Talking Rheumatology
Talking Rheumatology
Ep 26. INNOVATORS - Leading transformation as a Chief Registrar
In this episode of our Innovators mini-series, Amanda Mootoo, Mariam Malik and Nick Sands join Lizzy MacPhie to explore the role of a Chief Registrar.
Whether you're a trainee interested in the Chief Registrar role and how it gives unique access to leadership and management training and experience, or if you are a member of a senior management team wondering how your Trust could benefit from having a Chief Registrar in post, this episode will provide you with a whole collection of ideas and insights.
Want to find out more? Explore these further resources:
RCP Chief Registrar programme
Chief Registrar yearbook 2022-23
BSR members may also like to check out the Quality Improvement Spotlight on the e-learning platform.
If you have an example of innovative practice in rheumatology, contact us at bsr@rheumatology.org.uk with the subject line "Innovators podcast".
Thanks for listening to Talking Rheumatology! Join the conversation on X using #TalkingRheum or tweet us @RheumatologyUK.
BSR is the UK's leading specialist medical society for rheumatology and MSK health professionals. To discover how we can support you in delivering the best care for your patients, visit our website.
Lizzy MacPhie 0:08
This week I'm talking to a rheumatology registrar who is just coming to the end of a year as a chief registrar and a consultant rheumatologist who also held the role. A couple of years ago, as well as a chief registrar, recruiter and mentor. So, welcome. We're going to do a quick fire round just to get to know you and to get to know our guests. So Amanda, Mariam and Nick, welcome to this podcast and thanks for joining me to chat through your roles.
Coming to Amanda first, what's your current job role and organisation and how long have you worked in rheumatology?
Amanda Mootoo 0:50
I recently completed the chief registrar job at the Royal Surrey Hospital in Guildford and recently started ST7 Rheumatology at Kingston Hospital. I've been in rheumatology since 2017.
Lizzy MacPhie 1:06
And coming to you next, Mariam.
Mariam Malik 1:09
Thank you, Lizzy. I'm a rheumatology consultant at Hampshire Hospital Foundation Trust, and I've been a consultant in rheumatology for just over a year before that I was a specialist trainee in Wessex region for about 5 years. And before that I worked as an SHO in rheumatology for a bit. So I think seven years or so, something like that.
Lizzy MacPhie 1:26
And Nick, how long have you worked in your organisation?
Nick Sands 1:30
I'm Nick, Director for Transformation and Digital at Royal Surrey. I've been doing my current role for just under five years.
Lizzy MacPhie 1:38
Great. I'm really keen to know whether you have a particular interest. Amanda?
Amanda Mootoo 1:48
So I think I would say I'm quite interested in musculoskeletal ultrasound. I had the opportunity of doing a fellowship in Lisbon last year for three months and really got to explore that, really. So, yeah, I'd say musculoskeletal ultrasound and inflammatory arthritis is my particular interest.
Lizzy MacPhie 2:05
Good stuff. And Mariam, how about yourself?
Mariam Malik 2:09
I love my field, honestly, so I just enjoy seeing the variety of conditions we see in rheumatology. I do have particular interest in the complex connected tissue disease patients that we see and I've done some work on biologics as well. So I find it really exciting when new treatments come in and things.
Lizzy MacPhie 2:26
We are constantly kept on our toes each year with a raft of new drugs, aren't we? So and Nick, how about yourself? Any particular interest?
Nick Sands 2:35
Well, I'm actually an engineer by background, so I've got an interest in woodworking.
Lizzy MacPhie 2:40
Right. Ah ha! You'd be the Orthopaedics of rheumatology!
Nick Sands 2:44
Something like that.
Lizzy MacPhie 2:47
OK, a bit of a bit of fun now, so I'm keen to know what your favourite joint is. So, Amanda?
Amanda Mootoo 2:57
I think I'm going to go with knee and maybe fifth MTP. I think the knee is interesting. Lots of structures in the knee, it can, , carry a lot of fluid and the 5th MTP because you can check for erosions there on ultrasound.
