Three Hot Tips From Three of Australia’s Most Successful Founders

First published May 31, 2016

We tuned into the Sunrise Conference that was awesomely available for livestream yesterday, as part of Vivid Festival in Sydney. (Thanks guys!) While we flitted between conference sessions, three things we heard from three of Australia’s most successful founders really stood out:

(Photo: Atlassian’s Mike Cannon-Brookes and his designer value the people behind the product. Credit: Atlassian)

  1. “Every single entrepreneur goes through the same challenges,” Canva founder Melanie Perkins advised. Kicking off as the first guest, she shared how she came to this realisation when she met Google’s Lars Rasmussen, the founder of Google Maps. “I sat across the table from him, and I realised, he’s just a normal person,” Mel explained. She described how Canva’s “overnight success that took nine years” taught her two things about entrepreneurship: “It’s possible, and it’s hard.” But, she added, definitely worth it.

     

  2. “Technology is all about people- the app, the coding, it’s all about the people behind it,” said Mike Cannon-Brookes, co-founder of Atlassian, on the importance of vision and teamwork. It can be tempting as a founder to set your eyes squarely on your product. By being team-facing rather than product-facing, Atlassian allows its team members to work to their strengths and build the best product possible.

     

  3. We decided not to follow NASA’s model (operating as a space company); we ran PlanetLabsas a regular software company,” explained PlanetLabs CTO Chris Boshuizen. Breaking PlanetLabs’ vision into its basics- as a software company, rather than a space behemoth- allowed PlanetLabs to be nimble, rising from its beginnings in rural New South Wales to Silicon Valley acclaim with its satellite-imagery technology.

    Okay, we loved this bonus tip: “Let’s get it 80% correct, and move forward. It’s probably a negative decision to get 100% of things correct. If you get your gut-calls 80% correct, and you’re constantly moving forward, you’ll be fine. Speed is the single most important thing that moves you forward,” said Mike Cannon-Brookes. In the medical world, 100% accuracy is the norm, and this perfectionism extends to other industries too. As a startup, though, Mike challenges this thinking by reminding us that speed is the startup’s biggest predictor of success. By testing quickly, and making mistakes quickly, your startup can move forward faster than your competitors, including your biggest competition- yourself. 

Interested in more events like these at Vivid Sydney? Check out our post on the Top Picks for Medical Startups and people interested in entrepreneurship

Events for Healthcare Startups and Creatives at Vivid Festival

First published May 30, 2016

 

Vivid Festival, Sydney’s annual festival of light, culture and ideas, is back! Amidst the jampacked program of international music artists, brilliant light shows over the Sydney Opera House, and inspiring speakers, here’s our picks for people interested in startups, entrepreneurship, medicine and creativity.

Vivid Sydney 2016, Opera House, Lighting The Sails, Songlines. Artist: Donny Woolagoodja. 26/5/2016 Photo Credit – James Horan/Destination NSW

 

  • Sunrise Conference hosted by Blackbird Ventures. Not strictly medical, but very inspirational for the calibre of Australian success stories that are presenting- the likes of Atlassian, Canva, Planet Labs and Vinomofo and Stylerunner are on the lineup! Learn how they worked their way to success. The conference runs today and, if you missed out on tickets or can’t make it, they’ll be live-streaming from their website! Follow @blackbirdvc on Twitter and #TheSunrise with any questions.

  • Design for Social Innovation brings together people concerned with improving health outcomes for the elderly. Learn from insightful talks by speakers in this field.

  • Dare to Design Healthcare is a brainstorm session bringing together healthcare workers, designers, and anyone else who’s interested in designing better solutions for healthcare’s biggest problems. Attendees will be taught the principles of design thinking, and apply this to the workshop.

  • Rare Birds Convention: featuring speakers from across multiple industries- panel includes robotics engineer Marita Cheng, who does incredible work with engineering and healthcare.

How Is Telehealth Used in Australia? Lessons from the Australian Telehealth Conference ’16

First published May 27, 2016

 

Many of us may not know how telehealth is actually used in patient care. Whether in a metropolitan hospital or clinic setting, we may not be exposed to telehealth in Australia unless our clinical team has partnered with a rural healthcare provider using telehealth. Without this exposure, how are clinicians able to advocate for telehealth?

