistent with what our team.

 1:00:18
 Has a consensus around as well.

 1:00:20
 I think the only issue is it does look quite like the College of Physicians.

 1:00:23
 So we we might need to consider that.

 1:00:26
 But thank you for that input.

 1:00:28
 I'll hand back to Georgia.

 1:00:31
 Awesome.

 1:00:31
 Thank you, Anthony.

 1:00:33
 So thank you to Andy and Anthony, both of you for what you've said this evening.

 1:00:39
 It has made for interesting listening and also promoted a lot of questions.

 1:00:45
 So we're going to look at two questions that came through from the previous webinar and then two questions that were submitted from registrants of this webinar prior.

 1:01:00
 And then we'll be turning to what people have asked in the Q&A.

 1:01:04
 So you're welcome to still ask your questions in the Q&A.

 1:01:10
 We certainly won't be able to get to all of the questions, but I think we'll attempt to answer them at some point in the future.

 1:01:21
 So to begin with, will the college's graduate outcomes be relevant to key stakeholders, particularly those with lived experience and other mental health professionals?

 1:01:35
 Anthony Yeah.

 1:01:37
 Look, that's a very good question.

 1:01:42
 And the answer is yes, that is the intent.

 1:01:45
 I think the best test of whether they are or not is not me saying they are.

 1:01:51
 It's probably what our, as I said, our external stakeholders come back and tell us.

 1:01:55
 So if saying Australia says that we've got it right.

 1:01:59
 If the mental health nurse, forget their, their acronym, but the Australian Mental Health Nursing Association used to comment and tell us we've got things right, then, then we probably have moved made a a good shift in terms of where we want to go.

 1:02:17
 The collaborator role is an is another interesting one where I think sometimes there's a bit of a struggle, but we have certainly tried to put in a, some more framework around into disciplinary work and, you know, respecting the roles of other and health professionals.

 1:02:35
 And and certainly there's been a lot of work going into looking at the perspectives of lived experience.

 1:02:41
 And one of the, the key, you know, the key debating points is, I mean, like most people with mental illness would like to be called by their name.

 1:02:52
 We acknowledge that.

 1:02:54
 Do we call them patient or do we talk about person centred care, etcetera.

 1:02:58
 So getting the language right is actually important, but also it needs to also be reflecting things like, you know, sharing power with with our people, with lived experience.

 1:03:12
 And how do we do that?

 1:03:13
 How do we listen and engage and use our use our expertise as a psychiatrist to help empower them both on an individual level, but also on a community level.

 1:03:27
 But yes, as I said, I think the best test will be when we go out for external consultation.

 1:03:33
 Yeah.

 1:03:34
 Just just to add to that answer, I think you make some, some good points and the the graduate outcomes will absolutely be relevant to those with lived experience.

 1:03:46
 And this is going to be achieved for the Co, Co design that we mentioned and the focus very much on utility and sustainability.

 1:03:55
 And I think the words that we use are absolutely crucial and sharing the values, which is behind what the curriculum is.

 1:04:04
 And so we're going to spend time working.

 1:04:05
 And I think it reflects really the transition say from 2012 when you know, the live experience voice was was less kind of sort of strong and now we need to include it.

 1:04:15
 And if you get a conference as you, you will hear that in particular.

 1:04:18
 So that is an absolute key, key focus and that underpins why we're going to do those big collaborations, which Anthony's doing as well.

 1:04:27
 Thanks.

 1:04:30
 All right.

 1:04:30
 And the second question, how does the college assure high standards in psychiatric training in Australia and New Zealand?

 1:04:39
 And I think there are lots of questions in the Q&A today which reflect this question, particularly with changes in assessments.

 1:04:53
 Yeah, I, I think it's a very valid question to be asking.

 1:04:59
 I think we've tonight presented an element that shows how we are improving the quality assurance around psychiatric training by, you know, I, I think updating something that that's a very key element of the programme that is not changed for 15 years is, is easily arguable as something that will has the potential to really vastly improve and keep us at a high standard.

