Annual Review Of Competence Progression Research Articles

Enhancing cardiology trainee competence through simulation-based pericardiocentesis training: a pilot programme evaluation

Abstract Introduction Cardiology training requires trainees to manage clinical duties whilst developing practical skills. Changes to the UK curriculum have resulted in reduced time available for procedural teaching. Pericardiocentesis is one of many required competencies. The Joint Royal College of Physicians Training Board cardiology curriculum cites the importance of simulation-based education to teach procedures. Procedural training encompasses the development of clinical reasoning alongside motor skills. Gange (1962) and Carless (2010) emphasized the importance of expert-guided practice, interactive teaching, and instant feedback in motor skills teaching to maximize the educational experience. Aim Develop a simulation teaching programme to enhance trainees' confidence and competency in pericardiocentesis. Procedures form part of a summative Direct Observation of Procedural Skills, enabling trainees to learn in a safe environment and use as evidence at their Annual Review of Competence Progression (ARCP). Method We developed a pilot programme for pericardiocentesis facilitated through high-fidelity equipment between February 2023 and February 2024. Participants were recruited through medical education departments. The sessions were delivered on a one-to-one basis by a cardiology consultant to facilitate discussion and interactivity. The teaching involved a core knowledge presentation, discussion of trainee experiences, case studies as examples, including review of echocardiography features. This was followed by clinical skills teaching of pericardiocentesis, utilizing a model, and transthoracic echocardiography. Trainees were sent anonymous feedback forms after the session. Results 46 cardiology registrars participated; 48% were within their first few years of training. 87% reported difficulty in practicing this skill in clinical practice due to: lack of exposure, other clinical responsibilities taking priority, and the need for consultant-delivered care on patients requiring an urgent or emergency procedure. Mean trainee confidence before teaching was 3.24 out of 5 (SD = 1.14), with a significant improvement to 4.48 (SD = 0.59 p<0.001). 52% improved in confidence by 1 unit and, 31% improved in confidence by 2 or more units. Trainees reported the following themes regarding the session: knowledgeable trainer, high fidelity equipment, instant feedback to predict, prevent, and overcome challenges, and a multi-modal approach to teaching, incorporating presentation and discussion on pericardial effusion, tamponade, and drainage. Conclusion Our programme offers a unique multi-modal teaching approach, with dedicated time with an expert. We supported the progress of 46 trainees and enhanced their training competencies. We aim to expand the programme to incorporate more procedures in line with growing curriculum requirements. Tracking trainee progress until ARCP outcomes will reveal the impact of simulation teaching on their experience and professional development.

SP8.7 - The Impact of Covid-19 on ARCP Outcomes issued to Higher Specialty Trainees in General Surgery

Abstract Aims To quantify the impact of the Covid-19 pandemic on the Annual Review of Competency Progression (ARCP) outcomes of higher specialty trainees in General Surgery in the UK. Methods All ARCP outcomes awarded to higher specialty trainees in General Surgery between 2017 and 2022 were collated from Intercollegiate Surgical Curriculum Programme (ISCP). Associations between year, trainee sex, age, stage of training, and outcome were explored using multivariate logistic regression models. Results A total of 7,414 outcomes issued to 1,874 trainees were analysed. The Adjusted Odds Ratio (AOR) of receiving a non-standard outcome in 2020 (compared to 2017) was 3.07 (95% CI:2.47–3.81, P<0.001) and this remained elevated through 2022 (2.11, 95% CI:1.69–2.64, P<0.001). Female (AOR 1.27 (95% CI: 1.13–1.43, P<0.001) and older trainees (1.51 (95% CI:1.34–1.70, P<0.001) were more likely to receive non-standard outcomes. Being at a later stage of training during the pandemic did not increase the chances of receiving non-standard outcomes (AOR 1.09, 95% CI:0.97-1.22, P=0.134), but more outcomes advising extra training time were issued to this group (15.5% versus 4.3% in 2021). There was significant regional difference in the use of Covid-19 outcomes. The awarding of non-standard outcomes rose most years, even outside of the pandemic. Conclusions The Covid-19 pandemic had significant impact on the training trajectory of UK General Surgical trainees. Female and older trainees were more likely to receive non-standard ARCP outcomes before and during Covid-19. Urgent efforts are required to restore surgical training, and addressing differential attainment is essential for success.

