Who's who: the medical hierarchy and NCHD posts
Consultants, registrars, SHOs and interns: what each role usually covers, how training and non-training posts differ, and where you fit.
On this page 8 sections
Jump to the next lessonKey points
- Each inpatient is admitted under a named consultant who holds overall responsibility; find out who it is for every patient you look after.
- SHOs often carry out the ward jobs day to day: confirm your exact role locally.
- Training and non-training posts are both valuable; they differ in structure.
- Know your escalation chain and how to reach each person.
Consultant-led teams
Hospital care in Ireland is consultant-led. Each patient is under a named consultant, who holds overall responsibility, and a team of non-consultant hospital doctors (NCHDs) works with them.
Teams vary in size, with the standard structure being one registrar, SHO and intern. Some teams have more than this; others can have less. Typically the out of hours cover will be more lean than cover during the day.
The NCHD grades
Titles and exact duties vary by hospital and specialty, but broadly:
- Intern: The first postgraduate year for Irish graduates and some others; works under close supervision and is under provisional registration with the Irish Medical Council
- Senior House Officer (SHO), often covers the ward day to day, keeps the jobs list, reviews patients, and covers on call.
- Registrar. A more senior NCHD who leads rounds in the consultant's absence, takes referrals and supports SHOs. Usually take responsibility for patients in the moment, even though overall responsibility belongs to the consultant. Specialist registrars are in higher specialist training.
- Consultant. The senior clinician with overall responsibility for patients under their care. They are also involved in guiding and teaching their NCHDs, as well as shaping policy and service in their field.
Select a role to see what it usually covers.
Consultant
Typically: The senior clinician with overall responsibility for every patient under their care.
Supervision and help: Usually reached through the registrar; on call, the chain may run through the on-call registrar.
- Consultant
- The senior clinician with overall responsibility for every patient under their care. Usually reached through the registrar; on call, the chain may run through the on-call registrar.
- Registrar
- Leads rounds in the consultant's absence, takes referrals and supports SHOs. Usually an SHO's first point of escalation, then the consultant.
- SHO
- Often runs the ward day to day: keeps the jobs list, reviews patients and covers on call. Escalate to your registrar, then the consultant. Escalation is expected, not a failure.
- Intern
- The first postgraduate year for Irish graduates and some others. Works under close supervision from the team.
Exact duties and on-call chains vary by hospital and specialty. Nurses and health and social care professionals are collaborators with their own expertise. In an emergency, use your hospital's emergency process first.
Training and non-training posts
Some NCHD posts are part of structured training programmes run by postgraduate training bodies (such as RCPI or RCSI). Others are non-training, sometimes called service or stand-alone posts, which are filled directly by hospitals.
Both are real clinical jobs; they differ in supervision structures, rotation and progression. Many international doctors start in non-training posts and later apply for training. Unit 5 covers this in detail.
NCHD posts are generally recorded centrally through the NCHD Employment Record, overseen by National Doctors Training and Planning. Check with medical workforce that your record is correct; it helps when you later provide evidence of experience.
Your escalation chain
As an SHO, your registrar is usually your first point of escalation, then the consultant. On call, the chain may run through the on-call registrar for the specialty. Learn your team's chain on day one and save the numbers.
Escalation is expected, not a failure, and in an emergency, use your hospital's emergency process first.
NB The worst mistake you can make is to not escalate appropriately in an emergency! Don't be scared to escalate and keep reading to find out more tips on how to refer effectively!
Worked example · fictional
Clarifying your chain on day one
Your registrar is briefing you before the round.
- You
- “If I'm worried about a patient while you're in clinic, should I call you first, or the consultant?”
- Registrar
- “Me first, always, and if you can't get me within a few minutes and you're worried, call the consultant or the on-call reg.”