 1:05:27
 As Andy has said, part of it is about us being accredited by the Australian Medical Council and being held to a high standard.

 1:05:35
 Part of it is about us looking externally about what are the contemporaries are doing and, you know, taking good stuff from them, which we have attempted to do here.

 1:05:45
 But I'm I'm actually kind of taken by Alyssa's comment about the fact that curriculum transparency is the most important principle.

 1:05:56
 And yeah, I would agree to to some extent that one of the big challenges with a curriculum is to show how it's actually being delivered and, you know, demonstrate how the framework is is being made live through the other parts of the curriculum and not.

 1:06:15
 And I guess you know, many of those what on the webinar tonight would be aware of what's called the hidden curriculum with which often emerges if the the formal curriculum is not properly planned and rolled through the programme.

 1:06:33
 So, so, yes, I think one thing I would like to see is a better visualisation that all trainees and fellows and members of the public could see that shows how the framework lines up with the learning experiences, the the, the teaching, the assessments, etcetera in a, in some sort of table or, or whatever is the best way of representing it.

 1:06:54
 And, and also obviously in our documents.

 1:06:56
 So you can understand that how everything does clearly link back to the competencies that we end up endorsing.

 1:07:09
 Yeah, that's, yeah, this is this critical question around standards.

 1:07:13
 But I think our view of standards is, is short as as mentioned before, like Anthony said by the AMC and demonstrating that we're delivering in line with, you know, the new conceptualizations or the professionalisation of medical education that we're doing.

 1:07:27
 But I do wonder if the question is really kind of about, well, how do exams fit in psychiatric training?

 1:07:35
 And that's really kind of what's being asked behind it.

 1:07:38
 And just to say a few things in defence of exams, you know, the exams are a critical part of any assessment programme.

 1:07:45
 They're not the only part, but they provide standardised, structured evaluation, ensuring coverage in particular of key knowledge areas.

 1:07:54
 And they allow, you know, concepts of validity and reliability to achieve be achieved to to good, good levels.

 1:08:01
 And but they have to be complemented.

 1:08:04
 And this is the key point by other assessment types, work based assessments, which can give you that narrative feedback to drive forward the learning case based discussions portfolios to ensure a broader, holistic, integrated view of competency.

 1:08:22
 So exams certainly have their place and they certainly have to be up for scrutiny and they have to be carefully included in the programme says they don't increase the burden of assessment.

 1:08:34
 And where they're there, they absolutely are essential to cover the, the lower levels, if you like, of the mirrors pyramid, not not the being, but the ones which are related to authentic practise.

 1:08:47
 And I think that's what's behind this question.

 1:08:50
 And I think the standards that, you know, I went through in terms of my medical training when I was younger, I had a different, different view of what education was.

 1:08:58
 It wasn't that more nuanced integrated professional view that we have at the moment.

 1:09:05
 So the other point to say about how do we maintain validity or high standards goes back to a question that a point that I made earlier was through high level faculty development.

 1:09:15
 If the tools that are in the curriculum are delivered in ways that actually can ensure value in terms of learning for the trainee, ensure value in terms of understanding what's being assessed.

 1:09:28
 So if we're successful in training up teachers and supervisors, then standards will be achieved in that space.

 1:09:38
 So it's a complex question and, and I think it's probably one that we're going to come back to a few wide points and it goes to a point that we made last time in the webinar, which is that nowadays we think competence is determined by the wisdom of crowds.

 1:09:52
 So multiple low stakes or and higher stakes where needs be snapshots of somebody's clinical practise.

 1:10:01
 The more snapshots we have, the more we're able to achieve that understanding.

 1:10:06
 So by ensuring that multiple Wbas are done in the context of complemented with exams, then we'll achieve standards.

 1:10:15
 Yeah.

 1:10:16
 Thanks Andy.

 1:10:17
 And and the, the one last thing I would say about the assessment piece is that it is really important, important that assessment does not drive the curriculum.

