Differential attainment at MRCS according to gender, ethnicity, age and socioeconomic factors: A retrospective cohort study

Ricky Ellis* (Corresponding Author), Peter Brennan, Amanda Lee, Duncan S.G. Scrimgeour, Jennifer Cleland

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
5 Downloads (Pure)



A recent independent review on diversity and inclusivity highlighted concerns that barriers to surgical career progression exist for some groups of individuals and not others. Group-level differences in performance at the Intercollegiate Membership of the Royal Colleges of Surgeons (MRCS) examinations have been identified but are yet to be investigated. We aimed to characterise the relationship between sociodemographic differences and performance at MRCS.

Retrospective cohort study.


Secondary care.


All UK MRCS candidates attempting Part A (n = 5780) and Part B (n = 2600) between 2013 and 2019 with linked sociodemographic data in the UK Medical Education Database (https://www.ukmed.ac.uk).

Main outcome measures

Chi-square tests established univariate associations with MRCS performance. Multiple logistic regression identified independent predictors of success, adjusted for medical school performance.


Statistically significant differences in MRCS pass rates were found according to gender, ethnicity, age, graduate status, educational background and socioeconomic status (all p < 0.05). After adjusting for prior academic attainment, being male (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.87–2.92) or a non-graduate (OR 1.98, 95% CI 1.44–2.74) were independent predictors of MRCS Part A success and being a non-graduate (OR 1.77, 95% CI 1.15–2.71) and having attended a fee-paying school (OR 1.51, 95% CI 1.08–2.10) were independent predictors of Part B success. Black and minority ethnic groups were significantly less likely to pass MRCS Part B at their first attempt (OR 0.41, 95% CI 0.18–0.92 for Black candidates and OR 0.49, 95% CI 0.35–0.69 for Asian candidates) compared to White candidates.


There is significant group-level differential attainment at MRCS, likely to represent the accumulation of privilege and disadvantage experienced by individuals throughout their education and training. Those leading surgical education now have a responsibility to identify and address the causes of these attainment differences.
Original languageEnglish
Pages (from-to)257-272
Number of pages16
JournalJournal of the Royal Society of Medicine
Issue number7
Early online date16 Feb 2022
Publication statusPublished - Jul 2022

Bibliographical note

Open access via Sage agreement
The authors would like to acknowledge Iain Targett at the Royal College of Surgeons of England, for his help with data collection and John Hines and Gregory Ayre from the Intercollegiate Committee for Basic Surgical Examinations for their support during this project. Our thanks to members of the UKMED Research Group who provided useful feedback on an earlier version of this manuscript, and whose comments helped refine the paper. The authors would also like to acknowledge Daniel Smith for his help with the UKMED database. Data Source: UK Medical Education Database (“UKMED”). UKMEDP043 extract generated on 25 July 2018. We are grateful to UKMED for the use of these data. However, UKMED bears no responsibility for their analysis or interpretation. The data include information derived from that collected by the Higher Education Statistics Agency (“HESA”) Limited and provided to the GMC (“HESA Data”). Source: HESA Student Records 2007/2008 to 2015/2016. Copyright Higher Education Statistics Agency Limited. The Higher Education Statistics Agency Limited makes no warranty as to the accuracy of the HESA Data, cannot accept responsibility for any inferences or conclusions derived by third parties from data or other Information supplied by it. The dataset used in this study was acquired from the UK Medical Education Database and is held in Safe Haven. All counts have been rounded to the nearest 5 according to HESA data standards to ensure person-level anonymity, as per UKMED policy. Data access requests must be made to UKMED. Full information for applications can be found at https://www.ukmed.ac.uk.


  • Clinical
  • medical education
  • non-clinical
  • postgraduate
  • surgery


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