Emma Fletcher, Senior Data Analyst at the Medical Schools Council, explores how sociodemographic and educational factors impact clinical academic career progression.
The UK clinical academic workforce is facing significant challenges. Workforce numbers are declining and concerns are growing about the long-term sustainability of the research pipeline. Not only this, but the gender and ethnic diversity is limited within the workforce, especially at higher grades. To understand these trends we need to look upstream and examine the characteristics of medical students who participate in research, the resident doctors who pursue academic training pathways and the factors influencing retention within these pathways over time. Despite the need, there is currently little national data examining on how sociodemographic and educational factors influence progression through the clinical academic pipeline.
Our recently published study aimed to explore medical students’ and resident doctors’ engagement in intercalated degrees and recruitment to the Academic Foundation Programme, now known as the Specialised Foundation Programme (SFP) and Pre-doctoral Fellowships (PFs). Using linked, national data from the UK Medical Education Database (UKMED), we looked at a cohort of UK-domiciled resident doctors who graduated from a UK medical school between 2017 and 2022 and who directly applied to the Foundation Programme. We focused on sociodemographic and educational factors to identify characteristics associated with progression and success within the UK clinical academic pathway.
The findings reported below relate to standard-entry graduates only.
Who intercalates?
After adjusting for sociodemographic characteristics, participation in intercalated degrees varied across groups. Intercalation was more common among male graduates, doctors from ethnic minority backgrounds and those who had attended private schools. In contrast, graduates from more deprived areas (as measured by the Index of Multiple Deprivation (IMD)) were less likely to have undertaken an intercalated degree, as were those with a declared disability. Uptake was also considerably lower among graduates from newer medical schools.
Who applies to and enters the Specialised Foundation Programme?
After adjusting for sociodemographic characteristics and medical school attainment, patterns similar to those observed for intercalation were evident. Male graduates, most ethnic minority groups (with the exception of those of Mixed ethnicity) and graduates from private schools were more likely to apply to the SFP. Unlike intercalation, however, application rates were higher among graduates with a declared disability. Encouragingly, none of these characteristics were associated with differences in SFP acceptance rates.
Several educational factors were also associated with SFP participation. Intercalation showed the strongest association with application, with graduates who intercalated being more than five times as likely to apply and also more likely to be accepted. Similarly, having a publication during medical school was associated with both higher application and acceptance rates. Graduates from newer medical schools, despite being less likely to have intercalated, were more likely to apply to and be accepted onto the SFP.
Who applies to and enters Pre-doctoral Fellowships?
When considering application to the PF programme, relatively few factors were independently associated with participation. However, male gender, prior publication and intercalation were all associated with a greater likelihood of applying. Prior SFP acceptance showed the strongest association by far, with those who had previously secured an SFP post having almost eight times the odds of applying to the PF programme compared with those without prior SFP experience.
Interpretations and implications
Overall, these findings highlight potential inequalities in early clinical academic progression, particularly affecting women, ethnic minority doctors and those from less advantaged backgrounds. Educational experiences such as intercalation and publication remain important associates of progression and unequal access to early research opportunities may risk a perpetuation of such inequalities down the pipeline.
Sustaining the clinical academic pipeline requires both nurturing interest in research from an early stage and ensuring that progression is determined by ability and potential, rather than background or structural barriers. The recent Office for Strategic Coordination of Health Research (OSCHR) report recommends measures to strengthen early research engagement, including funded intercalated degree bursaries and research internships. Such initiatives could help address disparities at the earliest stages of the pathway and support more equitable progression into academic careers. Further qualitative research is also needed to better understand the experiences of aspiring academics and to explore the factors underpinning the disparities identified in this study.
