̽��ֱ�� of Cambridge - Dinesh Aggarwal

Minority ethnic doctors less likely to get specialty NHS training posts while some specialties show gender bias

cjb250 — Wed, 19 Apr 2023 23:01:16 +0000

Their analysis, published today in BMJ Open, also found that while female applicants are more successful overall, particular specialities tend to appeal to different genders.

Researchers from the ̽��ֱ�� of Cambridge and Cambridge ̽��ֱ�� Hospitals NHS Foundation Trust examined data from applicants to Specialty Training Posts through Health Education England for the recruitment cycle 2021-22 to look at potential disparities in the success of applicants according to gender, ethnicity and disability.

During this period, there were just under 12,500 successful applicants to Health Education England for training posts – a success rate of one in three (32.7%). Overall, females were more successful than males (37.0% versus 29.1%).

̽��ֱ��researchers found clear evidence that certain specialities were more attractive to females or to males. Of note, surgical specialities and radiology had the highest proportion of male applicants (65.3% and 64.3% respectively), while obstetrics and gynaecology and public health had the highest proportion of female applicants (72.4% and 67.2% respectively).

Senior author Professor Sharon Peacock, from the Department of Medicine at the ̽��ֱ�� of Cambridge, said: “ ̽��ֱ��success by female applicants in many specialties is a positive step towards gender balance, and perhaps reflects existing efforts to address disparities. But the skew in applications and subsequent recruitment by gender, particularly amongst surgical specialities, is concerning.”

Gender disparities are known to have knock-on effects. For example, a lack of female representation contributes towards a male dominated culture, which can then result in fewer female role models to inspire and encourage aspiring female doctors.

̽��ֱ��researchers say there are several reasons for these disparities. In surgical specialities, for example, a male-dominated workplace culture, bullying and harassment, few female role models, and career inflexibility, have been suggested as factors that deter females from applying. Female surgeons have reported quality of life and fewer unsocial hours as explanations of why women prefer other clinical specialities, in addition to the fear that working less-than-full-time or taking career breaks is perceived negatively.

Approximately half (50.2%) of the applicants were non-UK graduates. ̽��ֱ��overall success rate of UK graduates was 44.5%, compared with 22.8% for non-UK graduates.

When it came to minority ethnic groups, after adjusting for country of graduation, applicants from eleven out of fifteen groups (73.3%) were significantly less likely to be successful compared to White British. Those who fared worst were those of Mixed White and Black African ethnicity, who were only half as likely (52%) to be successful as White British applicants.

Dr Dinesh Aggarwal, the study’s first author, also from the Department of Medicine, said: “ ̽��ֱ��data suggests there’s a need to review recruitment policies and processes from a diversity and inclusion perspective. But the issues extend beyond recruitment – doctors from minority ethnic groups can struggle to progress within the NHS and report disproportionately high levels of discrimination from colleagues.

“More than four in ten of the medical and dental workforce in NHS trusts and clinical commissioning groups in England are from a minority ethnic group, and ensuring that they are able to work within an inclusive environment, that allows them to thrive and progress, should be a priority.”

Although only a very small proportion of successful applicants (1.4%) declared a disability, they were more likely to be successful (38.6% compared with 32.8% of non-disabled applicants). However, there were no disabled applicants to 22.4% of the specialities, and for a further 36.2% of specialities, no disabled applicants were accepted.

Dr Dinesh Aggarwal added: “It’s encouraging to see a high proportion of acceptances among individuals disclosing a disability. ̽��ֱ��NHS needs to ensure that application and recruitment processes are accessible and open to adjustments for all disabilities, eliminate any fear of discrimination, and provide assurance that all NHS workplaces will accommodate reasonable adjustments to ensure that disabled doctors can carry out their work. This will not only help to encourage more disabled applicants, but also allow disabled clinicians to feel more comfortable disclosing this information.”

Professor Peacock added: “ ̽��ֱ��NHS is the largest employer in the UK and it’s vital that it nurtures diverse talent to benefit patient care. People from diverse backgrounds bring different lived experiences and perspectives, which in turn strengthens the pool of knowledge and skills within the NHS. A lack of workforce diversity can be detrimental to patient care, and research shows that inherent biases can influence how clinicians treat patients.”

Dr Aggarwal is a PhD student at Churchill College. Professor Peacock is a Fellow at St John’s College.

Reference
Aggarwal, D et al. Applications to medical and surgical specialist training in the UK National Health Service, 2021-22: a cross-sectional observational study to characterise the diversity of successful applicants. BMJ Open; 20 April 2023; DOI: 10.1136/bmjopen-2022-069846

Most minority ethnic groups are less successful than their White British counterparts when applying to specialty training programmes in the NHS, Cambridge researchers have shown.

