For each specialty, a hospital may be "certified" or not certified as a training center. They may still have Registrars in the field, even if not certified. So there are "service" registrars and "training" registrars. And, even at the certified hospitals, there can be both types of registrars. The "service" registrars do the work - as an orthopedist, for instance - but aren't getting any credit towards eventual certification as a consultant orthopedist. They end up doing a lot of the routine stuff, and a lot of the consultations. While the "training" registrars are in the operating theatre doing the surgery.
Many of the guys do one or more years as a service reg while waiting for a chance to enter a training program. And, may move from hospital to hospital during that time. Some hospitals have only partial training certification, so that you can do some training but not the entire program (ER can get only 6 months credit for their time at Lonnie).
High prestige (plastics and max-facieal and dermatology) can take many years as a service reg before getting a training position. Low prestige (internal medicine and emergency medicine) "all you have to do is raise your hand, and you've got a job." (That from one of my EM Reg's). It's all very disjointed compared to the US.
I've got a bit more sense of why the ACEM board exams have to be so tough - I don't see that there is the day-to-day program of training and supervision and evaluation that we're used to, so instead there is a very tight orifice to squeeze through at the end of the tunnel.
One of my Registrars did his very first chest tube 3 days ago, and his second yesterday - and it appeared that having some supervision and guidance was an unexpected bonus for him (it was nice for me to identify the subcutaneously placed tube by palpation rather than having the embarrassment of finding it on the post placement XRay).
Later, Mates.
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