 1:10:28
 Yeah, the curriculum framework should set the assessment programme and I think everyone would probably have a view about what's happening at the moment.

 1:10:39
 But as I, I go back to the point that because we haven't reviewed our framework for 15 years, there is a risk that our assessments are somewhat taking on a life of their own and, and, and, and driving training and it it should be the other way around.

 1:10:53
 We set our outcomes and then we determine what's the best suite of assessments, be that exams, be that Wbos and all the other things to ensure good outcomes.

 1:11:05
 Yeah, and this is a critical question.

 1:11:07
 So Georgia, if you don't mind, just expand a little bit further on what Anthony's saying.

 1:11:11
 So over times, what's happened is this sort of decoupling between how we're assessing and what we're expecting the outcomes to be.

 1:11:18
 So this bringing together the assessments with these outcomes that we're talking about is absolutely critical.

 1:11:26
 And the other thing is goes to a point that I made earlier on that no assessment on its own will say, yes, you're competent or not.

 1:11:33
 It's the collection.

 1:11:35
 And some assessments are of such high level, more complex kind of aspects that are required that they wouldn't sit comfortably to be assessed in examinations in that way.

 1:11:47
 So that's why we need that suite in particular.

 1:11:51
 But just to go back to Anthony's point, bringing together what we're assessing in the college to what we're wishing to assess in an effective way is really our core business.

 1:12:03
 Yeah, it's interesting.

 1:12:04
 It's it's two questions.

 1:12:05
 I can see which kind of show the conflict here in the the paradox one reflecting that there's not enough good feedback about the multi multiple essay question exam.

 1:12:18
 And then I'm assuming you may be the same person.

 1:12:20
 I don't know that they're anonymous, but then saying their workplace based assessment is too variable.

 1:12:26
 So almost feel like a rock and a hard place here.

 1:12:29
 I think it goes back to the point that there's always trade-offs in assessments.

 1:12:36
 You will generally say that the trainees will say that they feel they get much better feedback from like there's there's very little complaints about the feedback you get from a WBA because that's what a WBA does right there, right now.

 1:12:48
 You get feedback about your performance.

 1:12:50
 It's specific measurable, but as an MEQ you've got to wait several months and it's, and it's calculated feedback.

 1:12:55
 So it, it just, I think it highlights that, you know, as we said, there are you need a suite of assessments and no one assessment is perfect.

 1:13:06
 Yes, we can work to improve them and we've, we've worked to improve both over time.

 1:13:10
 As, as Andy highlighted it earlier on, one of the things that we've recognised is there needs to be a lot more supervisor development, particularly around their assessor role, but also their facilitator role so that there is more consistency about the the application of Wbas.

 1:13:30
 But we also know that and we also, we know if we get that right, that they are seen as more valuable experiences.

 1:13:35
 So yeah, I just thought it was interesting.

 1:13:37
 There's, there's a, there's a paradox there in the questions being posed.

 1:13:43
 So before we before we go to this slide, I just want to pick up on a couple of the things from that last question which have come up quite a lot in the Q&A, which is who monitors the supervisors who are carrying out these WBA with us as trainees.

 1:14:04
 So one of the questions was, do you think these changes to the curriculum and the changing responsibilities of supervisors will be acceptable in the workforce shortages in psychiatry across New Zealand and Australia, and that the supervisors may not have time to effectively upskill and deliver these changes?

 1:14:26
 Who will monitor progressive supervisors and hold them accountable?

 1:14:31
 And there are a few other questions in that vein as well.

 1:14:35
 So I'm wondering if you can comment on that.

 1:14:37
 The latest question is how do we know that they're doing their job properly?

 1:14:42
 So again, it's a very good question and we've actually been held to account by the Australian Medical Council on this, OK.

 1:14:49
 We have been criticised as a college for not having visibility around supervisor quality and we have been told that it is not good enough that we don't do surveys or feedback on supervisors.

 1:15:06
 Other colleges do have mechanisms where trainees can provide feedback on the quality of their supervisor.

