Demographics, distribution and experiences of UK clinical academic trainees using GMC NTS Survey data.

Involvement in research plays an integral role in the delivery of high-quality patient care, benefitting doctors, patients and employers. It is important that access to clinical academic training opportunities are inclusive and equitable. To better understand the academic trainee population, distribution of academic posts and their reported experience of clinical training, we analysed 53 477 anonymous responses from General Medical Council databases and the 2019 National Training Survey. Academic trainees are more likely to be men, and the gender divide begins prior to graduation. There are very low numbers of international medical graduates and less than full-time academic trainees. A small number of UK universities produce a greater prevalence of doctors successfully appointed to academic posts; subsequent academic training also clusters around these institutions. At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen. Foundation academic trainees report a poorer experience of some aspects of their clinical training placements, with high workloads reported by all academic trainees. Our work highlights important disparities in the demographics of the UK clinical academic trainee population and raises concerns that certain groups of doctors face barriers accessing and progressing in UK academic training pathways.

Demographics, distribution and experiences of UK clinical academic trainees using GMC NTS Survey data.

Involvement in research plays an integral role in the delivery of high-quality patient care, benefitting doctors, patients and employers. It is important that access to clinical academic training opportunities are inclusive and equitable. To better understand the academic trainee population, distribution of academic posts and their reported experience of clinical training, we analysed 53 477 anonymous responses from General Medical Council databases and the 2019 National Training Survey. Academic trainees are more likely to be men, and the gender divide begins prior to graduation. There are very low numbers of international medical graduates and less than full-time academic trainees. A small number of UK universities produce a greater prevalence of doctors successfully appointed to academic posts; subsequent academic training also clusters around these institutions. At more senior levels, academic trainees are significantly more likely to be of white ethnicity, although among UK graduates, no ethnicity differences were seen. Foundation academic trainees report a poorer experience of some aspects of their clinical training placements, with high workloads reported by all academic trainees. Our work highlights important disparities in the demographics of the UK clinical academic trainee population and raises concerns that certain groups of doctors face barriers accessing and progressing in UK academic training pathways.

Trends in Usage and Outcomes for Expanded Criteria Donor Kidney Transplantation in the United States Characterized by Kidney Donor Profile Index.

There has been increasing concern in the kidney transplant community about the declining use of expanded criteria donors (ECD) despite improvement in survival and quality of life. The recent introduction of the Kidney Donor Profile Index (KDPI), which provides a more granular characterization of donor quality, was expected to increase utilization of marginal kidneys and decrease the discard rates. However, trends and practice patterns of ECD kidney utilization on a national level based on donor organ quality as per KDPI are not well known. We, therefore, performed a trend analysis of all ECD recipients in the United Network for Organ Sharing (UNOS) registry between 2002 and 2012, after calculating the corresponding KDPI, to enable understanding the trends of usage and outcomes based on the KDPI characterization. High-risk recipient characteristics (diabetes, body mass index ≥30 kg/m2, hypertension, and age ≥60 years) increased over the period of the study (trend test p<0.001 for all). The proportion of ECD transplants increased from 18% in 2003 to a peak of 20.4% in 2008 and then declined thereafter to 17.3% in 2012. Using the KDPI >85% definition, the proportion increased from 9.4% in 2003 to a peak of 12.1% in 2008 and declined to 9.7% in 2012. Overall, although this represents a significant utilization of kidneys with KDPI >85% over time (p<0.001), recent years have seen a decline in usage, probably related to regulations imposed by Centers for Medicare & Medicaid Services (CMS). When comparing the hazards of graft failure by KDPI, ECD kidneys with KDPI >85% have a slightly lower risk of graft failure compared to standard criteria donor (SCD) kidneys with KDPI >85%, with a hazard ratio (HR) of 0.95, a confidence interval (CI) of 0.94-0.96, and statistical significance of p<0.001. This indicates that some SCD kidneys may actually have a lower estimated quality, with a higher Kidney Donor Risk Index (KDRI), than some ECDs. The incidence of delayed graft function (DGF) in ECD recipients has significantly decreased over time from 35.2% in 2003 to 29.6% in 2011 (p=0.007), probably related to better understanding of the donor risk profile along with increased use of hypothermic machine perfusion and pretransplant biopsy to aid in optimal allograft selection. The recent decline in transplantation of KDPI >85% kidneys probably reflects risk-averse transplant center behavior. Whether discard of discordant SCD kidneys with KDPI >85% has contributed to this decline remains to be studied.

Exploring the potential uses of value-added metrics in the context of postgraduate medical education.

