Abstract
Despite rising numbers of doctors in the workforce with disabilities, little is known about the impact of disabilities on postgraduate performance. To ensure all groups are treated fairly in surgical training, it is essential to know whether any attainment differences exist in markers of surgical performance. To address this gap, we assessed the impact of disabilities on performance on the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS). Retrospective cohort study. Secondary care. All UK MRCS candidates attempting Part A (n = 9600) and Part B (n = 4560) between 2007 and 2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Chi-square tests and correlation coefficients established univariate associations with MRCS performance, while multiple logistic regressions identified independent predictors of success. Though MRCS Part B pass rates were similar (p = 0.339), candidates with registered disabilities had significantly lower first-attempt Part A pass rates (46.3% vs. 59.8%, p < 0.001). Candidates with disabilities also performed less well in examinations taken throughout school and medical school, and after adjusting for prior academic performance and sociodemographic predictors of success, logistic regression found that candidates with disabilities were no less likely to pass MRCS than their peers (odds ratio 1.04, 95% confidence interval 0.66 to 1.62). No significant variation was found in MRCS performance between type of disability or degree of limitations caused by disability (p > 0.05). Although candidates with registered disabilities performed less well in formal, written examinations, our data indicate that they are as likely to pass MRCS at first attempt as their peers who achieved similar grades at high school and medical school. In order to enable equity in career progression, further work is needed to investigate the causes of attainment differences in early career assessments.
Highlights
IntroductionVarious definitions of diversity and inclusivity exist but generally, while diversity acknowledges individual differences, such as disability, gender and ethnicity, inclusivity considers how we engage with these differences to establish equity or fairness
Diversity and inclusivity are high on social and political agendas worldwide
In the United Kingdom UK, ethnicity has been an area of particular focus since the landmark case of the British Association of Physicians of Indian Origin vs. the Royal College of General Practitioners and General Medical Council in 2014, which highlighted the potential legal ramifications of attainment differences in postgraduate examinations.[2]
Summary
Various definitions of diversity and inclusivity exist but generally, while diversity acknowledges individual differences, such as disability, gender and ethnicity, inclusivity considers how we engage with these differences to establish equity or fairness. Equality and diversity have been prioritised on medical workforce agendas to ensure fairness within the profession, and for the medical workforce to reflect and represent the population for which they provide care.[1]. In the United Kingdom UK, ethnicity has been an area of particular focus since the landmark case of the British Association of Physicians of Indian Origin vs the Royal College of General Practitioners and General Medical Council in 2014, which highlighted the potential legal ramifications of attainment differences in postgraduate examinations.[2] Despite this, there remains a paucity of data on the performance of doctors with other protected characteristics, such as registered disabilities, in postgraduate assessments
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