 1:15:14
 And there's many reasons why we've not, you know, there are impediments to doing this, but we've been clearly told by the IMC that that we we need to actually do do something around this.

 1:15:25
 So one of the the strategies will be having a process of supervisor feedback where trainees are given the opportunity to, you know, fill in a survey about the quality of the supervision.

 1:15:39
 Obviously there are concerns about anonymity, anonymity and protecting trainees.

 1:15:46
 And I think one of the challenges because we have 6 month rotations, it may be difficult because by the time you get to enough volume, it may be a few years down the track.

 1:15:56
 But we've got to work through some of these issues and and find out how other colleges are grappling with this.

 1:16:00
 So that is one idea.

 1:16:03
 Obviously the other thing is accreditation.

 1:16:07
 We, we do ask when we go and do accreditation, it is the responsibility of the dots to be looking at the quality of supervisors as well.

 1:16:16
 So that's another way that we assure quality through supervision.

 1:16:21
 Now again, we need to work, we've recognised that we need to work more in partnership with the training zones and we are, you know, we're aiming and working towards providing much better tools and resources to help with supervisor training.

 1:16:39
 And the next webinar we'll be talking about the OCA and IACA training.

 1:16:44
 That's been an interesting project to be involved with because initially there was this assumption that Oh well, everyone does an OCA so it shouldn't be too hard for people to learn how to do an IACA.

 1:16:56
 But when we took another look, we understood that actually it had been some time since there'd been a real strong approach to giving supervisors the training around how to do Anoka.

 1:17:09
 And so really the training is about this is how you do Anoka.

 1:17:12
 Oh, and these are the key differences for an IOCCA.

 1:17:16
 And as was said by the the DOTS meeting last week, all supervisors should be trained in how to do Anoka.

 1:17:25
 Now, how do we actually achieve that, that, that actually is quite intense to get all supervisors to do around 4 hours worth of training, probably once every four or five years perhaps.

 1:17:41
 I'm not sure when, how often you have to repeat it, but that's a big challenge.

 1:17:45
 And, and we can, we can lead that from the education team, but we need the help of the branches in the training zones to do something like that.

 1:17:54
 So, so we are very much committed to actually having a programme of supervisor development, not a project approach, which has been the way it's been done up until now.

 1:18:06
 The literature clearly says you need to have a programme, but we need to make sure that we've got the appropriate resourcing within the College in Melbourne, if you like, as well as at the branch and training zone level to have an effective programme of supervisor development tailored to the local needs of supervisor the and the and the programmes as well.

 1:18:35
 Do you have any further comments on that, Andy, the yeah, yeah, very, very briefly.

 1:18:43
 Just appreciate those other questions as well.

 1:18:44
 I mean, what's really essential going forward is that we need to demonstrate the value of these new tools in practise and also make it easier for supervisors to use tools and use supervision effectively.

 1:18:59
 There are supervisor handbook and materials that are being developed and we're working within train as well to try and you know, make reduce the burden of set of assessment through better systems.

 1:19:10
 In addition, I think what's critical because it's a, it's a change in paradigm, a change in direction is the relationships that we have with the dots and to really work closely and to ensure that the leaders educationally are in a position to share understandings and abilities to actually deliver these tools to make it more effective.

 1:19:33
 And so it's not seen as a burden as such.

 1:19:36
 There are, you know, lots of exciting ways that you can achieve things like mass calibration and other aspects too.

 1:19:42
 But the first step is developing resources.

 1:19:44
 So that's what our focus is to make it easier to to deliver because the assumption is that the curriculum will be assessed in in practise in a way which aligns to how we assume it should be done.

 1:19:58
 Thanks, Georgia.

 1:20:01
 Will you have a look at the ones from rego?

 1:20:03
 Yeah.

 1:20:04
 So our first question from the registration for this evening was how will the trainees be supported in integrating an emerging understanding of cultural safety and other evolving challenges into their clinical practise?

 1:20:21
 Yeah, so I.

