1. Acute medical care – supporting the acute take Dr Andrew Goddard Registrar Royal College of Physicians

3. +28% -23% -38%

5. The Medical Registrar

6. Medical Training Flows 2013 700 CMT Expected fate ST3 Expected source 700 390120 No training break 300 Training break ‘previous CMT at some point’ Non Medicine Training GP Other Leave Medicine 260 ‘Never CMT’ Predicted vacancy = 280 posts

8. Solutions - Workforce Increase number of CMTs to fill vacancies Divert funding from locums to training posts including LATs Expand MTI scheme

9. Solutions – Organisation of acute take Ensure adequate support teams – stop the scut! Employ specialist nurses and physician associates Involve medical specialties early Use intelligent rota design (blocks) Ensure H@N team adequate (2 registrars) Broaden access to the acute medical take……..

10. Solutions – Broaden access to acute take All doctors who have PACES and have completed CMT should have the competences to be a medical registrar 44% of these do not feel they are prepared to be a medical registrar Involving single specialty registrars needs careful planning and involvement of LETB/dean Specialty training must not suffer Participation for non-GIM registrars should be restricted to in the first 12-24 months

12. Workload Teamwork Interactions with other teams Training and supervision Recruitment and retention

13. Solutions - Workload There should be a named consultant physician who ‘champions the medical registrar’ There should be a hospital manager responsible for assessing the roles and responsibilities of the medical registrars Use the RCP ‘roles of the medical registrar’ Free up the medical registrar from non-priority jobs

14. Solutions – Interactions with other teams Clear mechanisms for referring patients under non- medical teams to medicine in and out of hours Set up ‘buddy’ arrangements between medical teams and surgical wards Clear definitions of which primary presenting complaints are admitted under which team Referrals should be made by adequately experienced staff

15. Solutions - Training Routine and regular – Consultants directly observing ward rounds lead by the registrar – Feedback of clinical outcomes to admitting registrar (e.g. discharge summaries) – One-to-one meetings with supervising consultant (not just specialty) – Attendance by registrar on post-take review of patients they have been involved with Formal procedural training easily available (including simulation)

16. Solutions - Other Chief resident Local Faculty Groups Inspirational leadership

17. References https://www.rcplondon.ac.uk/sites/default/files/future-medical- registrar_1.pdf https://www.rcplondon.ac.uk/sites/default/files/act8_registrars. pdf https://www.rcplondon.ac.uk/resources/supporting-acute-take- advice-nhs-trusts-and-local-health-board