You’re Now A Paediatric Registrar: Step Up, Survive & Thrive 

You’re embarking on your first paediatric registrar rotation – welcome to this exciting next stage of your career, and congratulations on getting here! 

This article is not intended to be a set of step-by-step instructions but to give you some ideas to consider and some tips and tricks from first-time registrars who have recently gone through this transition. 

Basics

First things first. Paediatric training is demanding and it’s easy to get caught up with your new responsibilities and forget the little things which can make a huge difference to your wellbeing and ability to perform at your best. Don’t forget the essentials: 

1. Eat 
2. Hydrate +/- caffeinate
3. Exercise
4. Unwind
5. Sleep

It’s not rocket science, but it’s shocking how many of us forget! Looking after yourself is a non-negotiable and something we must all prioritise so that we can also look after little people! 

What puts a pep in your step? –  Is it cycling?  Writing? Spending time with family and friends? Whatever the answer is – make sure you schedule it in. The simple pleasures can boost morale and give your mind and body that much needed rest and reset.  

Explore your environment:

Have you familiarised yourself with the practical things that can make your first shift go that little bit smoother? Don’t be afraid to ask the simple questions:

1. Where do I document? Where do I prescribe? Where do I place orders for investigations? – and most importantly do I have access? 
2. Where is the procedure room and all relevant equipment stored? 
3. Where is resus for the little people? 
4. Where are the nearest crash trolleys located? 
5. Where and how do I run a blood gas? 
6. How do I use the bleep/ SmartApp communication system? 
7. What are the local referral systems in place?
8. Are there distinctive sub-specialty referral pathways for your area e.g. liver, burns, surgery, neurosurgery etc. 
9. What is the escalation/retrieval pathway?  
10. Most importantly – where is the nearest loo? Where is the staff room? 

Luck of the draw [or maybe you’re a known s*** magnet] can mean that you’re thrown into a baptism of fire where your first shift is an understaffed on-call with a very unwell patient, and awareness of some of these basics can make you feel a tiny bit more in control! 

Talk to your team

A no-brainer, but make the effort to introduce yourself and to get to know everyone on your team! Generally speaking, paediatricians are quite good at this, but the benefits of a supportive and collaborative working environment cannot be underestimated! 

Crucial colleagues to befriend: 

Consultant

Touching base with your consultant at the start of your shift is always a good idea. Tell them what you’re comfortable doing, and more importantly tell them what you’re less comfortable doing. Highlight anything you’re worried about and anything you’d like support with. Clarify how best to get in contact with them, should you need them! Consultants remember how daunting it was transitioning from SHO to registrar and are there to support us through the process. They do not expect you to know the answer to every dilemma – just be safe in your practice and escalate if concerned. 

SHOs / Residents

Yesterday, you were an SHO, and today, you are a registrar; always support your SHOs! Identify their learning needs – what are they comfortable with and what do they want support with? Have they done heel-pricks before? Have they been to deliveries before? Where appropriate, empower them to have autonomy and increase their confidence in making decisions. Again, it seems so obvious but ensuring your team feels trusted and supported can make the shift so much more enjoyable for everyone! 

Nurse in Charge (NIC)

Some would argue that this is the most important working relationship for a smooth sailing shift. Your NIC is a vital link between the medical and nursing team and good communication between the two is key. Checking in with the NIC at the start and throughout a shift is great for flagging any unwell patients, along with discussing admissions/ discharges/ transfers. They have a wealth of experience and are often an excellent “phone a friend” option overnight when you feel stuck. 

Nursing and HCA Team

They will be the first to notice if anything is wrong with a patient. Introducing yourself to them can mean that they are more comfortable in escalating any concerns they have. Be aware that each shift will have a different mix of team members with varying levels of experience. Make sure you clearly communicate your plans and thresholds for escalation. Top tip: verbally communicating your plan followed by clear documentation can help avoid confusion! 

Play team

We have all experienced trying to put cannulas into very unhappy children. Knowing where the play team is and getting them involved in procedures that you anticipate may be challenging can make the patient and family experience much more pleasant and save you time, too. 

Everyone else

We will all end up working shifts in different areas, where we will meet a huge variety of people. We will get to know them, learn from each other, and try to have some fun along the way. 

Nuggets of advice

• Sometimes knowing when and who to ask for help is just as good as knowing the answer yourself.
• Finding the right balance between being supportive and micro-managing can make or break the SHO’s learning experience.
• Create a psychologically safe environment where everyone feels that their input is valued, but they also feel comfortable in escalating and asking for help when needed. 
• Offering your colleagues a cup of tea and a biscuit is appreciated more than you will ever know! 
• Be proactive in making sure everyone gets a break. A well-rested team is a safe and productive one. Ever heard of a WOCL? It’s your window of circadian low (typically 0200 – 0500 on a night shift) where your sleepy levels are high and your performance levels are low. The aviation industry incorporates it into planning strategic rest times to maximise performance and optimise safety! 
• Think about starting a book club/ run club to encourage team bonding outside of work or even just breakfast after a stretch of nights.