CONTEXT: Increasing pressure is being placed on external accountability and cost efficiency in medical education and training internationally. We present an illustrative data analysis of the value-added of postgraduate medical education. METHOD: We analysed historical selection (entry) and licensure (exit) examination results for trainees sitting the UK Membership of the Royal College of General Practitioners (MRCGP) licensing examination (N = 2291). Selection data comprised: a clinical problem solving test (CPST); a situational judgement test (SJT); and a selection centre (SC). Exit data was an applied knowledge test (AKT) from MRCGP. Ordinary least squares (OLS) regression analyses were used to model differences in attainment in the AKT based on performance at selection (the value-added score). Results were aggregated to the regional level for comparisons. RESULTS: We discovered significant differences in the value-added score between regional training providers. Whilst three training providers confer significant value-added, one training provider was significantly lower than would be predicted based on the attainment of trainees at selection. CONCLUSIONS: Value-added analysis in postgraduate medical education potentially offers useful information, although the methodology is complex, controversial, and has significant limitations. Developing models further could offer important insights to support continuous improvement in medical education in future.

Women in senior post-graduate medicine career roles in the UK: a qualitative study.

OBJECTIVES: This qualitative study sought to elicit the views, experiences, career journeys and aspirations of women in senior post-graduate medical education roles to identify steps needed to help support career progression. DESIGN: In-depth semi-structured telephone interviews. SETTING: UK. PARTICIPANTS: Purposive sample of 12 women in a variety of senior leadership roles in post-graduate medical education in the UK. MAIN OUTCOME MEASURES: Self reported motivating influences, factors that helped and hindered progress, key branch points, and key educational factors and social support impacting on participants' career in postgraduate medicine. RESULTS: Respondents often reported that career journeys were serendipitous, rather than planned, formal or well structured. Senior women leaders reported having a high internal locus of control, with very high levels of commitment to the NHS. All reported significant levels of drive, although the majority indicated that they were not ambitious in the sense of a strong drive for money, prestige, recognition or power. They perceived that there was an under-representation of women in senior leadership positions and that high-quality female mentorship was particularly important in redressing this imbalance. Social support, such a spouse or other significant family member, was particularly valued as reaffirming and supporting women's chosen career ambition. Factors that were considered to have hindered career progression included low self-confidence and self-efficacy, the so-called glass ceiling and perceived self-limiting cultural influences. Factors indirectly linked to gender such as part-time versus working full time were reportedly influential in being overlooked for senior leadership roles. Implications of these findings are discussed in the paper. CONCLUSION: Social support, mentorship and role modelling are all perceived as highly important in redressing perceived gender imbalances in careers in post-graduate medical education.

The predictive validity of selection for entry into postgraduate training in general practice: evidence from three longitudinal studies.

BACKGROUND: The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis study AIM: To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre. DESIGN AND SETTING: A three-part longitudinal predictive validity study of selection into training for UK general practice. METHOD: In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3). RESULTS: Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training. CONCLUSION: In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered.

Developing the high-flying registrar: a qualitative evaluation of the Severn Deanery education scholar programme.

The introduction of the Education Scholarship and Education Fellowship programmes in the Severn Deanery in 2008 was in response to an emergent need for a more formalised career structure for the most able GPSTs and specifically for identified education scholars to progress over time from a scholar to temporary and substantive training programme director (TPD) posts. As a result, two scholars have progressed to being appointed as fellows (one-year fixed-term TPDs) over the last three years and one of these is now a TPD. This qualitative research study sought to identify the value and acceptance of the scholar scheme within the Severn Deanery and in particular assess the impact of the scholar scheme in terms of educational benefits, impact on professional practice and future career opportunities. It also undertook to examine the key factors affecting the quality of experience of the scholar scheme (e.g.induction, mentorship, autonomous vs. prescribed education opportunities etc.). Findings showed unequivocal and universal support for the scheme.

GPs' experiences of the Returner (Induction and Refreshment) scheme in Severn: a qualitative study.

The introduction of the General Practice Returner (since renamed the Induction and Refreshment) scheme in England by the Department of Health and London Deanery in 2002 provided placements providing training for qualified GPs seeking to return to the primary care workforce after significant time away from clinical general practice. This qualitative research study sought to explore issues around such placements and involved in-depth telephone interviews with an opportunistic sample of 14 GP returners and five trainers on their experiences of the GP returner scheme within Severn Deanery. Findings showed unequivocal and universal support from both returners and trainers for the value of the scheme. However, issues around the 'two-year rule' and funding arrangements whilst returning to practice may need to be re-addressed. GP returners reported significant improvements in their clinical skills and knowledge, understanding of changing NHS policy/protocols and enhanced perceived self-confidence. The importance of a peer-respected scheme organiser, easily accessible internationally, was felt to be crucial. Opportunities for the transferability of unique experiences from GPs returning from overseas should also be further explored.

Comparing performance among male and female candidates in sex-specific clinical knowledge in the MRCGP.