An overview and evaluation of the differential attainment champion role in the North West of England GP school

ABSTRACT Background and aims In the Northwest of England, a national allocation of funding to minimise the effects of differential attainment has been used to support experienced GP educators to act as Differential Attainment Champions (DAC) since October 2021. An evaluation of the role’s impact was undertaken. Methods The evaluation was designed to gather the views and experiences of DACs and their trainees via online semi-structured interviews during the first 12 months following establishment of the intervention programme. Results Thematic framework analysis identified three main themes: DACs’ adaptive approach to support trainees; barriers to fulfilling the DAC role; and the positive impact of the DAC role on training. The following aspects of the DAC role worked well: the freedom to tailor support to the individual needs of the trainees; the targeted and proactive support early on in GP core training; the support of trainees in a wide range of areas including e-portfolio advice, examination preparation, and personal help. Trainees valued one-to-one support when needed. Reported improvements included: improved examination outcomes; portfolio engagement recognised in some cases by Annual Review of Competence Progression (ARCP) panels. Conclusions The individualised and adaptive approach works well but it does mean it is difficult to quantify how many trainees can be supported by one DAC and their workload needs to be monitored.

WTP6.4 Influence of Annual Record of Competence Progression panel profile on Differential Attainment

Abstract Introduction Differential Attainment (DA) refers to divergent achievements when related to protected traits. Annual Review of Competency Progression (ARCP) panels play a key role which compositions should reflect, yet no guidance exists on panel profile related to protected traits. This study aimed to evaluate the influence of panel profile on DA. Methods Anonymised ARCPs numbering 1090 in a UK Statutory Education Body (SEB) were examined and primary effect measure was ARCP Outcome (ARCPO) with satisfactory ARCPO classified as 1, 2 or 6, and unsatisfactory as 3 or 4. Results Satisfactory ARCPOs numbered 1005 and unsatisfactory 85. Median panel number was 7 (range 1-15, p<0.001). Median female percentage consultant representation was 18.2% (0% (Urology, Plastic & Paediatric Surgery) to 40% (Core Surgery) and median ethnicity (BME) consultant representation 14.3% (0% (Vascular & Neurosurgery) to 80% (Cardiothoracic Surgery). Multivariable analysis revealed: Trainee seniority (OR 0.800, p<0.001), SAC Liaison Member gender (OR 0.720, p=0.013) and Panel gender balance (N ARCP panel females, OR 10.695, p=0.003) to be independently associated with adverse ARCPO. Discussion Important two to five-fold variance in ARCP panels were found related to gender and ethnicity profile respectively with apparent significant impact on DA.

Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study.

The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. DERR1-10.2196/40545.

How do the post-graduation outcomes of students from gateway courses compare to those from standard entry medicine courses at the same medical schools?

BackgroundWidening participation (WP) for underrepresented students through six-year gateway courses helps to widen the demographic representation of doctors in the UK. ‘Most students from gateway courses graduate, even though many enter with lower grades than standard entry medicine students.’ This study aims to compare the graduate outcomes of gateway and SEM cohorts from the same universities.MethodsData from 2007–13 from the UK Medical Education Database (UKMED) were available for graduates of gateway and SEM courses at three UK medical schools. Outcome measures were passing an entry exam on the first attempt, Annual Review of Competency Progression (ARCP) outcome and being offered a level one training position from the first application. The univariate analysis compared the two groups. Logistic regressions, predicting outcomes by course type, controlled for attainment on completion of medical school.ResultsFour thousand four hundred forty-five doctors were included in the analysis. There was no difference found in the ARCP outcome between gateway and SEM graduates. Gateway graduates were less likely to pass their first attempt at any membership exam than graduates of SEM courses (39% vs 63%). Gateway graduates were less likely to be offered a level 1 training position on their first application (75% vs 82%). Graduates of gateway courses were more likely to apply to General Practitioner (GP) training programmes than SEM graduates (56% vs 39%).ConclusionsGateway courses increase the diversity of backgrounds represented within the profession and importantly the number of applications to GP training. However, differences in cohort performance are shown to continue to exist in the postgraduate arena and further research is required to ascertain the reasons for this.

