Exploring Unexplained Gaps: Prospective Observational Cohort Study of Factors Influencing Core Surgical Training Success

OBJECTIVES Entrants into UK surgical training must undertake a 2-year Core Surgical Training (CST) program prior to National Training Numbers (NTN) application. The aim of this study was to quantify differential attainment and find factors associated with successful NTN selection directly from CST over 10-years (2014-2023). DESIGN Data was collected prospectively at trainees’ Annual Review of Competency Progression (ARCP). Primary outcome measure was NTN success. SETTING A CST program serving a single UK deanery (Wales). PARTICIPANTS Data was collected for 397 consecutive residents (256 male). RESULTS Overall MRCS pass, NTN success and CST attrition were 74.3%, 38.8%, and 8.3% respectively, regardless of gender, ethnicity or primary medical degree. Univariable analysis showed NTN was associated with IST (Improved Surgical Training) program (77.1% vs. CST 33.5%, p < 0.001), Universal ARCP Outcome 1 (ARCPO1 55.3% vs. not 9.9%, p < 0.001), MRCS pass (51.2% vs. 3.4%, p < 0.001), attendance at an induction bootcamp (43.1% vs. not 18.6%, p < 0.001), operative logbook number (median 459 [101-1410], p < 0.001; critical value 394), learned society communications (median 2 [0-18], p = 0.001, critical value 3), and scientific publications (median 0 [0-15], p < 0.001, critical value 1). Binary logistic regression revealed ≥3 learned society communications (OR 2.449, p = 0.003), an operative caseload of ≥394 (OR 2.462, p = 0.008), universal ARCPO1 (OR 2.862, p = 0.018), induction CST bootcamp attendance (OR 2.801, p = 0.019), MRCS pass (OR 27.266, p < 0.001) and IST (OR 37.663, p < 0.001) were independently associated with NTN success. CONCLUSION Differential attainment related to NTN success was common and related to CST program engagement, operative experience, focus on nonoperative technical skills, feeding into consistent ARCP Outcome.