Fair access to higher surgical training in the UK: an equity, diversity and inclusion analysis of national selection in 2024.

Abstract

To assess the impact of gender, age, ethnicity and country of primary medical qualification (CoQ) on outcomes in the 2024 UK ST3 surgical national selection process. Retrospective cross-sectional analysis of national recruitment data. UK-wide ST3 surgical training recruitment. 2009 unique ST3 applicants to six surgical specialties (otolaryngology, plastic surgery, urology, paediatric surgery, trauma and orthopaedics and general surgery); neurosurgery, cardiothoracic surgery and oral and maxillofacial surgery were excluded. Offer of a ST3 National Training Number (NTN). CoQ was the strongest factor associated with success. International medical graduates had lower odds of receiving offers in all specialties, notably in general surgery (adjusted OR (aOR)=0.21, 95% CI 0.14 to 0.33, p<0.001), and trauma and orthopaedics (T&O) (aOR=0.14, 95% CI 0.08 to 0.23, p<0.001). Older age reduced odds in T&O (aOR=0.44, 95% CI 0.26 to 0.72, p=0.001). Female applicants in T&O also had lower odds of success (aOR=0.44, 95% CI 0.25 to 0.79, p=0.006). Ethnicity was not independently associated with outcomes after adjustment. ST3 selection outcomes are primarily associated with CoQ. UK-trained applicants have a consistent advantage. Women remain less likely to be offered an NTN than men in Trauma and Orthopaedics. This analysis enables detailed and timely equity monitoring across surgical specialties and flags areas for intervention.