 1:20:22
 I loved this question.

 1:20:23
 This was like a really good question.

 1:20:28
 And like, like everything, you know, it's, it's probably needs a, a fairly nuanced, you know, multi pronged solution.

 1:20:40
 You know, I'm seeing the questions about, you know, how do we do better?

 1:20:44
 But this is not sustainable.

 1:20:45
 This is not practical.

 1:20:47
 These are all things that we've been challenged by the board to think about as well.

 1:20:51
 But I think if we want trainees to be better supported in in issues around cultural safety, then we can deliver some learning from centrally from the college.

 1:21:11
 But we know that the, you know, E module on cultural safety goes a small way in terms of having an impact.

 1:21:18
 And we know from an indigenous people that they want us to actually tackle proper, proper issues like racism in the, in the healthcare environment or what have you.

 1:21:29
 So a lot of there are already lots of examples of local training programmes.

 1:21:32
 I'm not just talking psychiatry here, but medical programmes doing local initiatives where they engage with the local community and do some really good solid learning and really beef up their skills and knowledge.

 1:21:46
 I think one of the key things here is that we also have to at the same time provide more support and resources to our supervisors so that they can feel that they have the skills and tools to engage in these topics.

 1:22:00
 Because unfortunately, often you see well meaning consultants say, well look, I'm not indigenous.

 1:22:10
 So I don't feel comfortable, you know, helping with that.

 1:22:15
 I don't feel like I'm the expert enough and I think that's not good, not good enough.

 1:22:20
 Indigenous people say that you can't keep coming back to them to solve all those problems.

 1:22:26
 So I believe it's it's possible to actually upskill oneself in cultural safety.

 1:22:32
 And I have been doing that over many years.

 1:22:35
 And I believe that you can teach these concepts from a non indigenous perspective.

 1:22:38
 So, so yeah.

 1:22:40
 So it'll be partly about and there is a plan to provide access to training for supervisors around cultural safety and then it'll be in the framework and we're envisaging that there may be an opportunity at when we, I'm hesitant to mention the exam that shall we not spoken about.

 1:23:05
 But when there may be an alternative to the CEQ, there's there's probably an opportunity to look at critical thinking skills from a cultural safety lens.

 1:23:16
 And I think that could actually be quite a good experience if we get that right.

 1:23:24
 Just to go back to the, the cultural safety element, this is really, really an important question given that, you know, the mental health outcomes in particular in Aboriginal and Torres Strait Islander populations.

 1:23:37
 We have taken the approach of embedding cultural safety elements within all the Epas and there's a, there's a key aspect that will need to be achieved.

 1:23:49
 What Anthony was referring to in terms of cultural loading is right.

 1:23:53
 And we're going to develop some core principles to ensure that we're all upskilled.

 1:23:57
 And there's, you know, we take a strength based approach to achieving these outcomes.

 1:24:03
 The other aspect as well, and this goes to the wider context, is that the AMC are really focusing on this concept, which is 100% right, which is that you cannot be clinically safe unless you're are culturally safe.

 1:24:17
 And that cultural safety by developing these outcomes will inevitably ensure that we will become better, more person centred doctors for all.

 1:24:27
 If we take that approach and build on where the AMC have left pre vocational doctors before they enter our fellowship.

 1:24:36
 And this is at a level of self actualisation, being able to reflect and take them to a higher level, then we're going to really, I think have an exciting development educationally for our trainees.

 1:24:47
 So the bar's been set high by the AMC, but it lends itself to really innovative approaches to achieving these outcomes, whether through yarning circles, Co design, reflections, other aspects too.

 1:24:59
 But it's a critical, it's a critical outcome.

 1:25:01
 And I'm really pleased.

 1:25:02
 I'm from the UK, so Aboriginal and Torres Strait Islander issues were relatively near a few years ago when I came here, but I think this is a really excellent approach to develop better psychiatric consultant skills.

 1:25:17
 Thanks, Anthony and Andy.

