Abstract
Objective
A recent independent review on diversity and inclusivity highlighted concerns
that barriers to surgical career progression exist for some groups of
individuals and not others. Group-level differences in performance at the
Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS)
examinations have been identified but are yet to be investigated. We aimed
to characterise the relationship between sociodemographic differences and
performance at MRCS.
Design
Retrospective cohort study.
Setting
Secondary care.
Participants
All UK MRCS candidates attempting Part A (n = 5780) and Part
B (n = 2600) between 2013 and 2019 with linked
sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk).
Main outcome measures
Chi-square tests established univariate associations with MRCS performance.
Multiple logistic regression identified independent predictors of success,
adjusted for medical school performance.
Results
Statistically significant differences in MRCS pass rates were found according
to gender, ethnicity, age, graduate status, educational background and
socioeconomic status (all p < 0.05). After adjusting for
prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence
interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were
independent predictors of MRCS Part A success and being a non-graduate (OR
1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51,
95% CI 1.08–2.10) were independent predictors of Part B success. Black and
minority ethnic groups were significantly less likely to pass MRCS Part B at
their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR
0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White
candidates.
Conclusions
There is significant group-level differential attainment at MRCS, likely to
represent the accumulation of privilege and disadvantage experienced by
individuals throughout their education and training. Those leading surgical
education now have a responsibility to identify and address the causes of
these attainment differences.
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