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After more years as an SHO than I care to remember, it’s time to take the leap. Admittedly my step up in responsibility to the esteemed position of A&E registrar has come as part of the Jeremy Hunt-induced mass exodus to Australia, and is slightly tempered by the fact that I’m not actually an emergency medicine trainee, but I’m considering it a promotion nonetheless.
My first day doesn’t get off to the best of starts. It turns out scrubs aren’t provided in my new hospital, so facing the unenviable choice of introducing myself to my new bosses wearing either tattered jeans with a lasagne-stained t-shirt, or a pair of scrubs I found lying on the floor in the corner of the changing room, I opt for the latter. Unfortunately the scrub top has ‘theatre staff’ etched in large letters across the front, and is at least four sizes too large.
I shuffle to the doctors’ office looking like an unfurled parasol, the equally ill-fitting trousers catching under my trainers with every step.
My new colleagues glance at me as I enter and introduce myself. They look suitably unimpressed.
‘Are you… a doctor?’ one of them asks, eyeing me up and down. Given my appearance, it’s a fair question.
‘Yes, I’m the new S H… registrar…’, I say, my voice tailing off. I curse myself inwardly. Old habits, it seems, die hard.
There’s a gut-wrenchingly long pause.
‘Is that a Pommie thing?’ asks the same doctor.
What the hell, I think, I’m going for it.
‘Yeah, it’s basically a registrar,’ I say, sounding far from convincing. ‘It… it’s a first year registrar…’
The doctor smiles knowingly. He works in A&E; he can smell bullshit a mile away. He’s enjoying himself though, and is not going to let me off the hook quite yet.
‘You look old to be a first year reg,’ he observes, displaying all the subtlety of a slap to the face. I’ve always loved the sensitive approach of the Australians.
This one stings. He’s clearly never worked an A&E rotation in the UK; an experience guaranteed to age even the most youthful of dispositions.
Fortunately, the day gradually improves, and all my new colleagues are welcoming and happy to help. Throughout the whole shift though, and all the shifts I’ve worked since, I feel like a fish out of water. Sure, I’m working in an entirely different healthcare system, and in a specialty that is not my own, but I think the problem is more deep-rooted. I’m suffering from a severe case of impostor syndrome.
There’s no objective reason for it; I don’t seem to be letting anyone down, and everyone seems relatively happy with my performance, but I seem incapable of internalising these facts. At any moment I expect to be found out and identified as a fraud, and the Australian Medical Council to descend en masse and drag me kicking and screaming from the building.
I look around the doctors’ office at others in my position and wonder whether anyone else feels like this. They all look so confident, and so self-assured. They project such a confident exterior, and look as though they’ve been registrars their whole lives.
I feel as though I’ve regressed; transformed from a self-assured and thoroughly competent SHO to a bumbling registrar, barely able to speak on the phone without tripping over my words and botching my referrals. I’m the England football team of registrars - I’ve developed the yips.
Maybe this confidence, and the ability to appear comfortable in a role befitting your experience, is all an act. Perhaps it’s just something that takes a bit of time. Otherwise I’m doomed to spend the rest of my career crippled by self-doubt and insecurity; a doggy-paddler in an Olympic swimming event.
Only time will tell what will happen in the long run, but in the meantime in my role as an ’S H registrar’, all I can do is keep on swimming.
Mike Forsythe is working in Australia as an A&E registrar. Back in the UK he is a GP trainee (ST3 level).
Oh my god. This has really hit the nail with me. I am in exactly the same situation and was an acute medicine trainee in UK about to start work in Aus next week and it has been 2.5 years since my last A&E shift. You're not alone! Woke up in a panic yesterday wondering if I have forgotten everything. But I am a firm believer that doctors who think they know everything are the most dangerous so..
Happens to everyone going through a transition. I've seen world class professors in academic specialties fumble like SHOs in their first few months. Give it time and if you were badass as an SHO, you will be as a registrar too.