Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study

Abstract

IntroductionKnowledge about allocation of doctors into postgraduate training programmes is essential in terms of workforce planning, transparency and equity issues. However, this is a rarely examined topic. To address this gap in the literature, the current study examines the relationships between applicants’ sociodemographic characteristics and outcomes on the UK Foundation Training selection process.MethodsA longitudinal, cohort study of trainees who applied for the first stage of UK postgraduate medical training in 2013–2014. We used UK Medical Education Database (UKMED) to access linked data from different sources, including medical school admissions, assessments and postgraduate training. Multivariable ordinal regression analyses were used to predict the odds of applicants being allocated to their preferred foundation schools.ResultsApplicants allocated to their first-choice foundation school scored on average a quarter of an SD above the average of all applicants in the sample. After adjusting for Foundation Training application score, no statistically significant effects were observed for gender, socioeconomic status (as determined by income support) or whether applicants entered medical school as graduates or not. Ethnicity and place of medical qualification were strong predictors of allocation to preferred foundation school. Applicants who graduated from medical schools in Wales, Scotland and Northern Ireland were 1.17 times, 3.33 times and 12.64 times (respectively), the odds of applicants who graduated from a medical school in England to be allocated to a foundation school of their choice.ConclusionsThe data provide supportive evidence for the fairness of the allocation process but highlight some interesting findings relating to ‘push-pull’ factors in medical careers decision-making. These findings should be considered when designing postgraduate training policy.

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

“…Our results could be interpreted as students who come from non-traditional backgrounds tending to perform less well, have significantly lower Foundation Programme selection scores (as evidenced by our findings), and not applying for certain specialties as they do not believe they can compete for a training post with those who performed better on the UKFP 32. However, the weaker performance of non-traditional students on Foundation Programme selection may be due to financial rather than ability differences.…”

“…However, we must also acknowledge some potential limitations of the study. First, in our previous research on selection into postgraduate (F2) training we reported how some of the contextual markers included in the analysis overlap, particularly socioeconomic class, ethnicity and place of medical qualification 32. We believe that these have a similar effect on specialty choice given the links between place, poverty and ethnicity in the UK 68 69.…”

“…While small-scale studies have shown that there is an association between doctors from certain sociodemographic background and preference for certain specialties,16 30 31 increasing the number of students in medical schools alone, without considering the effect of other factors such as specialty culture and perceived attractiveness, could lead to unintended consequences, such as training even more doctors who wish to work in urban specialist practice. Moreover, concerns about continued disadvantage in medical education and training, for students who come from non-traditional backgrounds, have been raised before 32. This leads to questions about whether specialty destination also differs on the basis of socioeconomic class or other contextual markers, including academic ability.…”

Today's doctors: What do men and women value in a training post?

“…However, this group has its own inherent biases. For example, most doctors in the UK are from more affluent or professional family backgrounds, and there is recent evidence that socio‐economic background is associated with specialty choice in the UK 80 . Unfortunately, we did not have details of respondents' socio‐economic background or insight into any other factors, which may have influenced their preferences (eg, amount of debt) so could not examine these relationships.…”

Taking a break: doctors opt out of training after foundation year 2

“…Research shows, for example, strong connections between admission decisions by medical schools and the choices made by FY2 doctors about both specialty and place of work 78…”