Differential attainment at national selection for higher surgical training: a retrospective cohort study
Objectives National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees’ career...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/15/1/e091796.full |
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| author | Amanda Lee Jennifer Cleland John Hines Peter Brennan Ricky Ellis Yasin Al-Tawarah |
| author_facet | Amanda Lee Jennifer Cleland John Hines Peter Brennan Ricky Ellis Yasin Al-Tawarah |
| author_sort | Amanda Lee |
| collection | DOAJ |
| description | Objectives National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees’ career progression and the diversity of the workforce, which should reflect the population it provides care for. The objective of this study was to characterise the relationship between candidate sociodemographic factors and performance at National Selection for HST in the UK.Design A retrospective cohort study.Setting National Selection for HST in the UK.Participants All UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST from 2012 to 2019.Outcomes and measures Performance at HST Selection for each surgical specialty is measured by assessment of the candidate’s academic portfolio and multiple objective structured clinical examination style stations testing knowledge and skills. Univariate analysis identified differences in success rates at first application. Logistic regression models identified sociodemographic predictors of success after adjusting for prior academic attainment (Membership of the Royal College of Surgeons (MRCS) performance).Results Of all applications to HST (n=2875), 66.5% were successful at the first attempt. Females were 32% more likely than males to be successful at selection for HST (OR 1.32 (95% CI 1.05 to 1.67)). MRCS performance was found to be a strong independent predictor of future success at HST selection. Females were more likely to be successful at general surgery selection (OR 2.69 (95% CI 1.63 to 4.45)), older candidates (graduates) were less likely to be successful at ENT selection (OR 0.21 (95% CI 0.05 to 0.95)), and candidates that were the first in their family to attend University were less likely to be successful at urology selection (OR 0.41 (95% CI 0.21 to 0.78)).Conclusions Our findings highlight few statistically significant associations and no consistent patterns between sociodemographic factors and performance at HST selection once we adjusted for prior academic attainment. This suggests that differences in performance on selection into HST may be more likely due to individual rather than group-level differences. |
| format | Article |
| id | doaj-art-e0aff829c59a4ccabe30be28785b08b5 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e0aff829c59a4ccabe30be28785b08b52025-01-30T11:20:14ZengBMJ Publishing GroupBMJ Open2044-60552025-01-0115110.1136/bmjopen-2024-091796Differential attainment at national selection for higher surgical training: a retrospective cohort studyAmanda Lee0Jennifer Cleland1John Hines2Peter Brennan3Ricky Ellis4Yasin Al-Tawarah54 Institute of Applied Health Sciences, Medical statistics team, University of Aberdeen, Aberdeen, UK6 Lee Kong Chian School of Medicine, Singapore5 Urology Department, University College London, London, UK3 Portsmouth Hospitals NHS Trust, Portsmouth, UK1 University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK2 Medical Statistics, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UKObjectives National selection for higher surgical specialty training (HST) in the UK is a high-stakes gatekeeping assessment. If barriers, such as differential attainment, exist at HST selection for some groups and not others, then this will have a significant and lasting impact on trainees’ career progression and the diversity of the workforce, which should reflect the population it provides care for. The objective of this study was to characterise the relationship between candidate sociodemographic factors and performance at National Selection for HST in the UK.Design A retrospective cohort study.Setting National Selection for HST in the UK.Participants All UK graduates in the UKMED database (https://www.ukmed.ac.uk) who underwent selection for HST from 2012 to 2019.Outcomes and measures Performance at HST Selection for each surgical specialty is measured by assessment of the candidate’s academic portfolio and multiple objective structured clinical examination style stations testing knowledge and skills. Univariate analysis identified differences in success rates at first application. Logistic regression models identified sociodemographic predictors of success after adjusting for prior academic attainment (Membership of the Royal College of Surgeons (MRCS) performance).Results Of all applications to HST (n=2875), 66.5% were successful at the first attempt. Females were 32% more likely than males to be successful at selection for HST (OR 1.32 (95% CI 1.05 to 1.67)). MRCS performance was found to be a strong independent predictor of future success at HST selection. Females were more likely to be successful at general surgery selection (OR 2.69 (95% CI 1.63 to 4.45)), older candidates (graduates) were less likely to be successful at ENT selection (OR 0.21 (95% CI 0.05 to 0.95)), and candidates that were the first in their family to attend University were less likely to be successful at urology selection (OR 0.41 (95% CI 0.21 to 0.78)).Conclusions Our findings highlight few statistically significant associations and no consistent patterns between sociodemographic factors and performance at HST selection once we adjusted for prior academic attainment. This suggests that differences in performance on selection into HST may be more likely due to individual rather than group-level differences.https://bmjopen.bmj.com/content/15/1/e091796.full |
| spellingShingle | Amanda Lee Jennifer Cleland John Hines Peter Brennan Ricky Ellis Yasin Al-Tawarah Differential attainment at national selection for higher surgical training: a retrospective cohort study BMJ Open |
| title | Differential attainment at national selection for higher surgical training: a retrospective cohort study |
| title_full | Differential attainment at national selection for higher surgical training: a retrospective cohort study |
| title_fullStr | Differential attainment at national selection for higher surgical training: a retrospective cohort study |
| title_full_unstemmed | Differential attainment at national selection for higher surgical training: a retrospective cohort study |
| title_short | Differential attainment at national selection for higher surgical training: a retrospective cohort study |
| title_sort | differential attainment at national selection for higher surgical training a retrospective cohort study |
| url | https://bmjopen.bmj.com/content/15/1/e091796.full |
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