̽��ֱ��NHS is the largest employer in the UK and it’s vital that it nurtures diverse talent to benefit patient care

Sharon Peacock

DarkoStojanovic

Doctor's white coat with stethoscope and pens

̽��ֱ��text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Public Domain

Genomic study shows that England’s travel quarantine measures were effective – up to a limit

cjb250 — Wed, 23 Feb 2022 10:00:17 +0000

In July 2020, following the first months of the pandemic, the UK government established new rules for travellers to and from England, in order to reduce the number of COVID-19 cases being imported into the country. Between 4 July 2020 and 1 February 2021, it established ‘travel corridors’ to countries deemed to be low risk for COVID-19, meaning that travellers returning from these countries did not need to quarantine. However, the majority of people returning from countries outside these corridors were required to quarantine for 14 days at home.

In research published today in Nature Communications, a team of scientists from the ̽��ֱ�� of Cambridge, Wellcome Sanger Institute, COVID-19 Genomics UK (COG-UK) consortium and UKHSA (formerly Public Health England) examined the effectiveness of this policy by analysing contact-tracing data from NHS Test and Trace and genome sequences made available through COG-UK.

̽��ֱ��team compared the number of contacts reported per case prior to a COVID-19 diagnosis between individuals returning from a country with a requirement to quarantine and those who did not need to quarantine on return. They tracked the spread of genomes from imported cases.

̽��ֱ��researchers identified 4,207 positive COVID-19 cases in England between 27 May 2020 and 13 September 2020 related to international travel – with more than half (51%) of all imported cases coming from just one of three countries, Greece, Croatia, and Spain.

Travellers with COVID-19 returning from countries that required them to quarantine had fewer contacts than those returning from countries within the travel corridors, and so were less likely to pass on the infection to others. Using mathematical modelling, they estimate that individuals travelling from a country requiring quarantine had an average (mean) of 3.5 contacts, 40% fewer than someone returning from a country that did not require quarantine measures (who had an average of 5.9 contacts).

̽��ֱ��number of contacts per case was greatest in the 16-20 age group who had travelled to countries with no requirement for quarantine, with a mean of 9.0. When quarantine was required, this fell to 4.7, similar to that of other age groups.

Genomic sequencing allowed a number of unique imported SARS-CoV-2 genomes to be identified that could be monitored to see how widely they had spread. ̽��ֱ��cluster size – that is, the number of related cases of onward transmission – for genomes imported from a country without a requirement to quarantine on return was significantly higher than for those related to countries with mandatory quarantine in place.

Dr Dinesh Aggarwal from the Department of Medicine at the ̽��ֱ�� of Cambridge, the study’s first author, said: “Although the pandemic now looks very different to how it was in 2020 – with the emergence of new variants offset by increased vaccination – there are still important lessons that can be learned about the effectiveness of quarantine, in particular for future pandemic preparedness.

“Our study shows that while travel restrictions are effective in reducing the number of imported COVID-19 cases, they do not eliminate them entirely. It’s likely that one of the main reasons that quarantine measures helped is that they put people off travelling during this period.”

For the most common destinations – barring Spain – the number of imported cases dropped when the government removed a country from the ‘safe’ list and reintroduced mandatory quarantine.

̽��ֱ��majority of importations from Greece came at the end of August and continued into September, a period during which there was no requirement to quarantine for travellers returning from the county – this was the source of greatest imported SARS-CoV-2 cases during the study period.

Dr Ewan Harrison from the Wellcome Sanger Institute, senior author, added: “Genomics has proven to be an invaluable tool in monitoring how the coronavirus spreads and helping inform infection control measures. By applying it to travel-related cases, it could help governments rapidly refine their travel policies and consider if any quarantine measures are appropriate.”

̽��ֱ��research was supported by Wellcome, UK Research and Innovation, and the COVID-19 Genomics UK (COG-UK) Consortium

Dr Aggarwal is a PhD student at Churchill College.

Reference
Aggarwal, D, Page, AJ, Schaefer et al. Genomic assessment of quarantine measures to prevent SARS-CoV-2 importation and transmission. Nat Comms; 23 Feb 2022: DOI: 10.1038/s41467-022-28371-z

Fourteen-day quarantine measures imposed on incoming travellers returning to England in summer 2020 helped prevent the spread of the SARS-CoV-2 virus, particularly among 16-20 year olds, say a team led by Cambridge scientists.

Although the pandemic now looks very different to how it was in 2020 – with the emergence of new variants offset by increased vaccination – there are still important lessons that can be learned about the effectiveness of quarantine

Dinesh Aggarwal

Jerry Zhang

Airplane wing

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

Yes

Licence type:

Public Domain

How mass testing helped limit the spread of COVID-19 at the ̽��ֱ�� of Cambridge

cjb250 — Tue, 01 Jun 2021 10:49:36 +0000

A combination of testing programmes for staff and students, infection control measures and genomic surveillance helped reduce the number of cases of COVID-19 at the ̽��ֱ�� and keep the wider community safe.

