SRS01 - Widening the gate: tackling inequity in higher surgical training

Abstract Background Ensuring fairness in higher surgical training is critical to building a representative workforce. This study analysed whether gender, age, ethnicity, and country of primary medical qualification (CoQ) influenced outcomes in the 2024 UK ST3 surgical national selection. Methods A retrospective cross-sectional analysis of anonymised UK-wide recruitment data was performed. All applicants with complete demographic and outcome data were included. The primary outcome was receipt of an ST3 training offer. Logistic regression generated adjusted odds ratios (aOR) with 95% confidence intervals (c.i.). Results A total of 1921 unique applicants were analysed. CoQ was the strongest predictors across all specialties. International medical graduates (IMGs) had substantially lower odds of receiving offers in General Surgery (aOR = 0.21, 95% 0.14–0.33, P < 0.001), Trauma and Orthopaedics (aOR = 0.14, 95% c.i. 0.08–0.23, P < 0.001), Urology (aOR = 0.29, 95% c.i. 0.15–0.53, P < 0.001), and Plastic Surgery (aOR = 0.36, 95% c.i. 0.16–0.75, P = 0.009). In T&O, older applicants had lower odds of success (aOR = 0.44, 95% c.i. 0.26–0.72, P = 0.001), and women were less likely to receive an offer than men (aOR = 0.44, 95% c.i. 0.25–0.79, P = 0.006). In contrast, gender and ethnicity were not significant predictors in General Surgery, Urology, or Plastic Surgery after adjustment. Conclusions ST3 selection outcomes are strongly associated with country of qualification, with IMGs facing consistent disadvantage. Women and older applicants are particularly disadvantaged in T&O. These findings highlight the need for targeted induction, mentorship, and preparatory support to ensure fair access to higher surgical training.