Chief Registrar Jobs (22 Feb 2023)

SPEAKER_02 0:00

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SPEAKER_01 0:32

Hello, my name is Carrie Baker, and I'm an acute position in NHS Fife and Director of Education at the Royal College of Physicians of Edinburgh. Didn't you know that according to the King's Fund, 44% of doctors in the UK are female? That's over one quarter of a million of us. That includes 55% of medical students and 54% of postgraduate trainees. If this trend continues, women will make up the majority of medical workforce within the next decade. However, only 32% of consultants and 24% of medical directors are women, and women are underrepresented in leadership and academic roles. Together, the Royal Colleges of Physicians and Surgeons of Edinburgh, on behalf of the Academy of Medical Royal Colleges, are hosting an exciting two-day women in leadership event on the 27th and 28th of April. The first day will be a hybrid conference at the Royal College of Physicians of Edinburgh in our city centre-based conference centre, and also available online via live web streaming for those who cannot attend in person. The second day will be an interactive in-person event at the Royal College of Asurgeons of Edinburgh, with workshops and parallel sessions and the opportunity to interact with a range of inspirational speakers and hosts. This event is about helping build the workplace that we and our future colleagues and public deserve. It's about celebrating and inspiring women in leadership to serve as role models. We have an incredible range of speakers lined up for you, including Professor Dame Sally Davis, the previous CMO for England, and Professor Dame Carrie McEwen, the chair of the GMC. We hope to see you there.

SPEAKER_02 2:18

Today I'm delighted to be joined by Dr. Jessica Morgan, who is a chief registrar at Bradford Teaching Hospitals. So, Jess, welcome. Hello. For our listeners, these podcasts are to try and introduce jobs that we may not particularly come across other than our normal training jobs. So could you briefly explain to us what is a chief registrar?

SPEAKER_03 2:42

Absolutely. Thanks, Marilyn Nestle. Thanks for having me on this podcast and giving me a bit of time to talk about what I do. So I'm currently Bradford's first chief registrar, but it's a scheme that's been around for quite a few years now. So there's a lot of chief registrars out there who are now consultants. It's a scheme where you have some protected time to learn about leadership management and quality improvement, whether that be 40% of your time or 50%, whilst allowing you also to continue your clinical work. And I'm just under halfway through at the moment here in Bradford and learning loads. So it'd be good to talk to you a bit more about it.

SPEAKER_02 3:15

Okay, so at what stage can someone apply for a chief registrar job?

SPEAKER_03 3:20

Yeah, so I think from ST4 onwards, I might actually have to check that, Marilena. So once you're a registrar, that it's an open scheme through the Royal College of Physicians. You don't actually need to be a physician to apply to be a chief registrar. You can come from any speciality that'd be surgical. So we've got neurosurgeons who are currently working as chief registrars and people from AE. And once you're in your registrar training programme, you can apply and through the Royal College of Physicians. And they also put you through extra training through the Royal College about leadership management and quality improvement. So you get some training, but also some exposure to leadership and management within your local hospital.

SPEAKER_02 3:55

And what does that training comprise of? Is it like a PG CERT or is it training days? What kind of things do you get to learn about and how do you learn about them?

SPEAKER_03 4:03

Yeah, so you have 10 training days through the Royal College of Physicians. Some of them are remote and some of them in person. And you're also directed to other quality improvement modules and training to learn more about quality improvement. So you don't have a sort of formal qualification at the end of it, but there are opportunities to obviously extend your learning and training and the time and space to do it through the scheme.

SPEAKER_02 4:24

Okay. And you mentioned that your on calls could be either 40 or 50%. Is that something that you choose or is it something that comes with each job as you apply?

SPEAKER_03 4:33

So it's between your trust and yourself to decide really about whether you want to do 60% clinical or 50% clinical. And then your on calls often reflect that. So you tend to do either 50 or 60% on calls. I personally opted for 50% clinical and 50% non-clinical because as I was the first chief reg here, I thought it might take a bit more time to establish the role and to give myself a bit more time and breathing space in order to be able to understand it and try and get the most out of it.

SPEAKER_02 5:00

Right. Okay. So Jess, do you mind just talking us through what a typical non-clinical day would look like for you?

