Article: When the Odds Aren’t Equal

Recent studies demonstrate that Black applicants experience poorer recruitment outcomes than their White counterparts at multiple stages of UK surgical training and across several specialties. The critical question is whether surgical organisations will acknowledge this disparity and take deliberate, intentional action to address it.

Disparities Across the Surgical Recruitment Pipeline

A sub-analysis of national surgical recruitment data conducted by Sheila Cunliffe identified significant differences in outcomes for Black candidates throughout surgical training.¹ The most striking disparities are evident at the level of Core Surgical Training (CST), the principal gateway to a career in surgery. Only 19% of Black applicants were shortlisted, compared with 65% of White applicants. The disparity persists at the offer stage, where only 8% of Black applicants received an offer, compared with 42% of White applicants.¹ (Tables 1-3).

This disparity is not confined to CST. In General Surgery ST3 recruitment, only 20% of Black applicants received offers, compared with 47% of their White counterparts. Similarly, in Trauma and Orthopaedic Surgery ST3, the respective figures were 18% and 55%. Where comparisons are possible, further analysis across specialties indicates that Black applicants consistently experience some of the lowest rates of offer attainment.¹ (Tables 1-3).

What the Adjusted Analysis Tells Us

These findings are consistent with those of a separate national study by Seehra et al., Mapping Equity at the Gateway to Surgical Training, which examined data from the 2024 Core Surgical Training applicant cohort.² The study employed multivariable analysis to examine applicant characteristics and adjust for confounding variables that could influence recruitment outcomes.

The study found that: 

  • Asian, Black and Other/Chinese applicants had significantly lower odds of receiving a CST offer than White applicants, even after full multivariable adjustment (Asian aOR 0.54; Black aOR 0.31; Other/Chinese aOR 0.67) .
  • Black applicants experienced the lowest odds of success of all ethnic groups, with adjusted odds indicating they were around 69% less likely than White applicants to receive an offer (aOR 0.31) .
  • Ethnic disparities persisted even within UK/ROI graduates and UK/ROI nationals, meaning the current gap cannot be explained by nationality or country of qualification.

Overall, Black applicants had the lowest adjusted odds of receiving a CST offer among all ethnic groups analysed .² The persistent disparity between Black and White applicants therefore remains clearly evident even after accounting for nationality and primary medical qualification. 

This finding should not be dismissed because of its uncomfortable implications. Rather, it warrants careful scrutiny and raises serious concerns about systemic ethnic inequities within the surgical training selection process. Such disparities demand rigorous examination, institutional accountability, and proactive intervention to identify and address their underlying causes.

From Evidence to Accountability

Behind every number is a real person — someone with the ambition to become a surgeon, whose hopes, opportunities and future are determined by the systems we put in place for recruitment into training.

At our 2024 national conference, Moving Beyond the Data, we called on surgical organisations to publish ethnicity data clearly and transparently, identify and address inequities in recruitment, establish measurable actions and targets, and report openly on progress.

As defacto gatekeepers to the profession, if surgical organisations are serious about fostering a fair and inclusive workforce, addressing ethnic inequity cannot be regarded as a “nice to have.” It is both a moral imperative and a responsibility under equality legislation that all candidates be treated fairly.

What Next?

BABS is ready to work collaboratively with surgical organisations to ensure that ethnic inequity remains firmly on the agenda, underpinned by meaningful measurement, accountability, and action. This must include examining outcomes for Black applicants specifically, rather than subsuming them within broader ethnic categories that may obscure the particular barriers they experience.

We welcome partnerships with all those willing to understand these disparities, confront the evidence, and implement measurable change.

We therefore call on all UK surgical organisations involved in recruitment to:

  1. Independently review the selection process to identify and address potential barriers or inconsistencies in areas such as shortlisting, assessment criteria and the appeals process.

  2. Strengthen assessment standards through clear procedures, diverse and transparent panels, and regular checks of scoring.

  3. Involve affected applicant groups and representative organisations in improving the recruitment process and review whether these changes are effective.

Tables

References:

  1. https://citou.com/our-research-on-racism-in-medical-training-progression-and-selection
  2. Seehra JK, Ellis R, Doleman B, McLarty E, Lund J. Mapping equity at the gateway to surgical training: National CST selection outcomes in 2024. Surgeon. 2026 Feb;24(1):8-13. doi: 10.1016/j.surge.2025.10.005. Epub 2025 Oct 26. PMID: 41145322.