Abstract
Objectives
To investigate whether demographic factors are associated with self-reported experience amongst medical trainees in the UK.
Design
Retrospective analysis of survey data.
Setting
General Medical Council (UK) National Training Survey data for 2014 and 2015.
Participants
A total of 105,549 responses were provided from 68,551 participants when no data were removed. After removing data to preserve participant anonymity, there were 64,278 participants providing 99,076 responses.
Main outcome measures
Considered trainee factors were gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery. Self-reported outcome measures were ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’.
Results
The experience of medical trainees across various indicators is differentially related to gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery.
Conclusions
It is demonstrated here that trainee factors are associated with subjective experience across different indicators. Further work is required to explore the reasons behind this, and how this relates to trainee quality of life, work performance and career progression.
Keywords: Medical careers, medical education, General Medical Council, National Training Survey, experience, training, National Health Service
Introduction
The medical workforce in the UK is demographically diverse.1–3 Both undergraduate and postgraduate performance have been shown to vary across different groups, with associated factors including gender,4,5 ethnicity,5–9 and country of primary medical qualification.3,10,11
Ongoing progress is being made to explore the mechanism relating such demographic factors to performance.4,6,9,12–16 It is likely that subjective experience also plays a role.11,17 This may differ depending on grade,18,19 specialty,20 and deanery of training.21–23
The General Medical Council National Trainee Survey monitors the quality of training and education of all doctors in the UK annually.24 In 2014 and 2015, it collected survey responses to quantify the subjective experience of trainees to include the indicators ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’.24 Trainee gender, ethnicity, country of primary medical qualification, grade, post (rather than programme of training) specialty and deanery were also included.24 General Medical Council National Trainee Survey data for 2014 and 2015 were analysed to investigate whether trainee demographic factors are associated with self-reported experience.
Methods
This research has been undertaken using the results of the National Trainee Survey data set available on application from the General Medical Council. The questions asked in the 2014 and 2015 survey are included in Supplementary Files 1 and 2, and can be accessed at www.gmc-uk.org/education/nts_documents.asp. A user guide which details how the indicators are scored is included in Supplementary File 3 and can also be found at www.gmc-uk.org/NTS_reporting_tool_user_guide.pdf_48363475.pdf. Prior to release from the General Medical Council, data were anonymised by replacing respondent identifiers and removing responses from doctors in training where there were fewer than three respondents sharing the same demographic characteristics. A total of 6473 out of 105,549 (6.1%) cases were removed, and a breakdown by each category is shown in Table 1.
Table 1.
Summary of responses for each of the trainee factors considered.
| Number (including excluded responses) | Number of responses removed | Percentage of responses removed (%) | Number (excluding removed responses) | Percentage (%) | Overall satisfaction; median (IQR) | Adequate experience; median (IQR) | Work load; median (IQR) | Clinical supervision; median (IQR) | Educational supervision; median (IQR) | Access to educational resources; median (IQR) | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Year of NTS | |||||||||||
| 2014 | 52,588 | 3252 | 6 | 49,336 | 49.8 | 84 (20) | 80 (20) | 44 (27) | 91 (11) | 100 (25) | 71 (19) |
| 2015 | 52,961 | 3221 | 6 | 49,740 | 50.2 | 84 (24) | 80 (30) | 50 (25) | 91 (11) | 100 (25) | 71 (19) |
| Gender | |||||||||||
| Man | 46,858 | 3210 | 7 | 43,648 | 44.06 | 84 (20) | 80 (20) | 50 (27) | 91 (10) | 100 (25) | 71 (20) |
