Egalitarianism in surgical training: let equity prevail

Area of Science:

• Medical Education
• Surgical Training
• Health Equity

Background:

• Core Surgical Trainee (CST) differential attainment (DA) requires investigation across diverse graduate cohorts.
• Understanding disparities is crucial for equitable surgical training programs in the UK.

Purpose of the Study:

• To quantify DA among White UK Graduates (White UKG), Black and Minority Ethnic UK Graduates (BME UKG), and International Medical Graduates (IMGs).
• To analyze differences in Annual Review of Competence Progression (ARCP) outcomes, Intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass rates, and National Training Number (NTN) selection.

Main Methods:

• Retrospective analysis of Intercollegiate Surgical Curriculum Programme (ISCP) portfolios from 264 CSTs (2010-2017) in a single UK postgraduate region.
• Comparison of ARCP outcomes, iMRCS pass rates, and NTN selection across White UKG, BME UKG, and IMG cohorts.

Main Results:

• ARCP outcomes were similar across all groups (p=0.395).
• iMRCS pass rates were significantly lower for IMGs (50.0%) compared to White UKG (71.4%) and BME UKG (71.2%) (p=0.042).
• NTN success rates were substantially lower for IMGs (6.7%) versus White UKG (36.9%) and BME UKG (36.4%) (p=0.023).
• Multivariable analysis identified operative experience, bootcamp attendance, and UK graduate status as predictors for NTN appointment.

Conclusions:

• While DA is equitable for BME UKGs, significant disparities exist for IMGs in iMRCS pass rates and NTN selection.
• Targeted interventions are necessary to ensure equity in UK CST programs for all trainees.