Differential attainment, socioeconomic factors and surgical training.

Differential attainment (DA) is the gap in levels of achievement between different groups; socioeconomic factors are thought to play a significant role in DA. The aim of this study was to review and assess the evidence for DA in early surgical training and to examine the potential influence of socioeconomic status. Data were obtained from the General Medical Council GMC for those taking Membership of the Royal College of Surgeons (MRCS) examinations between 2016 and 2019 and core surgical training annual review of competency progression (ARCP) outcomes between 2017 and 2019. The index of multiple deprivation (IMD) was used as a measure of socioeconomic background. Trainees were then divided into deprivation quintiles (DQ1=most deprived, DQ5=least deprived). MRCS and ARCP outcomes were compared between DQ groups using 95% confidence intervals and chi-square tests. Those from lower socioeconomic backgrounds had significantly lower overall MRCS pass rates (DQ1=45.5%, DQ2=48.9% vs DQ4=59.6%, DQ5=61.5%, p<0.05) and 1st time pass rates (DQ1&2=46.6% vs DQ4&5=63.5%, p<0.001). Additionally, they had a significantly higher number of attempts required to pass MRCS (DQ 1&2=1.86 vs DQ 4&5=1.54, p<0.01). Those from lower socioeconomic backgrounds had a significantly greater proportion of unsatisfactory ARCP outcomes (DQ1&2=24.4% vs DQ 4&5=14.2%, p<0.05). There is clear evidence of the influence of socioeconomic background on DA in early surgical training. However, the reasons for this are likely complex and more work is required to investigate this relationship.

Coress is an independent charity, supported by AXA Health, the MDU and the WPA Benevolent Foundation.

We are grateful to those who have provided the material for these reports. The online reporting form is available on the website (www.coress.org.uk), which also includes previous Feedback reports. Published cases will be acknowledged by a Certificate of Contribution, which may be included in the contributor's record of continuing professional development, or which may form part of appraisal or annual review of competence progression (ARCP) portfolio documentation. Trainee contributions are particularly welcome.

CORESS Feedback: Cases from the Confidential Reporting System for Surgery.

CORESS is an independent charity, supported by the AXA Health, the MDU and the WPA Benevolent Foundation We are grateful to those who have provided the material for these reports. The online reporting form is available on the website (www.coress.org.uk), which also includes previous Feedback reports. Published cases will be acknowledged by a Certificate of Contribution, which may be included in the contributor's record of continuing professional development or may form part of appraisal or annual review of competence progression (ARCP) portfolio documentation. Trainee contributions are particularly welcome.

Annual review of competency progression: time for universal 'no blame' ARCPs?

Annual review of competency progression: time for universal 'no blame' ARCPs?

Differences in progression by surgical specialty: a national cohort study

The aim of surgical training across the 10 surgical specialties is to produce competent day 1 consultants. Progression through training in the UK is assessed by the Annual Review of...