| Woman | 58,691 | 3263 | 6 | 55,428 | 55.94 | 84 (20) | 80 (20) | 50 (27) | 91 (14) | 100 (25) | 71 (19) |
| Ethnicity | |||||||||||
| White | 62,375 | 2134 | 3 | 60,241 | 60.8 | 80 (24) | 80 (30) | 44 (27) | 91 (11) | 100 (25) | 71 (20) |
| BME | 37,176 | 2339 | 6 | 34,837 | 35.16 | 84 (20) | 80 (20) | 50 (29) | 91 (11) | 100 (25) | 71 (19) |
| Unspecified | 5998 | 2000 | 33 | 3998 | 4.04 | 80 (20) | 80 (20) | 44 (27) | 91 (15) | 100 (25) | 66 (23) |
| Migration status | |||||||||||
| UK | 88,265 | 2734 | 3 | 85,531 | 86.33 | 84 (20) | 80 (30) | 44 (27) | 91 (14) | 100 (25) | 71 (19) |
| EEA | 3897 | 1809 | 46 | 2088 | 2.11 | 84 (24) | 80 (30) | 44 (27) | 94 (14) | 100 (25) | 71 (20) |
| Other | 13,387 | 1930 | 14 | 11,457 | 11.56 | 84 (16) | 80 (10) | 50 (25) | 95 (11) | 100 (25) | 73 (15) |
| Specialty | |||||||||||
| Anaesthetics | 9205 | 519 | 6 | 8686 | 8.77 | 88 (16) | 90 (20) | 56 (19) | 95 (10) | 100 (25) | 73 (18) |
| Emergency medicine | 6241 | 521 | 8 | 5720 | 5.77 | 84 (16) | 90 (20) | 31 (19) | 90 (14) | 100 (25) | 70 (18) |
| General practice | 12,285 | 426 | 3 | 11,859 | 11.97 | 92 (20) | 90 (20) | 58 (25) | 95 (11) | 100 (0) | 75 (18) |
| Medicine | 30,219 | 691 | 2 | 29,528 | 29.8 | 80 (20) | 80 (20) | 42 (25) | 91 (15) | 100 (25) | 69 (20) |
| Obstetrics and gynaecology | 5875 | 590 | 10 | 5285 | 5.33 | 80 (16) | 80 (20) | 50 (19) | 91 (15) | 100 (25) | 70 (18) |
| Occupational medicine | 138 | 113 | 82 | 25 | 0.03 | 80 (20) | 90 (30) | 58 (25) | 89 (13) | 75 (25) | 71 (18) |
| Ophthalmology | 1368 | 514 | 38 | 854 | 0.86 | 88 (16) | 90 (20) | 50 (21) | 95 (14) | 100 (25) | 75 (19) |
| Paediatrics and child health | 8874 | 579 | 7 | 8295 | 8.37 | 84 (16) | 80 (10) | 44 (25) | 92 (10) | 100 (25) | 71 (16) |
| Pathology | 1440 | 492 | 34 | 948 | 0.96 | 88 (16) | 80 (20) | 58 (25) | 95 (10) | 100 (25) | 75 (20) |
| Psychiatry | 7840 | 647 | 8 | 7193 | 7.26 | 84 (20) | 80 (20) | 58 (19) | 94 (13) | 100 (25) | 73 (17) |
| Public health | 459 | 209 | 46 | 250 | 0.25 | 84 (20) | 80 (20) | 68 (17) | 94 (11) | 100 (25) | 79 (23) |
| Radiology | 3158 | 543 | 17 | 2615 | 2.64 | 84 (16) | 80 (20) | 56 (25) | 95 (13) | 100 (25) | 75 (16) |
| Surgery | 18,447 | 629 | 3 | 17,818 | 17.98 | 80 (24) | 80 (20) | 44 (25) | 91 (15) | 100 (25) | 68 (20) |
| Grade | |||||||||||
| Foundation | 29,946 | 1605 | 5 | 28,341 | 28.61 | 80 (24) | 80 (20) | 42 (31) | 87 (18) | 100 (25) | 69 (20) |
| Core/lower | 47,596 | 2499 | 5 | 45,097 | 45.52 | 84 (20) | 80 (20) | 50 (25) | 91 (10) | 100 (25) | 71 (18) |
| Higher ST4+ | 28,007 | 2369 | 8 | 25,638 | 25.88 | 84 (20) | 80 (20) | 50 (21) | 95 (10) | 100 (25) | 71 (18) |
| Deanery | |||||||||||
| Defence Postgraduate Medical | 607 | 97 | 16 | 510 | 0.51 | 88 (20) | 90 (20) | 50 (29) | 94 (13) | 100 (25) | 73 (20) |
| East Midlands Healthcare Workforce | 6081 | 368 | 6 | 5713 | 5.77 | 80 (20) | 80 (20) | 50 (29) | 91 (14) | 100 (25) | 70 (21) |
| East of England Multi-Professional | 6371 | 426 | 7 | 5945 | 6 | 80 (20) | 80 (20) | 44 (27) | 91 (11) | 100 (25) | 71 (19) |
| Kent, Surrey and Sussex | 6904 | 296 | 4 | 6608 | 6.67 | 80 (20) | 80 (20) | 44 (27) | 91 (15) | 100 (25) | 71 (20) |
| London | 18,381 | 383 | 2 | 17,998 | 18.17 | 84 (20) | 80 (30) | 44 (25) | 91 (10) | 100 (25) | 70 (20) |
| Mersey | 4774 | 387 | 8 | 4387 | 4.43 | 84 (24) | 80 (30) | 50 (25) | 91 (14) | 100 (25) | 71 (19) |
| NHS Education for Scotland (East Region) | 991 | 238 | 24 | 753 | 0.76 | 84 (24) | 80 (30) | 50 (21) | 91 (15) | 100 (25) | 71 (20) |
| NHS Education for Scotland (North Region) | 1389 | 290 | 21 | 1099 | 1.11 | 84 (24) | 80 (20) | 50 (29) | 91 (14) | 100 (25) | 70 (21) |
| NHS Education for Scotland (South-East) | 2520 | 309 | 12 | 2211 | 2.23 | 84 (20) | 80 (20) | 50 (25) | 91 (10) | 100 (25) | 71 (21) |
| NHS Education for Scotland (West Region) | 5053 | 336 | 7 | 4717 | 4.76 | 84 (20) | 80 (30) | 50 (31) | 91 (14) | 100 (25) | 71 (21) |
| NHS West Midlands Workforce | 8718 | 401 | 5 | 8317 | 8.39 | 84 (20) | 80 (20) | 50 (25) | 91 (10) | 100 (25) | 73 (15) |
| North Western | 7166 | 367 | 5 | 6799 | 6.86 | 84 (16) | 80 (30) | 50 (25) | 91 (14) | 100 (25) | 71 (17) |
| Northern | 5057 | 373 | 7 | 4684 | 4.73 | 84 (20) | 80 (20) | 50 (29) | 95 (14) | 100 (25) | 72 (18) |