SPEAKER_03 5:06

Yeah, of course I can, Marilyn. So the first thing is you have a bit more autonomy in your day. There's no sort of necessarily scheduled, you know, that we're all very used to fitting into. So, you know, wardround clinic time and that sort of thing. You have a lot more time and control over how your day set out. But if I give you a typical day of being the chief registrar, I'm often in work the normal time. And I try to do as much as I can in person and at work, although obviously there is the option and flexibility to work remotely, and that's obviously a lot easier these days. But I've found that actually being present at your workplace makes it a lot easier because conversations in person and all those ad hoc conversations that you have in Costa actually have a lot of added value. So I'll come to work. I often have a lot of meetings and a lot of emails, which is a new phenomenon. I think it's something that you probably have to do a lot of as a consultant, but you don't have maybe as much exposure to as a registrar. And I'll often have meetings with various people around the trust, whether that's the quality team or other junior doctors or clinical staff and talking about the project which I'm currently engaged with. And then I spend a lot of time just sort of going around the wards, finding out information, speaking to people and trying to move the project that I'm doing forwards. Also, I often spend some time either doing some learning and modules as well or doing chief registrar training days, which we have. So it's really varied. And you can get involved in all sorts, whether that's education, quality, junior doctors' rotors, well-being, there's so many options, and it's a very open scheme and it's deliberately that way so that you can get as much out of it as you want.

SPEAKER_02 6:32

And you mentioned that you're obviously working on one big project with all your meetings and everything that happens throughout the day. Does that give you the opportunity to dip in and out of other projects as well? Or is all the work you do kind of guided towards your one end goal?

SPEAKER_03 6:48

Yeah, no, that's a good question, Maria. It depends. Some chief registrars have lots of different things on the go and they might have lots of smaller projects, and some of it might be dictated to them, or they might come with an idea of what they want to try and improve. And I say dictated to them as in the trust might have some ideas about things that they think would be good for the chief registrar to be involved with. You know, some people are looking at clinic letters, for example, other people are looking at education for junior doctors and registrars. Some are creating pathways within their department or their speciality, they're working sort of clinical pathways. So it's really varied. And actually, I'd say most chief registrars have some smaller projects alongside the maybe bigger thing that they're doing, but not everyone has that. Some people do lots of smaller things from my experience. Okay. And are you allowed to tell us about the project that you're working on? Yeah, of course. It's definitely not a secret. So I'm currently trying to introduce hospital at night in Bradford, which is obviously something that's available in lots of other hospitals around the country, but we don't have here in Bradford. And I think would be a great opportunity to introduce. So not a small project because it involves some digital technology and looking at that. So employing some new people in different roles and changing the way we operate and work out of hours. So yeah, it's exciting but daunting sometimes as well. I can imagine.

SPEAKER_02 7:57

But I think exciting is the best adjective to describe a project like that. And is that a project that was your idea or is that a project that kind of came with a job role?

SPEAKER_03 8:06

So people do this different ways. So I was mentioning that when some people, as chief registrants, have an idea because they might have worked in a trust before and they think actually this would be something that'd be really good to improve. I came along to Bradford, and as part of the role, you're supposed to meet people who are important within the trust. So the chief executive team, the chief nurse nursing team, the medical director team. And I started off pretty open-minded in Bradford and spoke to people like the chief executive here and the medical directors and was open to suggestions. And I was led in this direction. And I thought, actually, yeah, that sounds like a good idea, which I think has pros and cons, but the main pro being you've got buy-in from the very beginning in your project because it's something that the trust is already looking at, and you can kind of run with it with support from people at the very top, which is what you need.

SPEAKER_02 8:54

Yeah, okay. And you obviously have this one year to complete the project. Could that be expanded if for any reason you know the project wasn't fully finished, or would you have to then hand over the reins to somebody else?

SPEAKER_03 9:08

So sustainability is something that's obviously very important. And it's something I can relate to and struggle with because we have to deliver quality improvement projects throughout our training. And it often feels like it's a tick box exercise, and actually you move on and nothing happens. If you stayed within the trust, you could obviously have some ongoing input, but it is a year-long program. So you have to build into your project the sustainability of it and how it's going to survive when you're not there. So that's something you have to think about early on. And it's something you also have training in because it's often difficult, that sustainability and spread of the project. And it's something that's valuable for us to learn as trainees and then as consultants of the future, how you maintain the energy and success of a project.

SPEAKER_02 9:47

I'd actually never thought of it like that, but that's so important because how many times have we done a quality improvement project or an audit on the ward, and then as soon as you leave, it's just gone, which is a shame. So, yeah, that's really important to learn. Going into the role, what qualities were you asked to have? Or if you weren't asked to have any or any skills, what skills do you think it's important for someone who might potentially be interested in applying for a role like this to have?

