School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, UK
Prince Charles Hospital, Merthyr Tydfil, United Kingdom.
Postgrad Med J. 2020 Nov;96(1141):650-654. doi: 10.1136/postgradmedj-2020-137563. Epub 2020 May 5.
This study aimed to quantify core surgical trainee (CST) differential attainment (DA) related to three cohorts; white UK graduate (White UKG) versus black and minority ethnic UKG (BME UKG) versus international medical graduates (IMGs). The primary outcome measures were annual review of competence progression (ARCP) outcome, intercollegiate Membership of the Royal College of Surgeons (iMRCS) examination pass and national training number (NTN) selection. Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 264 consecutive CSTs (2010-2017, 168 white UKG, 66 BME UKG, 30 IMG) from a single UK regional post graduate medical region (Wales) were examined. Data collected prospectively over an 8-year time period was analysed retrospectively. ARCP outcomes were similar irrespective of ethnicity or nationality (ARCP outcome 1, white UKG 60.7% vs BME UKG 62.1% vs IMG 53.3%, p=0.395). iMRCS pass rates for white UKG vs BME UKG vs IMG were 71.4% vs 71.2% vs 50.0% (p=0.042), respectively. NTN success rates for white UKG vs BME UKG vs IMG were 36.9% vs 36.4% vs 6.7% (p=0.023), respectively. On multivariable analysis, operative experience (OR 1.002, 95% CI 1.001 to 1.004, p=0.004), bootcamp attendance (OR 2.615, 95% CI 1.403 to 4.871, p=0.002), and UKG (OR 7.081, 95% CI 1.556 to 32.230, p=0.011), were associated with NTN appointment. Although outcomes related to BME DA were equitable, important DA variation was apparent among IMGs, with iMRCS pass 21.4% lower and NTN success sixfold less likely than UKG. Targeted counter measures are required to let equity prevail in UK CST programmes.
本研究旨在量化核心外科受训者（CST）在三个队列中的差异（DA），包括白种英国毕业生（White UKG）、黑人和少数民族英国毕业生（BME UKG）和国际医学毕业生（IMG）。主要的结局测量指标是年度能力进展审查（ARCP）结果、大学间皇家外科医师学会会员（iMRCS）考试及格率和国家培训名额（NTN）选择。对来自英国一个区域研究生医学区（威尔士）的 264 名连续 CST 的大学间外科课程计划（ISCP）组合进行了检查（2010-2017 年，168 名白种 UKG、66 名 BME UKG、30 名 IMG）。在 8 年的时间内收集的数据进行了回顾性分析。无论种族或国籍如何，ARCP 结果相似（ARCP 结果 1，白种 UKG 60.7%比 BME UKG 62.1%比 IMG 53.3%，p=0.395）。白种 UKG 与 BME UKG 与 IMG 的 iMRCS 及格率分别为 71.4%比 71.2%比 50.0%（p=0.042）。白种 UKG 与 BME UKG 与 IMG 的 NTN 成功率分别为 36.9%比 36.4%比 6.7%（p=0.023）。多变量分析显示，手术经验（OR 1.002，95%CI 1.001 至 1.004，p=0.004）、训练营出勤率（OR 2.615，95%CI 1.403 至 4.871，p=0.002）和 UKG（OR 7.081，95%CI 1.556 至 32.230，p=0.011）与 NTN 任命相关。尽管与 BME DA 相关的结果是公平的，但 IMG 之间的 DA 差异仍然明显，其 iMRCS 及格率低 21.4%，NTN 成功率低 6 倍。需要采取有针对性的对策，以使英国 CST 计划中的公平性占主导地位。
