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Employing chief registrars: fresh eyes and a great opportunity

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Dr Carlo Prina reflects on his experience of being a chief registrar mentor over the past two years and outlines some key benefits of having a chief registrar at Homerton University Hospital.

Last year I mentored two chief registrars working in acute medicine in an east London district general hospital. I have been fortunate enough to employ a further chief registrar this year. It has been a fantastic experience and one I would highly recommend. These are highly motivated passionate trainees who provided us with essential insight into how we can improve quality.

Recruitment – the name matters

I am sure you, like us, have struggled to fill various clinical fellow posts over the years. In addition to this, sometimes the time to get really stuck into quality improvement (QI) work has been difficult to find! We had many ideas on how care could be better in our hospital but needed clever clinically trained people to help us find the solutions.

Because of the RCP 'kite mark', the chief registrar programme carries a lot of heft and is attractive to trainees as an out of programme experience (OOPE)* opportunity which they know they will get something out of.

We found recruitment straightforward and our unfilled clinical fellow posts provided the funding within our service without having to find extra money. We were genuinely both surprised and delighted by the quality of the applicants we interviewed. I think having the RCP name attached also made securing the OOPE process easier for the trainees as well.

Fresh eyes

The programme is only open to more senior trainees who bring a huge wealth of experience to the team and can critically analyse problems and provide helpful challenge to the organisation. We really benefitted from this. The issue of overnight cover and response to deteriorating patients had become a significant one for us and the chief registrars were able to helpfully question how we had thought about these problems before.

Skilled eyes

The RCP provides excellent training in QI methodology, project management and other leadership skills as part of the programme. The chief registrars had the tools to do the job and understood the methodology well enough to challenge the rest of us on what we were doing. I found I didn't have to teach QI to them – they taught me!

A voice for the medical registrar

A central problem we faced was that of the cohesive identity of the medical registrars doing general medical on calls. They all have strong specialty identities but far too often the general internal medicine (GIM) component has been viewed as an add-on that they do, and then they go back to their specialty tribe. Our chief registrars did a lot of work with the medical registrars to build them up as a group including setting up a safe space for them to talk through their experiences and to cohesively present the views of the whole group to the consultant body. The work really helped to influence the culture of the trainees and the organisation as a whole because everyone took them seriously.

Real results

So many projects are left unfinished with rotating trainees often doing the work in their spare time. Because we had two registrars spending the majority of their time on these projects we got real results: a redesigned hospital at night team, successful rollout of new escalation pathways, a revamped handover process, embedding of in situ simulations on our ward. It is not just pleasing for us – it's pleasing for the registrars as well that they got real results from their hard work. They have now been presented at multiple national and international conferences which is another definite plus for trainees.

Finally – the added extra of some clinical resource

While extra clinical resource is not the main aim of the project there is no denying this was a very pleasant side effect helping to address the usual rota gaps and staffing issues we all face. In fact, the clinical work is essential for the chief registrars to be grounded in the organisation and for their projects to be taken seriously.

In summary – the scheme is a great opportunity that I would recommend to anyone looking to improve their service and mentor some amazing doctors.

Dr Carlo Prina is a consultant geriatrician clinical lead for acute care at Homerton University Hospital NHS Foundation Trust.

*The out of programme experience (OOPE) post is flexible and can also be done in programme (IP).