Relationship between sociodemographic factors and specialty destination of UK trainee doctors: a national cohort study

Protocol for the Swiss COhort of Healthcare Professionals and Informal CAregivers (SCOHPICA): Professional trajectories, intention to stay in or leave the job and well-being of healthcare professionals

INTRODUCTION

Healthcare professionals' shortage, low job satisfaction, high levels of burnout, and excessive staff turnover are some of the challenges health systems face worldwide. In Switzerland, healthcare stakeholders have called to address the health workforce crisis and have pointed out the scarcity of data on the conditions of healthcare professionals (HCPs). Hence, the Swiss Cohort of Healthcare Professionals and Informal Caregivers (SCOHPICA) was developed to study the career trajectories, well-being, intention to stay in or leave the position/profession/health sector, and their determinants, of HCPs and informal caregivers, respectively. This paper describes the protocol for the HCPs cohort of SCOHPICA and discusses its implications.

METHODS

SCOHPICA is a prospective open cohort using an explanatory sequential mixed methods design. All types of HCPs working directly with patients and practicing in Switzerland are eligible, irrespective of their healthcare setting and employment status. Baseline and annual follow-up electronic surveys will take place once a year, featuring both core questions and modules developed according to information needs. While outcome variables are HCPs' trajectories, well-being, intention to stay in or leave the position/profession/health sector, independent variables include organizational, psychosocial, and psychological determinants, as well as occupational (professional) and sociodemographic factors. The qualitative phase will be organized every two years, inviting participants who agreed to take part in this phase. The findings from quantitative analyses, along with the issues raised by healthcare stakeholders in the field, will guide the topics investigated in the qualitative phase.

DISCUSSION

Using innovative methodologies, SCOHPICA will gather nationwide and longitudinal data on HCPs practicing in Switzerland. These data could have numerous implications: promoting the development of research related to HCPs' well-being and retention intentions; supporting the development of policies to improve working conditions and career prospects; contributing to the evolution of training curricula for future or current healthcare professionals; aiding in the development of health systems capable of delivering quality care; and finally, providing the general public and stakeholders with free and open access to the study results through an online dashboard.

The hidden costs of the intercollegiate membership of the Royal College of surgeons examinations: Can trainees afford it?

BACKGROUND

The Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination is a mandatory requirement for higher specialty surgical training in the UK. However, there is a significant economic impact on trainees which raises the question of whether the costs of this exam hinder surgical career progression. This study explores the burden of these exams on trainees.

METHODS

A 37-point questionnaire was distributed to all trainees who were preparing for or have sat MRCS examinations. Univariate analyses included the cost of the preparatory resources, extra hours worked to pay for these and the examinations, and the number of annual leave (AL) days taken to prepare. Pearson correlation coefficients were used to identify possible correlation between monetary expenditure and success rate.

RESULTS

On average, trainees (n ​= ​145) spent £332.54, worked 31.2 ​h in addition to their rostered hours, and used 5.8 AL days to prepare for MRCS Part A. For MRCS Part B/ENT, trainees spent on average £682.92, worked 41.7 extra hours, and used 5 AL days. Overall, the average trainee spent 5-9% of their salary and one-fifth of their AL allowance to prepare for the exams. There was a positive correlation between number of attempts and monetary expenditure on Part A preparation (r(109)=0.536, p ​< ​0.001).

CONCLUSIONS

There is a considerable financial and social toll of the MRCS examination on trainees. Reducing this is crucial to tackle workforce challenges that include trainee retention and burnout. Further studies exploring study habits can help reform study budget policies to ease this pressure on trainees.

Socioeconomic Disparities in Research Participation: Bias in Plastic Surgery Residency Match

Background

Integrated plastic surgery residency applicants have increased at a rate disproportionate to available positions. Research productivity has become a surrogate marker for competitiveness, and many applicants pursue it to distinguish themselves. To date, no study has investigated socioeconomic disparities in extended research experience (ERE) participation.

