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In or out of programme: Being an in-programme chief registrar

In the first part of our Chief registrar: In or out blog series, Dr Fasihul Khan describes his experiences of taking on the chief registrar role in-programme.

  • Read part two of the series for an out of programme perspective. 

My tenure as chief registrar has undoubtedly been an invaluable and enjoyable learning experience. The beauty of the Royal College of Physicians (RCP) chief registrar scheme is the flexibility it provides. When I applied for the post last year, I was initially unsure whether to undertake it as an in-programme or out of programme opportunity, but eventually decided to remain in-programme.

Whilst I’m not the only chief registrar in the country who is in-programme, we do seem to be in the minority group. However on reflection I think my choice has worked extremely well for me. 

The beauty of the RCP chief registrar scheme is the flexibility it provides.

Dr Fasihul Khan, chief registrar 2017/18

Chief registrars are a conduit between the junior doctors and senior clinicians and managers. In order to represent junior doctors effectively, the chief registrar must be known and approachable, and be able to understand numerous challenges whilst collectively identifying possible solutions. Sharing rotas, work patterns and workplace challenges with colleagues enables this, simultaneously supporting and encouraging one another.

It has become an almost pastoral role, where junior doctors frequently approach me for advice or as someone to talk to. Perhaps undertaking an out of programme experience, with more time away from the clinical environment would not have allowed this relationship to flourish so well.

I was initially concerned about signing off a whole year’s clinical competencies in just 60% of the time. However due to the overlap in competencies, I have achieved a lot more than anticipated. Many of the general internal medicine and speciality curriculum competencies are related to leadership and management. Often these competencies are left just prior to CCT and then panic ensues! I have been able to concentrate on these, and have successfully signed off the majority. It certainly does require greater organisation and efficiency, managing various targets and pressures, but as future senior clinical leaders, this surely should not be seen as a problem, but as an opportunity. 

Not only have I been able to develop and apply my leadership skills attending meetings and carrying out quality improvement projects as chief registrar, but doing this directly in the clinical setting has enabled me to “experiment” and identify various styles of leadership in different environments. My clinical and non-clinical experiences have complemented each other well. 

From a trust perspective, an in-programme chief registrar is certainly more cost-effective. The on-call rota slot does not need to be replaced or even filled with locums, and this may be an important consideration. From a personal perspective, my certificate of completion of training (CCT) has not been delayed by the chief registrar role, and as I plan to undertake research, this was an important consideration. Whilst an in-programme experience has worked well for me, I think any decision should be taken on an individual basis in the context of the local set-up, rather than a “one size fits all” approach. 

Dr Fasihul Khan is a Royal College of Physicians (RCP) chief registrar at the University Hospitals of Leicester NHS Trust. 

In part two of our Chief registrar: In or out blog series, Dr Raunak Singh describes his experiences as an out of programme (training) chief registrar.