A Day in the life of a GP Registrar

The GP registrar year is a qualitative step up from the first two training years in terms of responsibility and scope. It should feel very different to any previous training job, even when compared to your GP post in ST1 or 2. The year should be informed by the RCGP curriculum but the individual trainee’s learning needs should be considered throughout.

The ‘timeline’ (see separate link) should, where applicable, be interpreted with a degree of flexibility. One size doesn’t necessarily fit all!

The aim of the post is to continue to cover the curriculum, thereby supporting the doctor through the transition from a trainee – seeingsupervised lists of patients – to a qualified GP, practicing in a fully autonomous capacity by the end of the year.

The year will start with an induction program (see separate link), the content of which should be informed by prior discussion with your trainer to be. Whether it includes sitting in with the practice nurse, joining the district nurse on visits, doing a day ‘on reception’ will to an extent depend on your experiences to that point, and the vagaries of your training practice. If you are unfamiliar with the computer system in use at your practice, an introduction to this will be covered. The first couple of weeks are a critical time in terms of getting to know the practice administration and allied health staff; first impressions stick so be friendly, and work hard at remembering names!

After your induction period, you will begin surgeries, normally seeing patients at 20-30 minute intervals, though this will speed up as the year progresses. A full time registrar will typically work for 7 clinical sessions a week, with 2 set-aside for the DRC most weeks, and one for private study. The last can be used in any educational capacity, as agreed with your trainer. The full time trainee will often be the only member of the practice team there for 4 or 5 days a week and therefore should become an integral part of the team fairly quickly!

The DRC

The DRC continues in the theme of that encountered at ST1/2, with morning small group work and afternoon lecture based teaching. The increased frequency often adds to the intimacy and depth of the small group work. Two overnight events add to the bond that develops amongst the trainees and program directors. The first focuses on communication skills and later in the year a session on management issues aims to set up the nearly qualified trainee for the realities of life post qualification. More on the DRC is available elsewhere on the site.

The Tutorial

The tutorial is an essential and integral part of the registrar year and is covered in a separate link.

Practice Meetings

The number of practice meetings a registrar attends is somewhat at the discretion of the GP partners, but as a general rule, exposure during the year should be adequate to give you a good feel for how the management side of primary care operates. The agenda can vary from clinical matters to QOF targets to staff issues. The meetings may be the only opportunity to experience this important aspect of primary care before you’re a partner yourself, so consider discussing the situation with your trainer if you are not invited with any frequency.

My Tips for the Registrar Year

Get to know all the practice staff, names and roles as soon as possible. A ‘mug shot’ of staff may be available from the practice manager.

Find out whom of the clinical staff have special interests or are local clinical leads – they’re good people to tap into before contacting a specialist about a particular problem

Make use of joint surgeries or video surgeries – useful for picking up bad habits, mannerisms etc, even if it’s very uncomfortable to start with!

The trainee/trainer relationship can be quite intense and character clashes are recognized and only infrequently are anyone’s ‘fault’. If you realize the relationship is persistently less than ideal, discuss it with your trainer, or if this is uncomfortable, with the programme directors.

The Tutorial

The weekly tutorial with your GP trainer aims to provide a protected, structured opportunity to cover the curriculum, ensure your PDP is being maintained, and address any learning needs you or your trainer think are important. There are as many different formats to the tutorial as there are training practices, and the format adopted will of course depend on the learning and teaching styles of you, the trainee, and your trainer respectively, as well as the results of your initial learning needs assessment.

Most tutorials take place at the surgery, in protected teaching time, and tend to take about an hour. Avoid using tutorial time to complete WPBAs if at all possible. The tutorial is a learning, not an assessment opportunity There is no list – at present – of core tutorials, but most trainers will have a few topics he or she will want to discuss, especially earlier on in the year. As your confidence and awareness of your strengths and weaknesses increase, you may wish to have greater input into suggesting the tutorial topics.

Tutorials tend to fall into one of five categories:

  • The Consultation;e.g. models of consulting, problem patients
  • Management Issues; e.g. complaints, significant events, sickness certification
  • Professional development; e.g. appraisal, audit
  • Clinical topics
  • IT; e.g. reputable sources of information on line, using your practice software effectively

A few tips:

  • Try and get hold of an up to date copy of the topics to be covered at the day release course and avoid covering these in tutorials.
  • If any of the other practice doctors have an area of particular interest, don’t be afraid to ask if they’ll give you a tutorial on this.
  • If you’re ever at a loss as to what to discuss, a random case analysis – basically reviewing a series of patients you’ve recently seen – can be very useful in identifying those unknown unknowns!

Make all efforts to meet and discuss the year ahead with your trainer, if you have not already met him or her. A discussion about the induction is especially valuable.

The CSA – a Trainee’s Perspective

There is some evidence from the RCGP that sitting the CSA at the latest possible opportunity (i.e. May of the ST3 year) yields the best results, but the general consensus amongst my peers was that the Jan/Feb sitting provided the best balance of experience with a ‘second chance’ later in the year if the candidate had a shocker on the day!

With an exam that costs the same as a decent second car, you’ll want to minimise your chances of being one of the minority that fails. My top ten tips –

  1. Book your exam session well in advance as the more popular sessions fill rapidly.
  2. Start practicing early! Perhaps 3 months before the exam date, so that by D-Day you’re super confident.
  3. Practice in groups. You can’t ‘revise’ for this exam on your own! Although very few people enjoy role-playing, the quicker you get into the swing of it the quicker you’ll get used to it. It’s not that bad, particularly if you…
  4. …Set some ground rules. Start and finish times for the sessions, constructive feedback only, and limited time to role-play and then discuss each case.
  5. Use the Wessex case cards. They’re good at the end of a group session when everyone’s role-played out. Buy them second hand, or split the costs between you to keep the price down.
  6. Read the feedback on the RCGP website– it highlights the areas where candidates are weakest.
  7. Get at least one book of cases between you, preferably more. True, they’re all less than keenly priced but they hold their value reasonably well. MRCGP Practice Cases: Clinical Skills Assessment by Raj Thakar is pretty good.
  8. Get your hands on a registrar or newly qualified GP who’s been through the exam and ask them to talk through the revision process and perhaps facilitate your first group session.
  9. Scrutinize with due care and attention the ‘information for candidates’ section on the RCGP website, particularly when you need to be at the exam centre, and what you need to bring. People have been turned away because they forgot their relevant I.D - you have been warned!
  10. Treat the actual exam as you would a real-life surgery – be realistic about what you can offer patients. And when, inevitably, a case goes less than perfectly, try not to panic, you’re allowed to fail up to four cases.

Good luck!!