Working with registrars: a qualitative study of interns’ perceptions and experiences

Christopher S Lack and John A Cartmill
Med J Aust 2005; 182 (2): 70-72. || doi: 10.5694/j.1326-5377.2005.tb06578.x
Published online: 17 January 2005


Objective: To identify and explore behavioural characteristics of registrars that interns find helpful in their working relationships and workplace learning.

Design, setting and participants: Semistructured interviews with 18 interns at Nepean Hospital, Penrith, NSW, at the end of their first working year as doctors. The survey was conducted between December 2003 and February 2004.

Main outcome measure: Desirable and undesirable behavioural characteristics in registrars, as reported by interns.

Results: Overall, interns’ opinions of registrars were positive. Desirable characteristics in registrars included approachability, availability, good communication skills, and a willingness to teach. Undesirable characteristics included an unwillingness to listen, unreasonably high expectations, a condescending attitude, apathy and rudeness.

Conclusion: The behavioural characteristics of registrars that interns find helpful are identifiable, and there is significant room for improvement in the quality of clinical mentoring by registrars. The next step is to facilitate regular feedback from interns on registrars’ performance, and to develop ways to encourage desirable behaviours in registrars while actively discouraging undesirable behaviours.

Aviation industry research suggests that when people are happy and satisfied with their colleagues, communication and teamwork naturally improve.1,2 In turn, the likelihood of poor communication and interpersonal interactions resulting in adverse events is reduced.3 This is vital in high-risk industries like medicine and aviation, in which errors can be catastrophic.4

Not everyone agrees that the safety lessons learned by aviation are applicable to medicine, but, if aviation’s exemplary safety record is due in part to applied research into communication and interpersonal interactions, then medicine may also expect to gain from similar research.5,6

Doctors begin their postgraduate training as interns working under supervisors, usually registrars. Given the degree of contact between registrars and interns, behavioural characteristics of registrars have the potential to affect the quality of interns’ clinical training and the intern experience as a whole. Furthermore, interns’ exposure to registrars as role models may have significant consequences for their own effectiveness as future supervisors. However, we could find no published research in medical or educational literature on interns’ perceptions of their supervisors.

We set out to examine desirable and undesirable behavioural characteristics in registrars from the intern’s perspective, in areas such as guidance and supervision, interpersonal dynamics, teamworking ability, and communication skills. We sought to discover whether these issues are currently a problem in intern training and how registrars might improve their performance as clinical supervisors, as we believe such issues have implications beyond the intern training experience to broader issues of error minimisation and patient safety.

Data collection and analysis

We used semistructured face-to-face interviews involving both open- and closed-ended questions7 to identify registrar characteristics that interns considered either desirable or undesirable in their working relationship.8 All responses were kept confidential and de-identified.

To maintain consistency of questioning and recording, one of us (C S L) conducted all the interviews. Responses were recorded manually in an abbreviated form during interviews; interesting comments were noted verbatim. Notes were subsequently transcribed into point form, and the data analysed. Audio recordings were not used.

A content analysis method9 was used to process the data. We assembled a list of coded categories based on interns’ responses,10 then cut and pasted each excerpt from the transcribed data into one of those categories. We used sequential, or “iterative”, data collection and analysis (ie, results from early interviews influenced data collection in later interviews).11 In the categorisation process, clear recurring themes were obtained from the data using grounded theory inductive techniques.12 From these, a number of desirable and undesirable behaviours and attitudes emerged.13,14


Overall, interns’ responses were positive, most describing high levels of satisfaction with registrars’ abilities to deal with the varied demands of learning, teaching, and practising medicine.

Interns emphasised the importance of “good” registrars (Box), with comments such as, “It is the registrar that makes or breaks a term, rather than the consultants or the particular ward where one is placed”. Although a number of undesirable characteristics were elicited, many of these were thought to result from — or be much amplified by — an overstressed healthcare system that places great demands on registrars.

Teaching and supervising skills

Many interns resented registrars who did not answer their pagers and felt that having their registrar out of contact for significant periods adversely affected their confidence and, on occasion, the quality of patient care. For interns doing surgical terms, some registrars were often out of contact in theatre, leaving their interns to cope with emerging problems alone.

“Good” registrars, on the other hand, gave warning if they were going to be out of contact, called between surgical cases, organised other registrars to cover for them, or left pagers with theatre nurses who could relay messages.

Respondents also preferred registrars who scheduled regular meetings throughout the day. The suggested ideal minimum was a full morning ward round together, then two “paper rounds” by phone, and a final check-in by the registrar before leaving for the day.

Willingness and ability to teach were considered important characteristics. Interns preferred registrars who would teach on the spur of the moment at the bedside without prompting. Other themes relating to good teaching included being willing to listen to and answer interns’ questions or suggestions; having an encouraging and supportive attitude; allowing a progressive increase in interns’ responsibilities, thereby building their confidence; and appreciating the intern as being a member of the team with a valued perspective, not just a “secretary”. (One intern was told by a registrar to “go to the cafeteria and tell me what hot foods are available today”.)


Our results suggest that interactions between interns and registrars play a large role in determining interns’ work satisfaction and learning opportunities. Although interns in our study identified certain negative characteristics of registrars, indicating that there is room for improvement in registrars’ communication and teamwork skills, they believed most registrars performed admirably under difficult conditions.

The limitations of our study include a relatively small sample size, with all participants working in a single hospital. Ideally, future similar studies will be conducted at other hospitals, but we have no reason to believe that the opinions expressed in our study are unrepresentative of the NSW intern experience generally. We looked exclusively at Australian-trained interns, and did not correlate individual factors such as sex, ethnicity, or rotations undertaken. However, using this project as a basis, a future, bidirectional study could conduct multivariate analysis on such factors. A larger study would also ideally include a wider variety of medical staff, such as medical students, residents, registrars and specialists, and would assess how interpersonal dynamics, tutoring and communication skills might be improved.

We recommend that an instrument be designed to facilitate regular feedback from interns on the performance of their registrars, covering the themes indicated by our study. Such an instrument would allow interns to give a more objective and constructive evaluation of their satisfaction level with registrars and help registrars function more effectively as clinical mentors.

These would be logical steps towards hospitals achieving not only a higher quality of care, but also the added safety benefits that the aviation industry attributes to its commitment to researching team behaviours and using the results to guide professional training.

Received 18 June 2004, accepted 25 October 2004

  • Christopher S Lack1
  • John A Cartmill2

  • 1 Faculty of Medicine, University of Sydney, NSW.
  • 2 Nepean Hospital, Penrith, NSW.



We would like to thank Captain Graham Beaumont, Dr Kathy Kramer and Mr George Truman for their advice on developing and presenting our study.

Competing interests:

At the time of our study, Associate Professor Cartmill was a board member of ErroMed, a human factors training company. He is no longer a board member, but remains on its teaching faculty.

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