Mapping equity at the gateway to surgical training: National CST selection outcomes in 2024

Differential attainment (DA), defined as unexplained variation in educational outcomes, persists throughout medical training. This study investigates whether demographic characteristics are associated with differences in the likelihood of receiving a Core Surgical Training (CST) offer during the 2024 UK national selection round.

A retrospective cross-sectional analysis of anonymised applicant-level data from UK-wide CST recruitment was performed. All applicants with complete demographic and outcome data were included. The primary outcome was the offer of a CST training post. Logistic regression evaluated associations between offer outcomes with gender, ethnicity, nationality, age, country of qualification, and disability status.

Applicants applying directly from FY2 were significantly more likely to receive CST offers than those from other backgrounds (RR = 1.73, 95 % CI: 1.51-2.00). Female applicants had higher odds of receiving an offer compared to male applicants (aOR = 1.44, 95 % CI: 1.19-1.74, p < 0.001). Applicants identifying as Asian (OR = 0.54), black (OR = 0.31), and other/Chinese (OR = 0.67), as well as non-UK nationals (OR = 0.24), non-UK graduates (OR = 0.68), and applicants aged >30 (OR = 0.39) had significantly lower odds of receiving an offer (all p < 0.001). Applicants reporting disabilities had increased odds of success (OR = 3.36, 95 % CI: 1.53-7.38, p = 0.002). No significant difference was observed related to sexual orientation or pregnancy/maternity leave.

Despite structured recruitment processes and individual portfolio scoring, differential attainment persists across multiple demographic groups in CST selection. Targeted early support is essential to improve equity, especially for international medical graduates, older applicants and applicants from minoritised ethnic backgrounds.