Only 7.3% of trainees progressed from ACF to CL, with significant post-COVID decline.

Gender parity exists in progression rates, but overall attrition in IAT remains high.

Older trainees faced worse progression overall.

Craft specialties see limited benefits, as academic skills don't aid technical training.

The Integrated Academic Training (IAT) pathway was introduced to support surgical academic careers encouraging research integration alongside clinical training. Success of the IAT pathway remains unclear. This study aims to investigate the progression of IAT surgical trainees from Academic Clinical Fellowship (ACF) to Clinical Lecturship (CL) while exploring the impact of gender, age and COVID-19.

A retrospective cohort study (2016-2024) of 686 academic trainees across 10 surgical specialties was conducted using data from the Joint Committee on Surgical Training (JCST) and ISCP. Statistical analysis was performed using cox proportional hazards and logistic regression models to assess factors influencing progression from ACF to CL. Demographic variables and the impact of the COVID-19 pandemic (defined by training start year) were analysed.

Progression from ACF to CL was low (7.3%) with no significant gender differences observed in progression rates (7.62% for men vs 6.32% for women). COVID-19 had a significantly negative impact on progression, with an adjusted odds ratio of 0.09 (95% CI: 0.003-0.30, p < 0.001), indicating a markedly reduced likelihood of progressing during the pandemic era. Specialty had no effect (p = 0.94), and age under 30 showed a trend toward improved progression, though not statistically significant (p = 0.316). Trainees in Paediatric Surgery and Neurosurgery had the longest academic placements.

The surgical IAT pathway has high attrition and unequal progression rates, especially post COVID-19. Despite gender parity in progression rates, systemic issues such as COVID-19, insufficient support and the inequalities in non-run-through training pathways hinder academic career development. Reforms are needed to address these challenges and improve the IAT pathway’s effectiveness in developing a future surgical academic workforce.

gender disparity

integrated academic pathway

surgical academia

differential attainment

© 2025 The Authors. Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.