From mentoring a chief registrar to life-long colleagues, Dr Rachel Tennant reflects on her experience of being a chief registrar mentor over the last three years.
Making the case
I saw adverts for the Royal College of Physicians Chief Registrar Programme in 2017 and thought it sounded great. I also thought this was something that would be pursued by teaching hospitals but would be hard to make the case for in a cash-strapped district general hospital (DGH).
Luckily, our ST5 registrar in acute medicine spurred me into action. It was indeed challenging to find the funding for the role. Both deputy medical directors were supportive in principle, and the head of finance was moderately enthusiastic, but actually coming up with the money to backfill two days per week of clinical time took a lot of persistence. Our incoming medical director was not amused to find a big hole in his transformation budget.
Our first chief registrar was our ST5 trainee who returned at ST7 grade to perform a 60% clinical and 40% leadership role, in programme.
Her executive sponsor was the deputy medical director/divisional clinical director for emergency care while I performed the more day-to-day mentoring role. We started with a round of introductory meetings and a selection of potential projects. It rapidly became apparent that there were multiple areas in which our chief registrar could contribute and rationing her time so that she didn’t get overburdened became crucial. We ended up with one overarching project, a secondary role as spokesperson for training issues, and also a role as a repository of ideas for smaller scale quality improvement (QI) projects to which junior doctors could be matched.
Developing a vision
Our acute medicine service had grown in exponential fashion over the past five years. We had built three new fit-for-purpose wards, but medical staffing levels were inadequate. Mitigation was achieved by enthusiastic specialty physicians helping out on the acute medical unit (AMU), but this meant that the service was fragmented and inefficient. The RCP Guidance on safe medical staffing highlighted where we needed to focus.
Our chief registrar led three focused meetings using plan, do, study, act (PDSA) cycles to develop the ideal AMU model.
She used skills that she had learnt on the superb chief registrar training days, engaging a wide variety of stakeholders. Executive-level sponsorship, both from the deputy medical director but also the chief operating officer, was crucial in developing the narrative that we needed to invest in a new model. This work ultimately led to approval of a £1.5 million business case to invest in RCP safe staffing levels for the AMU.
My role mostly involved being a sounding board and having a lot of chats over a coffee – it was a thoroughly enjoyable experience! We developed a good friendship and it was invaluable having a trusted ‘ear to the ground’ in the department who was not shy of telling the unvarnished truth. As a result of the work, the new AMU model is running successfully with a dramatic improvement in length of stay, staff satisfaction and efficiency.
Recruiting a subsequent chief registrar was pain free after such a successful pathfinder. Our second chief registrar has just completed an equally productive year and getting approval for a third chief registrar was the work of a few minutes. Moreover, our first chief registrar enjoyed her experience with us so much that she has now joined us as a consultant, with the intention that she will continue using the skills she developed during the year in future leadership and transformation roles. I suspect my days as clinical director may now be numbered!
The benefits of recruiting a chief registrar go far beyond the financial cost, and I would wholeheartedly recommend all trusts (including cash-strapped DGHs!) to consider the programme.
Find more information on the Royal College of Physicians Chief Registrar Programme here.