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University of Cape Town & Groote Schuur Hospital


University of Cape Town & Groote Schuur Hospital

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									University of Cape Town & Groote Schuur Hospital

Department of Medicine

A Guidebook for Medical Registrars

INTRODUCTION The purpose of this Booklet is to give an outline of the functions and duties of the Medical Registrar in the Department of Medicine at the University of Cape Town (UCT) and Affiliated Hospitals, and to provide information which will be of value in the running of their wards and the management of their patients. All registrars should familiarise themselves with the contents of this guidebook. If you have any questions at all please contact the Chief Medical Registrar. Your training as a Medical Registrar at UCT will be hard work and will involve you in many complex medical and non-medical problems. You will have considerable responsibility, particularly when running the wards, during which time you will carry the major responsibility for the admission of patients and much of their management. The Consultants in Department of Medicine are eager to provide you with all the assistance you need and do not hesitate to obtain a Consultant‟s opinion if there is ever any doubt concerning the management of your patients. We hope that you will make maximum use of all the opportunities available to you and in this way derive full satisfaction from the challenging job of a Medical Registrar. The academic and training activities of the Department of Medicine are conducted at several hospitals in Cape Town, always under the guidance of Consultant staff holding appointments at the University of Cape Town. The principal base of the Department is Groote Schuur Hospital, adjacent to the Medical School, but the training platform extends to the Departments of Medicine at George Hospital (George), GF Jooste Hospital (Manenberg), New Somerset Hospital (Green Point), II Military Hospital (Wynberg), and Victoria Hospital (Wynberg),and Brooklyn Chest Hospital, Milnerton. Training in General Internal Medicine occurs both at Groote Schuur Hospital and the outlying community-based institutions: George Hospital (GH), G F Jooste (GFJ), Somerset (NSH), Victoria (VHW), Brooklyn Chest Hospital (BCH), and II Military Hospital (IIMil). GH, GFJ, NSH VHW, and II Mil are secondary level hospitals and BCH is a treatment centre for patients with pulmonary tuberculosis. Training in special units / sub-speciality disciplines is provided at Groote Schuur Hospital (GSH), where opportunities are offered in the following disciplines: Cardiology Emergency Unit Endocrinology and Diabetes Medicine


Gastroentorology Geriatric Medicine Hepatology and Porphyria Clinic Haematology Infectious Diseases and HIV Medicine Lipidology Nephrology and Hypertension Clinic Neurology Pulmonology and Respiratory ICU Rheumatology The four year training programme attempts to provide each registrar with a balanced exposure to both General Internal Medicine and sub-specialist disciplines, but it is not possible to rotate through all the sub-specialty units on offer in four years. APPOINTMENT OF REGISTRARS Registrar training in Internal Medicine takes place over four years. Registrars are appointed on one-year contracts, renewable annually subject to satisfactory performance and academic progress. Registrars wishing to leave the training programme prematurely are required to serve out the balance of their year‟s contract in order to minimize disruption of the training rotation for their colleagues and for the sake of their patients. suitable replacement be available. ACADEMIC AND TRAINING ACTIVITIES Registration All candidates must register on an annual basis as Registrars with the Health Professions Council of South Africa (HPCSA). Additionally, all Registrars must register as postgraduate students of UCT, usually for the degree Master of Medicine (MMed). This should be done at the Dean‟s office in January of each year. Failure to register with the HPCSA and UCT will result in non-recognition of the period of training time. This requirement may be waived should a


Regulations and Registrar Portfolio All registrars are required to read the Regulations and Curriculum for the FCP(SA) examination at the start of training. The details of the Regulations and Curriculum are available on the website of The Colleges of Medicine of South Africa (CMSA) ( Registrars are required to obtain the 78-page Registrar Portfolio at the beginning of their training from the CMSA. The Registrar Portfolio is designed to serve as a record of rotations, continuous assessment reports, procedures undertaken, research projects and presentations undertaken during the four years of training. The Registrar Portfolio must be completed prior to admission to the Fellowship of the College of Physicians of South Africa [FCP(SA)]. Academic Goals It is expected that registrars should achieve academic targets within set periods of time:


FCP Basic Sciences (Part I): Preparation should occur in the first year of training
and this portion of the FCP successfully completed by the end of the second year of training.