Methods

A 35-question cross-sectional survey was distributed to applicants to United States-based integrated plastic surgery residency programs during the 2019-2022 application cycles. Summary tables, student t test, and chi-square tests were used for statistical analysis.

Results

A total of 161 responses (response rate: 20.9%) were recorded. Fifty-nine (40.7%) respondents participated in an ERE. The most common reason for ERE participation was strengthening one's application. The most common reason against participation was avoiding delays in career progression. A greater percentage of respondents from Northeastern medical schools participated in EREs (P = 0.019). There were no significant differences in debt burden between those who did or did not participate in an ERE. A greater percentage of applicants whose parents had advanced degrees participated in EREs (P = 0.053).

Conclusions

There may be geographic and socioeconomic biases present in access to ERE for students interested in plastic surgery. The growing popularity of EREs may have unintended consequences for applicant diversity. As most plastic surgeons ultimately practice in nonacademic settings, applicants and plastic surgeons may consider the financial hardships and possible socioeconomic disparities in research opportunities before participating in or recommending them.

Factors affecting young doctors' choice of medical specialty-A qualitative study

BACKGROUND

Young doctors' choice of medical specialty is essential to maintaining a sufficient health workforce and developing a sustainable healthcare system. The choice of specialization is the result of numerous factors, including doctors' preferences, population needs, and the number of available residency slots. The aim of this article is to explore the factors taken into consideration by young Polish physicians in choosing their future specialty.

METHODS

We have conducted 30 structured interviews with randomly selected recent medical school graduates (17 female and 13 male). The study was conducted from December 2022 until February 2023 using online platforms. Data from in-depth interviews were coded using NVivo Release 1.6.1. Then thematic analysis was performed.

RESULTS

Respondents indicated remuneration and career-associated factors as the main determinants, emphasizing that work-life balance, personal motivations, and the flexibility to choose the type of workplace (hospital vs. outpatient clinic) were even more important. Young doctors expect flexibility in working hours and better working conditions in future work, and these factors are important when choosing a medical specialty. Significant difficulties during the selection of medical specialty include limited residency slots in preferred specializations and lack of knowledge concerning the everyday aspects of work in a particular specialty.

CONCLUSIONS

Factors and limitations influencing the choice of medical specialty should be taken into account by policymakers to address the shortages of doctors in deficit specialties. Knowledge about doctors' preferences regarding their medical specialty could support the development of targeted policies to increase the attractiveness of deficit specialties and reduce the uneven distribution of medical staff.

Does medical education reform change who is selected? A national cross-sectional survey from China

OBJECTIVES

Approximately 10 years ago, China introduced an education plan to improve the overall quality of medical education and to better serve the population's health needs. Many medical schools were then recognised and financed by China's Ministry of Education to develop and operationalise new pilot programmes (PPs) aligned with this plan. These ran in parallel with the traditional programmes (TPs). One way to achieve the plan's first aim, improving the quality of medical education, is to select academically stronger candidates. We, thus, examined and compared who were selected into PPs and TPs.

DESIGN

Cross-sectional study.

SETTING

Data were collected from 123 medical schools across China via the 2021 China Medical Student Survey.

PARTICIPANTS

Participants were undergraduate clinical medicine students across all year groups.

PRIMARY AND SECONDARY OUTCOME MEASURES

Medical school selection was via the National College Entrance Examination (NCEE). Medical students' NCEE performance and their sociodemographics were used as the primary and secondary outcome measures. Mann-Whitney or χ2 tests were used to compare the means between educational programmes (PPs vs TPs) and various selection outcomes. Multilevel mixed-effects regressions were employed to account for school idiosyncratic selection results.

RESULTS

Of the 204 817 respondents, 194 163 (94.8%) were in a TP and 10 654 (5.2%) a PP. PP respondents (median=75.2, IQR=69.5-78.8) had significantly higher NCEE scores than their TP counterparts (median=73.9, IQR=68.5-78.7). Holding constant their NCEE score, PP respondents were significantly more likely to come from urban areas, not be first-generation college students, and have parents with higher occupational status and income.

