My guideline for IMGs who are starting as a registrar as their first job in the NHS
Some doctors are working at a registrar level in their home countries/ have given PACES/ have come via MTI route and get a non training registrar post in the UK as their first job in the NHS.
They are asked to shadow junior doctors and work as a SHO initially in order to get used to the system. This time period may be anything from 1 month to 6 months.
Once you feel confident, you can easily work as a registrar.
Also read this blog post:
http://omarsguidelines.blogspot.co.uk/2015/05/after-plab-2-applying-for-jobs.html
My advice for IMGs who are working as SHOs and see such registrars struggle:
You need to point this out to the registrar- tell them how things work. Guide them as much as possible. We are all one big family here. We have to help each other to provide the best care for the patient. We cannot afford to stay quiet and let someone make a mistake (which is highly unlikely but can happen- the swiss cheese model can take place at any time at any place)
They are asked to shadow junior doctors and work as a SHO initially in order to get used to the system. This time period may be anything from 1 month to 6 months.
A few IMGs struggle once they start working as a registrar after that "SHO doctor" period - especially those who have not give PLAB (and hence do not have a very good idea of how things work in the NHS).
Here are some important differences:
1. Here, a registrar is responsible for the whole ward. Registrars know the most about the patients on the wards. They need to be very organized and take a detailed handover from the team working before them.
Most registrars carry a small note book in their pockets and keep checking with the junior doctor covering that ward to ensure that the patient is stable. They also go and see the patient themselves to ensure that all the management plans are in place. They are the ones responsible therefore if anything happens, it will all come down to the registrar.
2. When registrars are on call, they have to take calls from GPs to accept patients, calls from A and E to accept patients under medicine/ other specialties and also handle all sick medical patients in the hospital.
Given the current bed status of NHS hospitals, registrars need to be very sensible about whom to admit and whom to discharge safely with a follow up as an outpatient the following day. If there is any sick patient, they can always ring the consultant on call if they are struggling.
3. A registrar stays on site at all times.
This is very important. The registrar is the senior most person in that specialty on site- especially at night. (S)he has to answer his/her bleep as soon as possible. If (s)he is busy, the juniors are asked to answer his bleep and ask the other person to either contact him/her in 10 to 15 min or pass on a message if it is urgent.
4. A registrar helps the juniors if they are struggling- be it a simple thing like cannulation, ABG or a complicated procedure like chest drain insertion.
Like every team leader, a registrars takes care of their team. They make sure that the juniors have taken a break and are not struggling. I remember a registrar helped me make a discharge summary once. And once my registrar helped me catheterize a patient.
5. The registrars consider their juniors as colleagues - they do not overburden their juniors and treat them with respect.
Like all doctors, registrars are also under constant scrutiny and their supervisors are given feedback on their performance by juniors, matrons, bed managers, other consultants and nurses. Therefore they need to consider everyone equally and respect them.
6. The registrars have to do clinics as well when they are working in the ward. They come to the ward after their clinics and ask their junior colleagues if they need any help/advice and always ask if there is any problem.
Some registrars stay after hours to help their juniors. I remember that once my registrar stayed till 730 PM with me as the registrar on call was very busy dealing with a CRASH call and we had a sick patient on the ward.
7. Some registrars do a quick handover with their junior colleagues at the end of the day to ensure that there are no outstanding issues.
The registrar should take full responsibility of all patients at all times. Even if there is a consultant. This is what makes them a good team leader.
8. Know the local guidelines in detail.
When registrars are on call overnight, they are the senior most people around. Sometimes when the consultants are busy in clinic, they ask the registrars to make a particular decision which is why it is important to know the local and national guidelines inside out.
Here are some important differences:
1. Here, a registrar is responsible for the whole ward. Registrars know the most about the patients on the wards. They need to be very organized and take a detailed handover from the team working before them.
Most registrars carry a small note book in their pockets and keep checking with the junior doctor covering that ward to ensure that the patient is stable. They also go and see the patient themselves to ensure that all the management plans are in place. They are the ones responsible therefore if anything happens, it will all come down to the registrar.
2. When registrars are on call, they have to take calls from GPs to accept patients, calls from A and E to accept patients under medicine/ other specialties and also handle all sick medical patients in the hospital.
Given the current bed status of NHS hospitals, registrars need to be very sensible about whom to admit and whom to discharge safely with a follow up as an outpatient the following day. If there is any sick patient, they can always ring the consultant on call if they are struggling.
