Predicting success at the Intercollegiate Membership of the Royal Colleges of surgery (MRCS) examination: The Syme Medal report.

Background: The MRCS is a key gatekeeping assessment in the UK, completion of which is a prerequisite for progression into higher specialist surgical training (HST) programmes. As a result, examination success or failure can have a significant and lasting impact on career progression. Yet despite such high stakes, little was known about factors that may influence examination performance.

Methods: To address this important gap in the literature, a series of large longitudinal cohort studies were undertaken. The work used data crossmatched from several national medical education databases to create the most extensive investigation of training outcomes for UK surgical trainees to date. MRCS data were matched to sociodemographic factors, training history and measures of prior academic attainment, and multivariate analyses identified independent predictors of MRCS success.

Results: Three key quantifiable factors were identified that predict success at MRCS: institutional differences in teaching and training, academic ability and individual differences in personal and social circumstances. This invited report for the Syme Medal discusses the key findings from this body of research and the implications for policy and practice.

Conclusions: The research studies discussed in this report are driving evidence-based changes at the national level. The findings contribute to the optimisation of surgical training and the recognition of candidates at increased risk of failure. This results in the appropriate reallocation of resources and support, enabling greater fairness, equity, diversity and inclusivity in surgical career progression.