Being a good ED registrar

Authors: Gavin Tunard, Charlotte Davies / Reviewer: Charlotte Davies / Codes: / Published: 01/09/2014 / Reviewed: 05/03/2024

How to be a “good” registrar

There’s a lot of tips out there for surviving as a new doctor, or as an old doctor. The transition from SHO to SpR is something that many are ready for, and many have picked up their own tips for. Some people are a little bit more apprehensive, and would appreciate some more tips. Here are a few suggestions from the @slemfoam team with special thanks to @240minDoc.

This is written differently here and here are some more up to date “crowd sourced” tips.

First set of solo ED Reg night shifts coming up this week. Feeling nervous Any advice from the Twitter floor?

Chris Wearmouth (@CCWearmouth) September 13, 2020

Editing this as an older (eek) Consultant now, I feel I have a different perspective on what a good registrar is, and I started by wondering what a good registrar is. I think broadly, it comes down to safe, effective, a role model and a communicator. I want you to be a safe practitioner for your patients, but also keep the department safe- and that means having situational awareness, excellent clinical knowledge, and the ability to ask for help. I want you to be effective – and keep as many people (staff and patients) safe, educated and treated as possible in as shorter time as possible. I also want to know you’re doing what you’ve said you will – whether that’s what I’ve asked, or what we’ve negotiated. I think it’s important to be a role model for everyone else – do your discharge summaries, don’t wander around on your phone, and really advocate for EM as a specialty. Finally, you need to communicate – with patients, and with staff. I feel sad inside if I have to talk to the nurse in charge who hasn’t been impressed with the registar’s response.

I’d love to hear your tips – whether you’re an SHO, SpR, Consultant, AHP – and what do you think of ours?

1 – Get a good handover

When you start a shift, make sure you know the plans for patients, and follow the plans up. Check for results, and when they’re back, prompt the doctor.

Walk round the department so that every member of staff, porters, nurses and doctors know who is in-charge for the shift, and who to get in touch with.

Have a look in all hidden cubicles and corridors and find the sick patient that no-one knows about.

2 – Encourage discussions with the juniors

Make sure they know they can, and should, ask you about patients. Chase them up if they don’t. Talk through your logic, so they can learn for next time. Signpost them to appropriate learning resources and protocols – and make sure they know about RCEMLearning!

3 – Review patients

You get told to always see patients that are discussed with you, and it’s difficult to. See the first patient every junior discusses with you, and then you get a better gut feeling of the junior’s capability. If something doesn’t sound right, the junior asks you to, you’re not sure or it just doesn’t make sense, be more likely to see the patient. Be extra careful with children – even if you’re just asked to review an x-ray, check the right body part has been imaged.

4 – Encourage Breaks

Even when you don’t feel the department can handle it, remind your juniors to have breaks. Remember “HALT” – youre more likely to make mistakes when you are hungry, angry, late or tired. This applies to you as well as your team!

5 – Solve problems

If someone tells you about a problem, solve it there and then, and don’t try and brush it under the carpet. If you hear about an angry patient, or a patient that doesn’t want to leave, go and see them – you can often nip problems in the bud.

6 – Know who you can ask for help

The medics, surgeons, orthopods etc., are there to help. If they “refuse” a referral go and see the patient, then speak to them. You can then identify whether your junior needs some help with referrals or whether the specialty registrar needs some guidance.

7 – Err on the side of caution

If youre not sure whether a patient should go home or should come in, always admit the patient. There’s no prizes for sending people home, but a lot to be lost by sending them home too soon. If your junior thinks you’re being overcautious, and you’re still not sure – admit the patient anyway – they’ve asked for your advice because they’re not really 100% sure.

8 – Maintain your portfolio

This is a pain, but really needs doing. Get an app on your phone to log all your FOAM, and procedures. Make sure you know what assessments need doing by the end of the year – I get google to pop up with the list once a week to remind me. It doesn’t work, but anything is worth a try.

There’s lots to try and get done. Think about having a learning month, an assessment month, and an ultrasound month – and rotating them all around.

9 – Party

Organise the departmental parties. Theres nothing like a party to break down barriers. Make sure you’re not too friendly with the juniors – once crossed, the line between friend and senior can be difficult to cross again – and respect is difficult to re-earn.

It’s also a good time to make friends with the rota coordinator…

10 – Lead By Example

Pick up the patient nobody wants to see at 07:30 after a busy night – it gives you kudos with juniors & nursing staff. If they see you with your game face on they will follow.

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