3. A registrar stays on site at all times.
This is very important. The registrar is the senior most person in that specialty on site- especially at night. (S)he has to answer his/her bleep as soon as possible. If (s)he is busy, the juniors are asked to answer his bleep and ask the other person to either contact him/her in 10 to 15 min or pass on a message if it is urgent.
4. A registrar helps the juniors if they are struggling- be it a simple thing like cannulation, ABG or a complicated procedure like chest drain insertion.
Like every team leader, a registrars takes care of their team. They make sure that the juniors have taken a break and are not struggling. I remember a registrar helped me make a discharge summary once. And once my registrar helped me catheterize a patient.
5. The registrars consider their juniors as colleagues - they do not overburden their juniors and treat them with respect.
Like all doctors, registrars are also under constant scrutiny and their supervisors are given feedback on their performance by juniors, matrons, bed managers, other consultants and nurses. Therefore they need to consider everyone equally and respect them.
6. The registrars have to do clinics as well when they are working in the ward. They come to the ward after their clinics and ask their junior colleagues if they need any help/advice and always ask if there is any problem.
Some registrars stay after hours to help their juniors. I remember that once my registrar stayed till 730 PM with me as the registrar on call was very busy dealing with a CRASH call and we had a sick patient on the ward.
7. Some registrars do a quick handover with their junior colleagues at the end of the day to ensure that there are no outstanding issues.
The registrar should take full responsibility of all patients at all times. Even if there is a consultant. This is what makes them a good team leader.
8. Know the local guidelines in detail.
When registrars are on call overnight, they are the senior most people around. Sometimes when the consultants are busy in clinic, they ask the registrars to make a particular decision which is why it is important to know the local and national guidelines inside out.
9. When there is a complaint the registrar is called in most cases to give an explanation
Which is why it is important for a registrar to see and document everything in a critically unwell patients notes.
10. A good registrar knows when to escalate.
At times, one or more members of the on call team may have called in sick making it difficult for the registrar to handle all of the patients. Therefore (s)he may call the consultant on call to come in and help if there is no SHO available for this. And the consultants do come, even if it is the middle of the night and act as the second registrar on call and help the medical team.
This may seem very difficult for people who have not worked in the NHS before. However those who have worked for a few months will not find this difficult at all.
My final advice:
Do not take a registrar post as your first job in the NHS - If you do sign some contract then make sure that you are fully aware of how the NHS works (By working as a SHO for a few months till you fully understand the system). Working as a registrar in the UK is different than working as a registrar in our home countries. Here the registrar is responsible for everything. If (s)he makes a serious mistake (due to not knowing about something even a well settled SHO would know about), (s)he can face serious consequences.
If you are asked to work as a registrar, shadow a registrar first and hold his/her bleep - get feedback for whatever you do and see if you will be able to manage this post. If not, talk to your supervisor and request him/her to allow you to continue working as a SHO as you do not feel ready. It is important to speak up and voice your concerns before it is too late.
Which is why it is important for a registrar to see and document everything in a critically unwell patients notes.
10. A good registrar knows when to escalate.
At times, one or more members of the on call team may have called in sick making it difficult for the registrar to handle all of the patients. Therefore (s)he may call the consultant on call to come in and help if there is no SHO available for this. And the consultants do come, even if it is the middle of the night and act as the second registrar on call and help the medical team.
This may seem very difficult for people who have not worked in the NHS before. However those who have worked for a few months will not find this difficult at all.
My final advice:
Do not take a registrar post as your first job in the NHS - If you do sign some contract then make sure that you are fully aware of how the NHS works (By working as a SHO for a few months till you fully understand the system). Working as a registrar in the UK is different than working as a registrar in our home countries. Here the registrar is responsible for everything. If (s)he makes a serious mistake (due to not knowing about something even a well settled SHO would know about), (s)he can face serious consequences.
If you are asked to work as a registrar, shadow a registrar first and hold his/her bleep - get feedback for whatever you do and see if you will be able to manage this post. If not, talk to your supervisor and request him/her to allow you to continue working as a SHO as you do not feel ready. It is important to speak up and voice your concerns before it is too late.
Once you feel confident, you can easily work as a registrar.
Also read this blog post:
http://omarsguidelines.blogspot.co.uk/2015/05/after-plab-2-applying-for-jobs.html
My advice for IMGs who are working as SHOs and see such registrars struggle:
You need to point this out to the registrar- tell them how things work. Guide them as much as possible. We are all one big family here. We have to help each other to provide the best care for the patient. We cannot afford to stay quiet and let someone make a mistake (which is highly unlikely but can happen- the swiss cheese model can take place at any time at any place)
Comments
Post a Comment