SRS03 - Gatekeepers of surgery: differential attainment in 2024 Core Surgical Training selection

Abstract Background Core Surgical Training (CST) is the gateway to surgical careers in the UK. Equity in selection is critical, yet differential attainment (DA) persists. This study examined predictors of success in the 2024 CST national selection round. Methods A retrospective cross-sectional analysis of anonymised UK-wide applicant data was performed. All candidates with complete demographic and outcome data were included. The primary outcome was receipt of a CST job offer. Logistic regression assessed associations with gender, ethnicity, age, nationality, country of qualification, and disability status. Results Of 3191 complete applications, FY2 applicants were more likely to receive offers than non-FY2 candidates (RR = 1.73, 95% c.i. 1.51–2.00). Female applicants had higher odds of success than men (aOR = 1.44, 95% c.i. 1.19–1.74, P < 0.001). In contrast, applicants identifying as Asian (aOR 0.54, 95% c.i. 0.43–0.68), black (aOR = 0.31, 95% c.i. 0.20–0.47), or other/Chinese (aOR = 0.67, 95% c.i. 0.50–0.89), as well as non-UK nationals (aOR 0.24, 95% 0.19–0.29), non-UK graduates (aOR = 0.68, 95% c.i. 0.55–0.83), and applicants aged > 30 (aOR 0.39, 95% c.i. 0.29–0.52) all had lower odds of success (all P < 0.001). Applicants reporting disabilities had increased odds (aOR = 3.36, 95% c.i. 1.53–7.38), P = 0.002). No significant differences were observed by sexual orientation or pregnancy/maternity status. Conclusions Despite anonymised scoring and structured interviews, DA persists at CST entry. Targeted support for international graduates, older applicants, and ethnic minority candidates is needed to ensure equity and a representative surgical workforce.