Core training and surgical opportunities: a UK-based analysis

The COVID-19 pandemic, the new Intercollegiate Surgical Curriculum Programme curriculum and the European Work Time Directive significantly reduced surgical exposure for trainees. This study analyzed the operative experience of Phase 1 trainees (CT1/ST1 vs. CT2/ST2) against the Annual Review of Competence Progression (ARCP) criterion of 120 procedures yearly. National survey research in October 2021. Study end-point was the completion of >4 weekly procedures, equivalent to 120 cases per year. Chi-square test and multivariate regression analysis were performed. 205 participants from 5 Deaneries were included, 48.3% were CT1/ST1 and 51.7% were CT2/ST2. About 54.5% of year-1 and 50% of year-2 trainees were 28 30 years old, 55.6% and 50.9% were male, and 39.4% and 38.7% were White British. About 39.4% of CT1/ST1 and 22.6% of CT2/ST2 performed <4 weekly procedures (P = 0.01), with no difference in the "Observed" (P = 0.6) or "Assisted" (P = 0.3) number of cases. CT2/ST2 recorded more "ST-S" (p 0.04), "S-TU" (P = 0.03), and "Performed" (P = 0.02) operations. For CT1/ST1, older age (HR 2.4, 95% CI [1.1; 5.3], P = 0.02) and southern deaneries (HR 1.7, 95% CI [1.2; 2.4], P = 0.004) were independent factor for <4 weekly procedures. For CT2/ST2, northern regions were associated with more favorable training (HR 1.4, 95% CI [1.1; 1.7], P = 0.01). Over one third of Phase 1 trainees do not meet the ARCP requirement of >120 procedures annually. Age and region of training are independent factors in the number of logbook cases. This research focuses on training opportunities for junior surgical residents across the United Kingdom. The degree and type of exposure to the operating theatre have a significant impact on the development of surgical competencies. These are undoubtedly related to patient outcomes, as the quality of care delivered to patients and relatives greatly relies on the training background of future consultant surgeons.

Trusting Judgements: A new approach to progression without a numeric scale.

Medical education has undergone significant reforms since the 1990s when there were multiple regulators with patronage, inequalities and unreliability for postgraduate training. Modernising Medical Careers was implemented from 2005 to ensure all training posts and equivalents were assimilated into programmes with a defined curriculum and national selection. However, this brought its own problems, with a more rigid route, much control and training not linked to workforce planning. In addition, Workplace-based assessments (WBAs), which had been intended as formative tools to support personal development, morphed into summative assessments together with the Annual Review of Competence Progression (ARCP) becoming high stakes rather than a light-touch review of progression as had been intended. Alternative models of competence progression were explored, and initial poll results suggested that from the perspective of trainee/students, 46% would prefer judgements of competence to be decided on team observations/comments. Initial discussion was based on the challenge of “compassionate, collaborative, competent, confident doctors” and the role of WBAs where the current assessment tools were not considered to be the key to improving them. The role of the educator and their relationship with trainees was explored in depth including how to enable practitioners to prioritise education and feedback within busy work environments which requires a change in organisational culture. However, some specialties (psychiatry and general practice) have an expectation that dedicated time will be allocated for trainee and trainer to meet together as a recognition of the importance of high-quality training and celebrating excellent educators. If this could be extended to all specialties, it would provide an opportunity for trainers to review and discuss progress with their trainee, thus ensuring that advancement is maintained and any fall off in improvement is identified early and corrected. However, this requires protected time and the service is often under strain. The flip side of this approach is if there is a breakdown in trainer/trainee relationships, degrees of mistrust, this may cause problems. There could also be a possible power imbalance since feedback should be in both directions. Other key themes included ARCP reform to promote a progressive approach with no surprises rather than summative decisions and a clearer recognition of educational growth within appraisal and revalidation. The way forward should include developmental conversations with a greater coaching and mentoring style rather than tick boxing, more near peer conversations and more focus on programmatic assessment aggregated across a variety of sources. Additional tools may be required to support his approach. It is important to celebrate good training and improve the skills of trainers in developing doctors we want for the future which means going beyond what we do now.

TP8.2.15 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

AimsThe COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.MethodsAll higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. ResultsSixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).ConclusionsThe preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

SP10.2.6 The Quantitative Impact of COVID-19 on surgical training in the United Kingdom

AimsCOVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom.MethodsAnonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI).Results5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory.ConclusionCOVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.