| Northern Ireland Medical & Dental | 3258 | 231 | 7 | 3027 | 3.06 | 84 (20) | 80 (30) | 44 (27) | 92 (10) | 100 (25) | 71 (20) |
| Oxford | 3452 | 341 | 10 | 3111 | 3.14 | 84 (20) | 80 (30) | 44 (25) | 91 (14) | 100 (25) | 71 (20) |
| Pharmaceutical Medicine Virtual | 228 | 27 | 12 | 201 | 0.2 | 88 (20) | 90 (20) | N/A | N/A | 100 (25) | 78 (25) |
| Severn | 4014 | 308 | 8 | 3706 | 3.74 | 84 (24) | 80 (30) | 44 (27) | 91 (11) | 100 (25) | 71 (18) |
| South West Peninsula | 2847 | 296 | 10 | 2551 | 2.57 | 84 (20) | 80 (20) | 44 (25) | 94 (10) | 100 (25) | 73 (20) |
| Wales | 4634 | 313 | 7 | 4321 | 4.36 | 84 (20) | 80 (20) | 50 (25) | 91 (14) | 100 (25) | 73 (16) |
| Wessex | 3981 | 294 | 7 | 3687 | 3.72 | 84 (20) | 80 (20) | 44 (27) | 91 (10) | 100 (25) | 71 (19) |
| Yorkshire and the Humber Postgraduate | 9123 | 392 | 4 | 8731 | 8.81 | 84 (20) | 80 (20) | 50 (29) | 91 (11) | 100 (25) | 70 (20) |
| Overall | 105,549 | 6473 | 6 | 99,076 | 100 | 84 (20) | 80 (30) | 50 (27) | 91 (11) | 100 (25) | 71 (19) |
NTS: National Trainee Survey; IQR: Interquartile range; BME: black and minority ethnic; EEA: European Economic Area.
Though reported as numerical outcomes within a 100 point scale, measures of subjective experience were not continuous, and were thus modelled as ordered categorical variables. The considered measures were ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’.
Survey respondents must answer at least one fewer than the maximum number of questions that contribute to any given indicator to have a valid score; for indicators that have only two questions, respondents need a valid response for both questions. Due to differences in the nature of training in particular specialties and deaneries, no clinical supervision and workload scores were obtained for the 201 trainees in the Pharmaceutical Medicine Virtual Deanery. Missing data in the results released by the General Medical Council as a result of these issues were excluded from analysis: ‘workload’ (201, 0.2%), ‘clinical supervision’ (429 responses, 0.43%), ‘educational supervision’ (86 responses, 0.09%), and ‘access to educational resources’ (3161 responses; 3.19%).
Statistical analysis was undertaken using Stata 14 (StataCorp LP). Medians and interquartile ranges are used to display the (non-parametrically distributed) responses by participant category. The survey design function of Stata (svyset) was used to create a one-stage clustered design with stratification model, thus accounting for any reduced variance in reported experience within deaneries (clusters) and specialties (strata). Ordered logistic regression models were used to explore the adjusted association between trainee factors and the different subjective experience measures (dependent ordered categorical variables), with the largest category within each trainee factor variable used as the base level (highlighted in bold below). Coefficients and confidence intervals (CIs) are used as indicators of effect size; p values with a cut off of <0.001 are used as indicators of statistical significance (a Bonferroni correction is applied for multiple testing).
Trainee factors modelled as independent categorical variables were the year of survey (2014 or 2015), trainee self-declared gender (male or female), ethnicity (white, black and minority ethnic or unspecified), country of primary medical qualification (Britain, European Economic Area or other country), training grade (Foundation Year, Core/lower or ST4+), post specialty (Anaesthetics, Emergency Medicine, General Practice, Medicine, Obstetrics and Gynaecology, Occupational Medicine, Ophthalmology, Paediatrics and Child Health, Pathology, Psychiatry, Public Health, Radiology or Surgery) and deanery (Defence Postgraduate Medical, East Midlands Healthcare Workforce, East of England Multi-Professional, Kent, Surrey and Sussex, London, Mersey, NHS Education for Scotland East Region, NHS Education for Scotland North Region, NHS Education for Scotland South-East, NHS Education for Scotland West Region, NHS West Midlands Workforce, North Western, Northern, Northern Ireland Medical & Dental, Oxford, Pharmaceutical Medicine Virtual, Severn, South West Peninsula, Wales, Wessex and Yorkshire and the Humber Postgraduate).
