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Differential attainment in higher surgical training: scoping pan-specialty spectra
  1. Oliver William Luton1,
  2. Katie Mellor1,
  3. David Bryan Thomas Robinson2,
  4. Zoe Barber3,
  5. Osian Penri James4,5,
  6. Arfon Gethyn Morgan Tregellis Powell6,
  7. Sarah Hemington-Gorse7,
  8. Leona Walsh8,
  9. Richard John Egan1,
  10. Wyn Griffith Lewis1
  11. On behalf of the Welsh Surgical Research Initiative (WSRI) Collaborative
  1. 1School of Surgery, NHS Wales Health Education and Improvement Wales, Cardiff, UK
  2. 2General Surgery, Cardiff & Vale University Health Board, Cardiff, UK
  3. 3Breast Surgery, Princess of Wales Hospital, Bridgend, UK
  4. 4School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
  5. 5General Surgery, Royal Gwent Hospital, Newport, UK
  6. 6Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
  7. 7Plastic Surgery, Morriston Hospital, Swansea, UK
  8. 8Professional Support Unit, Health Education Improvement Wales, Cardiff, UK
  1. Correspondence to Osian Penri James, School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw CF157QQ, Rhondda Cynon Taff, UK; osianpjames{at}gmail.com

Abstract

Introduction This study aimed to evaluate differential attainment during higher surgical training (HST; all specialties) related to three ethnic cohorts: White UK (WUKG), Black and Minority Ethnic UK Graduates (BMEUKG), and International Medical Graduates (IMG).

Method Anonymised records of 266 HSTs (126 WUKG, 65 BMEUKG, 75 IMG; 7 years) in a single UK Statutory Education Body were examined. Primary effect measures were Annual Record of Competency Progression Outcome (ARCPO) and Fellowship of the Royal College of Surgeons (FRCS) pass.

Results ARCPOs related to ethnicity and specialty were similar with the exception of general surgery (GS) trainees, four of whom received ARCPO 4 (GS 4.9% (75% BME; p=0.025) vs all other 0%). ARCPO 3 was commoner in women (22/76, (28.9%) than men 27/190 (14.2%), OR 2.46, p=0.006). FRCS pass rates (WUKG vs BMEUKG vs IMG) were 76.9%, 52.9% and 53.9% respectively (p=0.064) but unrelated to gender (M 70.4% vs F 64.3%). On multivariable analyses: ARCPO 3 was associated with Female gender and Maternity Leave (OR 8.05, p=0.001); FRCS pass with ethnicity (OR 0.21, p=0.028) and Hirsch Indices of ≥5 (OR 11.17, p=0.001).

Conclusion Differential attainment was plain with BMEUKG FRCS performance almost a third poorer than WUKG, and women twofold more likely to receive adverse ARCPOs, with return from statutory leave independently associated with training extension. Focused counter measures targeted at non-operative technical skills (including academic reach), Keeping in Touch, Return to Work, and re-induction programmed support are urgently needed for trainees at risk.

  • Adult surgery
  • MEDICAL EDUCATION & TRAINING

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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Footnotes

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

  • Correction notice Since this paper was first published, the following author names were edited: Wyn Lewis updated to Wyn Griffith Lewis, Richard Egan updated to Richard John Egan, Arfon Powell updated to Arfon Gethyn Morgan Tregellis Powell, Oliver Luton updated to Oliver William Luton.

  • Contributors OL, KM, DBTR, OJ: study design, data collection and analysis, editing. AP, SH-G, LW, RE, WL editing, proofing and agreed final manuscript, WL overall guarantor and final manuscript approval.

  • 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.