National Training Number Research Articles

BN O06 - CHOLE-SAFE: A pilot curriculum response to reduce bile duct injuries

Abstract Background The laparoscopic cholecystectomy is a cornerstone of modern benign upper GI surgery; approximately 3% of the population have symptomatic gallstones and over laparoscopic cholecystectomies 61,000 are performed every year in the UK (1). Whilst a relatively safe procedure, bile duct injury (BDI) is an iatrogenic catastrophe with significant consequences to both patient and surgeon. Despite understanding of how such injuries occur and pre-existing consensus methodology in minimising bile duct injuries (2,3); according to the bile duct injury registry incidence has increased. We present a novel curriculum in response. Method CHOLE-SAFE has been designed by expert panel with oversight from parent groups including AUGIS and BBUGSS. The course aims to convey a theoretical foundation in safe cholecystectomy, an understanding of relevant human factors in a no blame culture and provides a practical framework for managing difficult cases. A mixed methods course was delivered, with industry support, to a group of national training number registrars. We delivered a series of: didactic lectures, wet lab skills work and simulation and a written exam as a one-day course. Delegates were asked to provide feedback in an anonymous survey. Results Although delegates had varying experience, no trainee had performed more than 70 laparoscopic cholecystectomy. Two were experienced with X-ray cholangiogram however had only performed one. Most had ultrasound experience, however the average number of ultrasound cholangiograms performed was only 12. 36% of trainees had seen a BDI. There was no significant difference in procedural confidence after the course. Trainees felt more able to perform X-Ray and ultrasound cholangiogram independently (p<0.05). Before the course 72.7% of delegates felt they knew how to avoid a BDI, 36.4% felt able to manage one; this increased to 100% and 82% respectively after the course. Conclusion CHOLE-SAFE demonstrates a robust curriculum in the response to increased incidence of bile duct injury. Trainees benefit from increased understanding of how to avoid and manage complications and technical skill acquisition. Course delivery has been demonstrated to be replicable, feasible and practical to organise. We believe this curriculum to be necessary and addresses a significant training need.

Evaluating neurosurgical training: a national survey examining the British trainee experience

Purpose Neurosurgery training in the UK has undergone significant changes over the past few years, including the new competency-based curriculum and a reduction of elective operating due to the pandemic. We conducted a comprehensive survey to assess UK neurosurgical trainees’ experiences and perceptions to develop targeted action plans. Methods An online anonymised survey was developed and distributed amongst the BNTA mailing list. Question types included 10-point Likert scales and free text options. Descriptive statistics, non-parametric testing of Likert scores, and Spearman’s rank correlation were used to analyse responses. Pearson’s chi-squared test was used for subgroup analysis of categorical data. Results A total of 75 trainees with a National Training Number (NTN) responded. Overall trainees feel they are well trained, well supported, and have caught up with training emerging out of COVID. Funding for training varied between deaneries. There is significant concern amongst trainees regarding the workforce crisis. This, as well as financial concerns are leading to more than a quarter of trainees considering quitting. Half of the trainees are considering going OOP. More than one third of the trainees and more than half of the female trainees are considering working Less Than Full Time (LTFT). Most important supportive mechanisms towards completion of training were social support, along with personal satisfaction from work. An independent mentoring scheme is a preferred additional support mechanism. Conclusions Overall training experience for neurosurgery trainees in UK and Ireland was positive. There are significant concerns regarding the workforce crisis and costs of training, with a large proportion of neurosurgery trainees considering resigning. OOP and LTFT are popular means of becoming more competitive for consultant posts and to spend time with their families. Deanery experience, senior and peer support does, and will improve trainee experience and protect against attrition.