Results
A total of 99,076 responses were analysed. Table 1 shows a summary of responses for each of the trainee factors considered. The results of the regression models for each of the six outcome variables are summarised in Tables 2 to 5 and Supplementary Tables 1 and 2, and include coefficients and confidence intervals (CIs) as indicators of effect size, and p-values as indicators of statistical significance for the adjusted associations.
Table 2.
Results of the regression model for overall satisfaction.
| Overall satisfaction | Coef. | P | (95% Conf. | interval) |
|---|---|---|---|---|
| NTS year | ||||
| 2014 | −0.05011 | 0 | −0.076247 | −0.023974 |
| Sex | ||||
| Man | 0.1547898 | 0 | 0.1244366 | 0.1851429 |
| Ethnicity | ||||
| BME | −0.091892 | 0 | −0.124981 | −0.058802 |
| Unspecified | −0.56095 | 0 | −0.621865 | −0.500034 |
| Country of qualification | ||||
| EEA | −0.051058 | 0.37 | −0.16291 | 0.0607938 |
| Other country | −0.136681 | 0 | −0.188552 | −0.08481 |
| Grade | ||||
| Foundation | −0.138621 | 0 | −0.223142 | −0.0541 |
| Higher ST4+ | 0.4839267 | 0 | 0.4077083 | 0.5601452 |
| Deanery | ||||
| Defence Postgraduate Medical Deanery | 0.0526884 | 0.76 | −0.284799 | 0.3901759 |
| East Midlands Healthcare Workforce Deanery | −0.141982 | 0 | −0.225591 | −0.058372 |
| East of England Multi-Professional Deanery | −0.072735 | 0.25 | −0.197109 | 0.0516387 |
| Kent, Surrey and Sussex Deanery | −0.0447 | 0.45 | −0.161952 | 0.0725525 |
| Mersey Deanery | 0.0781565 | 0.05 | 0.0017082 | 0.1546047 |
| NHS Education for Scotland (East Region) | 0.1140671 | 0.22 | −0.067315 | 0.2954489 |
| NHS Education for Scotland (North Region) | 0.0948012 | 0.4 | −0.126998 | 0.3166002 |
| NHS Education for Scotland (South-East Region) | 0.2327519 | 0 | 0.1286861 | 0.3368176 |
| NHS Education for Scotland (West Region) | 0.0688916 | 0.47 | −0.119245 | 0.2570284 |
| NHS West Midlands Workforce Deanery | −0.006241 | 0.93 | −0.138277 | 0.1257948 |
| North Western Deanery | −0.015313 | 0.8 | −0.136789 | 0.1061635 |
| Northern Deanery | 0.2694034 | 0 | 0.1927797 | 0.3460272 |
| Northern Ireland Medical & Dental Training Agency | 0.1685889 | 0 | 0.0617164 | 0.2754615 |
| Oxford Deanery | −0.00947 | 0.92 | −0.189603 | 0.1706643 |
| Pharmaceutical Medicine Virtual Deanery | 0.4002007 | 0 | 0.2949145 | 0.5054868 |
| Severn Deanery | 0.0376144 | 0.46 | −0.063242 | 0.1384705 |
| South West Peninsula Deanery | 0.2266669 | 0 | 0.0887978 | 0.364536 |
| Wales Deanery | 0.1571742 | 0.01 | 0.0328225 | 0.2815259 |
| Wessex Deanery | 0.1354758 | 0.13 | −0.041071 | 0.3120225 |
| Yorkshire and the Humber Postgraduate Deanery | −0.016205 | 0.75 | −0.114262 | 0.0818512 |
| Specialty | ||||
| Anaesthetics Posts | 0.7330749 | 0 | 0.6021196 | 0.8640302 |
| Emergency Medicine Posts | 0.4638225 | 0 | 0.3554997 | 0.5721454 |
| General Practice Posts | 1.495513 | 0 | 1.382964 | 1.608062 |
| Obstetrics and Gynaecology Posts | −0.072557 | 0.12 | −0.164628 | 0.0195138 |
| Occupational Medicine Posts | −0.284283 | 0.63 | −1.453688 | 0.8851223 |
| Ophthalmology Posts | 0.7622742 | 0 | 0.6058899 | 0.9186584 |
| Paediatrics and Child Health Posts | 0.357096 | 0 | 0.2637479 | 0.4504441 |
| Pathology Posts | 0.7489165 | 0 | 0.6211184 | 0.8767147 |
| Psychiatry Posts | 0.5516597 | 0 | 0.4726449 | 0.6306744 |
| Public Health Posts | 0.617092 | 0 | 0.3372051 | 0.8969789 |
| Radiology Posts | 0.5624192 | 0 | 0.4097674 | 0.7150709 |
| Surgery Posts | −0.130944 | 0 | −0.210909 | −0.050979 |
NTS: National Trainee Survey; EEA: European Economic Area; BME: black and minority ethnic.
