OP30 Shape of Training – time to review the allocation processes for the hepatology Advanced Training Programme (ATP)?

Introduction

The hepatology ‘ATP’ year has been integral to the 2010 curriculum for trainees seeking subspecialty accreditation. Applications have always outnumbered posts and the current system supports competitive entry over geographical location. Some trainees feel disadvantaged when relocation is difficult. In light of this and the new 4-year Gastroenterology curriculum, we sought to revisit ATP allocation.

Methods

Anonymous survey responses were collated from successful ATP candidates from 2021 and 2022. Application data for these cohorts were subject to virtual modelling.

Results

Survey responses were obtained from 19 of the 39 successful ATP candidates from 2021 and 2022 cohorts (all aged 30–39, 11 female). Most (58%, 11/19) had never previously worked on a transplant unit. Of those that had, 75% (6/8) preferred to relocate to experience a different transplant centre for their ATP. Of the 11/19 who hadn’t, 45% (5/11) wished to stay in their parent deanery, 36% (4/11) preferred their ATP to be out-of-area, and 2/11 had no transplant centre in their parent deanery, so had no choice but to relocate. Whilst 16/19 (84.2%) were prepared to relocate for the ATP, 74% (14/19) would have preferred to have stayed in their home deanery. However, 15/19 respondents thought that changing the allocation process to prioritise applicants wishing to remain in their parent deanery, i.e. a region-first allocation system, would be unfair, and preferred the current merit-based system. Preliminary data from a ‘mixed model’ approach to allocation is promising (combining elements of rank-first and region-first) in terms of potentially improving the percentage of first choice jobs offered.

Discussion

Our survey suggests that trainees support a merit-based system and many wish to relocate (figure 1A&B). However, concerns remain regarding those disadvantaged by geographical ties. There has been significant post expansion over the last 3 years, with a 35% increase in ATP posts between 2021 (n=17) and 2023 (n=23) and with posts now in all UK regions excluding KSS (which links with South London) and Northern Ireland (figure 1C). This will improve access to ATPs as we move into SHAPE of training. A new mixed-model of allocation may better support both first choice success and geographical constraint. We intend to 1) refine the modelling further 2) re-survey trainees regarding a mixed model 3) seek to trial a new allocation process for the next recruitment round with SAC approval.