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Prognostic significance of competition ratios in surgical specialty training selection

Mellor, Katie, Robinson, David B., Luton, Oliver, James, Osian P., Powell, Arfon G. M. T. ORCID:, Hopkins, Luke, Hemington-Gorse, Sarah, Egan, Richard J. and Lewis, Wyn G. 2022. Prognostic significance of competition ratios in surgical specialty training selection. Postgraduate Medical Journal 98 (1163) , pp. 700-704. 10.1136/postgradmedj-2020-139491

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Background A competition ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body. Methods Consecutive core surgical trainees numbering 154 (105 men, 49 women; median years since graduation: four) were studied over a 6-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK NTN appointment. Results Overall NTN appointment was 45.5%. Median CR was 2.36; range Oral & Maxillofacial Surgery 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p=0.003), a single scientific publication (OR 6.25, p=0.001), cohort year (2019, OR 12.65, p=0.003) and Universal Annual Review of Competence Progression Outcome 1 (OR 45.24, p<0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n=8) versus 49.2% (n=62), p=0.018. Conclusion CRs displayed 30-fold variation, with CRs below 4.42 associated with twofold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.

Item Type: Article
Date Type: Published Online
Status: Published
Schools: Medicine
Publisher: BMJ Publishing Group
ISSN: 0032-5473
Date of First Compliant Deposit: 7 October 2022
Date of Acceptance: 29 May 2022
Last Modified: 24 Oct 2022 14:29

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