Barriers for Undergraduate Medical Students to Pursuing Plastic Surgery Training in the UK: A National Assessment of Gender, Regional, and Ethnic Disparities by the STEPS-UK Research Collaborative
This national study by the STEPS-UK Research Collaborative reveals that UK undergraduate medical students face significant barriers to pursuing plastic surgery training, including a lack of awareness, a mentorship bottleneck, and pronounced disparities in exposure and perceptions of fairness across gender, regional, and ethnic groups.
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Plastic surgery in the United Kingdom is a field dedicated to repairing, reconstructing, and reshaping the human body. It is a highly competitive career path where a small number of doctors compete for very few training spots. For decades, this specialty was dominated by men, but in recent years, more women and people from diverse backgrounds have begun to enter the field. Despite this progress, the path to becoming a plastic surgeon is not the same for everyone. To succeed, medical students must build a strong portfolio of experience, which includes attending conferences, conducting research, finding mentors, and completing specific medical rotations. These opportunities act as the stepping stones that allow a student to prove their skills and secure a place in training. However, if a student cannot access these stepping stones because of where they live, their background, or their identity, their chances of entering the specialty diminish.
A new national assessment conducted by the STEPS-UK Research Collaborative sought to understand exactly what stops medical students from pursuing this career. The researchers asked 702 medical students from eight different medical schools across the UK to share their experiences. They wanted to know if students from different genders, ethnicities, and regions faced different hurdles when trying to learn about plastic surgery or gain the necessary experience. The study, which gathered responses between July and October 2024, revealed that while the number of female students entering the field is rising, the system still contains significant barriers that affect some groups more than others.
The survey found that exposure to plastic surgery teaching is not evenly distributed across the country. Students in certain regions, such as the East of England and the West Midlands, were much more likely to report receiving no formal teaching on the subject at all. In contrast, students in Wales were more likely to have received both short and extended teaching series. This geographic divide suggests that where a student goes to medical school heavily influences how much they know about the specialty. Ethnicity also played a role; students identifying as Asian were more likely to report receiving no teaching, while White students were more likely to have received at least a short series of lessons. Furthermore, older students and those in specific age groups reported less exposure than their peers, indicating that the curriculum does not consistently introduce this field to students at the right time.
Beyond just learning in the classroom, the study looked at whether students could get hands-on experience through clinical rotations. The data showed that students from the East of England were less likely to have completed a rotation in plastic surgery or even intend to do so. Conversely, students from the Northwest and West Midlands were more likely to have completed a rotation or planned to. This disparity is significant because these rotations are often the first real taste of the specialty and are crucial for building the portfolio needed to apply for training later. When asked about their satisfaction with the availability of these placements, students in the East of England and the Southwest expressed the most dissatisfaction, while those in Wales reported being the most satisfied.
The researchers also investigated how students access professional development opportunities, such as research projects, conferences, and mentorship. While most students had access to general academic activities, a notable gap existed in plastic surgery-specific events. Only a small fraction of students had attended a plastic surgery conference or taken a specialized course. The study found that 25.5% of all respondents had not participated in any professional development opportunities at all. Among those who had not, the gender split was relatively even, but the lack of engagement remains a concern for the future diversity of the workforce.
One of the most striking findings concerned the experience of non-binary students. Although they made up a very small portion of the survey respondents, they reported significantly greater difficulty navigating professional development opportunities due to their gender identity or expression compared to their male and female peers. This suggests that the environment within the specialty may not yet be fully inclusive for all gender identities. Additionally, the study highlighted that the lack of mentorship and guidance from senior doctors was ranked as the most difficult barrier to overcome. While mentorship is universally valued, many students feel they cannot find the right guidance to help them navigate the complex application process.
The students' understanding of how to get into plastic surgery training was also found to be shaky. When asked if the national selection process was fair or if it adequately tested a candidate's abilities, the majority of students said they were unsure. This uncertainty was particularly high among female students and those from the East of England. The results suggest that many students do not fully understand what is required to succeed, which could discourage them from applying in the first place. When asked about what matters most in an application, students agreed that surgical experience, research publications, and awards were the most important factors, yet the path to gaining these experiences remains uneven.
The authors of the study conclude that there is a "bottleneck" in the system. This bottleneck is not just about the high number of applicants, but about the uneven distribution of early exposure, mentorship, and professional development opportunities. The disparities identified in the study mean that talented students from certain regions, ethnic backgrounds, or gender identities are being held back not because of a lack of skill, but because they lack access to the necessary resources. To fix this, the researchers suggest that medical schools and national bodies need to standardize early exposure to the field, expand mentorship programs, and remove the financial and systemic barriers that prevent a diverse group of students from pursuing their goals. Without these changes, the future workforce of plastic surgeons may not reflect the diversity of the population it serves.
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