Working with registrars: a registrar’s perspective

To the Editor: I am writing to offer a registrar’s perspective on the constructive comments by Lack and Cartmill on registrar–intern interactions.1 The same comments would be equally applicable to consultant–registrar interactions. The current strict hierarchical, “militaristic” structure of the hospital system, with a “top down” approach to performance assessment (which, in turn, influences career prospects), is conducive to neglect of junior colleagues, as they are often the most expendable cogs in the wheel.

In my experience, the two key selection criteria for hospital appointments and career advancement — namely, impressing senior colleagues and passing postgraduate examinations — bear little correlation to the ability to supervise or instruct junior staff. Training in human resource management is not part of any undergraduate or postgraduate medical curriculum. Yet, negative junior–senior staff interactions can potentially compromise patient safety, as junior colleagues, acting only as acolytes in the professor’s entourage, are not empowered to actively contribute to patient care.

So, what are the solutions? A formal circular feedback system that has “teeth” would be a start. Incorporating regular evaluations of senior staff by junior staff as part of the hospital’s quality assurance program and as a condition of continued employment may be effective in identifying those who are unsuitable for supervising junior colleagues. Simple educational measures may alleviate some of the difficulties experienced by interns as highlighted by Lack and Cartmill.1 For example, the difficulties of contacting surgical registrars “hidden” in the operating theatre are cited as a cause of intern distress. But operating theatres are not located on a distant planet beyond feasible means of contact. Most operating theatres are equipped with telephones and are located centrally within the hospital. Educating the intern to telephone through to the operating theatre or possibly even venture inside should enable resumption of contact with even the most evasive surgical registrar. Finally, published guidelines detailing acceptable behaviours and responsibilities towards junior colleagues may benefit senior staff who may not have had appropriate senior role models themselves.

Having a junior colleague attached to one’s team is not an assumed right that comes with consultant or registrar status. It is a distinct privilege that carries distinct obligations. Failure to respect these obligations should precipitate removal of this privilege.