Graduates from widening participation medical programs are disadvantaged on residency selection

INTRODUCTION: Despite efforts to increase the diversity of medical students, recent evidence suggests that graduates from underrepresented groups are disadvantaged in respect of postgraduate progression. This strongly suggests the need to identify and address structural factors that may perpetuate disadvantage. Thus, we examine the relationships between type of medical school program, postgraduate medical examinations and speciality training (residency) place offers. METHODS: This retrospective cohort study used data from the UK Medical Education Database (UKMED) to examine postgraduate career progression by program type (standard entry [SEM], graduate entry [GEM], or Gateway [GY] medical programs-note GEM and GY programs were established to widen participation). Data were included from UK-domiciled doctors graduating between 2012 and 2021, who had applied for specialty/residency medical training. Multivariable logistic regression analyses evaluated applications offers, and specialty preferences for graduates from the three program types, adjusting for prior attainment and socio-demographic factors including indicators of disadvantage. Differences in application timing and prior Royal College exams were also explored. RESULTS: Specialty applications were submitted by 33,540 SEM (80.6%), 4,425 GEM (86.8%), and 615 GY graduates (78.8%). Significantly more SEM graduates (35.5%) had sat and passed a Royal College examination prior to applying compared to GEM (31.9%) or GY graduates (11.1%). After adjusting for prior attainment and sociodemographic factors, GEM and GY graduates were less likely than SEM graduates to be deemed appointable (OR 0.89 and 0.72, respectively) or to receive an offer (OR 0.93 and 0.73, respectively) for specialty training. Significantly fewer GY graduates (60.1%) secured an offer within five years compared with GEM (72.5%) and SEM (67.7%) graduates. Groups also showed differences in specialty preferences/application patterns. CONCLUSIONS: These group‑level differences at the point of specialty training application are an important equity concern. Our findings will inform change in postgraduate recruitment processes to ensure equity and inclusivity.