Table 3.
Results of the regression model for adequate experience.
| Adequate experience | Coef. | P | (95% Conf. | interval) |
|---|---|---|---|---|
| NTS year | ||||
| 2014 | −0.0826676 | 0 | −0.1080057 | −0.0573295 |
| Sex | ||||
| Man | 0.188458 | 0 | 0.158784 | 0.218132 |
| Ethnicity | ||||
| BME | −0.1875599 | 0 | −0.219178 | −0.1559417 |
| Unspecified | −0.597724 | 0 | −0.6677686 | −0.5276795 |
| Country of qualification | ||||
| EEA | −0.0638932 | 0.267 | −0.1770658 | 0.0492793 |
| Other country | −0.0011677 | 0.964 | −0.0524673 | 0.0501319 |
| Grade | ||||
| Foundation | 0.0923636 | 0.027 | 0.0105416 | 0.1741856 |
| Higher ST4+ | 0.5567546 | 0 | 0.4782069 | 0.6353024 |
| Deanery | ||||
| Defence Postgraduate Medical Deanery | 0.0423144 | 0.796 | −0.2797009 | 0.3643297 |
| East Midlands Healthcare Workforce Deanery | −0.119388 | 0.01 | −0.2093368 | −0.0294393 |
| East of England Multi-Professional Deanery | −0.0260942 | 0.707 | −0.1628351 | 0.1106468 |
| Kent, Surrey and Sussex Deanery | −0.0251582 | 0.568 | −0.1118315 | 0.0615152 |
| Mersey Deanery | 0.0500133 | 0.182 | −0.0235271 | 0.1235537 |
| NHS Education for Scotland (East Region) | 0.0336902 | 0.758 | −0.1819208 | 0.2493011 |
| NHS Education for Scotland (North Region) | 0.1954306 | 0.083 | −0.0259812 | 0.4168423 |
| NHS Education for Scotland (South-East Region) | 0.2168774 | 0 | 0.1181342 | 0.3156206 |
| NHS Education for Scotland (West Region) | 0.0745986 | 0.267 | −0.0576219 | 0.206819 |
| NHS West Midlands Workforce Deanery | −0.0164852 | 0.773 | −0.1291486 | 0.0961782 |
| North Western Deanery | 0.0330282 | 0.587 | −0.0866814 | 0.1527378 |
| Northern Deanery | 0.2248745 | 0 | 0.1345954 | 0.3151536 |
| Northern Ireland Medical & Dental Training Agency | 0.0642345 | 0.326 | −0.0642494 | 0.1927183 |
| Oxford Deanery | 0.0040308 | 0.955 | −0.1374755 | 0.1455371 |
| Pharmaceutical Medicine Virtual Deanery | 0.7771865 | 0 | 0.6882555 | 0.8661174 |
| Severn Deanery | 0.045151 | 0.317 | −0.0435608 | 0.1338629 |
| South West Peninsula Deanery | 0.2087045 | 0.007 | 0.0586035 | 0.3588055 |
| Wales Deanery | 0.1187457 | 0.016 | 0.021979 | 0.2155124 |
| Wessex Deanery | 0.1156285 | 0.131 | −0.0345669 | 0.2658239 |
| Yorkshire and the Humber Postgraduate Deanery | −0.0001981 | 0.996 | −0.0772824 | 0.0768863 |
| Specialty | ||||
| Anaesthetics Posts | 0.933289 | 0 | 0.8341783 | 1.0324 |
| Emergency Medicine Posts | 0.7096084 | 0 | 0.579502 | 0.8397148 |
| General Practice Posts | 1.328737 | 0 | 1.239339 | 1.418136 |
| Obstetrics and Gynaecology Posts | 0.0467853 | 0.281 | −0.0386205 | 0.1321911 |
| Occupational Medicine Posts | 0.2440507 | 0.62 | −0.7233155 | 1.211417 |
| Ophthalmology Posts | 0.6971023 | 0 | 0.5327681 | 0.8614364 |
| Paediatrics and Child Health Posts | 0.3191126 | 0 | 0.249628 | 0.3885973 |
| Pathology Posts | 0.5810943 | 0 | 0.437272 | 0.7249167 |
| Psychiatry Posts | 0.4924271 | 0 | 0.3647447 | 0.6201096 |
| Public Health Posts | 0.7100714 | 0 | 0.403389 | 1.016754 |
| Radiology Posts | 0.4205957 | 0 | 0.2858815 | 0.5553099 |
| Surgery Posts | 0.0383929 | 0.215 | −0.0224749 | 0.0992608 |
NTS: National Trainee Survey; EEA: European Economic Area; BME: black and minority ethnic.
Table 4.
