Who is the medical registrar? Survivor, solver, supporter (3 Jun 2026)

This transcript has not been edited for accuracy.

Transcripts are available on popular podcast platforms.

Dr Marilena Giannoudi (MG): Hello everyone, and welcome to another episode of Career Conversations, brought to you by the Royal College of Physicians of Edinburgh Trainee and Members Committee. My name is Marilyn and I am on the T&MC. And today I'm delighted to be joined by Doctor Toby Merriman, an acute medical registrar in Lothian, and we will be discussing his recent Masters of Medical Education, where he investigated perceptions around being a medical registrar. For those of you that missed it, Toby presented his work at the Medical Trainees conference earlier on this year. So, January 2026 in Edinburgh, and we thought it was vital that anyone who wasn't able to either be there in person or listen to the conference on playback got to hear a little bit more about his research. So, Toby, hello. Welcome. Thank you for joining me.

Dr Toby Merriman (TM): Hello. Thank you for inviting me. A real honour to be invited to speak at the training conference and to do this. And it's just nice to be able to share this topic that I'm really passionate talking about. And I think it's relevant to anyone that's doing a medical specialty.

MG: Definitely. I think before we get to the ins and outs of your actual masters, for any listeners that perhaps aren't aware, do you mind just giving a brief overview of what being the medical registrar actually involves? Who is the medical registrar in the hospital?

TM: Yeah. So, I guess at the simplest level, medical registrar is the senior physician trainee grade for hospital doctors in the UK. And so most Specialties. Well, not all specialties should do a medical specialty. They have to do their specialty plus general medicine. And when you're on call for general medicine, you are the medical registrar. And the responsibilities of the medical registrar are pretty varied. They include supervising junior colleagues, acting as a senior decision maker, performing technical skills and providing advice and support to other specialties and about other medical patients as well. So, it's a pretty broad ranging role. Most of the work you do as the dredge. Well, it's often out of hours in the evenings or overnight. And that's where a lot of the experiences that we'll be talking about later come from.

MG: Perfect. I guess the only thing that I'll add there, because you alluded to it, is that you said that most or some medical specialties will need to do that for anyone that's interested. Those are the Group one medical Specialties, and we've got lots of podcast episodes on what it means to be a group one specialty in taking each one in turn. And I'll also just put the links to the GRC TB website that kind of outlines that on the footnotes of this podcast. So, let's move on from that small plug there. Do you mind giving us a brief overview of what your massive medical education regarding being a med reg was actually about?

TM: Yeah. So, I had to do a research project as part of my master's in medical education. And I really wanted to understand my experience of being the medical registrar. So, when I was choosing what I was going to do as my master's research project, I was drawn to some questions that would help me understand my experience of becoming the medical registrar. So, I started working as a medic in twenty seventeen as a core medical trainee in Cmt2, as it was back then, rather than internal medical training. And I remember that when I got told that I was going on to the reg rota for the first time, I was absolutely terrified. And that kind of high level of anxiety continued and probably peaked during my journey to work for my first night shift. And you know that discomfort that I felt really persisted very few weeks before it started to dissipate. And I really wanted to understand what it was that made me feel so uncomfortable about the role. And I initially thought that it might be to do with my perception as a junior doctor of what it meant to be the med reg as an phi one, Phi two when I was in Phi two or Phi one specifically, I just thought the metric was a superhero. I just thought that they could do anything. I remember whenever there was a crisis. Remember whenever there was something that was going wrong, someone was deteriorating. The med reg was the person that I wanted to be there with me. And even going into kind of core medical training before, whenever I went on call as a kind of ritual, I would write all the numbers at the top of my sheet, whatever I was using for the shift. And then the top number for that would always be the med reg. And I don't think I was particularly alone in that kind of perception. I know that there's some research that was published in the College Journal about junior doctors’ perceptions of the med reg, and people have felt that what they do is superhuman, with that belief being underpinned by a perception that they do a huge amount of work. I felt that I couldn't be that person that I had always imagined the med reg to be, and that was what made it so uncomfortable going into it. So, part of what I wanted to do was to gain a deeper understanding of what it did mean to be the metric to kind of clarify what it did mean to be the metric. A more clear understanding to help people going into that role. And that was one of the things I wanted to look into and did that by speaking to metrics. So, I asked medical registrars to tell me about stories of their work, and I said, you know, tell me about a time where you felt you really embodied the role of the metric. Tell me about the time we felt like you didn't belong in the role, even though you were acting. And they told me these amazing stories, and I did something called narrative analysis to see what kind of identities these doctors constructed during the stories of their work. And by defining these identities that the metric is kind of embodied during stories. I thought that you get a clearer understanding of what it did mean to be the average.