Can ChatGPT outperform a neurosurgical trainee? A prospective comparative study

Purpose This study aimed to compare the performance of ChatGPT, a large language model (LLM), with human neurosurgical applicants in a neurosurgical national selection interview, to assess the potential of artificial intelligence (AI) and LLMs in healthcare and provide insights into their integration into the field. Methods In a prospective comparative study, a set of neurosurgical national selection-style interview questions were asked to eight human participants and ChatGPT in an online interview. All participants were doctors currently practicing in the UK who had applied for a neurosurgical National Training Number. Interviews were recorded, anonymised, and scored by three neurosurgical consultants with experience as interviewers for national selection. Answers provided by ChatGPT were used as a template for a virtual interview. Interview transcripts were subsequently scored by neurosurgical consultants using criteria utilised in real national selection interviews. Overall interview score and subdomain scores were compared between human participants and ChatGPT. Results For overall score, ChatGPT fell behind six human competitors and did not achieve a mean score higher than any individuals who achieved training positions. Several factors, including factual inaccuracies and deviations from expected structure and style may have contributed to ChatGPT's underperformance. Conclusions LLMs such as ChatGPT have huge potential for integration in healthcare. However, this study emphasises the need for further development to address limitations and challenges. While LLMs have not surpassed human performance yet, collaboration between humans and AI systems holds promise for the future of healthcare.

A snapshot of equality and diversity among UK vascular surgery trainees

INTRODUCTION Increasing equality and diversity, widening access and maintaining a work–life balance are important aims for the future surgical workforce. The executive committee of the Rouleaux Club (the trainee association of vascular surgeons in the UK) sought to ensure that it represented its members fairly by establishing the diversity of the vascular surgery training workforce. METHODS The Rouleaux Club committee devised an anonymous online survey covering an extensive topic range (including sex and gender identity, ethnicity, less than full-time working and children). The link to the questionnaire was distributed via email to all members, via social media and via pre-existing mailing lists. The survey was open for four weeks (26 September to 23 October 2020). RESULTS A total of 117 vascular trainees participated in our survey (55% of 213 known with a national training number). There were 48 female (41%) and 69 male respondents (59%). This ratio is better than the national average in surgical specialties (35% female trainees) but lower than that in medical specialties (57%). One respondent’s gender identity did not align with their biological sex. Almost two-thirds (60%) of the respondents were White. The ethnic backgrounds of the remaining trainees were Asian (24%), Arab (5%), Black (4%) and mixed (5%). Two trainees preferred not to state their ethnicity. The majority of the respondents (n=101, 86%) were heterosexual/straight, three (3%) identified as bisexual and two (2%) as gay. Eleven participants (9%) indicated that they preferred not to answer this question. Ten trainees (10/101, 10%) stated that they had worked less than full time at some point during their training. Three of these continue to work less than full time. CONCLUSIONS This study is the first of its kind to assess the equality and diversity of the vascular trainee workforce; improvements can only be made if baseline data are known. The Rouleaux Club confirms that it represents its members fairly.

Surgical Training in the United Kingdom's National Health Service: The Challenges for International Medical Graduates.

The UK's National Health Service (NHS) is a hub that trainees from all over the world want to join. However, there are many challenges for International Medical Graduates (IMGs). The aim of this study is to raise awareness of these challenges and to attempt to identify areas for improvement in the surgical training experience for international graduates wishing to join the NHS and obtain a National Training Number (NTN). A 33-question survey was designed and distributed to the surgical community via The Upper Gastrointestinal Surgery Society (TUGSS) and social media. Eighty-fiverespondents, IMGs from 25 countries, participated. The results showed that 43.5% of doctors had a Master's degree (MSc). Most IMGs joined as locally employed doctors at the senior house officer or registrar level. They all faced many challenges in the UK, including difficulties finding a job in the NHS, obtaining an NTN, and adapting to the differences between UK surgical practice and their home country. More than 50% of doctors did not have a named educational/clinical supervisor, and 63.2% of them felt that the supervisor helped them to become more familiar with the system. The support doctors received from the human resources department of the hospital they joined was poor. In addition, more than half of the IMGs changed their career plans after joining the NHS (56.4%) and would like to stay in the UK (52.9%). The majority of them (43.9%) plan to obtain an NTN. This study showed that there is a need to support international doctors who wish to start or continue their training in the UK. Furthermore, IMGs should expect to face several challenges when applying to work in the UK NHS.