CONCLUSIONS

Assuming quality can be indicated by prior academic achievement at the point of selection, PPs achieved this mission. However, doing so limited medical students' diversity. This may be unhelpful in achieving the Education Plan's goal to better serve China's health needs.

Willingness to practice medicine and related influential factors among medical undergraduates during COVID-19: a cross-sectional study

BACKGROUND

As the medical undergraduates constitute the future workforce in China, their career preferences hold a significant bearing on the quality of healthcare services, particularly in light of the ongoing COVID-19 pandemic. We aim to understand the current state of the willingness to practice medicine among medical undergraduates and to analyze the related influential factors.

METHODS

During the COVID-19 epidemic, we conducted a cross-sectional survey via an online platform from February 15, 2022, to May 31, 2022, to collect participants' demographic information, psychology, and factors influencing their career choices. The general self-efficacy scale (GSES) was used to evaluate medical students' perceptions of their self-efficacy. Futhermore, we conducted multivariate logistic regression analyses to explore the influencing factors of medical undergraduates' willingness to pursure a caree in medicine.

RESULTS

A total of 2348 valid questionnaires were included, and 1573 (66.99%) were willing to practice medicine for medical undergraduates after graduation. The mean GESE scores in the willingness group (2.87 ± 0.54) were significantly higher than those of the unwillingness group (2.73 ± 0.49). The multiple logistic regression showed that several factors were positively associated with willingness to practice medicine as a career, including students' GSES score (OR = 1.87), current major, household income, personal ideals (OR = 1.97), family support (OR = 1.44), high income (OR = 1.77), and social respect (OR = 2.19). Compared with those who were very afraid of COVID-19, students who did not express any fear towards the COVID-19 pandemic had a higher preference for choosing the medical profession as a career. Conversely, students thinking of high tension in the doctor-patient relationship, heavy workload, and long training were less likely to choose medical work after graduation.

CONCLUSIONS

The study highlights a noteworthy prevalence of medical undergraduates who expressed their willingness to pursue medicine as a career post-graduation. Several factors, including but not limited to current major, household income, psychological factors, personal preferences, and career needs or preferences, were significantly associated with this willingness. Moreover, the impact of the COVID-19 pandemic on medical students' career choices cannot be overlooked.

How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools?

BACKGROUND

Widening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. 'Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.' This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities.

METHODS

Data from 2007-13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school.

RESULTS

Four thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%).

CONCLUSIONS

Gateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.

The Effect of Sociodemographic Factors on Obtaining a Place in Core Surgical Training

Competition for Core Surgical Training (CST) is rising, placing a strong emphasis on interview performance. Several interview courses offer to help candidates secure their chosen surgical job but at premium fees. A group of London-based CSTs started a free course offering high-quality mock interview experiences to over 90 applicants in 2022, with the aim of providing an accessible opportunity for financially disadvantaged candidates. Course candidates completed three sets of questionnaires, pre- and post-mock interview, and a final one upon job allocation. Candidates' educational background and schooling history were obtained as well as their self-assessment score, eventual rank after interview and the rank of the job they had accepted. The three sets of questionnaires were completed by 87, 73 and 45 candidates respectively. Overall, there was a statistically significant difference in self-reported confidence scores after the course (P < 0.001). There was no significant difference in the self-assessment score of the 44.2% of candidates who had attended private education in the UK, compared to publicly educated (P = 0.0525), nor was there a difference in their rank after interviews (P = 0.236). Candidates who spent £50 or more had higher self-assessment scores (P = 0.042) but they didn't rank higher in overall scores (P = 0.591). Interview preparation courses are helpful in increasing candidates' confidence, however spending more money does not translate into a better overall interview performance. Our study suggests that candidates from private education backgrounds do not have an advantage in the CST application process.

