Transitioning from resident to registrar in the ED – 6 top tips – By Claire Mitchell

There is no such thing as a perfect transition from resident to registrar. It is one of the scariest big jumps on the escalator (or treadmill) of medical career progression; a sudden leap in responsibility in which some thrive, and some flounder. Here are my 6 top tips to make it easier.

1. Be honest and humble. Whilst amazing that you have been deemed competent enough to step up, just remember your limits. You alone know your capabilities, and whilst stepping out of comfort zones is excellent for your growth as a doctor, it can put patients and careers at risk, so make sure you are well supported. Your boss should know what your comfort level is, be willing to support you with telephone or face to face advice, and help you debrief any issues in the morning after a night shift. Trust your ‘spidey sense’, feel free to say ‘I don’t know’, and seek help early.

2. Delegate. If you have been a diligent junior, this comes as a shock. It is not possible to do it all yourself. Relinquish some control and let little, non-dangerous mistakes be made. An intern getting a cannula in after a few attempts is much better for their confidence and future than you jumping in when they fail once. Giving an empathic second year doctor you trust the opportunity to break bad news to a patient with whom they have rapport, is far more valuable to them and may be better for the patient than you taking over. Fully clerking a simple right lower lobe pneumonia – badly – because you are short on time and the department is ramping, may take away the teaching opportunity for a resident who has never appreciated those clinical signs before. So delegate, let others learn, and take on a more supportive role.

3. Support your team. Suddenly you have residents, interns and students to supervise. Don’t let them have a bad moment and go to hide in the tea room all shift (it has happened to the best of us). Review their patients when able in order to build up trust (particularly whilst still learning to supervise), try to protect them from difficult referrals early on and don’t ask them to do a job you wouldn’t do yourself.

4. Look after your nursing and allied health colleagues. If you are liked, your life will be easier. If you listen to the nurses and address their concerns, the patients will be safer. Bring in snacks for the night shift, be a shoulder to cry on, or even give simple safe medical support to shift workers who are on nights and can’t get in to their GP. (More often than not that advice is: go and see your GP.) Catch up regularly with your nursing team leader on shift as they are your saving grace, and will let you know if one of your team is struggling before you notice it yourself.

5. Be ready for handover. Time keeping and prioritisation is a skill in emergency medicine. To a certain extent, we do get judged on how tidy the department is in the morning, no matter how much people deny it. Quite simply, stable patients waiting to be seen afresh come 8am, is preferable to many patients half baked, requiring repetition of work by the morning team. Give yourself enough time before handover to run through the list, make sure jobs are completed (using your delegation skills), and ensure you have thought about disposition plans for every patient. The huge benefit of doing this is that you will leave on time – essential for a career with high burn out.

6. Finally, look after yourself. Sleep, eat, exercise and enjoy life outside of work. Have a mentor and talk through challenges with them. It is an exciting transition with exponential learning and increased job satisfaction. In the trickier times, just remember why you chose emergency medicine in the first place; that adrenaline rush in resus, the team camaraderie, and the warm glow of genuinely helping those who need it most.

About Claire Mitchell