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Colleges work to improve the “med reg” role

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1010 (Published 01 March 2018) Cite this as: BMJ 2018;360:k1010

Re: Colleges work to improve the “med reg” role

Medical registrars working in hospitals across the globe have become increasingly dissatisfied due to high workloads, long shifts and limited supervision after hours. We agree with the need to optimize the work environment for these registrars who are integrally involved in critical decision making for acutely unwell patients. With the resource constraints faced by many health care organisations it is essential to identify novel strategies to help reduce the high workload of registrars.

Without any additional resources, we have tried on a small scale to address the workload of our lone night medical registrar. We accomplished this by staggering the after hours medical registrar shifts so as to provide an overlap of three hours with the night medical registrar. By doing this “no additional cost” change in the roster, a significant reduction in night medical registrar workload and improved work satisfaction were achieved. There was a reduction in the handover of pending daytime workload to the night registrar, a decrease in the total number of admissions required by the night registrar and consequently a reduction in the handover of incomplete work to the morning team. There was observed an increase in the absolute number of inpatient reviews by the night registrar which may have been related to more time available and a slight but not significant decrease in the number of MET calls. The increased time available provides a potential opportunity for enhanced supervision of junior medical staff working after hours, an issue that is of great concern.

The Joint Royal College of Physicians Training Board (JRCPTB) criteria are a positive step towards redesigning a safer, supportive and more satisfying medical registrar role. Incorporating these with meaningful improvements in workloads through innovative strategies that unleash hidden potential or through increased resource allocation may have flow on benefits on quality and patient safety.

References:
Chaudhuri E, Mason N, Logan S. The medical registrar: empowering the unsung heroes of patient care. London: Royal College of Physicians, 2013.
Wadhwa V, Brookes J. We must support junior doctors working after hours. BMJ 2018; 360 :k241
Joint Royal Colleges of Physicians Training Board. Quality criteria for GIM/AIM. www.jrcptb.org.uk/quality/quality-criteria-gimaim.

Competing interests: No competing interests

05 March 2018
Harsh V Thakkar
Senior Medical Registrar
Dr Vikas Wadhwa
Eastern Health
Eastern Health, 5 Arnold Street, Box Hill VIC 3128