Enhanced Stress Resilience Training for UK Surgical Trainees; Effect and Evolution Evaluated

Core Surgical Training (CST) programs are associated with high burnout. This study aimed to assess the influence of Enhanced Stress Resilience Training (ESRT) over a 2-year period in a single UK Statutory Education Body. CSTs participated in 5-weeks of formal ESRT to address work stressors. The primary outcome measure was career progression related to curriculum metrics and National Training Number (NTN) appointment. Secondary measures related to burnout using validated psychological inventories. Of 42 CSTs, 13 engaged fully with ESRT (31.0%; male 8, female 5, median age 28 year.), 11 engaged partially, and 18 did not. ESRT engagement was associated with better NTN appointment (ESRT 8/13 (61.5%) vs. not 1/18 (5.6%), p = 0.025), less burnout [aMBI; mean 5.14 (SD ± 2.35) vs. 3.14 (±2.25), F 6.637, p = 0.002, ηp2=0.167], less stress [PSS-10; 19.22 (±5.91) vs. 15.79 (±5.47), F 8.740, p < 0.001, ηp2=0.200], but more mindfulness [CAMS-R; 19.22 (±5.91) vs. 20.57 (±2.93), F 3.201, p = 0.047, ηp2=0.084]. On multivariable analysis, Improving Surgical Training (run-through CST) program (OR 5.2 (95% CI 1.42-28.41, p = 0.022), MRCS pass (OR 17.128 (95% CI 1.48-197.11, p = 0.023) and ESRT engagement (OR 13.249, 95% CI 2.08-84.58, p = 0.006) were independently associated with NTN success. ESRT was associated with less stress and burnout, better mindfulness, and most importantly 13-fold better career progression.

A retrospective cohort study of differential attainment, COVID and Chaos: taking the difference out of a terrible trinity.

This study aimed to evaluate Core Surgical Training (CST) differential attainment related to COVID-19, gender, and ethnicity. The hypothesis was that COVID-19 adversely influenced CST outcomes. A retrospective cohort study of 271 anonymised CST records was undertaken at a UK Statutory Education Body. Primary effect measures were: Annual Review of Competency Progression Outcome (ARCPO), Membership of the Royal College of Surgeons (MRCS) examination pass, and Higher Surgical Training National Training Number (NTN) appointment. Data was collected prospectively at ARCP and analysed with non-parametric statistical methods in SPSS®. CSTs numbering 138 completed training pre- and 133 peri-COVID. ARCPO 1,2&6 were 71.9% pre- vs. 74.4% peri-COVID (P=0.844). MRCS pass rates were 69.6% pre- versus 71.1% peri-COVID (P=0.968) but NTN appointment rates diminished (pre- 47.4% vs. peri- 36.9%, P=0.324); none of the above varied by gender or ethnicity. Multivariable analyses by three models revealed: ARCPO was associated with gender (m: f 1:0.87, OR 0.53, P=0.043) and CST theme (Plastics vs. General OR 16.82, P=0.007); MRCS pass with theme (Plastics vs. General OR 8.97, P=0.004); NTN with the Improving Surgical Training run-through program (OR 5.00, P<0.001). Program retention improved peri-COVID (OR 0.20, P=0.014) with pan University Hospital rotations performing better than Mixed or District General-only rotations (OR 6.63, P=0.018). Differential attainment profiles varied 17-fold, yet COVID-19 did not influence ARCPO or MRCS pass rates. NTN appointment fell by one fifth peri-COVID, but overall training outcome metrics remained robust despite the existential threat.

Prognostic value of interview rank when hiring for health: staff and nonsense or significant metric?

