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Egalitarianism in surgical training: let equity prevail
  1. David Bryan Thomas Robinson1,2,
  2. Luke Hopkins1,3,
  3. Osian Penri James1,4,
  4. Chris Brown1,
  5. Arfon GMT Powell5,
  6. Tarig Abdelrahman1,
  7. Sarah Hemington-Gorse1,3,
  8. Leona Walsh6,
  9. Richard John Egan1,3,
  10. Wyn Lewis1
  1. 1School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
  2. 2Prince Charles Hospital, Merthyr Tydfil, United Kingdom
  3. 3Morriston Hospital, Swansea, United Kingdom
  4. 4Royal Gwent Hospital, Newport, United Kingdom
  5. 5Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
  6. 6Professional Support Unit, Health Education Improvement Wales, Cardiff, UK
  1. Correspondence to Mr David Bryan Thomas Robinson, School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw CF15 5QQ, UK; david.robinson4{at}outlook.com

Abstract

This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010–2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.

  • education and training (see medical education and training)
  • medical education and training
  • surgery
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Footnotes

  • Twitter @daverobinson90, @Dr_Chris_Brown, @PowArG07, @LeonaAWalsh, @wynglewis

  • Contributors DBTR: data acquisition and analysis, drafting, final approval and submission. LH: data interpretation, drafting and final approval. OPJ: data interpretation, drafting and final approval. CB: data interpretation, critical revision and final approval. AP: data interpretation, critical revision and final approval. TA: data interpretation, critical revision and final approval. SH-G: data acquisition, critical revision and final approval. LW: data acquisition, drafting and final approval. RJE: concept design, data interpretation, critical revision and final approval. WL: concept design, drafting, final approval prior to submission, content guarantor. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding OPJ is supported by a Joint Surgical Research Fellowship from the Royal College of Surgeons of England and Health Education and Improvement Wales.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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