Introduction: 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.

Method and materials: 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.

Results: 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.

Conclusion: 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.

Keywords: differential attainment; gender disparity; integrated academic pathway; surgical academia.

Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

简介： 综合学术培训（IAT）途径被引入以支持外科领域的学术职业，鼓励在临床培训中融入研究。目前尚不清楚IAT路径的成功率。本研究旨在调查从临床研究员（ACF）到临床讲师（CL）的IAT外科住院医师的进步情况，并探讨性别、年龄和COVID-19的影响。

方法与材料： 该回顾性队列研究（2016-2024年），对来自手术培训联合委员会（JCST）和ISCP的10个外科专科的686名学术住院医师的数据进行了分析。使用Cox比例风险模型和逻辑回归模型进行统计分析，以评估从ACF到CL进步的因素。分析了人口统计数据以及COVID-19大流行的影响（根据培训开始年份定义）。

结果： 从ACF到CL的进步率较低（7.3%），未观察到性别在进步率上有显著差异（男性为7.62%，女性为6.32%）。COVID-19对进度有显著负面影响，调整后的优势比为0.09（95% CI：0.003-0.30，p

结论： 外科IAT路径存在高流失率和平等的进步率差异，尤其是在COVID-19之后。尽管在进步率上性别平等，但诸如COVID-19、支持不足以及非连续培训途径中的不平等等问题妨碍了学术职业的发展。需要改革来解决这些挑战，并提高IAT路径在未来外科领域学术工作者发展方面的有效性。

关键词： 差异成就；性别差距；综合学术路径；外科学术界。