Know your limits

There is a huge increase in the day-to-day responsibility as a registrar compared to your typical resident roles. Suddenly you will be holding the phone during day and evening shifts and are the first point of call for the emergency department, other units and external hospitals requesting surgical advice, transfers and admissions. You will never know what each call will bring and that is half the fun of being a surgical registrar, no two days are the same! The ability to think on your feet comes with experience so no one will expect you to have all the answers and management plans from day one. The best tips for holding the phone will be to take the patient details, the referring doctor’s contact number and location (if external), and the presenting history. If investigations have been done, write down the pathology results and find out how to access imaging as an external doctor (the report means little for most surgeons we want to see the pictures too!). Be sure to understand if the patient is stable and how time critical your response and answers are – do they want a plan for outpatient workup and clinic, or does this patient need to be admitted or transferred? You will need to discuss external transfers with your supervising fellow or consultant, and with any inpatients you should assess them face-to-face before deciding if they require admission and further workup and talking with your seniors.  My biggest advice is take your time, be thorough and know your limits.  There is always someone to ask for help! 

Delegation

As you can probably imagine, your day as a junior surgical registrar is going to be very busy, so it is time to develop your delegation skills. There are clear roles and responsibilities in every team and when you are junior and inexperienced there is a tendency to rely on yourself to get everything done because then you know it is done! However, it is easier to achieve more and go further in life with a team, not alone. Learning to delegate to juniors is an important step in your career progression. By discussing and learning from your senior registrars and fellows you will start to identify key tasks that are more suitable for an intern or resident to manage (eg. discharge scripts and outpatient follow up plans, medication reviews, minor clinical reviews such as a stable patient wanting to discuss their pain medications etc.). This will leave you time to divert your attention to jobs more suitable for a registrar (eg. reviewing your patient who re-presents to the emergency department with a wound complication; or adding a patient to the emergency theatre booking system and consenting them for their procedure). Always remember to reiterate the importance of closed loop two-way communication with your junior team members.

Teaching

Suddenly you are part of the senior team members, even if you still feel junior yourself! The beautiful thing about medicine and its apprenticeship-like approach is that you are often simultaneously a student learning from senior registrars, fellows and consultants, and a teacher teaching your residents and interns. You will also vividly remember your first days and weeks as an intern and resident transitioning into a new unit so you are in a good place to give them a guiding hand. Teaching is an important role of a registrar, from all the little things such as how to assess a chest x-ray to all the bigger things such as showing your interns how to suture. Your team will function more efficiently when registrars train their interns and residents too.

Balance

It is easy to get caught up in the rat race of life and find each day blurring into the next, particularly working long hours as a registrar. The mental fatigue and physical energy expenditure required from you is enormous as a registrar while you are constantly learning and developing. It sounds cliché and every article seems to say it, but ensuring you carve out time in your world for exercise, rest and social play is essential. Take the time to recharge your batteries mentally and physically when you can, because there will no doubt be other times where work requires your time and energy. I really like the term “work-life blend,” because to me that captures the spirit that some days and weeks will be work heavy and other days and weeks will be life heavy. Just be sure to actively create the blend that satisfies you best!

Keep an eye on the prize

I want to say a final reminder to always keep one eye on the prize – successfully gaining a place on an accredited training program! No one else will do this for you, so remember to focus sufficient time on addressing the selection criteria. Some months you will be writing up research and abstract submissions for conferences, other months you will be working extra hard to impress your clinical referees. If you don’t keep any eye on the prize, each year will pass quickly and you will find your dreams slipping further and further away from you - don’t let this happen! 

I hope as you read this article that you see there is so much more to being a competent and safe surgical registrar than just operating. Operative skills will come with time and experience as you progress in your surgical training.  As a junior registrar what is easily within your power to improve on each day is the non-technical competencies that RACS also look for in their trainee selection process.  

Good luck on day one of being a registrar on February 1st 2021!