MG: I'm listening to you and I'm recapping what I felt like before I started. And I remember a night shifts with my kind of CT two on call buddy coming up towards being a Med Reg, and we're both saying we're not going to cope. Like we shouldn't just go to work in August because all of a sudden, we're going to be the Med Reg and we're not ready. And how will you ever be ready? But we're just not ready. So, I remember these times very well. And I mean, obviously, I heard you at the MTC, and I think the listeners now have to hear the different kind of sides to the Med Reg that you so eloquently described. I think before we hear that, I will just say that I was quite surprised as to how different people perceive the Madrid. And other than the actual problem solver, how many times you do something without even thinking, but someone else sees you doing that and immediately gives you this personality trait that you didn't even know you had. So, I will stop babbling. And without further ado, I will ask you to tell us what were the kind of different faces of the mega-rich.

TM: Yeah, so I did this. It's called a positioning analysis. This is what I did as a type of narrative analysis, where you look at the stories in detail and you assess how they position themselves and the stories to construct their identity. And there was kind of overall in the stories that we had, there was nine identities that the participants constructed. So, there was the linchpin, and the linchpin was able to coordinate a team of skilled individuals and kind of challenging circumstances, things like cardiac arrests or medical emergencies or challenging shifts. There was the workhorse that was bearing the load of the tasks that were giving them from around the hospital. So different hospital areas, clerking, seeing people in A&E, seeing people in critical care areas, all of these kind of things. There was the firefighter, a term that I think a lot of us will be familiar with. When I asked one of the participants how they would describe the mattress, they immediately said, A firefighter. So, I guess that's the idea of having to go between tasks and providing a solution, but maybe a superficial solution rather than engaging problems with as much depth as they might require. There was the navigator. So that wasn't about knowing everything. It was about being able to find the required information that might be needed at any time. The improviser was able to come up with a solution to a task, even if that wasn't necessarily within the remit of their kind of knowledge base. And I think as metric is often, we get calls that are maybe not something that we have a special interest in or specialist knowledge. Even though we are often able to come up with a solution. It was the veteran. So, individuals that have accrued as much experience and expertise that helps them answer different clinical questions. The migrant, and I think that comes about the idea that as a metric, you're often traveling around the hospital offering your expertise in different clinical areas. The imposter, and I think we all get a bit of impostor phenomenon sometimes. And that's when, you know, you feel that despite the training that you've had, maybe you're not the right person to do a task that you've been given. And that often came up in the context of performing technical skills. And the stories that I heard there was the counsellor. So that's providing advice and support to your colleagues who are facing challenges that you've faced before. And that's often kind of pastoral support, maybe in the context of recent challenging shifts, cardiac arrests, medical emergencies that colleagues haven't dealt with before and took all those different identities and kind of synthesized them into three core identities based on the stories during which they were told. And those three were the survivor, the supporter and the solver. And the survivor is the. So, I guess the most interesting thing I found from my research was you ask a bunch of medical registrars to tell you about a shift where they really felt they embodied the role. They would tell you the story about this absolutely horrendous shift that they had, where they were pushed to the limit of their ability, but they were able to get through it, and they were able to survive these shifts by acting as a linchpin or a workhorse, a firefighter, but they were really left affected by these shifts and in a way, being able to get through them. They felt that they earned their stripes as the medical registrar. They kind of proved Themselves to themselves what they could do. This role, the solver is kind of. Combining the improviser, the navigator, the migrant, the veteran, and the imposter. And. That's the idea about, you know, a quintessential story was the med reg being approached to solve different types of problems. Sometimes those problems were quite unusual that normally the med reg was able to find a solution to those problems, either by improvising a solution, by finding the right information, finding the right person to talk to. And if they couldn't, or they felt they weren't the right person to deal with that problem, then they might feel like they were an imposter. But generally, people, you know, you hear it's like the classic story about being phoned about a bat in the corridor. And one of the ones that I heard in the research was about someone who was called because the hospital low oxygen alarm went off. And another one I heard recently was someone got called because the car, the barrier to the car park was broken. I'm not sure that's something they dealt with themselves, but you do get approached by these different types of problems, and often as you feel able to kind of find a solution. And the final core identity was the supporter. So that was the idea that you could provide both clinical support terms of clinical decision making, but also pastoral support to your colleagues when they're facing challenging circumstances. And I think a big part of what I learned from the research was how important that providing pastoral support to your colleagues is in the role. And that was something that came up again and again. And I think it's a really important part of the role. I think before I stop rambling, one of the really important things that I think came out of it is that at no point did a hero narrative come out. People weren't describing themselves as superheroes at any stage. And rather than describing situations where they had all the knowledge or they knew the answer straight away, there was much more of a focus on being able to find the right information and being able to get the support that you needed from colleagues, consultants, supervisors, if you were unable to deal with a particular problem yourself.

