DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) study: sex trends across surgical specialities.
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Spazzapan M.
Bola H.
Grover S.
Raj S.
Russell B.
Malde S.
Vig S.
Fleming, S.
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2026
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BACKGROUND: Women remain underrepresented in surgery, with dropouts occurring at every stage of training, and women representing under 20% of consultant surgeons. This study explored the relationship between sex, applications for national selection for Higher Specialty Training (ST3), and receipt of an offer. METHOD(S): This retrospective longitudinal cohort study used data from the UK Medical Education Database. The study population included 1, 960 doctors eligible to progress to higher training between 2014 and 2019. The primary outcomes of interest were application for and offer of an ST3 post. Logistic regression analysis was conducted after adjusting for confounders using a directed acyclic graph. RESULT(S): Within the cohort, paediatrics and ear, nose and throat (ENT) had the highest proportion of female applicants (50%), followed by plastic and reconstructive surgery, general surgery (including vascular surgery applicants), urology, and trauma and orthopaedics, with the lowest (22%). Significant (p<0.01) associations were identified between being female and applying for ST3 general, paediatric, and plastic surgery, while applications to orthopaedics favoured men. No association was found between sex and ENT or urology applications. For ST3 offers, significant sex associations favouring women were identified for general surgery and urology. No associations were observed for the other specialties or the cohort as a whole. CONCLUSION(S): Differences exist in the proportion of women applying for ST3 across surgical specialties, with women more likely to obtain a post in general and urological surgery. Recognising these disparities and promoting efforts to cultivate a more diverse and inclusive workforce remains critical.
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Annals of the Royal College of Surgeons of England