WTP1.01 The Use of Audit and Quality Improvement for Selection to Surgical Training

Aims Audit and quality improvement (QI) are routinely used as part of shortlisting for national selection in surgical specialties. This may incentivise behaviours to maximise rewarded points, such as high volume and low quality, to improve chances of selection. This study aims to quantify how each surgical specialty uses audit & QI for selection and explore this in the context of national priorities in the area. Methods A comprehensive list of surgical specialties was gathered from NHS England webpages, along with shortlisting matrices. Proportion of points allocated for audit and QI was calculated. Further analyses were performed to investigate the number of projects required, whether it must be specialty-specific, as well as the maximum potential yield of this activity. Results 12 surgical specialties were included (5 core/ST1 level entry, 7 higher/ST3 entry), accounting for 1364 training places and 7759 applications in 2024. Mean proportion of points ringfenced for audit/QI was 12% (range 6-35). 1/12 specified audit activity must be undertaken for points, the remainder accepted either audit or QI. 2/12 required specialty-specific activity to occur. In fulfilling all audit/QI points available, post holders would generate 2098 individual projects, and applicants 11,631. The average number of complete audit/QI projects required for maximum points is 1.9 (range=1-4). Conclusions All surgical specialties use audit/QI for shortlisting. This may influence applicant behaviour with regards audit/QI practice, and generates significant data burden. Further research is needed to examine whether this activity improves patient outcomes.