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PGMJ Online First, published on October 9, 2017 as 10.1136/postgradmedj-2017-135199 Original Article

Securing a cardiology speciality training programme in the UK: how did other people do it? Majd B Protty,1 Kevin Mohee,2 Hannah C Hoskins,1 Hasan N Haboubi3 1

Medical School, Cardiff University, Cardiff, UK 2 Medical Directorate, Singleton Hospital, Swansea, UK 3 Medical School, Swansea University, Swansea, West Glamorgan, UK Correspondence to Dr Majd B Protty, Medical School, Cardiff University, Cardiff CF10 3XQ, UK; m ​ ajd+​pmj@p​ rotty.​net Received 13 July 2017 Revised 15 September 2017 Accepted 21 September 2017

Abstract Background  Application to cardiology specialty training is competitive with uncertainty among candidates as to what the secret recipe for a successful appointment is. We aimed to investigate objective variables, which were demonstrated by successful appointees to cardiology training schemes in the UK. Methods  Data from successful cardiology applicants for the years 2014 to 2016 were obtained from the Joint Royal Colleges of Physicians Training Board under the Freedom of Information Act. These data included basic demographics as well as objective scores awarded for selection categories such as qualifications, academic, teaching and other achievements. Results  There were a total of 976 applicants during the study period, of whom 423 were successfully appointed, generating a competition ratio of 2.3 applicants for each position. There was an increasing proportion of successful female applicants (22% in 2014, 28% in 2015 and 32% in 2016). Median scores for postgraduate exams (14/14), presentations (6/6) and quality improvement (10/10) scores corresponded to maximum possible scores, whereas median scores for additional undergraduate and postgraduate degrees were 0. Median scores for prizes, publications and teaching experience were 6/10, 4/8 and 9/10, respectively. Conclusion  The secret to a successful cardiology training appointment is associated with completion of all postgraduate clinical exams, completion and presentation of quality improvement projects, national presentations and substantial teaching achievements. At least half of the successful candidates had no additional undergraduate or postgraduate degrees but had evidence of some prizes and publications. The ratio of successful female candidates is rising, but remains less than males in cardiology training.

Introduction

To cite: Protty MB, Mohee K, Hoskins HC, et al. Postgrad Med J Published Online First: [please include Day Month Year]. doi:10.1136/ postgradmedj-2017-135199

Cardiology is considered to be a competitive, rigorous and complex specialty choice for doctors who have completed their general internal medicine training.1 In the UK, trainees may choose to apply for a cardiology training programme after completing their core internal medicine training at least 4 years after completion of medical school.1 Applicants face stiff competition and traditionally three hurdles exist that influence successful appointment as a cardiology specialty trainee (StR). These are: a standardised curriculum vitae geared towards cardiology, short-answer reflective questions probing experiences and suitability of candidates and the interview stage.2

Since the introduction of the Modernising Medical Careers programme in 2005,3 selection processes have been increasingly standardised to generate objective scores that may be used for both shortlisting and successful appointment of trainees to a cardiology StR scheme. Our study aims to investigate objective variables that successful appointees to cardiology training schemes in the UK were able to display for the years 2014 to 2016.

Methods Data were obtained from the Joint Royal Colleges of Physicians Training Board (JRCPTB) using a request under the Freedom of Information Act 20004 with a list of questions pertaining to all successful cardiology appointments in the UK from 2014 to 2016 (3 years). The JRCPTB is the body responsible for processing all applications to internal medicine subspecialties. Variables that were collected include basic numbers of applicants and successful appointments, demographic data including age and ethnicity and objective scores for selection categories as defined by the JRCPTB (table 1). Analysis was carried out using the SPSS Statistical package version 21 (IBM, USA).

