Discussion
Synopsis of key/new findings
Understanding what makes a successful interview candidate has for some time interested the medical community.6 As the ENT ST3 competition ratio increases (2.57 applicants per post in 2019) junior trainees interested in securing a national training number (NTN) will seek to gain a ST1 run through post.5 In addition, the run through programme will likely further increase the competition ratio at ST3 by reducing overall available posts. This questionnaire demonstrates that schooling, be it private or state, does not affect interview success. Holding an additional degree and transitioning directly from foundation programme seems to increase the likelihood of interview success. Although candidates graduated from 12 different universities a large proportion came from the University of Birmingham (Figure 1). It could be proposed that undergraduates at this institution had a greater exposure to ENT or that training better prepared them for the core interview process.
The pilot currently allows candidates to gain an ENT NTN by a non-ENT selection process. A specialty-specific selection process would be able to deliver a comparable interview to ST3 recruitment and assess candidates’ interest and engagement with ENT. This would standardise recruitment to ENT NTN posts and encourage applications from only those with a true interest in the specialty. This study demonstrates that many current run through trainees had little exposure of ENT prior to application (Figure 2). As a result, it may prevent immediate transfer from foundation training and there is no doubt that duplication of the interview process would increase consultant time required.
Exposure to ENT certainly does not preclude candidate success (Figure 2). Nine of the trainees had less than 4 months ENT exposure prior to gaining an NTN. Some may argue that this is insufficient exposure to determine a true interest in the specialty and could lead to a higher dissatisfaction and dropout rate. In addition, it is interesting that the majority of trainees decided to pursue a career in ENT during the interview year or 1 year previous (Figure 3). This suggests that the introduction of the run through pilot may have influenced the speciality decision of junior trainees attending the core surgical interview. Results show that the pilot has succeeded by attracting candidates with geographical training stability and the majority of trainees are engaged with ENT UK.
Trainees should have access to a regional trainee run through lead. The questionnaire results demonstrate that less than half of trainees had contact with the lead and those who did only 45% found this useful. Regional leads may find it difficult to guide and advise trainees when there is little information available and the pilot programme is in its infancy. Furthermore, exposure to secondary and tertiary ENT services seems to be variable amongst the run through trainees. The majority of trainees have exposure to 2 allied specialities which would achieve maximum points in this domain in the 2020 ST3 portfolio marking scheme. Standardisation of placements is required to provide exposure to both secondary and tertiary ENT and allied specialities prior to ST3.
Trainer engagement is vitally important in helping to motivate and fulfil the potential of trainees. The perceived increase in ENT trainer engagement further solidifies the role of the run through programme in ENT training. However, this may come at the cost of reduced engagement with allied speciality trainers who may have a reduced motivation to train those whose speciality interest has already been decided (Figure 4).
Of the ST2 trainees the majority felt prepared to start ST3 and would engage with the ST3 boot camp. It was interesting that 27% of ST2s intended to attend the ST3 interview in 2020 so to change region. This slightly contradicts the benefit of improved geographical stability with the run through programme.
Strengths of the study
This study had an excellent uptake of the questionnaire with 88% of the current run through trainees responding in full. This provides a very good representation of the current run through cohort. The total number of trainees was calculated from the number of run through jobs advertised. It is not possible to say whether those who did not respond chose not to, the post was not filled or is now vacant.
Comparisons with other studies
This is the first study to investigate the background and progress of ENT run through trainees. Manjaly and Radford surveyed successful ENT ST3 applicants in 2012.6 They also found that trainees who held additional degrees and spent less time out of training were more likely to be successful at interview. Furthermore, they observed that trainees had a range of ENT exposure (6-30 months) prior to application which mirrors the findings of the current study.6
Clinical applicability of the study
This nationwide ENT run through questionnaire allows an insight into the background and progress of the trainees who were successful in attaining a run through post. The pilot has been successful in attracting candidates by providing geographical stability and removing the need for further interview at ST3. An additional benefit of the run through programme has been to improve ENT trainer engagement which is critical at this stage of training. Changes should be made to improve contact between the regional run through lead and their trainees and to ensure standardisation of placements. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post.