Results of the regression model for workload.
| Workload | Coef. | P | (95% Conf. | interval) |
|---|---|---|---|---|
| NTS year | ||||
| 2014 | −0.123785 | 0 | −0.147871 | −0.099699 |
| Sex | ||||
| Man | 0.0729118 | 0 | 0.0384929 | 0.1073308 |
| Ethnicity | ||||
| BME | 0.0240264 | 0.18 | −0.011113 | 0.0591657 |
| Unspecified | −0.305534 | 0 | −0.376991 | −0.234078 |
| Country of qualification | ||||
| EEA | −0.120932 | 0.04 | −0.236183 | −0.00568 |
| Other country | 0.1655146 | 0 | 0.1112163 | 0.219813 |
| Grade | ||||
| Foundation | −0.192291 | 0 | −0.277091 | −0.107491 |
| Higher ST4+ | 0.0993959 | 0.01 | 0.026267 | 0.1725248 |
| Deanery | ||||
| Defence Postgraduate Medical Deanery | 0.1115573 | 0.38 | −0.138446 | 0.3615601 |
| East Midlands Healthcare Workforce Deanery | 0.1617226 | 0.06 | −0.007299 | 0.3307438 |
| East of England Multi-Professional Deanery | 0.0301829 | 0.75 | −0.155003 | 0.2153685 |
| Kent, Surrey and Sussex Deanery | 0.0378941 | 0.78 | −0.225609 | 0.3013977 |
| Mersey Deanery | 0.2519565 | 0 | 0.0871542 | 0.4167589 |
| NHS Education for Scotland (East Region) | 0.3470021 | 0.01 | 0.0838783 | 0.6101258 |
| NHS Education for Scotland (North Region) | 0.3713105 | 0.02 | 0.0490519 | 0.693569 |
| NHS Education for Scotland (South-East Region) | 0.3418963 | 0 | 0.1252514 | 0.5585412 |
| NHS Education for Scotland (West Region) | 0.298131 | 0.01 | 0.0890429 | 0.5072192 |
| NHS West Midlands Workforce Deanery | 0.4301412 | 0 | 0.2616436 | 0.5986387 |
| North Western Deanery | 0.320573 | 0 | 0.1657998 | 0.4753462 |
| Northern Deanery | 0.319863 | 0 | 0.1304559 | 0.5092701 |
| Northern Ireland Medical & Dental Training Agency | 0.2517991 | 0.02 | 0.0348412 | 0.4687569 |
| Oxford Deanery | −0.035613 | 0.73 | −0.239436 | 0.1682098 |
| Severn Deanery | 0.2078641 | 0.04 | 0.0117077 | 0.4040204 |
| South West Peninsula Deanery | 0.1836349 | 0.09 | −0.029851 | 0.3971208 |
| Wales Deanery | 0.427265 | 0 | 0.2574042 | 0.5971257 |
| Wessex Deanery | 0.2075148 | 0.01 | 0.0434657 | 0.3715639 |
| Yorkshire and the Humber Postgraduate Deanery | 0.2400331 | 0.02 | 0.0370278 | 0.4430383 |
| Specialty | ||||
| Anaesthetics Posts | 1.14019 | 0 | 1.023263 | 1.257118 |
| Emergency Medicine Posts | −0.527802 | 0 | −0.642702 | −0.412903 |
| General Practice Posts | 1.974929 | 0 | 1.86594 | 2.083918 |
| Obstetrics and Gynaecology Posts | 0.5618605 | 0 | 0.3721124 | 0.7516086 |
| Occupational Medicine Posts | 1.881576 | 0 | 1.559858 | 2.203293 |
| Ophthalmology Posts | 1.022056 | 0 | 0.7905606 | 1.253551 |
| Paediatrics and Child Health Posts | 0.4098094 | 0 | 0.2651561 | 0.5544627 |
| Pathology Posts | 1.994993 | 0 | 1.745653 | 2.244332 |
| Psychiatry Posts | 1.726099 | 0 | 1.498277 | 1.953921 |
| Public Health Posts | 2.937548 | 0 | 2.586935 | 3.288162 |
| Radiology Posts | 1.428318 | 0 | 1.155673 | 1.700962 |
| Surgery Posts | 0.294615 | 0 | 0.1591027 | 0.4301272 |
NTS: National Trainee Survey; EEA: European Economic Area; BME: black and minority ethnic.
Table 5.