Results There were a total of 976 applicants to cardiology subspecialty programme in the 3-year period from 2014 to 2016. Of these, 423 were successfully appointed, generating a competition ratio of 2.3 applicants for each position. Gender distribution shows an increasing proportion of successful female applicants during the study period (22% in 2014, 28% in 2015, 32% in 2016). Mean age decreased from 33 in 2014 to 30 in 2015 and 2016. Approximately a quarter of candidates reported being Caucasian and a similar proportion reported being of Asian origin (South Asia: India, Pakistan, Bangladesh and surrounding areas). Table 2 provides a breakdown of demographic descriptors of successful candidates. Median scores awarded objectively for achievements of successful candidates can be seen in table 3,  with postgraduate exams, presentations and quality improvement scores corresponding to maximum possible scores, whereas median scores for additional undergraduate and postgraduate degrees were zero.

Protty MB, et al. Postgrad Med J 2017;0:1–4. doi:10.1136/postgradmedj-2017-135199

Copyright Article author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence.

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Original Article Table 1  Objective points awarded to achievements including qualifications, academic, teaching, prizes and quality improvement projects Degrees and exams

Academic achievements

Teaching achievements

Other achievements

Postgraduate degrees

Presentations

Teaching experience

Quality improvement

 Doctor of Philosophy (PhD)—10 points

National oral—6 points

Designed and organised a programme with local tutors—7 points

Led a full project, not presented—8 points

 Doctor of Medicine (Research MD*)—8 National poster (two or more)—6 points points

Led a full project and presented—10 points

 Master of Philosophy (MPhil)—6 points National poster (one)—4 points

Designed and organised a programme—6 Participated, full project, presented—6 points points

 Masters degree (MSc/MA)—5 points

Regional oral—4 points

Regular teaching 3 months of more—4 points

Participated, full project, not presented—4 points

 Doctor of Medicine (Dissertation MD*)—4 points

Regional poster—3 points

Occasional teaching—2 points

Participated in parts of project—2 points

 Postgraduate diploma/certificate—3 points

Local presentation—2 points

Undergraduate degrees

Publications†

Teaching qualifications

Prizes

 First class honours—10 points

First author of two or more original articles—8 points

Qualifications—3 points

National prize - 10 points

 Second upper class (2:1)—5 points

Co-author of two or more original articles—8 points

Substantial training—2 points

Honours/Distinction—8 points

 Other class—2 points

First author of one original article—6 points Brief training—1 point

Two or more undergraduate prizes—6 points

Postgraduate exams

Co-author of one original article—5 points

One undergraduate prize—4 points

 Full MRCP (UK)—14 points

First author of two or more other articles—4 points

Scholarship/Bursary—2 points

 MRCP PACES—10 points

First author of one other article—3 points

 MRCP Part 2 written—4 points

Published abstracts—2 points

*MD is a postgraduate degree in the UK that can have minimal research (dissertation only) or original research of at least 2-year duration. MRCP, Membership of the Royal college of physicians, consisting of two written components (Part 1 and Part 2 written) and a clinical component; PACES, Practical Assessment of Clinical Examination Skills. These points are used in the shortlisting and selection process to appoint candidates to subspecialty training by the Joint Royal Colleges of Physicians Training Board. Source:www.st3recruitment.org.uk as at June 2017. †All articles need to be PubMed-cited.

Discussion

This study describes the pattern of achievements that was demonstrated by candidates who were successfully appointed to cardiology training programmes in the UK between 2014 and

2016. It shows that most successful candidates exceeded the minimum criteria described by the JRCPTB person specifications for entrance into the StR training.2 5 It is therefore not surprising that the application process is a source of angst among

Table 2  Baseline characteristics of candidates successfully appointed to the Cardiology speciality training (ST) scheme in 2014–2016 Year of application 2014

2015

2016

n

%

n

%

n

%

Number of applications

312

100

324

100

340

100

The number of trainees who secured an appointment

152

49

123

39

148

47

 Female

34

22

35

28

48

32

 Male

115

76

87

57

99

65

 Prefer not to say/Not available

3

2

1

1

1

1

 White

42

28

36

24

36

24

 Black

8

5

6

4

4

3

 Asian

38

25

28

18

43

28

 Chinese

12

8

8

5

12

8

 Mixed

2

1

4

3

4

3

 Other

42

28

33

22

38

25

 Not stated/Not available

9

6

8

5

11

7

The subgroup numbers for gender

The subgroup numbers for ethnicity

Age of the successful candidate

2

 Minimum

26

25

24

 Mean

33

30

30

 Maximum

51

47

49

Protty MB, et al. Postgrad Med J 2017;0:1–4. doi:10.1136/postgradmedj-2017-135199

