Equity in anaesthetic procedural training: a UK survey

Differential attainment by protected characteristics is described in the setting of medical education, but its relevance to UK anaesthetic training is not well established. This study examined whether personal characteristics influence access to procedural and training opportunities among resident doctors (or doctors in training) and speciality anaesthetists practising in the UK. A national, cross-sectional, web-based survey was distributed via the Association of Anaesthetists, Regional Anaesthesia UK and social media between 01/06/2023 and 30/09/2023. Eligible respondents were resident doctors, speciality doctors, locally employed/trust doctors and clinical fellows practising in UK anaesthetic posts. We collected demographic data, protected characteristics, self-reported numbers of procedures performed, receipt of simulation training, self-reported confidence and self-declared supervision levels. Data were anonymised and analysed using mixed-effects proportional odds logistic regression models to identify associations between personal characteristics and outcomes, adjusting for potential confounders, including socio-economic deprivation. There were 874 respondents of whom 699 (80%) were resident doctors. Four hundred and twenty-seven (49%) identified as female, 414 (47%) as male and 17 (2%) as non-binary. The majority were White (66%) and worked in England (79%). After adjustment, female compared with male gender was associated with being in a lower category for number of procedures performed (OR 0.68, 95%CI 0.54-0.86), self-reported confidence (OR 0.48, 0.37-0.61) and supervision requirements (OR 0.49, 0.37-0.64). Older age was associated with greater procedural exposure and confidence. Compared with white ethnicity, Asian ethnicity was associated with higher confidence (OR 1.55, 1.15-2.11) and perceived need for more distant supervision (OR 1.63, 1.17-2.27), but not with greater procedural numbers. No significant adverse associations were found for disability, sexuality, less than full time training, religion, marital status, socio-economic background or carer status. Gender-based barriers were perceived by 43% of female respondents, compared with 3% of male respondents. Access to procedural training in UK anaesthesia appears broadly equitable across ethnicity, disability and training status. Significant gender disparities in procedural exposure, self-reported confidence and perceived need for supervision remain. These findings highlight the need for equitable training practices and further qualitative work to address underlying causes and promote diversity within the anaesthetic workforce.