Discussion

Understanding what makes a successful interview candidate has interested the medical community for some time.^{Reference Manjaly and Radford7} This is the first study to investigate the background and experience of ENT run through trainees. As the ENT specialty training year 3 competition ratio increases (2.57 applicants per post in 2019), junior trainees interested in securing a national training number will seek to gain a run through post.⁶ In addition, the run through programme will likely further increase the competition ratio at specialty trainee 3 by reducing overall available posts.

This questionnaire demonstrated that 52 per cent of successful run through candidates came from a private schooling background. A recent report from the social mobility commission showed that only 7 per cent of the UK population attends a fee-paying school,⁸ therefore showing that there is an over-representation of those with a private education entering the ENT run through programme. Holding an additional degree and transitioning directly from a foundation programme seems to increase the likelihood of interview success. Manjaly and Radford surveyed successful ENT specialty trainee 3 applicants in 2012.^{Reference Manjaly and Radford7} They also found that trainees who held additional degrees and spent less time out of training were more likely to be successful at interview. It is interesting that candidates graduated from 12 different universities, but a large proportion came from the University of Birmingham (Figure 2). It could be proposed that undergraduates at this institution had a greater exposure to ENT or that training better prepared them for the core interview process.

The pilot programme currently allows candidates to gain an ENT national training number by a non-ENT selection process. A specialty-specific selection process would be able to deliver a comparable interview to specialty trainee 3 recruitment and assess candidates’ interest and engagement with ENT. This would standardise recruitment to ENT national training number posts and encourage applications from only those with a true interest in the specialty. This study demonstrates that many current run through trainees had little exposure of ENT prior to application (Figure 3). As a result, it may prevent immediate transfer from foundation training, and there is no doubt that duplication of the interview process would increase consultant time required.

Lack of exposure to ENT certainly does not preclude candidate success (Figure 3). Nine of the trainees had less than four months ENT exposure prior to gaining a national training number. Some may argue that this is insufficient exposure to determine a true interest in the specialty and could lead to a higher dissatisfaction and dropout rate. In addition, it is interesting that the majority of trainees decided to pursue a career in ENT during the interview year or one year previous to it (Figure 4).

A similar pattern was observed when surveying ENT specialty year 3 trainees in 2012, with 32 per cent of successful applicants deciding to pursue a career in ENT one year prior to interview.^{Reference Manjaly and Radford7} This suggests that the introduction of the run through pilot may have influenced the specialty decision of junior trainees attending the core surgical interview. The majority of trainees (91 per cent) selected non-run through core surgical training posts in their job preferences list in addition to ENT run through posts. This demonstrates that trainees were interested in the specialty regardless of national training number success. Attracting trainees to the specialty is vitally important to maintain high standards within ENT. The results also show that the pilot has achieved two of its objectives, by attracting candidates with geographical training stability and early engagement with ENT UK.⁴

Trainees should have access to a regional trainee run through lead. The questionnaire results demonstrate that less than half of trainees had contact with the lead, and of those who did, only 45 per cent found this useful. Regional leads may find it difficult to guide and advise trainees when there is little information available and the pilot programme is in its infancy. Furthermore, exposure to secondary and tertiary ENT services seems to be variable amongst the run through trainees. The majority of trainees have exposure to two allied specialties which would achieve maximum points in this domain in the 2020 specialty trainee 3 portfolio marking scheme. Standardisation of placements is required to provide exposure to both secondary and tertiary ENT and allied specialties prior to specialty trainee 3.

Trainer engagement is vitally important in helping to motivate and fulfil the potential of trainees. The perceived increase in ENT trainer engagement further solidifies the role of the run through programme in ENT training. However, this may come at the cost of reduced engagement with allied specialty trainers who may have a reduced motivation to train those whose specialty interest has already been decided (Figure 5).

Of the specialty year 2 trainees, the majority felt prepared to start specialty training year 3 and would engage with the specialty trainee boot camp. It was interesting that 27 per cent of specialty year 2 trainees intended to attend the specialty training year 3 interview in 2020 in order to change region. This slightly contradicts the benefit of improved geographical stability offered by the run through programme.

This study had an excellent uptake of the questionnaire with 88 per cent of the current run through trainees responding in full. This provides a very good representation of the current run through cohort. The total number of trainees was calculated from the number of run through jobs advertised. It is not possible to say whether those who did not respond chose not to or whether the post was not filled or is now vacant.

This nationwide ENT run through questionnaire allows an insight into the background and progress of the trainees who were successful in attaining a run through post. The pilot has been successful in attracting candidates by providing geographical stability and removing the need for further interview at specialty training year 3 level. An additional benefit of the run through programme has been to improve ENT trainer engagement which is critical at this stage of training. Changes should be made to improve contact between the regional run through lead and their trainees and to ensure standardisation of placements. These results will enable development of the pilot programme and provide valuable information for those applying to an ENT run through post.