Leadership and the medical registrar: how can organisations support these unsung heroes?

Preparedness for the transition to medical registrar from senior house officer-What's the problem?

INTRODUCTION

Transitions in clinical training are a hallmark in medical trainee's careers. The transition from senior house officer (SHO) to the role of medical registrar is often viewed as one of the most challenging, but to date, there is little research exploring why the transition is proving problematic for so many learners. The aim of this study was to explore the experiences of trainees preparing to make this transition.

METHODS

Using an interpretative phenomenological analysis (IPA) approach, this qualitative study employed semi-structured interviews to explore the lived experiences of transition in a purposive sample of trainees on the cusp of transition from SHO to registrar or who were in their first year of being a medical registrar. Interviews were recorded, transcribed verbatim and analysed using an IPA approach.

RESULTS

Six trainees participated in this study, four of whom were currently in SHO positions, with the remaining two in their first year of medical registrar. Two main themes emerged from data-perception of the medical registrar and barriers in transition. The role of the medical registrar was perceived to represent a strong leadership role, with barriers created due to increasing expectations, lack of support and uncertainties regarding the job.

CONCLUSION

The role of the medical registrar is a challenging one, representing periods of uncertainty, increased expectations and reduced supports. Within this, there is potential to further support SHOs in transitioning to the role of medical registrar.

The kindness COVID-19 toolkit: a mixed-methods evaluation of a programme designed by doctors in training for doctors in training

OBJECTIVES

The impact of a coronavirus disease (COVID-19)-specific professional development programme on the well-being of obstetrics and gynaecology (O&G) doctors in training (DiT) working during the pandemic.

DESIGN

A mixed-method evaluation of a single group pre-post test design study.

SETTING

Melbourne, Australia between September 2020 and April 2021.

PARTICIPANTS

55 O&G DiT working across four healthcare sites of a major tertiary hospital in Victoria, Australia, were included in the programme.

INTERVENTIONS

The delivery of a codesigned peer-to-peer programme, which identified and addressed the well-being goals of O&G DiT. Seven interactive workshops were run alongside the implementation of a number of participant-led wellness initiatives.

MAIN OUTCOME MEASURES

Repeated-measures analysis of WHO Well-being Index (WHO-5) and Copenhagen Burnout Innovatory (CBI) scores across three time points during the programme. Multilevel generalised linear mixed-effects models with random intercept were fit to the data, both in the entire population (intention-to-treat) and restricted to those who attended the workshop ('per-protocol' analysis). Participatory experiences and programme learning were captured using the Most Significant Change (MSC) technique, which included inductive thematic analysis.

RESULTS

We demonstrated an overall 31.9% improvement in well-being scores (p=0.006). The MSC evaluation captured a shift in workplace culture as a result of the programme, with improvement across the domains of connection, caring, communication, confidence and cooperation.

CONCLUSIONS

We have successfully used a mixed-method approach to contextualise a productive programme to improve the well-being of COVID-19 front-line healthcare workers.

“Growing as a Stronger Clinician in Adverse Conditions”—A Snapshot of Clinical Training during COVID-19

Transformative learning theory has been recommended as a pedagogy of uncertainty for accommodating new beliefs that enable humans to thrive amid the challenges and complexity of our world. As higher education institutions embrace new roles and responsibilities, few studies have focused on how the disruptions caused by COVID-19 may facilitate formative learning experiences. This study explored how registrars responded to the challenges facing clinical training during the first wave of COVID-19, and how the impact of these disruptions prompted personal and professional development. Registrars completed an online qualitative SWOT (strengths, weaknesses, opportunities, and threats) analysis of their training experiences during the COVID-19 pandemic. Data were thematically analysed. Four hundred and five responses were received from 54 registrars. Themes related to challenges included mental distress, resource constraints, and compromised and inadequate training. Themes related to strengths and opportunities included new learning experiences, resilience, coping strategies, and enhanced graduate competencies related to leadership, collaboration, communication, and health advocacy. The disruptive and disorienting elements of COVID-19, although situated in chaos, aggravating the constraints of training in under-resourced settings, also provided unexpected learning opportunities. These findings highlight the transformative potential of disrupted learning contexts and the need for responsive curricular to enhance graduate competencies, adaptability, and resilience.

Staggering shifts to rebalance night medical registrar workload

BACKGROUND

Lone night medical registrars, particularly those working at busy urban hospitals have high workloads and low job satisfaction. Handover of pending referrals from day staff can contribute to further delays in providing care with increased risks for patient safety.

AIM

To evaluate the impact of a staggered roster for daytime medical registrar on the workload of night registrar.

METHODS

Prospective data were collected of the night medical registrar workload over a 6-month period. The first 3 months included standard shifts from 1330 to 2130 hours with two registrars. The second 3 months followed the introduction of a staggered shift for one registrar to 1530 hour-midnight, providing a 3-h overlap with the night registrar commencing at 2100 hour. Parameters recorded included the number of total admissions, pending admissions, referrals from emergency department, ward reviews and Medical Emergency Team (MET) calls/CODE Blues. Data from weekends and public holidays were not recorded.

RESULTS

During the standard rostering period, the average number of medical admissions completed per night shift was 8.66 (n = 60, SD = 3.58). With staggered shifts, the average number was significantly reduced at 6.38 (n = 65, SD = 2.74, P = 0.000057). In addition, there was greater number of ward reviews conducted by the night registrar in the staggered roster period, potentially reflecting greater time availability and reduction in MET calls/codes.

CONCLUSION

Rearranging medical registrar shifts can result in significant reduction in night medical registrar workload. It may also have other potential benefits in terms of increased capacity for ward reviews and reduced MET calls/codes.

Trainee Leadership Board: learning about NHS leadership

Introduction

The development of a new generation of clinical leaders in the NHS has been increasingly endorsed by most recent literature in medical leadership and management. Despite providing academic rationale and argument, however, current training programmes fail to integrate the theoretical and practical aspects of clinical leadership and to implement them in practice within medical training curricula.

Methods

In Oxford Health National Health Service Foundation Trust, a Trainee Leadership Board programme was offered to a small group of next-generation clinical leaders as an opportunity to learn about current leadership and management in the Trust. This programme provided insights and practical experiences through an integrated educational and experiential approach in resolving a real issue facing the Trust.

Results and conclusion

Overall, the programme proved successful in creating a culture of increased interest and promoting change in attitude and behaviour around leadership and management. Time constraints and implementation of change represented significant challenges for the Trainee Leadership Board. However, the programme holds promise for its diffusion across the country.