Raj Siddarth, Grover Sarika, Spazzapan Martina, Russell Beth, Jaffry Zahra, Malde Sachin, Vig Stella, Fleming Simon
King's College London Guy's, King's and St Thomas' Medical School, London, UK.
Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Bone Jt Open. 2024 Aug 22;5(8):697-707. doi: 10.1302/2633-1462.58.BJO-2024-0036.R2.
The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).
Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal cohort study comprising 1,960 CSTs eligible for ST3. The primary outcome measures were whether CSTs applied for a T&O ST3 post and if they were subsequently offered a post. A directed acyclic graph was used for detecting confounders and adjusting logistic regression models to calculate odds ratios (ORs), which assessed the association between the primary outcomes and relevant exposures of interest, including: age, sex, ethnicity, parental socioeconomic status (SES), domiciliary status, category of medical school, Situational Judgement Test (SJT) scores at medical school, and success in postgraduate examinations. This study followed STROBE guidelines.
Compared to the overall cohort of CSTs, females were significantly less likely to apply to T&O (OR 0.37, 95% CI 0.30 to 0.46; n = 155/720 female vs n = 535/1,240 male; p < 0.001). CSTs who were not UK-domiciled prior to university were nearly twice as likely to apply to T&O (OR 1.99, 95% CI 1.39 to 2.85; n = 50/205 vs not UK-domiciled vs n = 585/1,580 UK-domiciled; p < 0.001). Age, ethnicity, SES, and medical school category were not associated with applying to T&O. Applicants who identified as 'black and minority ethnic' (BME) were significantly less likely to be offered a T&O ST3 post (OR 0.70, 95% CI 0.51 to 0.97; n = 165/265 BME vs n = 265/385 white; p = 0.034). Differences in age, sex, SES, medical school category, and SJT scores were not significantly associated with being offered a T&O ST3 post.
There is an evident disparity in sex between T&O applicants and an ethnic disparity between those who receive offers on their first attempt. Further high-quality, prospective research in the post-COVID-19 pandemic period is needed to improve equality, diversity, and inclusion in T&O training.
本研究旨在描述与申请并获得创伤与骨科（T&O）高级外科培训（ST3）职位的核心外科培训生（CST）相关的人口统计学、社会经济和教育因素。
本回顾性纵向队列研究使用了英国医学教育数据库（UKMED）在2014年1月1日至2019年12月31日期间收集的数据，研究对象为1960名符合ST3资格的CST。主要结局指标为CST是否申请了T&O ST3职位以及他们随后是否获得了职位。使用有向无环图来检测混杂因素并调整逻辑回归模型以计算优势比（OR），评估主要结局与感兴趣的相关暴露因素之间的关联，包括：年龄、性别、种族、父母社会经济地位（SES）、居住身份、医学院类别、医学院情境判断测试（SJT）分数以及研究生考试成绩。本研究遵循STROBE指南。
与CST总体队列相比，女性申请T&O职位的可能性显著降低（OR 0.37，95% CI 0.30至0.46；女性n = 155/720，男性n = 535/1240；p < 0.001）。大学前非英国居住的CST申请T&O职位的可能性几乎是其他人的两倍（OR 1.99，95% CI 1.39至2.85；非英国居住n = 50/205，英国居住n = 585/1580；p < 0.001）。年龄、种族、SES和医学院类别与申请T&O职位无关。自我认定为“黑人和少数族裔”（BME）的申请人获得T&O ST3职位的可能性显著降低（OR 0.70，95% CI 0.51至0.97；BME n = 165/265，白人n = 265/385；p = 0.034）。年龄、性别、SES、医学院类别和SJT分数的差异与获得T&O ST3职位无显著关联。
T&O职位申请人之间存在明显的性别差异，首次申请即获得职位者之间存在种族差异。在新冠疫情后时期需要进一步开展高质量的前瞻性研究，以促进T&O培训中的平等、多样性和包容性。
