Background The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. Objective The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. Methods This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. Results Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. Conclusions Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. International Registered Report Identifier (IRRID) DERR1-10.2196/40545

BACKGROUND A diverse healthcare system is required to meet the needs of an increasingly cosmopolitan patient population. One barrier to this is the differential attainment in educational outcomes between Black and Minority Ethnicity (BME) and white medical students and doctors in the U.K. Several factors have been identified, however there has been limited evidence to date looking specifically at surgical training experiences and its relationship to differential attainment. OBJECTIVE The “vAriation in experiences and aTTainment In surgery between ethNicities of UK medical students and doctors” (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. METHODS This protocol describes a nationwide cross-sectional study of medical students and non-consultant grade doctors. Participants will complete an online questionnaire that will collect data on experiences and perceptions of surgical placements as well and self-reported academic attainment data. A comprehensive data collection strategy will be employed to collect a representative sample of the population. RESULTS The primary aim will be to determine any potential differences in the experiences and perceptions of medical students and junior doctors in surgery and its link to surgical attainment. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variation in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. CONCLUSIONS Drawing upon the conclusions of this study we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive dataset can be used for further research. CLINICALTRIAL The protocol was approved by the University College London Research Ethics Committee on 16/09/2021 (Ethics approval reference 19071/004).