Asymptomatic screening and genome sequencing help Cambridge understand spread of SARS-CoV-2 among its students

cjb250 — Mon, 11 Jan 2021 10:32:57 +0000

Initial results suggest that the screening programme, together with the ̽��ֱ��’s public health measures and responsible student behaviour, has helped limit the spread of the virus.

Now, the team running the programme has joined up with researchers at the COVID-19 Genomics UK Consortium (COG-UK) to track how infections spread among the student population. They have shown how a small number of transmission events early on were likely responsible for most of the infections at the ̽��ֱ�� and found little evidence of substantial transmission of SARS-CoV-2 between students and the local Cambridge community in the first five weeks of term.

Around 12,000 students living in College accommodation (80% of eligible students) signed up to the asymptomatic screening programme, which uses a pooled sample approach to reduce the number of tests to fewer than 2,000 per week. In the first weeks of term, 1-2 students from each ‘household’ were tested each week; this has now increased to all participating students being tested each week. In addition, the ̽��ֱ�� offers tests to students and staff who show symptoms of potential COVID-19.

̽��ֱ�� ̽��ֱ�� is also playing a leading role in COG-UK, which is sequencing the genetic code of samples of the virus isolated from infected individuals to help better understand the spread of infection. As a virus spreads, its genetic code acquires mutations. By comparing the genetic code of samples, it is possible to plot a genetic ‘family tree’ known as phylogenetic tree and to say, coupled with epidemiological information, whether two cases are related – identical or almost-identical samples are likely to be closely related, while genomes with a larger number of genetic differences are less likely to be related.

As part of this work, COG-UK is analysing virus samples from students identified as positive through the ̽��ֱ�� of Cambridge’s testing programmes and comparing them to samples taken from people in the wider Cambridge community. COG-UK and the ̽��ֱ�� have released their interim report, covering the first five weeks of term.

̽��ֱ��analysis showed that in week two, 90% of infections were confined to three lineages (related viral genomes). This lack of diversity suggests that a small number of transmission events at the start of term led to the majority of infections in the ̽��ֱ��.

Outbreaks that have largely been restricted to single Colleges appear to have been contained, suggesting that measures to prevent spread of the virus were successful. In one of the largest clusters (which included 32 cases by week three), half of the students were asymptomatic, highlighting the importance of screening programmes in helping identify infected individuals.

̽��ֱ��largest cluster of cases (139 cases by week five, including 135 students, 1 staff member and 3 individuals from the local community) was the source of ongoing transmission within the ̽��ֱ��. It included students from a number of Colleges, courses and years of study. However, it is not clear whether these can be traced back to a single event that led to dispersion amongst colleges and courses.

Dr Dinesh Aggarwal from the Department of Medicine at the ̽��ֱ�� of Cambridge and a member of COG-UK said: “It appears that a few instances of the virus being introduced to the ̽��ֱ�� account for the majority of cases of established transmission. This suggests to us that in most cases, when a virus was introduced, students behaving responsibly and complying with infection control measures helped stop the virus in its tracks.

“We hope it will be particularly reassuring that so far we have not found evidence of substantial transmission between our students and the local community.”

Dr Ben Warne, a Clinical Research Fellow and one of the leads on the ̽��ֱ��’s asymptomatic screening programme, added: “It’s clear we need to better understand how the virus spreads between students on different courses and at different Colleges. Once established, these widely-distributed outbreaks are more challenging to control, potentially resulting in continued spread. Genomics should help us piece together this puzzle and help us target prevention strategies.”

̽��ֱ��team say their findings appear to suggest that a regular screening programme to detect asymptomatic infection and robust containment measures can be effective at limiting transmission both within the ̽��ֱ�� and to the wider community. This will be particularly important with the emergence of a new, more transmissible variant and substantially higher levels of transmission within the community.

Patrick Maxwell, Regius Professor of Physic at the ̽��ֱ�� of Cambridge, said: “Getting our screening programme up and running in time for the start of term was no small order, but we believe it has paid off. Asymptomatic screening can help identify cases of infection early, including where students are unaware of infection, and inform infection control measures. This has never been more urgent, with the emergence of the new variant.”

̽��ֱ�� ̽��ֱ�� recently announced that while it will remain open, almost all teaching and learning for undergraduate and postgraduate taught students will move online for the entirety of the Lent term. Undergraduate and postgraduate taught students have been asked to remain where they are currently staying, other than for certain exceptions.

Since the start of the academic year in October 2020, the ̽��ֱ�� of Cambridge has been offering regular SARS-CoV-2 tests to all students living in its Colleges, even if they show no symptoms.

Asymptomatic screening can help identify cases of infection early, including where students are unaware of infection, and inform infection control measures. This has never been more urgent, with the emergence of the new variant

Patrick Maxwell

Sir Cam

Cambridge ̽��ֱ�� shield

Yes