Lizzy MacPhie 3:13
I’ve found, with a few ultrasonographers, they really enjoy the joints that they can have a good look at and see those interesting findings and there's nothing more satisfying than getting a load of fluid off a knee - very satisfying. So, Mariam, how about yourself?
Mariam Malik 3:30
Favourite joint - if you're talking about anatomy, I like the knee. Nice and simple. But for injecting, for some odd reason, I like injecting shoulders. Can't tell you why, but yeah.
Lizzy MacPhie 3:41
Why not? Now, Nick, I think we might be going a bit off-piste with you.
Nick Sands 3:47
So, yeah, my favourite joint - the perfection of a dovetail joint is fantastic.
Lizzy MacPhie 3:54
I had a funny feeling when you said you, “your woodworking”.
Amanda, coming back to yourself, what was the best thing you were taught in training?
Amanda Mootoo 4:06
I think, there's obviously been lots of things over the years, but, I would say putting yourself in situations and seeking opportunities that allow you to grow.
Challenge yourself and develop in different ways, and, I think, I've hopefully tried to do that over the years. And I would share that with others because I think that's really helpful.
Lizzy MacPhie 4:27
Great tip. Mariam, how about yourself?
Mariam Malik 4:31
At the start of my SPR training, my programme director actually said to me, “use this time as an opportunity to learn, as what you see in these years will remain with you forever”. And I find that absolutely true. Sometimes I think about cases, I can see the patients, I can picture it all. It stays with you. It does. I think that's really important. I just learned stuff that has stayed with me.
Lizzy MacPhie 4:56
Great advice, great advice. Nick, how about yourself?
Nick Sands 5:20
So in engineering terms: to have function over form.
Lizzy MacPhie 5:27
You like your short, sharp answers.
Great. So I'm really keen now to get on to learning a little bit more about the chief registrar role. So, what inspired you to take on the role of chief registrar, Amanda? I'll put that to you first.
Amanda Mootoo 5:46
I think before going into…I completed ST6, I took a year out after that and did some travelling, and then I went into the chief registrar role. So before I went into ST7, I did the chief registrar job, and I felt that I really wanted to explore the leadership and management avenue to see if this was an area that I'd be interested in that I could develop and maybe pursue in the future. And I was hearing consulting colleagues around me saying that when they became consultants it was assumed or expected that they would just have the skill sets of leadership qualities and, actually, in reality, it is quite challenging.
And we have limited time and training to be able to explore these things because you're balancing general medicine, rheumatology and life, really. So, I decided to embark on the chief registrar programme. The chief registrar programme is a senior leadership programme and it's aimed at registrars in specialty training. So you're essentially employed by an NHS organisation and it's usually a 12 month employment role where you have protected time to do leadership, quality improvement activities, connect with senior leaders, attend board meetings and take part in Trust-level projects.
The role is split more or less 50:50, depending on where you work, between the chief registrar activities and the clinical activities. I was fortunate in my case I did more-or-less 60% chief registrar and 40% clinical work.
The RCP have developed this programme and it's delivered over 10 months of the year and you attend either for face to face or online modules and the modules are focused around team culture development, change management, leadership approaches and reflecting on your own style. I decided to do my chief year out of programmes that I did this in OOPT so I could really focus on the chief registrar role.
So that's a summary of why I decided to do it.
Lizzy MacPhie 7:55
Goodness, I had quite realised that there was this structured component to it as well. Sounds fantastic. And how about yourself, Mariam? What inspired you to take on the role of chief registrar?
Mariam Malik 8:06
So I was ST6 when I applied for this role – so basically second-to-last year in my training. So I applied for this Wessex chief registrar role. I think it was it was the right time. I felt fairly confident in my clinical abilities and I felt it was the right time to explore the management and leadership side. A role also came up in the Trust and I'd had interaction with some of my colleagues and friends in the region who worked as chief registrars, and I found their journey really inspiring and I felt that I wanted to experience the role myself. So, good examples in the region, to be honest.