The Australian Telehealth Conference provided many examples of how telehealth is used in clinical settings. Here’s a summary of some of the highlights below.

Prof Mohamed Khadra at the Australian Telehealth Conference 2016. Photo: The Medical Startup

 

Prof Mohamed Khadra, Consultant Urologist and author, spoke of home dialysis monitoring through his colleague’s “My Home Hemo App,” allowing patients to log their haemodialysis sessions for their doctors and nurses to view remotely.  Telehealth is also used for Aged Care Outreach, where nurses can update clinical notes and pictures when they perform home visits, and patients can spend more time at home rather than in transit to appointments. In theatre, Prof Khadra spoke of double consoles for robotic surgery; the robot extends the range of the human wrist 360 degrees, providing immense help with surgery.

What does he think helped his Local Health District implement new programs and embrace change? “Having that model of people who are dedicated to the project,” he said. Telehealth-specific rooms and Telehealth staff members have been implemented in hospitals across the country to focus on these programs. Prof predicts that digital health can improve anaesthetic monitoring; medical and nursing student training; and post-op patient monitoring. Wearables may also grow into the mainstream; Prof Khadra imagined a sensor on OpSites (surgical wound dressings) which alerts the clinician when there’s a leak or increased warmth, so assessment and antibiotics can be started earlier.

A/Prof Andrew Kornberg (Paediatric Neurologist), and Susan Jury (Telehealth Program Manager) of the Royal Children’s Hospital discussed how attendance rates at child psychiatry clinics dramatically improved when conducted through telehealth. Children usually feel more comfortable at home, and thus are more likely to open up to their clinician. Being home also means the clinician can meet siblings and other family members they wouldn’t have seen otherwise, and see this interaction firsthand. Telehealth clinics are held in a dedicated Telehealth Clinic room, or in the specialist’s rooms.

Prof Kornberg also mentioned how Telehealth consults are performed by Anaesthetists at Pre-Admission Clinics; attendance rates are impacted as 20% of the RCH’s patients are from regional areas. Physiotherapists at the RCH also conduct HITH (Hospital in the Home) consults for cystic fibrosis sufferers. A lifelong condition, cystic fibrosis patients and their families are subject to countless appointments each year, and juggling this with school, work and other family members can take its toll.

For diabetic patients, screening for diabetic retinopathy can be challenging when working in isolated rural communities, like the mines of the Goldfields in Western Australia. Prof Yogi Kanagasingam of CSIRO has successfully used tele-assessment of retinal images to screen Goldfields residents for diabetic retinopathy (DR). 82 of the 1088 patients screened in his study had DR; 8 of these had severe, sight-threatening DR that needed immediate attention. His software, Remote-I, is able to grade the images according to severity of retinopathy.

Dr Shannon Nott, junior doctor (RMO) and founder of Future Health Leaders, explained how telehealth clinics in western NSW save thousands of kilometres in travel each year. “COPD (emphysema) patients make up 41% of bed days in hospitals,” he said, showing potential cost savings if early discharge programs could be developed with telehealth follow-up for patient convenience. What does he advise if you’ve got an idea for a telehealth program? A Churchill Fellowship recipient, Shannon emphasised the importance of teamwork, passion and keeping data in mind when dreaming up solutions: “As I’m designing this, how can I collect the data that can sustain this program? Find your champions in Clinical, IT and Administration; enthusiasm is like an infectious disease, one of the most potent infectious diseases out there.” 

Learning about these uses for telehealth helps us imagine a future where barriers to accessing quality healthcare are reduced. With Australia’s vast geography, some regions will be exposed to telehealth more than others, and the challenge will be to deliver the services to those who need it most, at minimal cost. We learnt a lot from attending the ATC, and similarly, clinicians and non-clinicians alike can learn from attending conferences like these for the future of medicine. For those who attended, full  presentations can be viewed for a very limited time via the Armchair Mobile App for online lectures.

The Health Informatics Society of Australia is led by Dr Louise Schaper, a former Occupational Therapist and now CEO of HISA. HISA runs education programs and events online and across Australia for anyone interested in health informatics and the future of healthcare. We thank HISA for providing us access to the Australian Telehealth Conference, and for those who couldn’t attend, their annual conference on Digital Health and Innovation, HIC 2016 and their Hacking Health hackathon, will be held in Melbourne in July. 