MG: And I appreciate that this isn't the way qualitative research works, but was there a role or a narrative that came up all the time, or was it very much mixed in? All of these different kind of personalities of the med? Reg were very balanced in how often the people that you interviewed were describing them.

TM: Yeah. So, the identities emerged in different types of stories. But I think, you know, the three kind of core stories were really those three. I had a really challenging shift that I managed to get through. I was Is approached to solve this problem, and this is how I solved it, or I needed to provide support to my colleagues because they needed support with clinical decision making or they needed support with a challenging situation. And this is the support that I provided. And I think that across all of the stories, they could generally be fit into those three categories pretty easily. And I think probably the distribution across them was pretty equal.

MG: I think it's really interesting that you said that not a single person kind of said that I did a good job or, you know, you quoted it as I was the superhero here. But ultimately, they were dealing with things that no one else could. How do you think your perception has changed when we consider this myth that, you know, being the metric is the most difficult job in the hospital? I don't know if I want to do it. Do you think your research embodies that or that. Actually, yes, it's tough, but we crack on and don't really think about it.

TM: Yeah, I think undeniably the role is challenging or it certainly can be challenging. You know, the reason that people come up with survival narratives is because they've been having really difficult shifts where they've having to deal with a lot of problems. But I think you can probably say that about most front door specialties, where there is a lot of acuity, there are a lot of people coming in like my wife is an obstetric registrar, and that sounds really challenging in the same way. What I learned is that though it is challenging, there are ways that we can reduce the amount of challenge and help each other get through those challenges. And actually, a lot of the work is really rewarding and really interesting and really valuable. The acting as a supporter for your colleagues either be that with kind of helping them with a clinical problem or supporting them in the aftermath of a difficult situation, that's a really rewarding and valuable part of the job. And solving problems is really satisfying and is something that I think that the people that do the role really enjoy. So, I think that I really was able to reflect on all the things about the role that are great, but I was also kind of able to be clear eyed that it can be hard. And I think that we can do better at supporting each other through those hard times. And that's at an individual and organizational and a kind of team level.

MG: Obviously, the difficulties are Highlighted, but through that, was there a lot about how enjoyable the role can be? Again, I obviously haven't done the research, but speaking to my colleagues, I do think anyone would actually change being a metric. And I think deep down, we all love our job. So, was that portrayed in the people that you spoke to?