Results of the regression model for clinical supervision.
| Clinical supervision | Coef. | P | (95% Conf. | interval) |
|---|---|---|---|---|
| NTS year | ||||
| 2014 | −0.0440857 | 0.001 | −0.0704952 | −0.0176763 |
| Sex | ||||
| Man | 0.2035731 | 0 | 0.1754534 | 0.2316927 |
| Ethnicity | ||||
| BME | −0.077912 | 0 | −0.112883 | −0.0429409 |
| Unspecified | −0.3849404 | 0 | −0.4382449 | −0.3316359 |
| Country of qualification | ||||
| EEA | 0.0833852 | 0.076 | −0.0086804 | 0.1754508 |
| Other country | 0.1789638 | 0 | 0.1269863 | 0.2309412 |
| Grade | ||||
| Foundation | −0.5709445 | 0 | −0.646233 | −0.495656 |
| Higher ST4+ | 0.717028 | 0 | 0.6577828 | 0.7762731 |
| Deanery | ||||
| Defence Postgraduate Medical Deanery | 0.0729838 | 0.43 | −0.1089335 | 0.2549011 |
| East Midlands Healthcare Workforce Deanery | −0.1574565 | 0.048 | −0.3137699 | −0.0011432 |
| East of England Multi-Professional Deanery | −0.0336628 | 0.704 | −0.2081328 | 0.1408072 |
| Kent, Surrey and Sussex Deanery | −0.0186136 | 0.804 | −0.1662333 | 0.1290062 |
| Mersey Deanery | 0.0045809 | 0.947 | −0.1320214 | 0.1411832 |
| NHS Education for Scotland (East Region) | −0.0332169 | 0.737 | −0.2281293 | 0.1616955 |
| NHS Education for Scotland (North Region) | 0.021227 | 0.825 | −0.1681351 | 0.2105891 |
| NHS Education for Scotland (South-East Region) | 0.14045 | 0.082 | −0.0180042 | 0.2989043 |
| NHS Education for Scotland (West Region) | 0.0379719 | 0.807 | −0.2678185 | 0.3437624 |
| NHS West Midlands Workforce Deanery | 0.0894896 | 0.211 | −0.0510754 | 0.2300546 |
| North Western Deanery | −0.086625 | 0.271 | −0.2412696 | 0.0680196 |
| Northern Deanery | 0.3940991 | 0 | 0.2607138 | 0.5274844 |
| Northern Ireland Medical & Dental Training Agency | 0.3068588 | 0 | 0.1553816 | 0.458336 |
| Oxford Deanery | −0.035232 | 0.685 | −0.2064454 | 0.1359814 |
| Severn Deanery | 0.0086333 | 0.9 | −0.1271749 | 0.1444415 |
| South West Peninsula Deanery | 0.2378881 | 0.025 | 0.0306404 | 0.4451358 |
| Wales Deanery | −0.0627973 | 0.416 | −0.2146185 | 0.0890239 |
| Wessex Deanery | 0.0777715 | 0.346 | −0.0845245 | 0.2400675 |
| Yorkshire and the Humber Postgraduate Deanery | −0.0368444 | 0.596 | −0.1736963 | 0.1000075 |
| Specialty | ||||
| Anaesthetics Posts | 0.6093095 | 0 | 0.4933132 | 0.7253057 |
| Emergency Medicine Posts | −0.0190031 | 0.792 | −0.1609679 | 0.1229616 |
| General Practice Posts | 1.025555 | 0 | 0.9157396 | 1.135371 |
| Obstetrics and Gynaecology Posts | −0.1976587 | 0 | −0.3048599 | −0.0904575 |
| Occupational Medicine Posts | −0.7799197 | 0.311 | −2.295091 | 0.7352521 |
| Ophthalmology Posts | 0.3874072 | 0.001 | 0.1678983 | 0.6069161 |
| Paediatrics and Child Health Posts | 0.3073307 | 0 | 0.1940871 | 0.4205743 |
| Pathology Posts | 0.7915133 | 0 | 0.6078734 | 0.9751532 |
| Psychiatry Posts | 0.4438941 | 0 | 0.3244746 | 0.5633136 |
| Public Health Posts | 0.4352268 | 0.015 | 0.0869019 | 0.7835517 |
| Radiology Posts | 0.3642086 | 0 | 0.1712133 | 0.5572038 |
| Surgery Posts | 0.0306072 | 0.57 | −0.0753556 | 0.1365701 |
NTS: National Trainee Survey; EEA: European Economic Area; BME: black and minority ethnic.
From 2014 to 2015, there was a statistically significant improvement in all considered outcome measures except educational supervision, which showed a non-statistically significant decline. Men reported superior subjective experience than women, reaching statistical significance for all six outcome measures.
Unspecified ethnicities reported worse experience in all measures compared to whites. Ethnic minorities reported worse experience in all measures compared to whites, except educational supervision and workload, where they reported better experience, though only reaching statistical significance for the former.
Medical graduates from the European Economic Area did not report a statistically significant difference in any of the six outcomes measures when compared to British graduates. As compared to British graduates, though those receiving their degrees from other countries (outside the European Economic Area) reported worse overall satisfaction, they experienced the workload, clinical supervision and access to educational resources favourably; differences in the other outcome measures did not reach statistical significance.
As compared to core and lower grade trainees, foundation year doctors reported worse overall satisfaction, workload, clinical supervision, and access to educational resources. As compared to core and lower grade trainees, ST4+ trainees reported superior overall satisfaction, adequate experience, clinical supervision and access to educational resources; they reported worse educational supervision, however.