 

Medical Startups at the Melbourne Accelerator Program Launch Party 2016

First published May 26, 2016

 

The Melbourne Accelerator Program (MAP) 2016 Launch Party last night was the first accelerator event we’ve attended, and it was a great introduction to Melbourne’s startup scene.

MAP’s Startup Accelerator awards each team with AU$20,000 equity-free, dedicated mentoring, office space, and opportunities to pitch across Melbourne, Sydney and even Silicon Valley. This year’s ten winning teams presented their 3-minute pitches to a packed Plaza Ballroom in Melbourne’s Collins St. In a nice gesture showing the warmth of the MAP community, each winner introduced the next presenter in relay team fashion.

Two of the winning teams were founded by medical doctors who are solving problems they’ve experienced first-hand with their patients.

 

“Imagine going to hospital, safe in the knowledge that medical errors are a thing of the past,” said Dr Chandrashan Perera, Ophthalmology registrar and founder of Nebula Health (formerly named Axon). Dr Perera explained how, in a landmark WHO trial, checklist implementation in clinical settings was shown to potentially reduce mortality by 50%. Nebula Health‘s IT platform builds upon this by generating workflows around each patient, which are then delivered to each carer at the right time. Nebula Health will do this intuitively so clinicians won’t be burdened having to learn another complicated software system in hospital. We can imagine the enormous benefits this could have with efficiency and risk reduction in surgical and other procedural specialties like cardiology and gastroenterology.

A/Prof Ajeet Singh from CNSdose is a psychiatrist and pharmacogeneticist who aims to tailor antidepressant prescriptions to a patient’s unique genetic profile.  Using precision medicine, a patient’s saliva sample is sent to an authorised lab and the results are sent to the doctor indicating which antidepressants are most likely to work. Prof Singh showed a remission rate of 72% in 148 patients studied through a randomised-controlled clinical trial published last August. “We have 3 value propositions; simpler prescribing for doctors, better outcomes for patients, and lower costs to society (in minimising prescribing costs),” he said. In a big win for their team, Prof announced that former Federal Trade Minister Andrew Robb has joined their advisory board. They are also working on distribution deals internationally. 

Another relevant healthcare startup, Kind aims to transform aged care in the community. Founder Lee told his moving story of how he was dissatisfied when he had to experience the aged care system with his mother. After speaking to others who felt the same way, he decided to create Kind, which will “connect carers with seniors in the community.” By focusing on safety and quality, performing rigorous background checks with potential carers, he looks forward to introducing Kind further once it goes live.

If you’re learning about startups, watching as many pitches as possible will help your knowledge. The other eight winners included:

  • Deliciou‘s healthy bacon-flavoured seasoning;

  • Allume‘s solar and grid-sharing renewable energy company;

  • Honees booking and reviews platform for health, fitness and wellness businesses;

  • Onomap‘s customer data analytics platform;

  • Black’s community of hackers for a smarter world;

  • BajaBoard‘s multi-terrain skateboard; and

  • Shacky‘s tiny houses for farmstays.

As MAP Program Director Rohan Workman said, the Melbourne Accelerator Program is ranked 8th of 1200 university accelerator programs in the world. This year’s MAP winners have benefited from Australia Post’s extra funding of 2 additional winners (there were 8 recipients last year), and Entrepreneur-in-Residence Jeremy Kraybill told the room, “We want to get as many of you involved as possible.” Acknowledging the perceived glamour of entrepreneurship, he continued, “entrepreneurship has an extremely high sweat to fireworks ratio, and tomorrow that hard work continues for the ten teams tonight, and everyone in this room.” With MAP‘s array of free programs for the wider community, it’s an exciting time to be an entrepreneur in Melbourne, and we wish this year’s winners the best success with their work.  

 

 

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Melbourne Accelerator Program Launch Party: Event Tonight!

First published May 25, 2016.

May 26 2016 Edit: We’ve now written about the event, learn more about what happened on the night here

Melbourne University’s Accelerator Program (MAP) has announced its ten participants for 2016. Tickets are available for their launch party tonight, where you can hear them pitch and learn about one of Melbourne’s leading accelerators for startups and enterprises.

Grab your tickets here. To learn more about the program, The Australian and Startup Daily have some great info on this year’s finalists.

