Acute care toolkit 8: The medical registrar on call

The medical registrar is perceived by many to be the medical ‘workhorse’ of the hospital and is relied upon heavily by many hospital and community teams. Registrars, however, are concerned about their ability to provide safe, high-quality patient care as their workload increases.

Key recommendations

  • Trust induction should include clear guidance with respect to the structure of the general medical rota and the roles of all members of the on-call medical team, including consultants.
  • Leadership of the on-call medical team should be transparent and consistent during normal working hours and out-of-hours.
  • Handover should be formalised, take place twice daily, be multidisciplinary, and implemented with reference to the RCP handover toolkit.
  • Team working can be improved by working a full shift rota with consistency in the members of the team.
  • Members of the on-call team should be responsible for making formal contact with their team leader (usually the medical registrar) at the start of every shift, either at handover or on an individual basis.
  • Effective communication is essential to good teamwork. Processes should be in place to ensure the flow of information, and technology should be used to facilitate this.
  • Medical registrars should be actively encouraged to take part in quality improvement projects in the trust. Adequate time should be allocated to this within working hours.
  • There should be an expectation that at least one trainee will attend management meetings.
  • All members of the medical team should be able to have adequate rest periods in a quiet, comfortable rest room.
  • Core medical trainees should gain experience in the skills needed as a medical registrar (eg assume the role under supervision when the registrar is reviewing patients with the consultant). In particular, more experience in managing acutely unwell medical patients is needed. This will make the prospect of applying for a medical registrar role less daunting.
  • The designated consultant physician ‘champion’ of the medical registrar and the lead hospital manager should be responsible for providing support and promoting a healthy work–life balance for the registrars.

Despite being passionate about patient care, morale among medical registrars is low and they feel undervalued with junior doctors being put off general medical specialties by the prospect of becoming the medical registrar. An urgent re-evaluation of this role is needed if we are to provide high-quality acute care while recruiting, training and, crucially, retaining future consultants in general medicine.

This toolkit aims to help hard-pressed and stressed medical registrars improve their workload, training opportunities and supervision.