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Prognostic significance of competition ratios in surgical specialty training selection
  1. Katie Mellor1,
  2. David B Robinson1,
  3. Oliver Luton1,
  4. Osian P James1,
  5. Arfon GMT Powell1,2,
  6. Luke Hopkins1,
  7. Sarah Hemington-Gorse1,3,
  8. Richard J Egan1,3,
  9. Wyn G Lewis1
  1. 1School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
  2. 2Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
  3. 3Department of Surgery, Morriston Hospital, Swansea, Wales, UK
  1. Correspondence to Katie Mellor, School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw CF15 7QQ, UK; kt.mellor{at}


Background A competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.

Methods Consecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK NTN appointment.

Results Overall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p<0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018.

Conclusion CRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.

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  • Contributors WGL conceived and designed the study, oversaw the data analysis, refined the reporting of the work and is the guarantor of this work. KM and DBR collected the data, analysed the data and reported the work. OL, OPJ, AP, LH, SH-G and RJE contributed to reporting of the work. All authors approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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