TM: Yeah, people love it. Yeah. People really enjoy doing it. Or the people that I spoke to really enjoyed doing it. I think there's probably a half bee acknowledgement that the people that I spoke to were probably enthusiastic about the role because they came to talk to me about it. I agree that despite the challenges, it's a role that people find rewarding, they really enjoy. And that's not because they are superhuman, it's because they've got good knowledge base. They're able to find the information that they need, and they know when to ask for help and they can manage the complexity of competing priorities. And I think those are all things that can be learnt and shouldn't put anyone off applying for a specialty that would require someone to be a med reg. But I think that I have to acknowledge that there are some people that do enjoy those busier, more challenging shifts more than others. And while I wouldn't say that, like, you know, those shifts that I've had to survive, as it were, are the exception rather than the rule. And I think that in most specialties, people are going to have those kind of experience. I certainly don't think they should put anyone off pursuing a job that is varied and interesting and rewarding and gets you to across the hospital, seeing different people with different types of problems, and really lets you help patients every day in different types of ways.

MG: And do you have any advice as to how one can deal with those busy shifts? Because obviously you've got a lot of experience being the med reg and now you've done this piece of work as well. Other than, you know, each shift is going to be different and just going with an open mind. How do you stay calm or how do you deal with those incredibly busy shifts that are the ones that you'll think about for years to come?

TM: So, when I was a med reg this and this happened, and I think there were definitely some pearls of wisdom that I got from participants over the time that I was doing the research. I think that one of the things that I thought was really interesting was, you're only one person and you can only do one person's work, and if there is more work that can be done by one person, then you need more than one person to do it. And you've just got to try and do the most important things at that time. Make sure that people are aware that you've gone beyond what a single person can achieve and get help if you need it. And I think that's a useful way to think that there are going to be times when you cannot do everything, and that's okay. I think when you're at the front door and particularly doing clerking, there can be a pressure to feel that you need to do them all or you need to, you know, leave with the decks cleared, nothing left to hand over. And that's just not a reality. We work in a twenty-four-hour service. The reason that we have a twenty-four-hour service, which is always more work to do. So, thinking that you need to be able to do it all, it's not realistic, and you need to accept that there are other people that are going to come, and they're going to be able to do that as well and hand it over. I think that the most important thing for me, I think, is about getting opportunities to talk about your experiences with your colleagues in some way, shape or form, any sort of challenging shift, traumatic situation, something you've really struggled with, whatever that might be, you're more likely to grow and develop from that experience rather than having a negative impact on you. If you can take an opportunity to engage in reflection with the support of someone else, and that could be a formal or informal mentor, a coach, or even just a group situation. But I think that it's really important that we have an opportunity to talk about our experiences with our peers, because it allows us to, you know, see that we're not the only one that's had these kinds of shifts before we get to learn about how other people deal with it, or what other people's experiences are, kind of offload some emotion associated with it, and then think about how we can develop. And that will help us kind of manage similar situations in the future. And I think that as the med reg are often working on your own, and I think finding an opportunity to talk about the role or what you've done or the challenges you've had and how you face them can help you, but it can also help those around you.

MG: Yeah, no, I totally agree. I guess the only ones that I'll add in, not that you asked, but I'll tell you anyway, is take a break. I think I learned that the hard way because, you know, similar to what you said, there's always going to be someone else to Clark. And it took me a really long time to really realize I am no longer being effective here, actually having a ten-minute break, eating something, even just leaving either the ward or A&E to come back in ten minutes can totally change your effectiveness. And going on to kind of your last point that you are usually working alone, it can be quite lonely. And I think to get through those shifts, it is important for all members of the team to really realise that you are working as part of a team. So, I try, and I'm not saying that everyone should or that this is a good idea. This is just what I do. I try and enforce kind of a meeting point where all members of the team will come. We'll do a small huddle, see what's what, try and troubleshoot any problems because sometimes, you know, more junior members of the team will be like, oh, the reg is busy. I can't bother them. But actually, that's quite a good way for everyone to just sit down, have a cup of tea, see that everything's, you know, going okay, if there's anything that needs to be dealt with and then get back to work again. And I think over the years, that's what I've learned. Can be quite helpful because if not, it can be quite overwhelming.

TM: Yeah. No, I totally agree that finding opportunities to huddle with the team give you an opportunity to check in with everyone and give them an opportunity to know that this is a time they can approach you for. Any troubleshooting issues can be really valuable. I think, you know, we want to be approachable because we want to know if there's any problems that we need to know about, and that really helps with that kind of thing.

