Applications to medical and surgical specialist training in the UK National Health Service, 2021-2022: a cross-sectional observational study to characterise the diversity of successful applicants

Abstract

Objectives: To compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status.

Design: Cross-sectional observational study.

Setting: National Health Service, UK.

Participants: All specialty training post applications to Health Education England, UK, during the 2021-2022 recruitment cycle.

Intervention: Nil.

Primary and secondary outcome measures: Comparison of success at application to specialty training posts by gender, ethnicity, country of qualification (UK vs non-UK) and disability. The influence of ethnicity on success was investigated using a logistic regression model, where country of qualification was included as a covariate.

Results: 12 419/37 971 (32.7%) of applicants to specialty training posts were successful, representing 58 specialties. The difference in percentage of successful females (6480/17 523, 37.0%) and males (5625/19 340, 29.1%) was 7.9% (95% CI 6.93% to 8.86%), in favour of females. Segregation of applications to specialties by gender was observed; surgical specialties had the highest proportion of male applicants, while obstetrics and gynaecology had the highest proportion of female applicants. The proportion of successful recruits to specialties largely reflected the number of applications. 11/15 minority ethnic groups (excluding 'not stated') had significantly lower adjusted ORs for success compared with white-British applicants. 'Mixed white and black African' (OR 0.52, 95% CI 0.44 to 0.61, p≤0.001) were the least successful minority group in our study, while non-UK graduates had an adjusted ORs for success of 0.43 (95% CI 0.41 to 0.46, p≤0.001) compared with UK graduates. The difference in percentage of success by disabled applicants (179/464, 38.6%) and non-disabled applicants (11 940/36 418, 32.8%) was 5.79% (95% CI 1.23% to 10.4%), in favour of disabled applicants. No disabled applicants were accepted to 21/58 (36.2%) of specialties.

Conclusions: Despite greater success by female applicants overall, there is an attraction issue to specialties by gender. Further, most ethnic minority groups are less successful at application when compared with white-British applicants. This requires continuous monitoring and evaluation of the reasons behind observed differences.

Trial registration: Not applicable.

Keywords: EDUCATION & TRAINING (see Medical Education & Training); GENERAL MEDICINE (see Internal Medicine); Health Equity; Health policy; Organisational development; SURGERY.

Figure 1

Success of applicants to training posts by specialty in the 2021 recruitment year by gender. Figure showing the applications of trainees to specialty training posts and percentage of successful applicants by gender, where data are complete. All values are provided to three significant figures. Where CIs for estimated differences between the percentage of successful applicants by gender does not cross zero, bars are highlighted in orange (greater female success) or purple (greater male success). Specialties marked with ∧contained small numbers (ie, expected frequencies were lower than five in any domain of the contingency table) and therefore Fisher's exact test results to examine differences in proportions of successful candidates are also provided in online supplemental table 3.

Figure 2

Applications and outcomes for specialty training posts separated into groups of specialties in the 2021–2022 recruitment year by gender. (A) Proportion of applicants to specialty groups by gender. (B) Number of applicants to specialty groups by gender. (C) Proportion of successful applicants to specialty groups by gender. (D) Number of successful applicants to specialty groups by gender. Groupings of specialties can be found in online supplemental table 1. EM, Emergency Medicine; ICU, Intensive Care Unit; GP, general practitioner.

Figure 3

Applications and outcomes for specialty training posts in the 2021–2022 recruitment year by ethnicity. Applications to specialty training posts in the 2021 recruitment year by ethnicity.

Figure 4

Applications and outcomes for specialty training posts in the 2021–2022 recruitment year by ethnicity and graduate status. (A) Unadjusted ORs for success by ethnicity when compared with white British applicants derived from a logistic regression model (B) Adjusted ORs for success by ethnicity compared with white British where country of qualification (UK vs non-UK) is included as a covariate derived from a multivariable logistic regression model. Non-medical applicants to public health specialty training have been removed (n=988). ORs are presented with 95% CIs. *p<0.05, **p<0.01, ***p<0.001.