DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) for general surgery applications in the UK: retrospective study

The process of securing a core surgical trainee (CST) position in the UK and Ireland remains highly competitive due to a limited number of posts and an increasing number of applicants.CSTs are at least 2 years postgraduate from their medical degree.In 2023, 2539 candidates competed for 609 CST posts in the UK, resulting in a competition ratio of 4.17, an increase compared with previous years 1 .Upon completing CST become eligible to apply for Higher Surgical Training (ST3); however, the number of ST3 posts, particularly in general surgery, has not kept up with increasing demand.For instance, in 2021, 607 candidates applied for 136 ST3 positions, a competition ratio of 4.46.Despite recent interest in fostering diversity within surgical specialties, particularly in addressing sex disparities, there remains a paucity of data on the demographic, socioeconomic and educational factors influencing both application and success rates for ST3 positions.This study seeks to address these knowledge gaps by analysing demographic, socioeconomic and educational characteristics associated with CSTs who apply for and receive offers for ST3 in general surgery.This retrospective study analysed data from the UK Medical Education Database (UKMED) between January 2014 and December 2019.Primary outcomes were applying to and receiving an offer for a general surgery ST3 post on the first attempt.Adjusted logistic regression models were used to calculate odds ratios (ORs) for variables including age, sex, ethnicity, socioeconomic status (SES), domicile status, medical school type, Situational Judgement Test (SJT) scores and postgraduate exam success.This methodology has been previously utilized for other specialties 2,3 .Further information can be found in the Supplementary Material.In this cohort of 1960 CSTs, the majority were male (63%), UK domiciled before medical school (81%) and attended Russell Group universities (69%).Of the 706 first-time applicants for general surgery ST3 positions, 477 (67.6%) received an offer.