Dr Josephine Quaynor, Dr Kingsley Ezinmor, Dr Rachel Yew

Wow, that came fast!

Yesterday, you were the SHO and today, you are starting your first paediatric registrar post. Congratulations on achieving this huge milestone!!!

As first-time registrars, we all felt those scary moments and thoughts of not being prepared enough for the job. But don’t worry, we’ve summarised our experiences into some top tips to help smooth your journey into registrar life – here are our ‘C-codes to Ace your First Registrar Job’

CHOOSE your approach

Planning your day starts from home. Always check your rota ahead of time to know what area of the shop floor you are covering so you can mentally prepare yourself and do some quick reads if needed prior to arrival. Every hero needs a game plan!

During the handover (especially on night shifts) remember to:

• Identify the sickest patients and familiarise yourself with any additional inputs such as individualised care plans, escalation thresholds and management, retrieval plans etc.
• Know your nursing staff and bed capacity to help plan, prioritise your admissions and transfer decisions. This is particularly handy in busy District General Hospitals (DGH) especially during winter night shifts.

Get COMFORTABLE with the Shop floor

Have you ever started a job where you had two days of overwhelming induction then started off on a night shift with a really sick child?

Situations like this would be nerve-racking for anyone – having a bit of knowledge of the little things (like the door code of the treatment room, sample-pod systems, where the blood gas machine is and how it works, etc) can make things much easier.

Being comfortable with the local communication system such as bleeps and extension numbers (and knowing how your consultant likes to be contacted – especially out of hours) will help you feel prepared.

Download the Induction App to easily get extension numbers and contacts of different departments in your local trust.

Be CONSCIOUS of your Team

Introductions at the start of every shift are always a good ice-breaker. From the lens of the #hellomynameis campaign, ‘Introductions are ways of establishing human connection between two people’.

Some tips for team building include:

• Making the effort to know the names of your team members during the shift.
• Being aware of the skill sets and abilities of various team members especially for task delegation.
• Being proactive with team breaks and looking out for your team members – especially during a night shift. Regular check-ins can help them feel supported, as well as keeping you ahead of any issues that might be developing.

Trust me, tasty chocolates and candies for nibbles always creates your dream team!!

Be CLUED-UP on your TOOLS (ApGAR)

Like everything else in life, it’s about working smart and not necessarily over working yourself. Just like the neonatal ApGAR score is ingrained in your memory – here are some things you should never be without:

Apps: PICU Tools, BNF, TOXBASE, Paediatric Emergencies App, MDCalc, Neomate, Bilimate, Growth App etc.

Guidelines: Regional or Local Trust policies, National guidelines (BSPED, NICE etc). Starship guideline comes in handy in some situations.

Assessment tools: stethoscope, ENT trolley set, pen torch, tendon hammer.

Referral pathways: Knowledge of Regional and Local subspecialty referral pathways will definitely save you some switchboard hassle especially in a DGH. For instance, DGH surgeons may not deal with children under 5 years.

Also, make sure you’re familiar with the in-patient, out-patient and community referral system for your local trust. There may also be some unique regional sub-specialty referral portals or direct lines (Burns and Neurosurgery) and regional retrieval pathways for emergency situations.

COMPREHEND the dynamics of MULTIDISCIPLINARY TEAM (MDT)

As a registrar in your first post, you will be working within and between many different teams to optimise patient care. Learning to effectively communicate with the ward nurses, clinical specialist nurses and other allied health professionals like pharmacists and physiotherapists are all parts and parcel of the routine day in the life of a paediatric registrar.

We strongly advise seizing the opportunity to sit in discharge planning meetings, strategy meetings for children with social concerns, and peer review meetings. These will help you get a rounded view of the workings of the multidisciplinary team, and will gear you towards being an effective leader.

COMMUNICATION is key

Remember being the SHO in that difficult parental conversation, hanging in there whilst awaiting the registrar to come to the rescue? Congratulations, you just became someone’s rescue plan! (of course, there is still always help available!)

As the Paediatric registrar, you’ll be involved in all sorts of communications scenarios which will challenge your clinical and non-clinical skills. Each situation is unique – as are you – and these years are when you start to develop your own personalised strategy for approaching any tricky situation.

Some helpful tips:

• Sit in with more experienced senior colleagues when they have those conversations to get some nuggets for a rainy day.
• Always arm yourself with the full picture of events before jumping into any communication situation and take someone with you.
• Attend communication courses for some useful approaches to particularly sensitive scenarios. Child bereavement courses, human factors training and debriefing courses are incredibly useful for practicing in a no-pressure environment.
• Don’t forget good old simulation training, which can hone your non-clinical skills such as closed-loop communication, mental-model sharing etc.

CLINCH moments of bite-size learning

Paediatrics is busy; with bleeps constantly going off and lots of people demanding your attention at the same time, it easy to just get caught up in the motion. However, its essential to keep expanding your knowledge base and this means you need to learn to ‘learn-on-the-go’.

Every patient and every discussion is a bite-size learning opportunity. Whether it’s refreshing your memory on disease pathophysiology, drug pharmacology, local guideline, etc. At every ward round, just pick one specific thing about a condition and briefly read about it. In the long run, this helps your confidence as the registrar.

As the old saying goes, ‘Little drops of water, makes a mighty ocean’.

CATCH opportunities for leadership and research

As a registrar, you will have other colleagues looking up to you and even more so in your first post. Good leadership and management skills are fundamental.

Take advantage of leadership and management opportunities such as rota coordination for clinical staff or medical education, leading grand rounds or simulation sessions, and organising local and regional junior doctor’s forum.

For people with no prior leadership experience, the Edward Jenner programme is a good place to start. .

Don’t hesitate to introduce new ideas and quality improvement initiatives that you might have seen working in other trusts. Some trusts also have hybrid roles to provide registrars with protected time to engage in leadership, management and quality improvement projects whilst undertaking clinical roles. Ask around to see what’s available in your deanery.

Be COGNISANT of your limitations

You may not be perfect with procedures, be able to identify every rash or explain unusual findings on new-born checks; even though you might feel like you should, nobody expects you to know it all! Remember that you are part of a team, and ‘success’ does not rest all on you as an individual.

Self-awareness is a crucial skill to develop alongside your personal ‘escalation plan’ for when things don’t go as planned.

It helps to have an understanding of how and why you react in certain ways, or find certain things challenging. There are loads of tools and articles on self-awareness and personality types. A good start would be doing the Meyers-Briggs Personality tool and the Johari window.

CREATE moments for well-being

One of the recurring themes when you speak to registrars about their first post was creating time to de-stress. Most will be aware of the ‘stress bucket’ model. Identifying your stressors and putting things in place to lower them reduces the threshold in your stress bucket and lowers your risk of burn-out and errors.

Do fun stuff with the people you love, be it colouring with your toddler, practising mindfulness, reading that bestseller novel, baking a cake with a friend or playing table tennis at the local club. Anything that keeps you rejuvenated to kick start another week. Another useful tip is having “rant partner” which could be a trusted colleague, friend, relative you can talk to about the stressful parts of your week and can provide a listening ear as you pour it all out.

These tips are just a guide and not a rule book. However, we’re confident that they will help ease your transition into the Reg Life.

Remember that the Reg life is a marathon and not a sprint.

Be kind to yourself, take it one step at a time, and know your C-codes; You will ace it!

What tips would you add to the list? Comment below!