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Original Article Table 3  Median scores for the different assessment categories of candidates successfully appointed to the Cardiology training programme 2014–2016 Year of application Shortlisting categories median scores 2014

2015

2016

Undergraduate degrees

0

0

0

Postgraduate degrees

0

0

0

Prizes

6

6

6

Postgraduate examinations

14

14

14

Presentations

6

6

6

Publications

4

4

4

Teaching

8

8

9

Quality improvement

10

10

10

core medical trainees and highlights the need for information on what makes an applicant successful. Our study aimed to cover this gap in information by being the first to publish data from the JRCPTB records for cardiology, one of the most highly competitive medical specialty.1 The JRCPTB score candidates applying to medical subspecialty training by their academic and teaching achievements (table 1). Successful candidates for cardiology specialty training had the maximum scores for postgraduate exams (Membership of the Royal College of Physicians (MRCP)), presentations and quality improvement projects, suggesting these criteria should be considered as essential for successful appointments (table 3). The importance of a completed quality improvement project and presentations may reflect the strong culture of evidenced-based practice within cardiology. The median score for publications remained stable throughout the study period, and suggested most candidates had at least first authorship on two or more published articles. In contrast, the median score for extra undergraduate or postgraduate degrees was 0. This suggests that the absence of extra degrees may not greatly discriminate against those applying to cardiology training in the UK. The median score for prizes remained at 6 throughout the study period, correlating with at least two or more undergraduate prizes. More points could be obtained by Honours and Distinctions or National prizes. This reflects how individual performance (as early as in medical school) can influence an application to specialty training. The ability to teach is considered an important criterion for cardiology training. The median JRCPTB score for teaching rose slightly over the study period (8 in 2014, 8 in 2015 and 9 in 2016) out of a possible 10 points. This was likely achieved by designing and organising a teaching programme with or without local tutors, and at least brief or substantial training for teaching. Completion of a postgraduate certificate in education or a full diploma would achieve maximum points for teaching qualifications. Historically, there are more male than female applicants to cardiology training.6 The data between 2014 and 2016 were consistent with this gender disparity (table 2). It has been hypothesised that factors such as difficultly in maintaining work/ family balance, the perception of cardiology as a ‘male’ dominant specially or gender bias have driven women away from pursuing a career in cardiology.6 However, our findings show that there was an increasing proportion of successful female applicants during the study period (22% in 2014, 28% in 2015, 32% in 2016). We know little of the factors driving this increase, Protty MB, et al. Postgrad Med J 2017;0:1–4. doi:10.1136/postgradmedj-2017-135199

but perhaps the increasing numbers of female consultant cardiologists are providing more female mentors in the specialty. It may also reflect the increasingly female output from medical schools within the UK.7 Other factors may also include expanding posts in certain ‘family friendly’ posts in some subspecialties of cardiology namely cardiac imaging and adult congenital heart disease which do not carry stressful on-site on-call commitments like coronary intervention. Previous literature reported that doctors who self-identified as being part of ethnic groups other than white had worse recruitment outcomes than white doctors within the UK.8 9 However, we found approximately a quarter of candidates for cardiology training in the UK reported being Caucasian and a similar proportion reported being of Asian origin (South Asia: India, Pakistan, Bangladesh and surrounding areas). The proportion of candidates who self-identified as black decreased during the study period (5% in 2014, 4% in 2015, 3% in 2016). This paper used all UK data covering a 3-year period obtained directly from the JRCPTB, thus avoiding any selection or recall bias. It is the first to describe the academic achievements and demographics of successful candidates to cardiology training in the UK. This study was limited by no data on performance at the interview. Future studies looking at similar data for unsuccessful candidates would be equally interesting, especially with regards to race, gender and scores. However, the authors do not have these data at the current time.