 1:25:19
 So just noting that we have about 8 or 9 minutes to go.

 1:25:23
 We'll move on to the next question.

 1:25:25
 When and how will the College implement the planned changes under the curriculum redesign project?

 1:25:31
 And how can psychiatrists and trainees provide feedback?

 1:25:36
 Yeah.

 1:25:37
 So look, I'm, I'm mindful of some of the, the, the questions in the Q&A reflecting sentiments that we're not being specific enough, that there's lots of change going on, that this is anxiety provoking.

 1:25:57
 And you know, the, the elephant in the room, which is the, you know, the, the, the stress and angst around the communication around the CQ exam, which isn't, has been an important element of the psychiatry training programme.

 1:26:11
 And you know, it's, it's, it's certainly not our intent going forward to be communicating in, in that way.

 1:26:21
 And again, I would bring it back to the fact that the intent of these webinars is to give you lots of lead in time about what's happening.

 1:26:28
 So sometimes we are talking in terms of aims and, and and what we think things would look like in a number of years time and we want to try and be as concrete and as possible.

 1:26:39
 But part of it's about engagement and we haven't yet agreed on the final curriculum framework.

 1:26:47
 We will actually need your help with that.

 1:26:50
 So as I said earlier on, we plan to provide the documents to everyone so they can read them, look at them, consider them, answer the survey, provide feedback in whatever way is they, they, they wish to do so.

 1:27:14
 And there will be lots of time for that.

 1:27:16
 There was a comment about involving academics we've had on our subject matter expert group.

 1:27:22
 Brad Hayhaw is an academic from WA.

 1:27:25
 Brad had previously LED our syllabus working group with a bunch of academics.

 1:27:29
 We also have a formal education course working group which has a bunch of academics on it.

 1:27:35
 So yeah, we are, we're very much wanting the input of as many people as possible.

 1:27:42
 The there's a comment about involving the New Zealand Medical Council in the changes.

 1:27:48
 So the, the New Zealand Medical Council have endorsed the cultural safety training plan for Atarara, but the way it works is that the Australian Medical Council does the accreditation of the college for both countries and then then usually the Medical Council reviews their report and accepts it.

 1:28:06
 So that's why we keep talking about the AMC.

 1:28:09
 But yes, it's important that we do recognise that we are, you know, training across two countries and there is another important entity, the New Zealand Medical Council, in the equation.

 1:28:29
 So I thought I probably should have said so just to reinforce we, we, we think the year that the change will come in will be 2028.

 1:28:38
 So 2027 is looking like any, you know, getting ready if you like.

 1:28:44
 And we want to aim to have things like the IT, the training resources, etcetera, all developed by that stage.

 1:28:52
 We can't yet answer questions like is this just is there going to be a teach out and a teach in according to the new frameworks?

 1:29:00
 Yes, the question has been raised a few times about all these changes looking like a new programme.

 1:29:07
 We we have to work through that that concept.

 1:29:11
 We have to actually go back to the Australian Medical Council and get their opinion on some of these things.

 1:29:19
 So we, you know, we'll be probably doing these webinars for the next few years, giving you updates on where we're up to with some of these changes.

 1:29:28
 Yeah.

 1:29:29
 And Georgia, just just to drawing from my previous experience of working in, you know, medical schools and other areas, curriculum change is very difficult in a sense.

 1:29:40
 But what's really critical is to set up points of communication as we go along the journey together, hear questions, understand challenges and then iteratively actually develop.

 1:29:51
 So as when we come to implement, we've actually been ahead to actually see some of the potential hurdles that we have there.

 1:29:57
 So the point of these webinars is to engage those questions as well as upscale with the directions and then make changes as we go along to actually ensure that when this new curriculum is delivered, it's done in a way that people have got understandings around and really aligned to the challenges of the workspaces where we will work, which I acknowledge are very challenging at the present moment, obviously with workforce issues too.

 1:30:25
 So I can hear all that.

 1:30:26
 But I'm very grateful for all the questions in the chat, which we shall look at, consolidate and inform future communications.