Lizzy MacPhie 8:40
And people encouraging you to take it on, by the sounds of it, as well.
Mariam Malik 8:43
Definitely. I was very lucky.
Lizzy MacPhie 8:46
I'm really keen to hear about the quality improvement aspects so, to each of you, can you describe an example of a quality improvement project you led while in post as a chief registrar? Amanda? How about yourself?
Amanda Mootoo 9:01
So I took part in many projects over the year and it really depends on what you want to get out from the year as a chief registrar, really. And I really wanted to look into what happens behind the scenes in management and get stuck in on the Trust level projects. So one of the projects that I was particularly proud of is that I designed and led on the development of a QI and audit tracker for the Trust. So, when I started, I found that great audits and quality improvement projects were happening across the Trust. Overall, there was a lack of visibility, shared learning and recognition of the hard work and often duplication of projects when junior doctors rotate every year. So I worked with the transformation team, audit team and scientific computing team and Nick was my mentor and basically we developed a web-based application whereby all the audits and projects across the Trust have been registered onto this tracker. But everybody in the Trust would also be able to track everyone's progress on these projects, download any supporting documents, i.e., an abstract or poster.
Collaborate with others and work on projects that you might be interested in with other people, but also to share the learning in that way so that was one of the main projects that I was particularly involved with.
Lizzy MacPhie 10:19
Great. And, Mariam, how about how about yourself? Can you describe a project you were involved in?
Mariam Malik 10:25
I got to do a few quality improvement projects, but the one closest to my heart is a project I did for the international medical graduates. So, in my hospital I got details of the doctors who are new to the NHS and had graduated in universities outside the UK. I met them. I spoke to them about their experience and I carried out a survey which I eventually presented in a meeting with the senior management colleagues and I spoke to the Director of Medical Education on improving the experience of the international medical graduates in the NHS and basically looking at improving ways to make sure that they get a thorough induction when they start their work in the NHS, shadowing when appropriate. Access to clinical and educational supervisors, access to the appropriate e-portfolio for their working level and in more involvement in projects and audits and presentations, publications and access to teaching, not only attending teaching, but also, experience in teaching as well. I felt this was close to my heart, probably because I was an international medical graduate when I started in the NHS in 2012, I think.
Lizzy MacPhie 11:41
It sounds like you're both speaking with passion about those projects and that, probably, wider learning across lots of teams as well.
So I'm keen to understand how you involve the multidisciplinary team and patients in your project. So, Amanda, are you able to reflect on that?
Amanda Mootoo 12:03
So. with the project I was just talking about, it's involved working with non clinical staff quite a bit in senior management to basically share the vision and also working with the software development team which I've never done before, really. The aim was to produce a product that would be helpful for staff across the Trust to be able to engage with and use. I think I found it really beneficial working with team members that I'd never really ever worked with before. And I learned a lot from them.
Lizzy MacPhie 12:35
And Mariam, yourself?
Mariam Malik 12:37
In this particular project, patients weren't involved in this one, but I did involve the HR team, the doctors in the Trust, the medical education team, including the director herself, and the senior management colleagues.
Lizzy MacPhie 12:54
So lots of interaction with people at different levels as well. What impact has your project had on your organisation? Coming to you first, Amanda?
Amanda Mootoo 13:06
So the tracker was about to be launched before I left, and the QI and audit tracker, essentially, would enable shared learning and collaboration between different teams. So, you can have a look at what other people are working on. But as past the tracker what we also did was introduced a new Trust-level certification, called “QI and audit, making a difference” certificate. And this is for anybody that registered their projects and uploaded a supporting document onto the tracker just to celebrate their hard work.
Every junior doctor at every hospital works on a QI and an audit, so, actually being recognised for their hard work was a great thing that we were able to incorporate into this particular project. And we also had a feature on it called Project Idea where particularly consultants can log a project idea and a junior doctor can say that that's actually a great inspiration, and I'll take that idea. Hopefully it will encourage more people to do projects and improvement work across the Trust.