BACKGROUND: Patients often seek doctors of the same sex, particularly for sex-specific complaints and also because of a perception that doctors have greater knowledge of complaints relating to their own sex. Few studies have investigated differences in knowledge by sex of candidate on sex-specific questions in medical examinations. AIM: The aim was to compare the performance of males and females in sex-specific questions in a 200-item computer-based applied knowledge test for licensing UK GPs. DESIGN AND SETTING: A cross-sectional design using routinely collected performance and demographic data from the first three versions of the Applied Knowledge Test, MRCGP, UK. METHOD: Questions were classified as female specific, male specific, or sex neutral. The performance of males and females was analysed using multiple analysis of covariance after adjusting for sex-neutral score and demographic confounders. RESULTS: Data were included from 3627 candidates. After adjusting for sex-neutral score, age, time since qualification, year of speciality training, ethnicity, and country of primary medical qualification, there were differences in performance in sex-specific questions. Males performed worse than females on female-specific questions (-4.2%, 95% confidence interval [CI] = -5.7 to -2.6) but did not perform significantly better than females on male-specific questions (0.3%, 95% CI = -2.6 to 3.2%. CONCLUSION: There was evidence of better performance by females in female-specific questions but this was small relative to the size of the test. Differential performance of males and females in sex-specific questions in a licensing examination may have implications for vocational and post-qualification general practice training.

Evaluating cognitive ability, knowledge tests and situational judgement tests for postgraduate selection.

OBJECTIVES: This study aimed to evaluate the validity and utility of and candidate reactions towards cognitive ability tests, and current selection methods, including a clinical problem-solving test (CPST) and a situational judgement test (SJT), for postgraduate selection. METHODS; This was an exploratory, longitudinal study to evaluate the validities of two cognitive ability tests (measuring general intelligence) compared with current selection tests, including a CPST and an SJT, in predicting performance at a subsequent selection centre (SC). Candidate reactions were evaluated immediately after test administration to examine face validity. Data were collected from candidates applying for entry into training in UK general practice (GP) during the 2009 recruitment process. Participants were junior doctors (n = 260). The mean age of participants was 30.9 years and 53.1% were female. Outcome measures were participants' scores on three job simulation exercises at the SC. RESULTS: Findings indicate that all tests measure overlapping constructs. Both the CPST and SJT independently predicted more variance than the cognitive ability test measuring non-verbal mental ability. The other cognitive ability test (measuring verbal, numerical and diagrammatic reasoning) had a predictive value similar to that of the CPST and added significant incremental validity in predicting performance on job simulations in an SC. The best single predictor of performance at the SC was the SJT. Candidate reactions were more positive towards the CPST and SJT than the cognitive ability tests. CONCLUSIONS: In terms of operational validity and candidate acceptance, the combination of the current CPST and SJT proved to be the most effective administration of tests in predicting selection outcomes. In terms of construct validity, the SJT measures procedural knowledge in addition to aspects of declarative knowledge and fluid abilities and is the best single predictor of performance in the SC. Further research should consider the validity of the tests in this study in predicting subsequent performance in training.

Evaluating candidate reactions to selection practices using organisational justice theory.

OBJECTIVES: This study aimed to examine candidate reactions to selection practices in postgraduate medical training using organisational justice theory. METHODS: We carried out three independent cross-sectional studies using samples from three consecutive annual recruitment rounds. Data were gathered from candidates applying for entry into UK general practice (GP) training during 2007, 2008 and 2009. Participants completed an evaluation questionnaire immediately after the short-listing stage and after the selection centre (interview) stage. Participants were doctors applying for GP training in the UK. Main outcome measures were participants' evaluations of the selection methods and perceptions of the overall fairness of each selection stage (short-listing and selection centre). RESULTS: A total of 23,855 evaluation questionnaires were completed (6893 in 2007, 10,497 in 2008 and 6465 in 2009). Absolute levels of perceptions of fairness of all the selection methods at both the short-listing and selection centre stages were consistently high over the 3years. Similarly, all selection methods were considered to be job-related by candidates. However, in general, candidates considered the selection centre stage to be significantly fairer than the short-listing stage. Of all the selection methods, the simulated patient consultation completed at the selection centre stage was rated as the most job-relevant. CONCLUSIONS: This is the first study to use a model of organisational justice theory to evaluate candidate reactions during selection into postgraduate specialty training. The high-fidelity selection methods are consistently viewed as more job-relevant and fairer by candidates. This has important implications for the design of recruitment systems for all specialties and, potentially, for medical school admissions. Using this approach, recruiters can systematically compare perceptions of the fairness and job relevance of various selection methods.

When and why do doctors decide to become general practitioners? Implications for recruitment into UK general practice specialty training.

All applicants to round 1 of national recruitment into the general practice specialty recruitment process were surveyed as to the reasons for, and the timing of their career choices. Most applicants reported decision making after completing undergraduate training citing variety, continuity of care and work-life balance as their main drivers for a career in general practice. Applicants were statistically more likely to have undertaken a Foundation placement in general practice than their peers on a Foundation programme. Reasons for choice of deanery were largely related to location and social ties, rather than to the educational 'reputation' of its programmes.