Introduction Core surgical training recruitment works via a centralised national selection process, during which each applicant is assigned an interview performance rank. The aim of this study was to evaluate the relative performance of core surgical trainees related to interview rank (CSTIR) in a single UK statutory education body. Methods Data for two cohorts of core surgical trainees (87 individuals) were analysed prospectively over two years (2018–2021). The primary outcome measures were Membership of the Royal College of Surgeons (MRCS) examination pass and specialty national training number (NTN) appointment. Results The overall MRCS pass rate was 67.8% and the NTN success rate was 43.7%. CSTIR &lt;332 was associated with MRCS pass (88.0% vs 59.7%, odds ratio [OR]: 4.90, p = 0.017) and CSTIR &lt;550 with NTN success (57.4% vs 42.6%, OR: 3.56, p = 0.006). Multivariate analysis revealed that NTN appointment was associated with audit completion (OR: 1.49, p = 0.045), scientific publication (OR: 2.08, p = 0.008), CSTIR (OR: 6.02, p = 0.014), universal annual review of competence progression Outcome 1 (OR: 25.10, p = 0.002) and Improving Surgical Training programme (OR: 108.96, p &lt; 0.001). Conclusions CSTIR was independently associated with conversion to higher surgical specialty NTN, suggesting that the current recruitment process predicts likely success in training.

SP1.2.2 Core Surgical Training Bootcamp- a five year review

Abstract Aims Surgical bootcamps may improve abilities across cognitive, affective and psychomotor domains. This deanery bootcamp is an intensive program involving induction, focussed teaching of core content, technical and non-technical skills. We aim to describe the successes and areas for development for this course through five years of feedback. Method A free three-day programme is delivered with lectures, workshops, skills teaching and simulation. Trainees are loaned equipment for self-taught surgical skills practice and laparoscopic simulation. Trainees must meet simulator proficiency targets which may improve early laparoscopic skills. Five years of feedback was analysed and previous attendees were contacted for retrospective focussed feedback. Results Across five years, 96–100% of trainees reported that they enjoyed the experience and would recommend attendance to others. 88–100% felt more confident to assess a surgical patient and 100% of responding attendees felt more prepared to begin core training. In the retrospective survey, 75% felt that Bootcamp helped them to get the best out of training and 70% felt that Bootcamp had improved their chances of passing annual progression meetings. There is evidence that attendance at induction core surgical bootcamps correlates with appointment to a national training number. In our study 50% of attendees regarded Bootcamp as helpful towards gaining their specialty training post. Conclusion This annual deanery bootcamp has benefited from five years of feedback and improvement. The program has evolved to reflect changes in the surgical curriculum and to tackle new challenges in education. We believe that each deanery should offer this and our format is applicable nationally and internationally.

The true length of training in vascular surgery

INTRODUCTION Workforce planning in vascular surgery remains challenging since there are no data on career path intentions of trainees. The Rouleaux Club, which is the UK vascular trainee association, undertook a snapshot survey of the vascular surgery trainee workforce to help guide the allocation of the future vascular surgery workforce. METHODS An anonymous survey was sent to national training number (NTN) and non-NTN vascular surgery trainees. The survey was open for four weeks from 26 September to 23 October 2020. Data were analysed by two Rouleaux Club executive committee members using Microsoft Excel®. RESULTS The survey was completed by 147 trainees (130 NTN and 17 non-NTN trainees). When taking into consideration time out of training and less than full-time training, the average predicted Certificate of Completion of Training date for NTN trainees is delayed by one year. Eleven per cent of NTN trainees had completed or were in less than full-time training at the time of the survey. Time out of training was taken by 75% and parental leave by 28%. Just under half (47%) of NTN trainees were planning on taking parental leave in the future. Over half (51%) of NTN trainees expected to retire aged between 61 and 65 years. CONCLUSIONS Our findings suggest that vascular surgery training is not a simple six-year higher surgical training experience and may vary considerably between individuals. Future vascular workforce planning needs to take these factors into consideration. Action must be taken now to recruit and retain the future workforce so that the demand for vascular surgeons can be met.

