A step up in experience

Gavin Yamey, the BMJ's newest editorial registrar, offers a personal view of the advantages of a LAS post

Becoming an MRCP brought me to a crossroads, and the signposts were blank. I was in no hurry to commit to a four or five year training programme and was eager to have a period of reflection before the next phase of my professional life. As I trawled through the pages of the BMJ classified for that dream job (minimal on-call, stimulating, life affirming and enriching), I spotted a LAS tucked away under “Rehabilitation Medicine”. It would be nine to five, with two half days for research, as a registrar to a brain injuries unit for young adults in East London. This appealed to my interests in neurology and disability and had a strong psychosocial flavour, so I took up the three month post, which became six, then 12. None of this will ever count towards a CCST, so have I wasted my time?

The overnight metamorphosis from SHO to registrar involves a huge leap in responsibility, and a LAS or LAT can be a useful transitional period provided you are well supervised. My post involved seeing acute neurology referrals, and I moved through terror to burgeoning interest to quiet confidence as I got to grips with neurological diagnosis under the guidance of my highly supportive consultant. All jobs inevitably have a service commitment, but a nurturing boss should ensure a mutually fruitful experience. I grabbed the chance to conduct my own qualitative research project, re-wrote a book chapter for a second edition, and attended interesting conferences and meetings. There is no reason why a locum appointment should be denied these educational opportunities.Choose carefully, and you may find that you learn skills rarely taught to doctors. I became a member of an effective multidisciplinary team of inspiring and dynamic health professionals. I began to understand the issues facing people with severe and complex physical, cognitive, and psychiatric difficulties. Working with a multicultural patient group was the stimulus to my transcultural research and to meeting others involved in the field.If you are a person with a detailed life plan, then I doubt you will be reading this. If you are still undecided about which specialty is for you, a locum registrar post could be the taster you need before sitting down to a heavy meal. This will be particularly valuable if you are facing the dilemma of general practice versus a “friendly” hospital specialty (such as rehabilitation medicine, rheumatology, genitourinary medicine, or elderly care). In theory you could sample a few different menus, although questions may start to be asked about whether you have the stomach to commit. I certainly had to deal with the occasional raised eyebrow or sarcastic enquiry (for example, fellow registrar, proudly NTN positive: “When are you going to get a proper job?”). This question reveals much about the cultural identity of locum doctors. It can be very frustrating to be dismissed because of your temporary nature, and there may be an uneasy relationship with your permanent colleagues. This can be a two headed monster, since I sometimes found myself hiding behind this very attitude for protection (“Don”t expect too much from me, I'm only a locum”).If the journey matters to you as much as reaching the final destination, and speed is not your principal concern, then you should savour the taste of the locum registrar's life. By doing more SHO posts, you may broaden your range, but you won't get the depth or quality of experience that seniority offers. My signposts now read “flexibility” and “variety”, which I continue to pursue. Auden advised us to “leap before you look”, and the leap up to a LAS/LAT will reward you with a valuable view.