Reach for those resources:

Nobody expects you to suddenly remember every guideline or every drug dose off the top of your head! Everyone will have their own preferences, but these are some which can make your shift a whole lot easier: 

1. Guidelines – ones specific to your Trust and also regional/ national guidelines used more widely. Familiarising yourself with these before a shift and having quick access to them can make a shift much more efficient. Try and have offline copies on your phone, so that you don’t have to worry about signal in the middle of an emergency.
2. There’s an app for everything these days. Popular paediatric ones include: Neomate, BiliApp, PICU Tools, BNFc, Toxbase, GrowthApp
3. Ask a friend – whether it’s your consultant or your NIC, two heads are better than one and if in doubt there are always people to ask.

There’s a wealth of resources available to you. Website? Trusted Colleague? A toastie from Costa? – find what works for you. Most importantly make sure it’s from a reliable and reputable source. 

Handover highlights:

We all know that paediatric handovers can sometimes go on for far too long, but headlines to pay attention to are: 

1. Unwell patients 
2. Senior reviews 
3. Escalation plans 
4. Safeguarding concerns
5. Bed capacity 
6. Planned admissions/ discharges/ transfers 

Skills to master:

Stepping onto the registrar rota seems daunting but with time, these are some skills which you can expect to improve with every shift: 

1. Leadership/ Management –Although this may feel slightly out of your comfort zone, it’s best learned by doing and gets easier with time. Top tip: as cringey as it can be, try to take the lead in settings such as simulation teaching to build up confidence in a safe environment. Other good opportunities are rota coordination, trust representative, medical education lead etc to build these skills further in a non-clinical setting. 
2. Teamwork – being a good team leader also means being a good team player. This is something that we all have experience in. Try to remain flexible based on the skillset of your team. Mutual respect, communication, and willingness to learn from one another can greatly enrich your experience along with patient outcomes. Sometimes the best ideas come from your junior colleagues who can offer a different perspective. 
3. Delegation – this is a new one which might be tricky at first. Remember to always check the skillset/ ability/ confidence level of who you are delegating to but sharing the workload is key to efficiency! 
4. Self-Awareness – arguably one of the most important skills as a new registrar. Nobody is expecting you to be the fount of all knowledge overnight. It’s okay to not know everything! Never forget that you are part of a team and there is always a consultant, a guideline or an experienced nursing colleague who can help you figure it out. Embrace the learning curve and amongst the chaos, try to learn something new every shift. Maybe it’s a guideline, maybe it’s a syndrome you’ve never heard of before, or maybe it’s how a colleague handled a challenging parent – whatever it is, try to learn from it. It all enriches your experience. 
5. Communication – in your new role, you will be thrown into a range of sticky situations and conversations. Perhaps it’s a Duty of Candour discussion after a medication error, perhaps it’s breaking bad news to a family, or perhaps it’s communicating diagnostic uncertainty to a family. Before you throw yourself into these conversations, make sure you have a good grasp of the events/information/results and a game plan to hand. 
6. Build time for reflection. This can take different forms for different people. There can be a fine line between reflection and overthinking; if you feel yourself stepping over this line, it can be helpful to reflect with a colleague or a friend. Celebrate the little wins and recognise all the great things you do! 

And now what happens?

It’s go time, enjoy the ride! There will be days that are tough and days that are great – embrace it all and remember to be patient with yourself. Challenge the imposter syndrome – it may feel like you are a child who has suddenly thrown on a doctor’s outfit but you have worked hard to get here! 

Remember you are not alone – find a buddy to chat with/ rant to / debrief with. 

If at any point it all feels too much, remember you have an educational/ clinical supervisor who is there to support you. 

Other additional support lines should you need them: 

1. BMA Counselling service (0330 123 1245): Free and confidential 24/7 telephone peer support and counselling available to all doctors and medical students.
2. Practitioner Health Programme (0300 0303 300): Free, confidential expertise in treating health and care professionals suffering with mental health or addiction. 
3. Occupational Health

Wise words from those who have been there: 

 “Trust your gut” 

“Don’t forget to eat and hydrate”

“It doesn’t happen overnight but one step at a time” 

“Celebrate the little wins”

“Support your colleagues and let your colleagues support you” 

“Seek regular feedback and always remain professionally curious”

“Talk to your colleagues, you are not on this journey alone”

“Never be ashamed of asking for help” 

“Enjoy the ride” 

What did you wish you knew before stepping up? Let us know in the comments.