Lizzy MacPhie 14:04
And it sounds like not everyone's got to come up with an idea themselves. They can go and look and see what's on there. It sounds great. Mariam, how about yourself? What impact has your project had on the organisation?
Mariam Malik 14:17
This project improved the experience of international medical graduates in the NHS and allowed the management team to understand the issues or maybe the experience that they had and appropriate steps were put in place for better support of doctors who were new to the NHS. The Director of Medical Education in the Trust was very kind, actually. And she had one-to-one meetings with these new doctors. And we also arranged an IMG conference in the region, which was a success. And we got great feedback.
Lizzy MacPhie 14:45
Fantastic. So Nick, I mean we've heard from Amanda and Mariam about the projects, but I realise these roles don't exist without support from above. So I'm really keen to hear your reflections, what inspired you to recruit and mentor a chief registrar.
Nick Sands 15:03
It's probably helpful to explain the high level role of the Transformation Director and it's definitely not a role where I go around telling everybody how to transform. I really see my job as creating the conditions in our organisation and the culture that allows the people that are doing the work every day, the experts in our organisation, to feel that they've got the permission to try new things and to innovate and to make a real difference to their working lives, and, therefore, the lives of the patients that they're serving as well.
So this, really, the opportunity to have somebody with the level of experience that a chief registrar comes with - the time and capacity to help move forward the Trust ambitions in terms of improvement and quality improvement culture, is a real win-win. So this is not just a kind of one sided thing that we're helping out, a chief registrar, the chief registrar's helping the organisation to move its strategy and culture forward as well.
Lizzy MacPhie 16:06
And it sounds like there's lots of inspiration, just with how you two came into your roles, seeing others doing the role. Brilliant. So, what impact has the chief registrar had on you personally? Mariam, I'm going to come to you with that question first.
Mariam Malik 16:57
Yes, working as a chief registrar gave me a great boost of confidence. It helped me grow my management and leadership skills; gave me the opportunity to understand the NHS, management and the other side that we, as clinicians, don't usually get to see.
Lizzy MacPhie 17:12
Yeah, it's interesting. I remember sneaking into board meetings and exec meetings when I was a registrar. It's fantastic to think there's now a structure that you can do that officially. So really, really interesting. And how about yourself, Amanda, what impact has the role had on you personally?
Amanda Mootoo 17:31
Before doing the chief registrar job, I didn't, because my rota was so busy, I didn't have the time and I didn't have the confidence to go to the board meeting. I didn't know what they really involved. I think it's definitely given me a much better understanding into the management sector of the Trust. What actually happens behind the scenes? What do these meetings entail? Who attends these meetings? What do the different roles of people mean, that are non-clinical.
I think the actual structured chief registrar programme really gave me the opportunity to reflect on my influencing and negotiating style and my personality traits. You get to do lots of activities in person with other chief registrars where you focus on what your various different personality traits are, so that that was super helpful.
I think also the importance of providing data and also a story to create change, so that you can communicate the vision on projects. I found that particularly really helpful and something that I'm certainly going to take forward. But I think one of the main things that's had an impact is developing confidence. As Mariam said, having the confidence to speak up at meetings with senior management and having the confidence to create meaningful change. And when you're met with resistance to change, how you approach that.
Lizzy MacPhie 18:56
Great. So, Nick coming to you. What impact do you feel having a chief registrar in your Trust has had on the organisation?
Nick Sands 19:06
Amanda's described one of the projects that she helped us deliver. And, yeah, these are things that we've known that we need to do and would like to do for quite some time. But, actually, that resistance to change, the complexity of making change in an NHS organisation is something that that holds some of those things back from being realised. And without making Amanda or Mariam blush, these are some of the sharpest brains in our organisation and with fantastic experience about how hospitals operate; what are the real problems that affect patient care. And, actually, working with them to deliver some of these complex projects and get them over line is, as I said before, it's a kind of win-win, for the organisation.