SPEAKER_03 10:16

So obviously, it's kind of in the name, it's chief registrar. Leadership is obviously very important, but also learning about leadership and what that entails and teamworking as well, because let's face it, leadership is all about how you work in a team and move together as a team. I think the key skill for this is communication, communication, communication. And I'm learning a lot about that. And it's not communication how we understand it from our training at medical school and our time as doctors, you know, with patients, it's about how we communicate with our colleagues to get things done, really. And whether that's via email, but also in person. And what I've learned a lot of during this time is one, how you communicate with people, and particularly people who hold a lot of power and influence, and try and get your agenda or your idea as the hot topic. And I think that's just by badgering as many people with power as possible and telling as many people as you can about what you're trying to do, but also things about like email etiquette, which is something I've not thought about before, but like how many emails you send, what's in your email, how you structure it, but also meetings and things, how you engage in meetings. There's a lot of the skills that are desirable in this post are the skills that you develop during your time. So it might be things that you're inherently interested in, you know, improvement enthusiasm, determination, self-motivation, but it's all the sort of skills that you're there to develop during the scheme. So it might be something you already have an interest in, but you definitely develop those skills during your time as a chief registrar.

SPEAKER_02 11:36

And Jess, why did you apply for the job? Did you feel that you know you wanted to learn about this? Was it a good time to maybe take a bit of a step back from training? What was your main motivation for doing so?

SPEAKER_03 11:49

My main motivation, Marlena, is I wanted a bit more time and space to actually nurture some of the interest that I have in terms of making things better when I see a problem, whether that's with an individual patient or a system or the way that we do things, I inherently am interested in seeing how we can change that and make that better. And I think as trainees, yes, we do quality improvement because we have two for our portfolio, but I don't think we often have the time to actually do that properly. So this gave me an opportunity to really develop those skills and have a bit more time and space to learn about how you do that successfully. And also, I really enjoy my time here in Bradford as here as an ST3. And this is a sort of place that I would like to work in the future as a consultant. So learning more about the structure of a hospital, you know, what does a chief executive do? What does a medical director do? How does each clinical department work and the structure of that? That's all really been valuable. And it's great to do it in a place like Bradford where I've really enjoyed working.

SPEAKER_02 12:47

Obviously, you're only about six months in. So the answer to this question may change, but what has been your biggest learning point take-home message so far?

SPEAKER_03 12:58

I've actually now been making myself a list as I go along because there's so much that you learn every day that I've tried to capture that so I can use that moving forward as a trainee, but also then in my future career. I think my main thing that I've taken from this, and I've already mentioned before, is about being present and here in person and reactive to ideas that you're given. Because there's some days when I've come to work and I've thought as a chief regent, it feels like things have stagnated a little bit. And then by the end of the day, I'll have had 20 different interactions which have really reignited the enthusiasm and the passion for what I'm doing and the projects that I'm involved in. And it's very much by being here and open-minded and reactive to ideas that have been proposed that results in that. So I think listening and trying to absorb what's the opportunities that are presented to you and being present are probably the main things that I've learned so far. But it's a constant learning process and very different to the sort of learning that we're used to clinically and medicine.

SPEAKER_02 13:56

And for any of our listeners that might potentially be interested in applying for a job like this, what would your advice be?

SPEAKER_03 14:04

So there are lots of chief registrars out there now. It's a big scheme, and in most deaneries and regions, there will be chief registrars around. Go and talk to people who've been a chief registrar, and some of them will be consultants now. And there's also a lot of information on the World College of Physicians websites. If you just Google the Chief Registrar programme, you'll find a lot of information about it. There's some old sort of like diary entries about people and case studies on the chief registrar programme website about different trests and projects that people have done, and diaries and entries about people's experience, which is what I looked at when I was looking to apply, as well as speaking to people who've been in chief registrar previously or done other sorts of leadership fellows to work out exactly what it is that I wanted to do and achieve.

SPEAKER_02 14:46

Excellent. Okay. I think what I'll do is I'll also place a link to that website on the footnotes of this episode for anyone that wants to go and have a look. Jess, thank you so, so much. Your experiences so far, I think everyone will agree with me that you made all our listeners think, could I do that job? And it's really nice to know that we can all make a difference because I think sometimes when you're stuck in the rut of going to work every day, you think that you know, if a system is broken, I by myself can't fix it. And it's really good to know that you can work with people in the hospital and make that change. So that's been really inspiring. Thank you so much for talking to me today. No problem. Thank you, Marilena. And thank you everyone for listening. You can keep listening to career conversations for all our different job roles and don't forget to listen to clinical conversations for our patient advice and new clinical guideline episodes. So thank you very much.