Differential attainment, socioeconomic factors and surgical training

INTRODUCTION

Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status.

METHODS

Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests.

RESULTS

Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05).

CONCLUSIONS

There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.

Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: a retrospective cohort study

Objective

A recent independent review on diversity and inclusivity highlighted concerns that barriers to surgical career progression exist for some groups of individuals and not others. Group-level differences in performance at the Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examinations have been identified but are yet to be investigated. We aimed to characterise the relationship between sociodemographic differences and performance at MRCS.

Design

Retrospective cohort study.

Setting

Secondary care.

Participants

All UK MRCS candidates attempting Part A (n = 5780) and Part B (n = 2600) between 2013 and 2019 with linked sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk).

Main outcome measures

Chi-square tests established univariate associations with MRCS performance. Multiple logistic regression identified independent predictors of success, adjusted for medical school performance.

Results

Statistically significant differences in MRCS pass rates were found according to gender, ethnicity, age, graduate status, educational background and socioeconomic status (all p < 0.05). After adjusting for prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were independent predictors of MRCS Part A success and being a non-graduate (OR 1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51, 95% CI 1.08–2.10) were independent predictors of Part B success. Black and minority ethnic groups were significantly less likely to pass MRCS Part B at their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR 0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White candidates.

Conclusions

There is significant group-level differential attainment at MRCS, likely to represent the accumulation of privilege and disadvantage experienced by individuals throughout their education and training. Those leading surgical education now have a responsibility to identify and address the causes of these attainment differences.

The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools

INTRODUCTION

Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research.

METHODS

Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows.

RESULTS

We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices).

CONCLUSIONS

Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.

National Implementation and Evaluation of a Virtual Subinternship in Urology

OBJECTIVES

To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic.

METHODS

In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale.

RESULTS

The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (OR 4.64, p=0.003) and class size ≤4 students (OR 3.33, p=0.015). Higher PD ratings were associated with full-time electives (OR 11.18, p=0.019), class size ≤4 students (OR 13.99, p=0.042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, p=0.038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives.

CONCLUSIONS

The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

Creating a Composite Index to Target Recruitment of UK Students from Areas of Low Participation in Higher Education

This research presents a framework through which a new Higher Education Access and Deprivation (HEAD) composite index was created to assist UK universities in efficiently recruiting and supporting students from areas with traditionally low engagement rates in higher education. The index was designed to be easily adaptable by university staff to suit their own work priorities and/or an institution's strategic requirements by utilising open socio-demographic data and construction techniques that require minimal technical statistical skills. Although Cornwall was used as the study area in this research, this index has been designed such that it can be readily applied elsewhere. Two differently weighted models were created using the framework - one with equal weights and the other based on the frequency the constituent indicators appeared in the reviewed academic literature. Both models were mapped across Cornwall, identifying areas of deprivation at a finer resolution than under the current widely used Participation of Local Areas (POLAR) methodology. The weighted model performed marginally better than both the equal weighted model and the current POLAR methodology when validated against external data, and additionally it worked well in both rural and urban environments leading to it being selected as the new HEAD index. The HEAD index maps smaller scale areas of deprivation than previously available, and by enabling users to investigate the underlying socio-demographic characteristics of an area, it also allows universities to create interventions, support, and policies that best targets the students they aim to recruit and teach.

Does performance at medical school predict success at the Intercollegiate Membership of the Royal College of Surgeons (MRCS) examination? A retrospective cohort study

BACKGROUND

Identifying predictors of success in postgraduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance on the educational performance measurement (EPM) and situational judgement test (SJT) used for selection into foundation training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination.

METHODS

This was a longitudinal, cohort study using data from the UK Medical Education Database (https://www.ukmed.ac.uk). UK medical graduates who had attempted Part A (n=2585) and Part B (n=755) of the MRCS between 2014 and 2017 were included. χ² and independent t-tests were used to examine the relationship between medical school performance and sociodemographic factors with first-attempt success at MRCS Part A and B. Multivariate logistic regression was employed to identify independent predictors of MRCS performance.