Thinking of a previous chief registrar that we had, she actually helped us to develop a reverse-mentoring programme with the Executive and junior doctors within the organisation. And for the Executive, being able to see the organisation through a different lens - through a lens of our junior doctors with really busy clinical roles - I think really helped us to think differently about how we lead and manage the organisation. So, yeah, as I said, great opportunity for, not just the chief registrar, but also the employing organisation.
Lizzy MacPhie 20:29
Yeah, as you say, real win-win, isn't it? So how do you think the rheumatology community can benefit from having rheumatology specialists taking on the chief registrar role, and how do you think the BSR can encourage more rheumatologists to sign up? Amanda, what are your thoughts?
Amanda Mootoo 20:49
I think by doing things like this really, so, just making people more aware of it. I think in terms of what it benefits the organisation, I think it makes them more well-rounded, well-equipped rheumatologists. I certainly feel that I'm much more equipped from a leadership perspective than I was before. Ultimately, we all have a role in creating change in some way within the NHS, but, I do feel that the chief registrar provides you with a better skillset to be able to do that. I think the other thing that we haven’t mentioned is that you're the interface between the junior doctors and senior management as well. So you feel quite proud that you’re representing the junior doctors and be able to be the voice that can then relay information to management and actually create change and make things happen in the Trust.
Lizzy MacPhie 21:42
Mariam. Any further thoughts from yourself with respect to that question?
Mariam Malik 21:48
I think Amanda put it really well, but, the chief registrar role does give you dedicated time and an opportunity to understand the management side and a good taste of what leadership and management feels like, especially for future roles that people might take like. Like being a lead in rheumatology, which will eventually give you more opportunities for service development as well as quality improvement and ultimately better care for our patients in rheumatology.
Lizzy MacPhie 22:13
What one bit of advice would you give to anyone considering applying to the next chief registrar cohort? So, Mariam, I'll come to you first.
Mariam Malik 22:25
I think the rheumatology registrar job is a good mix of acute and chronic medical conditions, and once you're well settled in your role you can build up on your management and leadership skills. So I would definitely advise to go for it and encourage everybody to apply, obviously when there is an opportunity, and I'm sure they'll enjoy it.
Lizzy MacPhie 22:47
And, Amanda?
Amanda Mootoo 22:50
I'd say to think about your CV or think about yourself; think about whether or not going into leadership is something that you'd be interested in, even if you don't know if you're interested in it but you think it's an area that you're maybe lacking that's helpful as well because it may be something that you need to then develop a bit further.
And, if you are interested, have a look at the RCP chief registrar website. It's very helpful. And what I did before I started when I was considering taking on the role, I went through and looked on the website. There are lots of previous yearbooks of chief registrars and you can read through the previous projects people have done. Network and speak to other chief registrars, so you can put a query - e-mail the RCP chief registrar websites and be in touch with other chief registrars that have done the role before and the alumni network if you have any particular queries.
Lizzy MacPhie 23:47
Right. And Nick, one what one bit of advice would you give to anyone recruiting or mentoring a chief registrar?
Nick Sands 23:55
Aside from just “do it”, because it's a great thing to do, it would be around not going into it with pre-determined or pre-selected projects for the individual. I think it's really, really important that you give them time to understand what's going on in your organisation, identify something that's meaningful and that they're really passionate about. And I think if you set up the projects on that footing then it's going to be successful all round.
Lizzy MacPhie 24:23
Yeah. And that's shone through with both Mariam and Amanda’s. Those were very much projects they identified and then drove forward. So, great. Well, thank you. Thank you to all of you for your contributions this evening. I've learned an enormous amount about the role. And I'm certainly enthused. I think if I was back there in my registrar days, you'd have convinced me to go and have a have a look at the RCP website and find out more. So, thank you for sharing your experiences. I think Nick summed it up in his brevity with, “it's a win-win for everyone”. It's a win for the individual. It's a win for the organisation. And I bet it's a big win for the transformation team to have people like this on board. So, thank you, Nick, for your time, to Mariam and Amanda for sharing your experiences, and to those listening, thank you for joining us and look out for another Innovators Podcast episode on Talking Rheumatology next month.