Less than full time training in plastic surgery: A qualitative survey-based study and practical suggestions for improvement

The General Medical Council (GMC) has voiced its support of less-than-full-time (LTFT) training, which has been shown to have a positive impact on workforce well-being, burnout and attrition and patient safety. However, barriers to LTFT exist within plastic surgery. This study aims to understand plastic surgery trainees' perceptions of LTFT and provide practical suggestions for improvement. Two surveys were disseminated by the UK Plastic Surgery Trainees' Association (PLASTA). Survey 1 formed part of the PLASTA National Training Survey (NTS) 2021, and all plastic surgery trainees with a National Training Number (NTN) were eligible. Survey 2 looked specifically at the lived experience of LTFT trainees in plastic surgery. A total of 177 trainees responded to the NTS. Seven per cent of respondents currently work LTFT, and 50% would consider it in future. Reported barriers to applying for LTFT included concerns about reduction in pay, extension of training time, and concerns about trainers' negative perceptions of LTFT. Twenty LTFT NTN trainees responded to the LTFT-specific survey. The majority of respondents reported an overall positive impact on their training and personal lives, although many still encountered negative attitudes from trainers and peers. Based on the results of this study, we provide practical suggestions to make LTFT more accessible to and acceptable for all trainees regardless of reason for applying or gender. Promoting the uptake of LTFT and improving the experience of LTFT in plastic surgery will support a healthy work-life balance in our workforce, prevent attrition and support gender equality.

SP2.1.17Prognostic significance of competition ratios in surgical specialty training selection

Abstract Aims 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 (median years since graduation: four, 105 male, 49 female) were studied over a six-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK National Training Number (NTN) appointment. Results Overall NTN appointment was 45.5%. Median CR was 2.36; range OMFS 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 ARCP Outcome 1 (OR 45.24, p &amp;lt; 0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n = 8) vs. 49.2% (n = 62), p = 0.018. Conclusions CRs displayed 30-fold variation, with CRs below 4.42 associated with two-fold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.

SP2.1.16Prognostic significance of Drivers at Work and Learning Styles in surgical training

Abstract Aims Drivers at Work (DW) and Learning Styles (LS) refer to a range of contentious theories that aim to account for differences in career progression, yet seldom feature in training assessment. This study aimed to quantify the influence of Core Surgical Trainees’ (CST) DW and LS on career progression. Methods Kolb LS inventories were distributed to 168 CSTs during five consecutive induction boot camps in a single Statutory Education Body. Primary outcome measures were MRCS and National Training Number (NTN) success. Results Of 108 responses received (response rate 64.3%), 64.8% were male and 35.2% female (p = 0.003). The spectrum of DW was: Please People (25%), Be Perfect (21.3%), Hurry Up (18.5%), Be Strong (13.9%), and Try Hard (0%, p &amp;lt; 0.001). DW was either unequivocal or not provided by 23 CSTs (21.3%). The spectrum of LS was: Converging (34.3%), Accommodating (28.7%), Diverging (23.1%), and Assimilating (13.9%, p = 0.021). MRCS success was not associated with DW (p = 0.703) or LS (p = 0.598). Men were more likely to have Converging LS (29/70, 41.4%), and women Diverging LS (15/38, 39.5%, p = 0.018) and to have team-based LS (Accommodating / Diverging, 26/38 vs. 30/70, p = 0.010). NTN success was associated with LS (p = 0.038) with Convergers achieving most NTNs (65.4%). Conclusions LS are associated with important differences in career progression with Converging LS three-fold more likely to achieve NTNs than Diverging LS.

SP2.2.1Improving surgical training: core programme performance related to rotation theme, design, and trainee protocol engagement

Abstract Aims Core Surgical Training (CST) and Improving ST (IST) programmes are in flux and their design controversial. This study aimed to evaluate the relative performance of a single Statutory Education Board’s (SEB) CST and IST programmes related to rotation design, theme, and protocol engagement. Methods Individual rotations numbering 181 were analysed prospectively over six-years (2014 to 2020). Primary outcome measures were MRCS pass and specialty National Training Number (NTN) appointment. Results Overall MRCS pass was 68.5% and NTN appointment 39.2%. NTN appointment related to rotation design varied from zero to 100% (median 40.0%). Conversion to NTN varied by specialty theme and ranged from: General surgery CST 35.6% to General surgery (IST pilot) 87.5% (p = 0.004). Multivariable analysis revealed NTN appointment was associated with: operative logbook caseload &amp;gt;464 (OR 3.02, p = 0.068), scientific article publication (OR 4.82, p = 0.006), and universal ARCP Outcome 1 (OR 37.83, p &amp;lt; 0.001), and IST (OR 55.54, p = 0.006). Conclusions Focused rotational design allied to enhanced performance management, and protocol engagement, were associated with improved conversion to higher surgical specialty training.