SP2.1.11Real-world use of workplace-based assessments in surgical training: a UK nationwide exploration of trainee perspectives and consensus recommendations from the Association of Surgeons in Training

Abstract Background The utility of Workplace-Based Assessments (WBAs) in surgical training depends on the way they are completed. This study aims to ascertain the real-world usage of WBAs, as perceived by UK surgical trainees. Methods An anonymous national online questionnaire was conducted via the Association of Surgeons in Training (ASiT). The evaluation employed mixed methods to interpret quantitative and qualitative data. Suggestions for improvement were identified from free-text comments and considered through a formal two-round modified Delphi consensus process by ASiT council members. Results Analysis included 906 complete responses from all surgical specialities across all training levels. WBA use was perceived to deviate markedly from the Joint Committee on Surgical Training standards with significantly identified misuse across all surgical specialities. Inaccurate completion was acknowledged by 89.6% of respondents, and some trainers appear complicit with 40.9% of respondents aware of 'unobserved sign-off', and 33.6% aware of 'password disclosure' by trainers. Most trainees felt the Annual Review of Competency Progression (ARCP) respected WBA quantity above quality (55.4%), and a third felt pressure to overstate the number completed (32.0%). Main reasons for misuse were time restraints, lack of engagement and the will to achieve career progression targets. Conclusions UK surgical trainees perceive a significant deviation from WBAs standards due to multiple factors. The frequency and nature of misuse are worrying and undermines the existing evidence for the WBAs role in training. We present consensus recommendations from ASiT for the improvement of WBA use in UK surgical training.

982 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic

Abstract Aim The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades. Method All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared. Results Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276). Conclusions The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.

ST3 national selection for surgical specialty training in the UK: a comparative analysis

Introduction National recruitment at ST3 level is the point for aspiring surgical trainees to obtain a national training number and progress to consultancy. In the 2020 recruitment year, face-to-face interviews were not possible owing to the COVID-19 pandemic. This highlighted wide ranging variability in recruitment processes for different surgical specialties. Methods Person specification details and portfolio scoring matrices were accessed through the Oriel recruitment portal. These were analysed and broken down into common domains for comparison purposes by two authors. Overall scores were totalled. Each domain was assessed in terms of its importance to each specialty by calculating its percentage contribution to overall portfolio marks. Results There was variability in all aspects of portfolio assessment and scoring. This started with how many overall ranking marks were contributed by the portfolio to each specialty. Further analysis and comparison of scoring domains demonstrated heterogeneity in how each specialty assesses and awards candidates marks based on achievements. Large emphasis is placed on certain domains by some specialties but not others. Conclusions The degree of variation in ST3 portfolio assessment and the differences between surgical specialties in how the scoring domains are valued has implications for core surgical trainees and those looking to apply for higher surgical training at ST3 level. Currently, core surgical trainees are assessed using a common process of annual review of competence progression that may not be suited to helping prepare candidates for gaining a national training number. There is no available evidence to account for variability between surgical specialty recruitment processes. Further work is needed to assess whether ST3 selection scoring variation has any impact on trainee progression to higher surgical training.

O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study

Abstract Introduction Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties. Method A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed. Result 8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&amp;O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&amp;O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05). Conclusion There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations. Take-home Message There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.

Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study

To identify demographic factors, including protected characteristics, and training specific factors which predict a nonstandard Annual Review of Competency Progression (ARCP) outcome during Trauma and Orthopedic Specialty training in the United Kingdom (UK). A longitudinal cohort study using data from UKMED was performed. ARCP outcome was the primary outcome measure. Multilevel univariate and multiple ordinal regression analyses were performed using STATA v 15. Two thousand five hundred and ten Trauma and Orthopedic surgery trainees (ST3-ST8) with an ARCP outcome between 2010 and 2017 were included, comprising 11,011 ARCP outcomes. Eighty five percent (2130/2510) of trainees were male. Eighty two percent of outcomes were satisfactory. Female trainees had a 26% increased risk of nonstandard outcome (OR 1.26 95% CI 1.10-1.44) after adjusting for other factors. Older age at ARCP was associated with an increased risk of nonstandard ARCP outcome (OR 1.04 95% CI 1.03-1.06). International medical graduates had a 34% decreased risk of nonstandard outcome compared to UK graduates (OR 0.66 95% CI 0.54-0.81). Less than full time training was not associated with risk of a nonstandard ARCP outcome (OR 0.92 95% CI 0.76-1.12). Female sex and older age at ARCP were significantly associated with nonstandard ARCP outcomes in Trauma and Orthopedic surgery, while international medical graduation was protective.