A new RCP acute care toolkit The medical registrar on call: maximising clinical experience, training and patient care will help hard-pressed medical registrars improve their workload, training opportunities and supervision.
The medical registrar is perceived by many to be the medical ‘workhorse’ of the hospital. The expertise of the on-call medical registrar is relied upon heavily by many hospital and community teams. Registrars, however, are concerned about their ability to provide safe, high-quality patient care as their workload continues to increase.
Despite being passionate about patient care, morale among medical registrars is low and they feel undervalued. Junior doctors are being put off training in medical specialties by the workload of the on-call medical registrar. An urgent re-evaluation of this role is needed to ensure the provision of high-quality acute care to patients while recruiting, training and, crucially, retaining future consultants in general medicine.
Workload
The lack of a definition of the role of the medical registrar has caused confusion and wide variation in practice and expectations across the UK. Medical registrars spend large amounts of time performing non-priority tasks that would be more appropriately carried out by other members of the team. Reducing the burden of this work is crucial to ensure they can prioritise the work that needs their specific expertise, with handover of non-priority tasks.
This toolkit therefore includes definitions of priority roles for medical registrars in leadership, supervision, direct patient care, communication, decision-making and training, against non-priority roles such as routine clerking of admissions, basic clinical tests and procedures, and admin tasks.
Training
The sheer amount and complexity of the work of medical registrars sometimes means that their training doesn’t receive the focus required in very busy wards. Only 60% of registrars in a 2011 survey felt that their training adequately prepared them for a general medicine consultant post. The toolkit has helpful recommendations to improve ward-based training, including regular attendance at consultant review rounds of patients they have been involved with, and better use of training opportunities provided by the specialty consultants they work alongside.
The toolkit includes case studies of good practice that enhance the training and working experience of medical registrars, such as this from Dr Aoife Molloy, a medical registrar in infectious diseases at the Royal Free NHS Foundation Trust:
Twice a week at 8am everyone goes to ‘morning report’. Consultants attend as it is part of their job plan and usually there are 20–30 doctors and students. Patients admitted over the previous few days are presented; there is a lively informal debate where trainees can participate as much as they wish. Interesting cases are fed back and it is a useful opportunity to handover a patient to a specialty team. I always learn something new and it is a great way to start the day.
Dr Sarah Logan, a recently appointed consultant physician and the lead author of the toolkit, said:
This toolkit offers all those interested in improving the quality of care provided by the medical registrar some clear, practical guidance on best practice. Implementing the recommendations will improve the training and morale of registrars which will in turn improve recruitment and retention to the grade.
For more information and to arrange an interview with Dr Logan, please contact Linda Cuthbertson, head of PR, on 0203 075 1254 / 0774 877 7919, or email Linda.Cuthbertson@rcplondon.ac.uk.