Differences in doctors’ career progression and attainment by medical degree course type

Background Reducing barriers to a medical career for those from disadvantaged backgrounds is a priority for medical educators, regulators and governments. However, evidence indicates attainment gaps for graduates from different course types. It is essential to determine whether any cohort faces systematic disadvantage during training. This paper examines the postgraduate (PG) performance of graduates of the three main UK undergraduate medical degree course types. Methods This was a retrospective study using the UK Medical Education Database (UKMED). Data were included from doctors who graduated between 2012 and 2022, were UK domiciled, with at least one PG outcome: Annual Review of Competency Progression (ARCP) outcomes (assessment within the training workplace), performance on first attempt at a UK Royal College examination, and time taken to sit the examination. Multivariate logistic regression analyses evaluated PG attainment for graduates from Standard, Graduate or Gateway Programs, while adjusting for prior attainment and demographic factors including ethnicity, area measures of disadvantage and first-in-family to attend university. Results Data were available for 41,290 standard entry (SEM), 5,055 graduate entry (GEM), and 770 gateway (GY) graduates. Significant associations were found between course type and all sociodemographic variables except for sex. SEM graduates were more likely to pass their first UK Royal College exam than GEM or GY graduates (ORs 0.86 and 0.37 respectively, p < 0.001 for both comparisons). Adjusting for all sociodemographic variables increased the OR to 0.49 for GY graduates and returned it to 1.05 for GEM graduates. The median time to sit the first Royal College exam was longer for GY graduates (41 months compared to 29 for SEM and 30 for GEM, p < 0.001). There were no differences in ARCP outcomes. Conclusions There are significant differences in postgraduate progression for UK Royal College exam performance and time taken to sit exams associated with undergraduate course type, particularly GY courses. These differences remain after accounting for prior attainment and socioeconomic factors, so may be associated with the training environment. Postgraduate learning providers, and those who regulate postgraduate examinations and training must now examine what underpins these differences, to ensure equitable opportunities to progress for all medical graduates.