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Bruno Rushforth on the roles we play

2 Feb, 09 | by BMJ Group

Bruno Rushforth It’s amazing how quickly one adapts. The first couple of days were a bit of a shock, but I soon accepted my fate and – rather worryingly – began to take on the role of the underling almost willingly.

I remember how the same thing happened when I’d started medical school. Having worked prior to medicine and thereby developed an identity and self-image as an independent “productive” citizen, it took a while to readjust to the role and expectations of being a student – being herded around and talked down to with depressing regularity.

And now here I was again. After a year as a GP registrar, with a fair amount of autonomy and self-reliance, and after six months of psychiatry, again with one’s own clinics and arm’s-length supervision, I was back in acute hospital medicine as a lowly junior.

Great.

At times it was like you weren’t even there, simply the odd request for a blood result or a telling off as the discharge summaries piled up. And with twice daily consultant ward rounds and omnipresent registrars, there was little encouragement to make any decisions for yourself.

It’s soon apparent that in the parallel world of paediatrics the hierarchy is shifted down one, such that the consultants act more like hands-on registrars, at times clerking patients and even taking blood; the registrars are the “SHOs,” running the acute admissions ward and coordinating the troops; and the “SHOs” are effectively the house officers, trailing behind on the ward round, notes flying as one arches to be involved as the seniors discuss patient management.

We mustn’t forget that – most importantly – this is great for patients: they have regular senior input and review. Indeed, one can’t help but think that this model will gradually spread across other specialties with patient safety issues gaining prominence and juniors’ working hours falling.

And there’s also something liberating at being relieved of responsibility, both as a junior and as a student. Starting medical school aged 27, I remember regressing to an unshaven, jeans and t-shirt clad, moody student demeanor, much to my wife’s amusement.

But there is a cost to all this: we need to encourage juniors to take on responsibility, appropriately supervised, or else we risk a generation of doctors obtaining their Certificate of Completion of Training (CCT) with limited clinical decision making experience.

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  • Matiram Pun

    Dear Bruno,

    Yes exactly!!!

    Me too had similar mixed ideas on stepping into house officer job from completing my medical school and internship. Much of the fun was there when many of the staff, nurses and attendants thought me as intern or still a medical student! This is because I joined the same university hospital where I was trained and completed just a month ago!!!

    The postgraduate students do exactly same work as your SHOs are doing. Therefore, I get some kind of supervised or feedback on the cases I consult or refer them if they are not that mild which I manage and sent back to home from Emergency section.

    Giving full authority to lead, manage and consult the cases with careful supervision is great! I love that.

    It is good training as well.

    Best wishes,
    mati

  • Udoka Onyeaso

    Bruno,
    As one of those omnipresent, lurking with intent paediatric registrars I know exactly what you mean. However, the defence for this is that paediatrics is quite specialised and newcomers to the speciality often don’t recognise that.
    Procedures are also a bit more tricky and support if not supervision is often necessary.
    As you settle in and demonstrate competency, you will be allowed more autonomy.
    Enjoy the 6 months,
    Udoka.

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