Event: Mental Health Hackathon at Spacecubed, Perth

First published May 21, 2016

 

Spacecubed, Perth’s largest coworking space, are running Australia’s first Mental Health Hackathon this weekend. From 20-21st May, you can collaborate with others from research, tech, clinical and consumer backgrounds to tackle some of Mental Health’s biggest challenges.

Mentors include former WHO head Dr Norman Sartorius (also formerly President of the World Psychiatric Association), and other key leaders in Mental Health Management in Australia. To read the full list of mentors and to purchase tickets, click here

We had the opportunity to meet Spacecubed’s team and learn about their new space, Flux, opening in June- stay tuned for our future post.

 

Event Tomorrow: Chronic Pain Hackathon

Chronic Pain Australia are presenting a Hackathon in Sydney from Friday 20-Sunday 22nd May. The world’s first Chronic Pain Hackathon is a great way for tech professionals and healthcare workers to collaborate by prototyping an app that can help chronic pain sufferers.

Chronic Pain Australia have provided some case studies that may provide inspiration for new working apps. The Hackathon will run using the “co-design” method, meaning the end-user (chronic pain sufferers) will be involved from start til finish.

No matter what your healthcare background is, a hackathon is a great way to get started in medtechand gain real experience creating a minimum viable prototype. It will be held at Fishburners, Australia’s largest tech coworking space in Sydney. Tickets are available here.

 

Events This Week: Webinar featuring Jay Samit, Serial Entrepreneur

First published May 16, 2016

We’re very pleased to partner with Startups Innovation for this weekend’s Webinar on Disruption with Jay Samit, serial entrepreneur and author of “Disrupt You!

Jay’s illustrious career spans multiple industries. He is the former Executive VP at Sony, CEO of Seachange International, and lectures on Startups at the University of Southern California’s School of Engineering. He also continues to be a key advisor with various startups and corporations.

 

We’ve been reading Jay’s book, “Disrupt You!“, and recommend it to anyone from any field or industry, whether you’re a student, graduate worker, founder, investor, board member, or just plain curious. Jay’s failed lotto machine in the 1980s pivoted to become the airport check-in kiosks that are used worldwide today. He saw the value of LinkedIn, streaming music, and telecommunications years before they hit the mainstream. And his book really struck a chord with us.

Disrupt You!” is about self-reflection and questioning your values, your outlook, and how you learn things and see the world. It’s about using your unique experiences to “disrupt” the world, and that’s exactly the kind of thinking that led to The Medical Startup. Reading Jay’s book, his experiences mirror the thought process that went into creating our blog, and we can’t wait to hear what he has to share this weekend.

To register, click here with the code MEDSTARTUP for live access and a recording after the event. The webinar will run Saturday 21st May from 1-3pm EDT (US Eastern Daylight Time), which is Sunday 22nd May 3am Australian EST; click here to check out the time in other cities.

Startups Innovation, based out of Boston, host key players in the startup world through their program of webinars, coaching and events. Be inspired by their list of other upcoming events.

More inspiration coming soon! Like us on Facebookand subscribe to our mailing list for updates via our home page, TheMedicalStartup.com

Highlights from the Australian Telehealth Conference 2016

First published May 9, 2016

The Australian Telehealth Conference 2016, hosted by HISA (Health Informatics Society of Australia), brought together clinicians and non-clinicians from all over Australia and New Zealand to discuss current use of, and future pathways for telehealth.

 

The ATC has run for several years, and chair Leigh Donoghue said, it’s progressed from being IT-focused to being broader in reach and scope. This is great, as we think it’s futile to discuss the future of telehealth without involving healthcare workers in the discussion. Who best to talk about the benefits and challenges of telehealth and other technologies than those at the frontline of healthcare?

Similarly, healthcare workers spanning medical doctors, Allied Health workers and nurses, got to meet stakeholders from local health networks across metropolitan and regional Australia and New Zealand. Startup founders presented along with Telstra Health, Elsevier, and NGOs. It really was a great mix of speakers for an introduction to telehealth, and showed how innovation can be sparked by people collaborating across disciplines at these events.

We learnt heaps from the conference and we’ll share some of those insights here very soon. (Edit: it’s now available here.) HISA is headed by former occupational therapist Dr Louise Schaper, and they hold a lot of exciting digital health events. Registration for their annual Health Innovation Conference and Health Hackathon in Melbourne in July is open here.