RESULTS

The odds of passing MRCS increased by 55% for Part A (OR 1.55 (95% CI 1.48 to 1.61)) and 23% for Part B (1.23 (1.14 to 1.32)) for every additional EPM decile point gained. For every point awarded for additional degrees in the EPM, candidates were 20% more likely to pass MRCS Part A (1.20 (1.13 to 1.29)) and 17% more likely to pass Part B (1.17 (1.04 to 1.33)). For every point awarded for publications in the EPM, candidates were 14% more likely to pass MRCS Part A (1.14 (1.01 to 1.28)). SJT score was not a statistically significant independent predictor of MRCS success.

CONCLUSION

This study has demonstrated the EPM's independent predictive power and found that medical school performance deciles are the most significant measure of predicting later success in the MRCS. These findings can be used by medical schools, training boards and workforce planners to inform evidence-based and contemporary selection and assessment strategies.

Predictors of ophthalmology career success (POCS) study

Objective

Ophthalmology is the busiest outpatient specialty with demand predicted to rise over 40% in the next 20 years. A significant increase in the number of trainee ophthalmologists is required to fill currently vacant consultant posts and meet the UK's workforce demands by 2038. Our aim was to understand what determines success in ophthalmology training, in order to inform future ophthalmologists, refine recruitment and facilitate workforce planning.

Methods and Analysis

This was a retrospective longitudinal cohort study using routinely collected data available from UK Medical Education Database (UKMED) (https://www.ukmed.ac.uk/). Data were analysed on 1350 candidates who had applied for ophthalmology specialty training (OST) between 2012 and 2018, as well as 495 candidates who had attempted Fellow of the Royal College of Ophthalmologists (FRCOphth) Part 1 between 2013 and 2018. Participants who had not obtained their primary medical qualification from the UK medical schools were excluded. Primary outcome measures included gaining a place on the OST programme and passing the FRCOphth Part 1 examination on first attempt.

Results

Higher education performance measure decile scores at medical school are strongly predictive in securing an OST post and passing the part 1 examination first time (p<0.001). Candidates who attempt FRCOphth Part 1 prior to their ST1 application are more likely to get a place on OST on first attempt. Socioeconomic factors, gender and ethnicity do not influence success in OST entry. Male trainees are more likely to pass FRCOphth Part 1 on their first attempt.

Conclusion

This study is the first quantitative assessment of the factors that determine success in OST recruitment and ophthalmology postgraduate examinations in the UK. Similar studies should be undertaken in all other medical and surgical specialties to understand what factors predict success.

Opening up the black box of a Gateway to Medicine programme: a realist evaluation

OBJECTIVES

A Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why.

DESIGN

This study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works.

SETTING

Participants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme.

PARTICIPANTS

Twelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2-3 points in their Gateway programme year.

RESULTS

Data were generated to determine what 'works' in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6).

CONCLUSIONS

By unpacking the 'black box' of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students' preparedness to transition.

Performance of Queen's University Belfast graduates at core and speciality application

INTRODUCTION

The general medical council (GMC) conducts the National Training Survey (NTS) annually. Part of the survey illustrates the statistics of United Kingdom medical school graduates in core and speciality application. We aimed to review the speciality training application and performance of graduates of Queen's University Belfast (QUB), and compared with graduates of medical schools in England, Scotland, and Wales.

METHOD

The progression reports from the GMC NTS 2016-2019 were accessed on the GMC website. All data available were extracted in April 2020. The mean results for all graduates of 33 UK medical schools in Northern Ireland, England, Scotland, and Wales were collated from the NTS. Applications to the seven specialities with the greatest number of posts available across the UK were analysed.

RESULTS

No differences were noted in the majority of the application stages when comparing graduates from QUB with other UK medical school graduates. However, QUB graduates were less likely to be invited for an interview when applying for core surgical training AND receive an offer for Core Anaesthetic and ACCS Training. QUB graduates were less likely to apply for General Practice training.