FCP Clinical Sciences (Part II): It is expected that this component be successfully
completed in the third or fourth year of training.


M.Med Dissertation (Part III): Each registrar should attend the Research Methods
Course for Registrars, identify a research supervisor and research topic in the first year of training. The protocol and data collection should be completed within the ensuing two years, and a dissertation submitted for the MMed degree during the fourth year of training.

Training and Preparation (a) Weekly group seminars are provided between 14h00 and 16h00 on Thursday afternoons in the Department of Medicine J-Floor Conference Room, Old Main Building, Groote Schuur Hospital under the supervision of a consultant. There are usually two groups of teaching a registrar can attend: “Basic Sciences”, which is the group preparing for the FCP Part I and “Clinical Teaching”, which is the group preparing for the FCP Part II. The teaching is coordinated by two appointed registrars and you need to provide them with


your e-mail address so that you can become part of the teaching programme as soon as possible. Registrars are expected to prepare short “seminar” papers addressing a range of questions set in advance. The collective effort covers a wide range of material and permits debate of contentious material. Sources of material should include relevant standard texts as well as review material from reputable medical and scientific journals (e.g., New England Journal of Medicine, The Lancet, the Journal of the American

Medical Association, and the South African Medical Journal).Registrars are strongly
advised to attend these seminars. A register of attendance will be recorded. (b) Case Presentations: All registrars are required to present clinical cases at Firm and

Departmental academic meetings and Journal Clubs. These occasions should be used to explore basic science and clinical concepts relevant to the topic under discussion. Guidance from the attending consultant must be sought in the preparation of clinical presentations. (c) Self-directed learning: The Medical Library offers an excellent range of reference texts, and access to a wide variety of medical and scientific journals, both in hard copy and electronic format. medical literature. (d) Teaching of junior staff and students: Teaching is an integral component of clinical service delivery and registrars are expected to participate in the formal clinical training programme of medical students. Requests to participate in the bedside teaching programme will come from the administration personnel coordinating teaching activities. In addition, registrars are expected to use all opportunities to engage in informal teaching while managing patients with interns and students in the clinical setting. Competence in clinical sciences demands good understanding of the pathophysiologic events, underlying illnesses and their manifestations; competence in the elicitation and interpretation of these manifestations; knowledge and efficient use of special investigations to elucidate and refine diagnoses; and sound judgement of considerations influencing treatment strategies. These skills are in large measure learned by apprenticeship to experienced consultants; at ward rounds, in clinics and at academic meetings and journal clubs. All patients in the care of a registrar must be assigned to a consultant. Registrars are expected to develop skills in critical appraisal of


Roster Every year a roster is set up determining through which special units/general medicine blocks you will be rotating. The roster always runs from February to January the following year and you will be rotating at 3 monthly intervals. When setting up this roster the previous rotations already done, level of seniority, clinical competence and your personal preference are taken into account. Leave You have 22 working days of leave per year. It is suggested that you take this leave as two 2week periods and then have 2 days left for the odd long weekend/unexpected need for leave. The reason for doing it this way is that there are always 2 registrars covering the registrars on leave so that clinical services are not disrupted and a „vacation relief roster‟ is set up one year in advance. It is thus important for you to let me know as soon as possible when you would like to take leave the following year, so that we can enter this information in the roster accordingly. Final Word I feel very privileged to be able to welcome you to the registrar rotation. You have been chosen to be trained by the finest clinicians working at Groote Schuur Hospital and its affiliated hospitals and you will meet most of them personally. Make use of every opportunity to learn from them. During your rotation you will have to work very hard, you will carry a lot of responsibility and junior staff will look to you for advice and guidance. Remember how you as a student or intern spoke with pride or disdain of “your registrar”? You are now that very registrar and the staff working with you will hopefully be speaking of you with pride and be inspired to follow in your footsteps! I wish you well on your journey to becoming a Specialist Physician. Study and work hard, persevere and remember to keep your sense of humour. Dr Jens Hitzeroth Chief Registrar (2008/2009)


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