Part 3: Interview with Dr Gregory Sam, Psychiatrist and Director of Conduit Health

First published April 29, 2016

 We hope you’ve enjoyed Greg’s series on starting his telepsychiatry business and his journey to success! Here he talks about dealing with the process of failure, and rising from that, along with future plans for Conduit Health.

You can now view Parts 1 and 2 as well.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Dr Gregory Sam, Consultant Psychiatrist, Australia. Image courtesy of Dr Sam.

Can you talk more about your failure process? How did you deal with criticism and get through failure? (Greg had to resit his exams a few times before qualifying as a consultant.)

Firstly, it’s a humbling thing, and there are some good resources. You should find those consultants or colleagues who can give you meaning to your failure.A lot of people will say, “oh, you did this wrong or maybe you did this wrong.” I’m not saying there should be an external locus of blame, I’ve been through that too- “oh, the college is out of its mind failing me because everyone I know is telling me I’m ready to be a consultant, couldn’t really figure that out. But one thing I was told is, “look at this person who’s now a professor, I know during his training he failed 4-5 times,” so I guess there are some comforting things like that. But it’s also about yourself being able to apply that meaning to your failure. Otherwise you go through all this pain, and you can’t get some benefit from it. And that’s pointless, absolutely pointless except to hurt you.

Failure is just an opportunity disguised as pain. 

So I thought, “I won’t let it hurt me or fail me.” With my career, I did think, “should I be doing this?” but I felt resolved that before failing and before I was in that frame of mind, I knew this was what I wanted to do, and this shouldn’t change it. Just because some people failed or I didn’t pass an exam, I will pass eventually.

My reflection of my failure brought about so many positive opportunities.

Medical people tend to become very disillusioned when they fail. We’re not used to failing, we’re high achievers, and when we do fail, it’s a huge fall, and some people don’t recover from that. Those who fail need support, and I know myself because when I did fail, I spent endless nights on YouTube looking up motivational videos and how to get through failing and how to get meaning from that. I felt alone.

I had colleagues who also failed, so we formed a bond and pushed each other through. They’re not entrepreneurial per se, but we had some support in that we failed together.

I think people should apply some meaning about failure. It’s all too painful an experience to do for nothing. Even if you eventually don’t pass, it’s okay, as long as you did something meaningful. Even if I didn’t pass and dropped out of my training, I took meaning from it, and reflected on it.

In fact, Conduit Health is thanks to failing. Had I not failed, I’d have sailed through my training program, with this inside disgruntlement of “this is what I am”.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

Conduit Health, Telepsychiatry Service. Photo courtesy of Dr Gregory Sam.

One of my bosses said, “I think this will make you a better psychiatrist, and this is because you now know what it’s like to fail. Previously you had no idea what it was like to fail. You excelled and  succeeded in everything. And now you can see that when your patients fail, you can feel a bit of that.”

The medical field, I think they kind of shun people who fail. And people who do fail, don’t talk about it, because they want to be seen as brilliant, successful, and never a failure. Whereas in business, the more I look, they talk about failure with pride. They go, “I started up ten companies, and all failed before I made Google.” They talk about failure with pride, and those who don’t talk about failure and don’t own it, they’re missing that opportunity to share with people. Everyone fails at something, in one way or another everyone fails at something. And people then tend to hide it and put it in a box and not share it with anyone.

We need to change the culture and say, “it’s okay to fail, lots of people fail, but what will you do with it?”. The famous words from Edison I think were, “It’s not that I’ve found the way to make a lightbulb, I’ve only found ten-thousand ways NOT to make a lightbulb.” 

It’s about mindset change.

It’s like, “ok, I failed four times.” It’s not to say, “I failed and I’m useless,” it’s, “I’ve failed and found four different ways to not pass an exam, and I just need to find that one way to pass it.”

Reflecting on my failures in the exams, what held me back wasn’t anything to do with my knowledge. A lot of people think it’s the knowledge (that makes them fail), not knowing enough. For me, it was the anxiety levels. I went into the exam thinking, “what do the examiners want to hear?” But the time that I passed, I gave that away, I said “I don’t care what the examiners think.”

