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Bridging the Gap: A Structured Acting Up Scheme for IMT Doctors

In our latest RCP next generation campaign blog, the winner of our 2025 ACT abstract competition, Dr Dominic mears, shares how he, along with colleagues Dr Ming-May Chung and Dr Emily Robinson introduced an Acting Up scheme at Worcestershire Acute Hospitals NHS Trust (WAHT) to give doctors training in internal medicine real-world experience of the registrar role.

The leap to medical registrar is one of the most daunting transitions in a doctor’s career. It’s a step that many resident doctors doing internal medicine training (IMT) approach with anxiety, and understandably so. Historically, this transition has been abrupt, with few opportunities for resident doctors to act up in the role under supervision. When acting up did happen, it was often informal, unstructured, and lacked meaningful feedback.

At Worcestershire Acute Hospitals NHS Trust (WAHT), we wanted to change that. our goal was to create a structured, supportive surroundings where second-year IMT doctors could experience the registrar role in a real-world setting, but with the safety net of supervision. We introduced a formal acting Up scheme,giving resident doctors a 5-day block of normal working days to hold the on-call medical registrar bleep under the direct supervision of the duty registrar.

getting started

As a team of associate and college tutors, we began by drafting a Standard Operating Procedure (SOP) to clearly outline expectations for both resident doctors and supervisors. this document became the backbone of the scheme, ensuring consistency and clarity.We then worked closely with the medical registrar team to secure their buy-in and participation. Their support was crucial, as they would be providing the direct supervision.

The SOP: Key Components

The SOP detailed several key components:

• Eligibility: The scheme was open to all second-year IMT doctors at WAHT.
• Preparation: Resident doctors were required to complete a pre-acting up checklist, confirming their familiarity with key hospital protocols and procedures.
• Supervision: The duty registrar provided direct supervision, available for immediate consultation and support. A structured handover process was implemented to ensure a smooth transition of responsibility.
• Feedback: Both formative and summative feedback were incorporated. Formative feedback was provided daily by the supervising registrar, focusing on real-time performance. summative feedback was given at the end of the 5-day block, using a standardized assessment form.
• Safety Net: The SOP explicitly stated that the supervising registrar retained ultimate responsibility for patient care. Resident doctors were encouraged to escalate concerns promptly.

Initial results and Feedback

The initial response to the Acting Up scheme has been overwhelmingly positive. Resident doctors have reported increased confidence in their ability to handle the registrar role. They appreciate the structured learning environment and the opportunity to receive constructive feedback. Supervisors have also noted an improvement in the preparedness of IMT doctors transitioning to registrar posts.

here’s what some participants had to say:

“The Acting Up scheme was invaluable. It allowed me to experience the pressures of the registrar role in a safe and supportive environment. The daily feedback from the supervising registrar was especially helpful.” – IMT doctor

“I’ve noticed a definite improvement in the confidence and clinical skills of the IMT doctors who have participated in the scheme. They seem much better prepared for the challenges of registrarship.” – Medical Registrar

Key Takeaways

• A structured Acting Up scheme can substantially improve the transition from IMT to registrar.
• Clear expectations and a robust SOP are essential for success.
• Supervisory support and constructive feedback are crucial for learning and advancement.
• Collaboration between associate tutors,college tutors,and the medical registrar team is vital.

Publication Date: 2025/09/26 22:21:07

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