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.