eMJA: Professional development of registrars

To the Editor: The CanMEDS 2000 report1 and its 2005 revision2 have emphasised that effectiveness as a medical specialist requires competencies in addition to clinical and medical expertise. These include being a communicator, collaborator, manager, health advocate, scholar and professional.

Building the non-clinical skills of doctors has been the focus of a professional development project in Australia that is targeting registrars. Junior doctors usually step up to the role of registrar in the 3rd year of their prevocational training. A national workshop convened by the Postgraduate Medical Council of Victoria in March 2004 agreed on a framework for the professional development of registrars, comprising the following 10 competencies: leadership; communication skills; supervision; mentoring; teamwork; self-awareness and empathy; time management; problem solving; professionalism and ethics; and safety and quality.3

To provide content for these competencies, a job-shadowing exercise involving two registrars at two different Victorian hospitals was undertaken in April 2005 to get a first-hand understanding of the roles of medical registrars as managers. The registrars were voluntary participants, and permission was obtained from all participants. I shadowed the two registrars during their entire 9-hour shifts. No major issues arose in relation to the shadowing process itself, and the consultants overseeing the two registrars were extremely accommodating in this process. The two observed registrars authenticated the veracity of the recorded observations. The observations from the job-shadowing exercise were clustered into competencies using the framework developed for the professional development of registrars discussed above. The Box summarises these observations and highlights the range of registrar interactions that are influenced by non-clinical competencies.

While the small number of registrars is an obvious limitation of the study, this job-shadowing exercise did demonstrate that managerial skills, knowledge and behaviour represent a significant component of the work of clinicians, especially as they move up the medical hierarchy. This assertion should not be misconstrued as suggesting that the clinical skills and knowledge become any less important. As noted in the 2005 CanMEDS framework, the medical expert role is the central role for doctors.

It is also worth noting here that some pilot professional development programs conducted recently as part of the registrar project show that registrars welcome training that enhances their non-clinical skills, especially when provided professionally in an environment conducive to learning.

Observations during job-shadowing of two registrars at two Victorian hospitals

Competency

Observed interactions

Supervision

Reviewing patient treatment plans and test results and prescribing a course of action
Ensuring that procedures are followed
Coaching intern on test procedures, completion of patient records, etc
Giving ongoing feedback to intern
Delegating tasks to intern
Coordinating patient treatment with other units

Leadership

Dealing with other health professionals, some of whom take directions from the registrar, as well others over whom there is no formal authority
Providing advice to intern and role modelling desired behaviour
Demonstrating the ability to respond quickly and with confidence
Involving subordinates and providing opportunities for them to participate in decision making
Using networking skills with other departments
Using negotiating skills in dealing with other departments, hospitals, etc

Communication skills

Using communication skills with patients, intern, medical colleagues, other health care professionals, and service departments
Dealing with cross-cultural diversity issues with patients, their families, and staff
Using negotiating skills in dealing with other departments, hospitals, patients, and family members
Using recording skills to ensure treatment plans properly documented for others

Time management

Prioritising patient list for ward rounds
The constant need to re-assess priorities during ward rounds, in light of time constraints
The ability to deal with constant interruptions from other colleagues, to provide necessary clarifications

Problem solving

Making decisions on patients’ continued treatment or discharge, and stipulating any follow-up action
Task contingency management skills to deal with patient treatment plans not proceeding as planned
Dealing with information gaps in patient historical records
Involving intern and other staff to assist in the decision-making process and raising issues with consultant

Professionalism and ethics

Dealing with demarcation issues with other doctors and professionals
Role modelling professional behaviour to patients, staff, and the public
Balancing the interests of patients with hospital needs, without sacrificing patient trust
Obtaining patient consent for procedures

Teamwork

Coordinating treatment plans with other doctors and health professionals
Sharing information and agreeing on treatment plans with allied health staff
Joint meeting with other colleagues to advise a patient and family members on surgical procedures and associated risks
Ability to work in both collaborative and individual modes during the day

Mentoring

Providing advice to intern to be more assertive and confident when dealing with consultant

Self-awareness and empathy

Patience and empathy in giving bad news to family
Dealing with patients who are aged or mentally or physically challenged

Safety and quality

Knowledge and application of safe practices in relation to patient management
Ensuring that procedures are followed, such as obtaining consent, ordering of tests, etc
Reviewing records before dispensing treatment
Recording treatment plans and medications