 1:30:34
 And I like to extend that invitation, Georgia, that I made earlier on to come to the Congress at the Gold Coast, learn about the evidence, attend the workshops, learn about supervision and other areas too.

 1:30:47
 So it's a dialogue which is ongoing.

 1:30:49
 And the next, the next stop, I believe will be the IACA stop.

 1:30:54
 Georgia, every to you, but just before if you finish there, Georgia.

 1:30:59
 I would also say that both Andy and I regularly attend the Training Advisory Council.

 1:31:06
 So for those trainees with concerns, you do have a body that you can that are your colleagues that you can pass those concerns up to.

 1:31:16
 And I try to get as meant to as many of those meetings as I can to hear directly from trainees about their concerns and, and try to keep them as up to date as possible about the changes that are occurring.

 1:31:29
 Sorry, Georgia.

 1:31:30
 No, that's all right.

 1:31:32
 I guess I do want to comment on, I guess what is really coming through in the Q&A, which is a lot of, I think stress and distress and, and, and unhappiness, which I think reflects a lot of things going on at the moment.

 1:31:53
 You know, I think there are a lot of changes in the education and assessment space as well as difficulty for a lot of people in their day-to-day jobs.

 1:32:06
 You know, we've got the, the situation in NSW, outside of NSW, I think, you know, we're short staffed in most places in Australia and you know, in New Zealand and it makes things really difficult.

 1:32:22
 And I think supervisors are worried about the impact on them and trainees are worried about the impact on us from, from what is going on.

 1:32:32
 So I guess yeah, it's difficult to be yeah, to, to be in anyone's shoes at the moment, I think.

 1:32:44
 So let's move to the last slide because we do need to finish up.

 1:32:52
 Oh, Andy, I, I think you were going to speak briefly here.

 1:32:56
 No, I wouldn't also just add to those points that you make.

 1:32:59
 I completely understand and we all completely understand that the challenging situation we have, I think, solid principles and aiming to reduce burdens of assessment.

 1:33:08
 I wish we could have said more today, but we're not in a position really to sort of elaborate further.

 1:33:13
 And the goal today was to talk really about the curriculum in particular.

 1:33:19
 So look, just a few 3 quick conclusions Reviewing and making changes to the curriculum is is takes time and requires an approach together.

 1:33:29
 What's critical is to ensure that we manage to align education and service processes and also, as Anthony was referring to before aligning assessment, so it's closer to learning activities and outcomes.

 1:33:41
 The direction aligned to contemporary thinking professionalised education is beneficial for patients.

 1:33:47
 We need to learn and to communicate and to develop more effectively and supervisors and trainees and work on this journey and monitor the delivery of the education as we go.

 1:33:58
 But I very much thank you for your comments and appreciate the the conversations and the questions to Georgia, back to you for the final minute.

 1:34:09
 All right.

 1:34:09
 Well, thank you everyone for joining us this evening.

 1:34:16
 There are quite a number of unaddressed questions this evening and we are going to keep a record of those and and try to address them at some point in the future.

 1:34:31
 Regarding the CQ questions, I don't think we actually have the information that people are looking for.

 1:34:38
 So I direct you to the FA QS on the website and hopefully there will be more information available soon.

 1:34:49
 When we finish this webinar this evening, you'll be directed to a post webinar survey.

 1:34:55
 So please fill that out so that we can incorporate your feedback for next time.

 1:35:03
 The webinar will be published in a few weeks and links to FA Hughes and the questions and where you can provide feedback will also be provided.

 1:35:16
 Or you can e-mail the education portfolio of the college.

 1:35:22
 And so I will just remind you that there are future webinars planned for this year, and we hope you'll join in.

 1:35:33
 All right, I think that's everything for this evening.

 1:35:36
 So once again, thank you for joining us, and I hope the rest of your day is OK.

 1:35:46
 Thank you.

 1:35:48
 Thanks, everyone.

 1:35:49
 Bye.