There was marked variation in the experience of trainees across the various deaneries and specialties through the different measures.
The described associations only explain a small component of the heterogeneity in reported experiences, with no coefficient within any of the models having magnitude greater than 3 points (Tables 2 to 5, Supplementary Tables 1 and 2).
Discussion
Principal findings
Despite the use of a stringent Bonferroni correction for multiple testing, this work suggests that self-reported experiences amongst UK medical trainees in the indicators ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’ are related to gender, ethnicity, country of primary medical qualification, grade, deanery and post specialty. Although there were various statistically significant associations, these only related to small changes in the observed responses, with no single trainee factor associated with a more than a 3 point change in any of the considered outcome measures (Tables 2 to 5, Supplementary Tables 1 and 2). Thus, while the considered aspects are indeed associated with self-reported experience, they explain only a small component of the overall variation.
Limitations
These data have been anonymised by the General Medical Council by replacing respondent identifiers and removing responses from doctors in training where there are fewer than 3 respondents sharing the same demographic characteristics. After removing data to preserve participant anonymity, there were 64,278 participants providing 99,076 responses. Thus, a significant proportion of trainees will have completed the General Medical Council National Trainee Survey in both 2014 and 2015, in turn potentially impacting on the independence of the responses seen. Furthermore, a total of 6473 out of 105,549 (6.1%) cases were removed (Table 1). Though the overall proportion of removed responses was low, there is marked variation in how much data were lost from the different categories (Table 1), with more than 20% of responses missing from the unspecified ethnicities (33%), European Economic Area graduates (46%), Occupational Medicine trainees (38%), Ophthalmology trainees (38%), Pathology trainees (34%), Public health trainees (46%), NHS Education for Scotland East Region trainees (24%) and NHS Education for Scotland North Region trainees (21%) categories. The removal of responses was not a random process, and had greatest effect on trainees in minority groups. However, the available sample was still sufficient to detect differences within many of the considered trainee factors and experience measures. Insufficient response to survey questions also meant that data were missing for three of the outcome measures considered, though this was smaller in magnitude and less likely to have affected the results: ‘clinical supervision’ (228 responses, 0.23%), ‘educational supervision’ (86 responses, 0.09%), and ‘access to educational resources’ (3,161 responses; 3.19%).
Relation to other studies
This is the largest published analysis of survey responses to compare the subjective experience of medical trainees to demographic factors. While these findings are consistent with previous work,1–8,10,11,14,17–22 the numerical scores used also allow for quantitative comparisons to be made between the different trainee factors and outcome measures.24 Furthermore, the General Medical Council National Trainee Survey is an annual survey, allowing the associations and differences between groups to be monitored yearly, and related to interventions targeting disparity. Work analysing the responses of the trainee survey in 2006 clearly highlighted that there were differences in the satisfaction and supervision of trainees in different specialty groups, but was not able to compare particular subsets of groups, and did not attempt to investigate the acknowledged effects of sex, year of qualification, time in post, and grade.23 This work differed in its methodological approach as compared to the current study; with a sample size of 23,267 it used in a multi-level model considering deaneries, training providers and specialty groups.23 Though adjustments were made for specialty group, training grade, time in post, sex, year of qualification, and the route used to respond to the questionnaire, ethnicity and country of primary medical qualification were not considered.23 The use of a multi-level model potentially offered superior statistical robustness, but may have also hindered in its complexity, with adjustment for the year of qualification not possible when considering supervision scores due to an inability to converge the model, and the repeated division of the cohort within clusters potentially limiting the ability to identify significant differences between groups.23
Implications and further work
As is a limitation with all such observational studies, this work only identifies associations, but does not explore the underlying mechanisms. To this end, while it is demonstrated here that trainee factors are associated with subjective experience across different indicators, further work is required to explore the reasons behind this, and how this relates to trainee quality of life, work performance and career progression. Given the demographic diversity of the medical workforce in the UK,1–3 and the recognised variation in performance across trainees of different gender,4,5 ethnicity,5–9 and country of primary medical qualification,3,10,11 it may be particularly prudent to explore how discrepancies in the experiences of these groups might affect their outcomes.
Supplementary Material
Supplementary Material
Acknowledgements
This research has been undertaken using data from the National Training Survey (NTS) data set available on application from the GMC. The GMC does not however hold any responsibility for subsequent analysis done from raw data provided as this is seen as creating new information. The GMC offered clarification on missing data and calculation of indicator scores. The final draft was also approved by the GMC.
Provenance
Not commissioned; peer-reviewed by Jeremy Brown
Declarations
Competing interests
The General Medical Council has provided DG with the data to support the submitted work; DG is a medical trainee and as such has a relationship with the General Medical Council that might have an interest in the submitted work in the previous 3 years; DG has no non-financial interests that may be relevant to the submitted work, other than those highlighted above.
Funding
None declared
Ethical approval
Not required; the research application was reviewed by the GMC and released data were anonymised.
Guarantor
DG had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
Contributorship
Sole authorship
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