I think there could be more constructive ways in which our colleges could address failure. One way I think is to talk about it more, and to show that it’s not life or death if we fail, we can get through this, and be more supportive, be able to talk about it. 

By having the courage to say “yes I failed my exams”;  other people find doctors as quite intimidating, they’re seen as being super successful and smart, and when you can bring yourself down a bit and be humble and say “I failed”- everybody fails at something, whether it’s their driving test or something, failure is something everyone has in common, so when I bring it up, a lot of people can suddenly relate to it.

In business, that’s super important, so people are not intimidated by you, they have something to relate to you, and it builds relationships. A lot of my GPs, mental health nurses and staff, they like me for being open about it, rather than hiding it away, rather than bringing across this facade that I’m super brilliant, never failed in my life, top notch.

How do you view competition in business? Doctors have that win mentality, how do you manage that in business?

I welcome competition in business. I feel that if somebody can – if somebody else comes forth, it’s always anxiety related, like, “I must be better than them.” But what I do is look at the competitor, and ask, “did they actually evaluate? Did they actually have new ideas about improving telepsychiatry, did I do that, and if I didn’t do that, why can’t I do that? If there are no competitors, you are at risk of becoming complacent, and competitors bring excitement. So I ask, is there value-add, or do I just have to do my job?It can become about less value, more competing on price point. But I know it’s hard for other companies in this space to compete on price point.

What are your other plans for 2016?

Trying to balance. It’s tempting to focus just on private practice, but Conduit would fall by the wayside. For me, what I’m trying to do is allocate time to Conduit Health and allocate other times for private practice . I’ll try organise more talks for GPs including interstate, hosting events.

I love going out to rural communities and seeing them, they really don’t have much psychiatry services. Same with their GPs, they don’t have much support and can get very isolated without someone coming from the metropolitan areas to offer help.

We’ve received the odd referral from the Great Barrier Reef, the Northern Territory, Tasmania, but I want to increase that. In business I think this is something we do- go back to fundamentals, think “why did I start the company, what did I want to achieve?”

The more isolated rural places, I’d rather focus on them. In the semi-metropolitan places, people travel 1-2 hours, whereas in the NT there’s no psychiatrist for a few hundred k’s.

The other thing will be statistics. Looking at 2015, we’ve been collecting data about how many patients we’re seeing, the outcomes, sending surveys to patients and GPs. Being able to publish them and say “this is where psychiatry services are at, this is what we’ve done.” Entrepreneurship is 24/7. It is on my mind 24/7. Even if you’re not doing something on it, it’s on my mind. My admin staff, everything, it’s on you. It’s like having a baby, it’s 24 hours, no escaping. Something people wanting to get into business need to be aware of. It can be like medicine, it can be all-consuming.

A few years from now, I’d really like to get government involved so that I can provide telepsychiatry services to public hospitals. Public services can be quite stretched, but for a private company like mine, that’s what we can offer.

What are lessons that medical professionals and people from other industries can learn about starting in business?

Guy Kawasaki’s lesson is, it’s not about how are we doing things now and how can we do things better; it’s about, “what is the next curve?” Conduit Health is jumping on the next curve. Not just about how to improve how doctors see patients face-to-face, sure there’s a lot of work to be done there, but if you want to jump on the next curve, (you’ve got to create) innovation.

Not too many doctors by nature are entrepreneurial. A large part of that is because we get comfortable doing our daily job. See patients, make a living. Innovation and startups are a huge risk. It’s out of our comfort zone. We stop seeing patients, and suddenly your startup becomes the neediest patient you’ve ever had. 

It’s important to get this out there. It’s people like you, me, people who dare. And hopefully this will help a lot of people find, “this has been inside me, this has been in the back of my mind, but I’m too scared to do anything about it.

 

Thankyou for your support of The Medical Startup and Greg’s interview. You can view Parts 1 and 2 of Greg’s interview by clicking here and here

If you wish to contact Greg for more enquiries about Conduit Health, or to sign up as a GP or psychiatrist for his service, please emailenquiries@conduithealth.com.au. Conduit Health is also on Facebook

Please note: In the medical world, “consultant” refers to a fully-qualified ie. board-certified specialist. “Registrar” is a doctor who’s a member of a training program and preparing to qualify for this certification. “Resident” is pre-registrar; “Intern” or “Houseman” is first-year out of medical training.