Conclusion

The formula to a successful outcome of cardiology applications seems to be (at least in part): completion of postgraduate clinical examinations (MRCP), completion and presentation of quality improvement projects, national presentations of at least one oral or two poster sessions and substantial teaching achievements. At least half of the successful candidates had no additional undergraduate or postgraduate degrees but had evidence of some prizes and publications. The ratio of successful female candidates is rising, but remains less than males in cardiology training.

Main messages ►► The average candidate who is successful in obtaining a

cardiology number often exceeds the minimal criteria set by the Joint Royal Colleges of Physicians Training Board. ►► Most candidates have maximised their marks on the following categories: postgraduate examinations, presentations and quality improvement projects. ►► Additional undergraduate or postgraduate degrees do not seem to be as prevalent among candidates, though some evidence of prizes and publications was noticed among successful candidates. Current research questions ►► The interview process is subjective and forms a significant

part of the selection process. What strategies have candidates employed to succeed? ►► The reverse question: What are the the most common failing points that unsuccessful candidates stumbled on ? ►► The correlation between the above achievements, which heavily influence selection, and successful completion of specialty training.

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Original Article Acknowledgements We acknowledge the Joint Royal College of Physicians Training Board (JRCPTB) for facilitating release of data under the FOI Act 2000. Contributors MBP, KM and HNH developed the idea and designed the project. All authors participated in collecting and analysing the data. MBP, KM and HCH generated the first draft of the paper. MBP and HNH reviewed the draft and amended it. All authors approved the final version. Competing interests None declared. Ethics approval None required (anonymised data obtained through the Freedom of Information act) Provenance and peer review Not commissioned; externally peer reviewed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

References

1. Jaques H. Cardiology is most competitive specialty for higher training. BMJ Careers  2011. http://​careers.b​ mj.​com/c​ areers/​advice/​view-​article.h​ tml?​id=​20004464.

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2 Joint Royal Colleges of Physicians Training Board. ST3 recruitment. http://www.​ st3recruitment.​org.​uk (last accessed 20 Jun 2017). 3 Department of Health. Modernising medical careers. 2003 http://www.​wales.​nhs.​uk/​ documents/s​ ho-​policy-​state-​e.p​ df (last accessed 20 Jun 2017). 4 United Kingdom Legislation. Freedom of information act. 2000 http://www.​legislation.​ gov.u​ k/​ukpga/​2000/​36/c​ ontents (last accessed 20 Jun 2017). 5 Health Education England.  Cardiology ST3 person specifications. http://​ specialtytraining.​hee.​nhs.u​ k/​portals/1​ /​Content/P​ erson Specifications/Cardiology/ Cardiology ​ST3.​pdf (last accessed 20 Jun 2017). 6 Smith F, Lambert TW, Pitcher A, et al. Career choices for cardiology: cohort studies of UK medical graduates. BMC Med Educ 2013;13:10. 7 Khan M. Medicine - a woman’s world? - is the rising number of women in UK medicine leading to overfeminisation? Student BMJ 2011. 8 General Medical Council. The state of medical education and practice in the UK.. 2015 http://www.​gmc-​uk.​org/​publications/​somep2015.​asp (last accessed 20 Jun 2017). 9 Woolf K, Rich A, Viney R, et al. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open 2016;6:e013429.

Protty MB, et al. Postgrad Med J 2017;0:1–4. doi:10.1136/postgradmedj-2017-135199

Downloaded from http://pmj.bmj.com/ on October 10, 2017 - Published by group.bmj.com

Securing a cardiology speciality training programme in the UK: how did other people do it? Majd B Protty, Kevin Mohee, Hannah C Hoskins and Hasan N Haboubi Postgrad Med J published online October 9, 2017

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Securing a cardiology speciality training programme in the UK: how did other people do it?

Application to cardiology specialty training is competitive with uncertainty among candidates as to what the secret recipe for a successful appointmen...
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