Factors associated with progression in higher surgical specialty training
Publication Date
August 1, 2022
Creator
Abstract
The demographics of surgical trainees have seen huge changes over the last decade. The proportion of female trainees, non-UK graduates and older trainees have all increased. The impact of trainee demographics and protected characteristics on progression throughout surgical training is unknown. Progression in surgical training can be measured by annual assessments, completion of training and clinical assessments. The aim of this thesis was to identify factors associated with progression throughout Higher Surgical Training.
The first study in this thesis (Chapter 2) is a systematic review and meta-analysis investigating factors associated with attrition and performance throughout surgical training worldwide. Attrition, defined as voluntary or involuntarily discontinuation of surgical training, remains a challenge. The pooled overall attrition rate was 17% with women having a significantly higher rate (24% vs 16%, p<0.001). Attrition rates for Higher Surgical Training in the UK are not well documented and have not been published.
During the course of this thesis, the COVID-19 pandemic caused huge disruption to the NHS and health services globally. Subsequently, surgical trainees were redeployed and elective operating lists were cancelled. Chapter 3 is a systematic review on the impact of COVID-19 on surgical training worldwide. Twenty nine studies comprising more than 5,000 surgical trainees across more than 20 countries were included in the review. The first wave of the COVID-19 pandemic caused huge disruption to the operative and non-operative clinical experience of trainees. The mental health and wellbeing of trainees was also adversely affected. Some positives to come out of the pandemic were increased research output reported in some studies and more time for self-directed study.
Two studies (Chapter 4 & 5) used the United Kingdom Medical Education Database (UKMED) to perform cohort studies of General Surgery and Trauma and Orthopaedics. The aim was to identify factors affecting progression in both specialities. The outcome measure was Annual Review of Competency Panel (ARCP) outcome on an ordinal scale. In General Surgery, older age at ARCP and those from more deprived social background were significantly more likely to receive a non-standard outcome while female sex and less than full time training were protective factors. In contrast, female sex was a risk factor for non-standard ARCP outcome in Trauma and Orthopaedics along with older age. International medical graduates were found to have lower odds of non-standard outcome compared to UK graduates in Trauma and Orthopaedics.
The final chapter (Chapter 6) utilising data from UKMED aimed to identify demographic factors and protected characteristics associated with non-standard ARCP outcome across specialities and to identify variation in ARCP outcomes. Across all specialities, female sex and older age were associated with higher odds of non-standard outcome. There was significant variation in ARCP outcomes between specialities with General Surgery having the highest proportion of non-standard outcomes and Urology the lowest.
This thesis provides new evidence regarding factors affecting progression and performance in Higher Surgical Training. It highlights areas that require further investigation in UK surgical training. Attrition in UK surgical programmes should be formally documented on a national scale and reasons for attrition identified. The longstanding impact of COVID-19 on surgical training will require follow up studies, in particular ensuring that no group of trainees are disproportionately disadvantaged and a recovery plan to recoup training losses. The pandemic has exacerbated pre-existing social inequalities with differences in disease burden between and within countries [1-3], it is possible these patterns are reflected in surgical training outcomes. Causes behind the differential attainment found in these studies need to be urgently investigated and the ARCP process reviewed.
Item Type
ethesis
Thesis Type
PhD
Supervisors
Subjects (LC)
Associated Schools / Departments
Division of Medical Sciences and Graduate Entry Medicine
School of Medicine
eprints ID
68991
UoN Repository URI
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