MG: Mhm. Yeah. Is there anything else that you feel, especially maybe more junior listeners who haven't quite picked their specialty, who are umming and ahhing. Oh, do I want to do group one specialty or do I want to do, you know, acute medicine because I'll be the Med Reg forever. Is there anything that you feel that really needs to be relayed to those listeners.

TM: Yeah, I think the main thing is that I don't think that being the medical registrar should put anyone off doing a group one specialty, and that would be my main message. If there's a group one specialty that you want to do, I would not do it because you want to be the medical registrar. Medical registrar is not an all-knowing hero that can solve any problem. They're a person. They have taken a step up at some point to take on that role, but they will always have support from consultants. They will have experience that will help them take on that role, and they will gain more experience that will help them operate effectively in it. Yes, there might be sometimes where it's challenging, and I think it's important that we acknowledge that, but there's going to be times like that in, I think, most specialties. I don't think that being the med reg is so much more challenging than any other specialty that it should put anyone off from doing it. Especially when you're a part of a bigger team that is helping you to achieve the goal of safe inpatient care. I think that would probably be my main message.

MG: I guess I just wanted to kind of follow on from what you said. You've been trained to do this. So, the fact that you've passed, you know, MCP, you've passed paces. I don't think the knowledge that you need to be a med reg is any more than that. It is just about having to deal with difficult situations. But again, experience is a wonderful thing. And I guess again, building on something else, you said the more senior we become, I think sometimes we fall into this trap that the buck stops with me. The book never stops with you. And I think one of the most wonderful things in medicine is that we have chosen to work in a career where we are constantly working as part of a team and there is always someone else to ask. And actually, even saying, I don't know what's going on is just as powerful as saying, I do know, and it's okay to not know. And I think sometimes it's even more important not knowing, because then you can take even more help from the rest of the team to get to where you need to be. So, I would totally agree and say that I don't think being a medic should be enough to put anyone off. I think if anything, it should give you a little spread to say, yes, I can do this. And I think a lot of the skills that you gain in work actually come in really handy outside of work. You learn how to, you know, balance your time. You learn how to communicate with specialties that perhaps drive you crazy. And we all have, you know, the one relative or friend or you know, that person in our lives where communication is difficult, you build on that, and I know I'm extrapolating here and perhaps trying to paint this picture that everything is great. And, you know, there are difficult shifts. But as you very rightly said, I think every specialty has difficult shifts. And I guess it's really important that we demystify this perception that only the med reg has a difficult shift, and only the med reg must have the answers to everything.

TM: Yeah, totally. I think probably the emphasis that I didn't quite get that I caught from you there is that as well as not putting people off doing a specialty, I don't want to like bring the media shouldn't put anyone off doing a specialty, require them to do that. It's really fun.

MG: It is really good.

TM: You see interesting things. You get to meet people from around the hospital. You get to deal with different types of problems, and it really increases your range of experience and will help you Develop into a better doctor. And I think it's a really valuable role because of that. Yeah, definitely useful out of work as well.

MG: Totally agree. And I think to be honest, we should probably end it there because we're ending on such a high. But jokes aside, anything else? Or do you think we've persuaded everyone who's swaying between a Group one and Group two specialty to definitely apply for that group one specialty?

TM: I hope so, I hope so, and you know, I would never discourage anyone from doing it because I really enjoy it. You know, I think the preparation for it is improving all the time as well, different courses and things like that. So, no one should ever think that they can't do it because they can with the right support.

MG: Yeah. Totally agree. Perfect. Thank you so much for sharing the valuable insights, for sharing. The overview of what I gather was a very long but enjoyable process with your dissertation. What I will say, and I know I did a plug earlier on, but we've got lots of career conversations episodes for both Group one and Group two specialties. I think to all our listeners that go into the Group one specialties, not one person has said that they didn't like being a med reg as part of their kind of parent specialty. So, I will just highlight that there. And we've obviously got loads of clinical conversations, episodes on our clinical conversations podcast channel, where you can tune in for lots of things that you may face on the wards and how to deal with them. So, Toby, thank you so much for joining me yet again, and I hope to see you soon.

TM: Thank you for the invite. It's been a real pleasure. Thank you.

MG: And thank you to everyone for listening.