James Fisher is a consultant geriatrician at Northumbria Healthcare NHS Foundation Trust. He tweets at @drjimbofish and in this blog article discusses a recent publication looking at the role of the medical registrar from the perspective of junior doctors interested in geriatric medicine.
Being the medical registrar, or ‘med reg’, is recognised as being a tough job. The med reg is often considered to be the ‘go to’ person for the hospital at night – to shamelessly rip off a well-known 1980s TV show, “If you have a problem… if no one else can help… and if you can find them… maybe you should bleep… the med reg”.
The medical registrar is the senior training grade in medical training; effectively it’s the last stop on the road to becoming a consultant physician. For trainees in the specialty of geriatric medicine this typically means at least five years in this role. The demanding nature of the role means that it does put some people off this career pathway; recent survey work showed that current geriatric medicine registrars cite the demands of the med reg role as a major downside of their job. This is crucially important to our specialty, because if people don’t want to be the med reg, geriatric medicine (as the biggest medical specialty) may end up facing a big challenge to attract people to a career in the specialty.
We wanted to learn more about what tomorrow’s potential geriatricians thought about ‘being the med reg’: What was good? What was bad? And how might we improve things? To draw on the experiences of a mix of Foundation doctors and Core Medical Trainees, we undertook focus groups at the 2015 Geriatrics for Juniors conference (held in Leeds). We analysed the data obtained from these focus groups using a three stage framework approach and identified six themes. You can read more about our findings here, but there’s a few key points to highlight.
Firstly, we found that many junior doctors held an unrealistic view of the med reg’s capabilities:
“It’s like looking up to ‘Superman’, because it’s essentially every single thing that goes through the registrar”.
This idea that the med reg was all-knowing and omnipotent meant some junior doctors were intimidated by the role and didn’t think they could live up to this expectation. Debunking this myth is crucial – perhaps allowing junior doctors to have periods of explicitly shadowing a med reg might enable the realisation that a lot of ‘being the med reg’ is just ordinary people, managing a big workload, in often very mundane and human ways.
Secondly, junior doctors told us about the ‘Jekyll and Hyde’ nature of the med reg on-call:
“Med regs come to my ward and look disgruntled and annoyed that we’ve called, but when you see them (with) a patient… it’s like they’re a different person – they become a doctor again”
The authors of our paper, all of whom are current or ex-medical registrars, are well aware of the pressures of the role – I can certainly recall past examples where I’ve let the stress of a med reg on-call shift morph me into a moody and melancholy med reg… We would however ask current med regs to reflect on how such ‘split-personality’ interactions with junior colleagues might influence their career choices – the power of role-modelling is huge, both in a positive and negative sense…
Thirdly, it seemed like junior doctors thought the role of the med reg was an isolated one, which generated anxiety amongst our contributors about fulfilling the role:
“When you’re the reg overnight in the hospital, you’re the last port of call”.
This led us to consider whether medical consultants, who supervise med regs out of hours, needed to do more to support them…? Or is dealing with these challenges just part of a med reg’s training…? We’d love to hear your thoughts on this – please do join the discussion on Twitter using #beingthemedreg
It wasn’t all negative though. Some junior doctors described a sense of ‘mission’; they wanted to change the culture at their workplace, where medicine was considered “a dumping ground” by other specialties, by becoming, and excelling as, a med reg. Also, junior doctors consistently told us how they aspired to have the skill set of the med reg.
We’d love to hear your suggestions about how the role of the med reg might be improved – feel free to tweet me @drjimbofish or the Association for Elderly Medicine Education (AEME) team @elderlymeded – but don’t forget the hashtag #beingthemedreg
You can also listen to some discussion about the role of the med reg by checking out CotECast, a geriatric medicine podcast produced by AEME. There’s even a ‘warts and all’ interview with a med reg before and after his first ever med reg shift…