Differential attainment in higher surgical training: scoping pan-specialty spectra

Abstract

IntroductionThis 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).MethodAnonymised 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.ResultsARCPOs 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).ConclusionDifferential 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.

Differential Attainment in Assessment of Postgraduate Surgical Trainees: A Scoping Review

“…Another study by Robinson et al [14] demonstrated similar pass rates between WUKGs and BME UKGs, but IMGs had signi cantly lower pass rates than all UKGs. The FRCS pass rates of WUKGs, BME UKGs and IMGs were 76.9%, 52.9%, and 53.9%, respectively, though these percentages were not statistically signi cantly different [15].…”

“…This contrasts with other specialities in which men are the in-group and women are seen to underperform. Outside of O&G, in comparison to men, women are less likely to pass MRCS [3,13], receive satisfactory ARCP outcome [15,17], or receive positive feedback [24], whilst not performing the same number of procedures as men [29,30]. This often leads to poor self-con dence in women [27], which can then worsen performance [22].…”

“…However, Robinson et al [14] presented no signi cant gender differences in MRCS success rates. A study assessing Fellowship of the Royal College of Surgeons (FRCS) examination results found no signi cant gender disparities in pass rates [15]. In MRCOG examination, no signi cant gender differences were found in Part 1 scores, but women had higher pass rates and scores in Part 2 [16].…”

“…Two studies [3,15] concentrated on educational background, considering factors such as parental occupation and attendance of a fee-paying school. MRCS part A pass rate was signi cantly higher for trainees for whom Medicine was their rst Degree, those with university-educated parents, higher POLAR quintile, and those from fee-paying schools.…”

“…Higher part B pass rate was associated with graduating from non-Graduate Entry Medicine programmes and parents with managerial or professional occupations [3]. Trainees with HD were associated with an almost vefold increase in FRCS success and seven times more scienti c publications than their counterparts [15].…”