Prognostic significance of drivers at work and learning styles in surgical training

Purpose of the studyDrivers at work (DW) and Learning Styles (LS) refer to contentious theories that aim to account for differential career development yet seldom feature in assessment. This study...

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.

Another lost tribe: Quantifying the experience of international medical graduates applying for a national training number (NTN) in the United Kingdom with a cross-sectional study

BackgroundInternational medical graduates (IMGs) have a primary medical qualification obtained from outside their country of practice. In the United Kingdom (UK), postgraduate medical training after foundation years involves obtaining a national training number (NTN) in their specialty of choice by national selection. In this paper, we aim to quantify how IMGs feel to obtain an NTN and what unique obstacles they may face in doing so. Materials and methodsA survey with a combination of closed and open-ended questions was circulated to IMGs via social media and text message. The survey was aimed at those IMGs practising at a middle grade (non-consultant) level, whether they had obtained a training number or not. Data collected included demographics, years of postgraduate experience before UK arrival, number of attempts at obtaining a training number, and the most significant perceived difficulty to obtaining a training number. We also asked whether difficulties in obtaining a training number would cause IMGs to contemplate changing specialty. Data from the survey responses were analysed using SPSS 22. ResultsOut of a total of 203 doctors approached, 197 responded, of which the majority were male. All responders had at least five years of postgraduate experience before relocating to the UK. Only 56 (28.8%) had a training number at the time of the survey. Almost all the responders had made at least one unsuccessful attempt to obtain a training number. In addition, 152 (76.6%) of responders felt that timely career progression in the UK was unlikely without having a training number. 57 (29.6%) of responders considered changing specialty due to inability to obtain a training number. ConclusionObtaining an NTN remains a crucial goal among IMGs in the UK, despite the obstacles and repeated failures in doing so.

Trainee perspective of the causes of stress and burnout in surgical training: a qualitative study from Wales

ObjectivesStress and burn-out among surgical trainees has been reported most prevalent in core surgical trainees (CST) and female trainees in particular. This study aimed to identify factors perceived by CSTs...

Prognostic significance of competition ratios in surgical specialty training selection

BackgroundA 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...

602 Specialty Training Progression from Core Surgical Training: Is There Evidence from Plastic Surgery of The Importance of Location, Location, Location?

Abstract Introduction Obtaining a National Training Number (NTN) in Plastic Surgery is highly competitive (&amp;lt;40 posts per year), with applicant:post ratios between 3.73 to 4.19 in 2017-2019. Our aim was to compare deaneries for numbers successfully progressing directly from CT2 into a ST3 post in Plastic Surgery. Method Data for surgical trainees progressing directly from CT2 to ST3 (2017-2019) in all specialties was obtained from the GMC. The percentage of those directly progressing that obtained a Plastic Surgery NTN and the total number progressing was calculated. Results A total of 840 trainees obtained a NTN directly from CT2 between 2017 and 2019, 61 of whom did so in plastic surgery. Of those directly progressing, there was no significant difference between deaneries for the percentage of plastic surgery posts obtained. The highest number of trainees progressed from London deaneries (16 total (26%); 7 South, 6 NC&amp;E, 3 NW) and the lowest number from Yorkshire and Humber (1). Conclusions Higher numbers of those undertaking core surgical training in London progress directly from CT2 to ST3 in Plastic Surgery. Low total numbers highlight the competitive nature of obtaining a Plastic Surgery NTN, necessitating many to undertake additional experience prior to obtaining a training number.