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BMJ Open. 2019 Mar 5;9(3):e025004. doi: 10.1136/bmjopen-2018-025004.

Effect of sex on specialty training application outcomes: a longitudinal administrative data study of UK medical graduates.

Author information

Research Department of Medical Education, University College London Medical School, London, UK.
Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Crawley, Western Australia, Australia.
North Middlesex University Hospital NHS Trust, London, UK.
Centre for Health Informatics and Multiprofessional Education, UCL, London, UK.



To examine sex differences in the specialty training recruitment outcomes of UK medical graduates; and whether sex differences were explained by prior academic attainment and previous fitness to practise (FtP) declarations.


Retrospective longitudinal cohort study.


Administrative data on entrants to all UK medical schools from the UK Medical Education Database.


10 559 doctors (6 155; 58% female) who entered a UK medical school in 2007 or 2008 and were eligible to apply for specialty training by 2015.


Odds of application, offer and acceptance to any specialty training programme, and on to each of the nine largest training programmes, adjusting for sex, other demographics, prior academic attainment, FtP declaration and medical school.


Across all specialties, there were no sex differences in applications for specialty training, but women had increased odds of getting an offer (OR=1.40; 95% CI=1.25 to 1.57; p<0.001) and accepting one (OR=1.43; 95% CI=1.19 to 1.71; p<0.001). Seven of the nine largest specialties showed significant sex differences in applications, which remained after adjusting for other factors. In the adjusted models, Paediatrics (OR=1.57; 95% CI=1.01 to 2.46; p=0.046) and general practice (GP) (OR=1.23; 95% CI=1.03 to 1.46; p=0.017) were the only specialties to show sex differences in offers, both favouring women. GP alone showed sex differences in acceptances, with women being more likely to accept (OR=1.34; 95% CI=1.03 to 1.76; p=0.03). Doctors with an FtP declaration were slightly less likely to apply to specialty training overall (OR=0.84; 95% CI=0.71 to 1.00; p=0.048) and less likely to accept an offer to any programme (OR=0.71; 95% CI=0.52 to 0.98; p=0.036), after adjusting for confounders.


Sex segregation between medical specialties is due to differential application, although research is needed to understand why men are less likely to be offered a place on to GP and Paediatrics training, and if offered GP are less likely to accept.


academic attainment; fitness to practise; medical workforce; professionalism; sex differences

Conflict of interest statement

Competing interests: KW reports grants, personal fees and non-financial support from General Medical Council, personal fees and non-financial support from Membership of the Royal Colleges of Physicians (UK), personal fees from University of Dundee School of Medicine, non-financial support from UK Medical Education Database, other from Higher Education Funding Council England, non-financial support from Medical Schools Council, grants from National Institute for Health Research, outside the submitted work. CV reports non-financial support from Actelion, outside the submitted work. HP reports grants from General Medical Council, outside the submitted work. EU reports non-financial support from the General Medical Council and financial support from University College London outside the submitted work.

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