Sociodemographic and educational influences on early clinical academic careers in UK medical graduates

Objective To examine how sociodemographic and educational factors influence progression into early clinical academic careers among UK medical graduates, focusing on intercalation, Academic Foundation Programme (AFP) participation, and Pre-doctoral Fellowships (PFs). Design Retrospective cohort study using linked national data from the UK Medical Education Database (UKMED). Setting All UK medical schools with graduates entering the UK Foundation Programme between 2017 and 2022. Participants 32,580 graduates (25,290 standard-entry (SE); 7,290 graduate-entry (GE)). Main outcome measures Completion of an intercalated degree; application to and acceptance for AFP; application to and acceptance for a PF during specialty training. Results Among SE graduates, 63.9% intercalated, 21.4% applied to AFP and 7.6% were accepted. Male, minority ethnic, privately educated, and less deprived graduates were more likely to intercalate; disability and higher deprivation were associated with lower intercalation. Intercalation, publications, high Education Performance Measure (EPM) scores and attendance at six-year programmes strongly predicted AFP application and acceptance. At PF stage, minority ethnic SE doctors were significantly less likely to be accepted (OR 0.60, 95% CI 0.45 to 0.80, p < 0.001), despite similar application rates. AFP completion was the strongest predictor of PF progression (OR 7.82, 95% CI 6.68 to 9.15, p <0.001). GE graduates had similar AFP application (21.9%) and acceptance (6.3%) rates. Male, minority ethnic graduates were more likely to apply to the AFP, while low EPM scores reduced acceptance. Few sociodemographic factors predicted PF applications, although prior AFP acceptance strongly did. Interaction analyses showed GE status attenuated some disparities in AFP application, but reversed patterns observed for ethnicity in acceptance. Conclusions Early clinical academic progression is shaped by educational achievements and persistent sociodemographic inequalities. Equitable access to funded research opportunities during medical school is likely to strengthen and diversify the future clinical academic workforce.