CONCLUSION

Our study evaluates the performance of QUB graduates compared to other UK medical graduates in core/speciality application. Based on our findings, QUB and postgraduate deaneries may consider focussing on strengthening applications for aspiring surgeons, improving interview performance for anaesthetics and ACCS applicants, and attracting trainees to pursue a career in General Practice.

Surgical training in the UK: is cost a barrier to entry?

BACKGROUND

There is good quality evidence linking socioeconomic background and the likelihood of a surgical career. Additionally, training in surgery is more expensive than in other specialties. Our aim was to assess the awareness and perceptions of trainees and medical students of the relative costs of surgical training and to determine whether perceptions of cost deter potential surgical trainees.

METHODS

Medical students, foundation doctors and core trainees in England were surveyed over a 2-week period. χ² tests of independence were used to assess statistically significant associations between measured variables MAIN FINDINGS: A total of 284 responses were received. More than half of respondents (54%) were not previously aware of the high costs of surgical training. More than a quarter of respondents (27%) did not take out a student loan. There was a significant association (p=0.003) between familial income and being less likely to consider a surgical career due to the costs. Respondents who reported receipt of a student loan were also significantly less likely to consider a surgical career due to the costs (p=0.033).

CONCLUSION

Our study demonstrates an important relationship between perceived costs of surgical training and future career aspirations. This suggests that access to surgical training may still be difficult for many. This study also highlights a general lack of awareness of high surgical training costs. It is important that surgical training is accessible. Financial status should not be a significant disincentive and widening access to surgical training can only serve to enrich and advance the specialty.

Factors influencing specialty choice and the effect of recall bias on findings from Irish medical graduates: a cross-sectional, longitudinal study

BACKGROUND

Despite being a vital part of medical workforce planning and development, how medical students and graduates choose their career specialty is still not well understood. This study aimed to identify the factors medical graduates consider important influences in their choice of specialty after their first year of practice, and to test the validity of relying on respondent recall to measure changes in specialty choice.

METHODS

The baseline survey was administered online to all final year students in Ireland's six medical schools. Those who consented to follow-up (n = 483) were surveyed 18 months later (June 2018), during the final month of first year of practice.

RESULTS

The baseline survey had a 67% (n = 483) response rate. At the follow-up survey, (n = 232, 48% response rate) the top specialty choices were: Medicine, n = 54 (26%); Surgery, n = 34 (16%); General Practice, n = 28 (13%); Anaesthesia, n = 16 (8%) and Paediatrics, n = 14 (7%). Of the 49 respondents (28%) reporting a change of specialty since baseline, 13 (27%) selected the same specialty in both surveys; of the 121 (69%) reporting no change, 22 (18%) selected a different specialty at follow-up. Over 90% of respondents rated as 'important or 'very important': 'Own aptitude', 'Work-life balance' and 'What I really want to do'. Over 75% rated as 'not at all', or 'not very important' 'Current financial debt' and 'Inclinations before medical school'. When adjusted for sex and age, compared with Medicine, General Practice rated as more important: continuity of patient care (RRR 3.20 CI(1.59-6.41), p = 0.001); working hours/conditions (RRR 4.61 CI(1.03-20.60), p = 0.045) and a career that fit their domestic circumstances (RRR 3.19 CI(1.27-8.02), p = 0.014). Those choosing Surgery rated as less important: patient contact (RRR 0.56 CI(0.33-0.95), p = 0.033) and working hours/conditions (RRR 0.55 CI(0.31-0.96), p = 0.035).

CONCLUSIONS

The different demographic and motivational profiles by specialty choice are consistent with other studies suggesting a distinct profile for doctors intending to enter General Practice. In addition, our results suggest longitudinal study designs guard against recall bias and so provide more robust medical workforce models to inform and direct recruitment drives and interventions in future medical workforce planning.