Evaluating core surgical training selection: Associations between the Multi-Specialty Recruitment Assessment (MSRA), interview performance and offer outcomes in the 2025 UK national cohort

BACKGROUND: The Multi-Specialty Recruitment Assessment (MSRA) is a national aptitude test increasingly incorporated into selection for Core Surgical Training (CST) in the United Kingdom. Although intended to enhance objectivity and equity, its relationship with subsequent interview performance and final CST offer outcomes remains unexplored. METHODS: A retrospective cross-sectional study analysed anonymised data from the 2025 UK CST national selection process. Applicants who completed both the MSRA and structured interview were included. Multivariable linear and logistic regression models examined associations between applicant characteristics (including demographic factors and requests for interview adjustments) and performance across three stages: MSRA, interview, and CST offer outcome. Results are presented as adjusted regression coefficients (β) or adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS: Of 1154 applicants, 1045 had complete data. Female applicants scored higher on the MSRA (β = 0.13, 95% CI 0.01 to 0.25) and interview (β = 0.18, 95% CI 0.05 to 0.30) than males. Higher MSRA performance was associated with higher interview scores (β = 0.22 per 1 SD, 95% CI 0.12 to 0.32) and greater odds of receiving a CST offer (aOR = 1.42, 95% CI 1.05 to 1.94). Non-UK graduates demonstrated lower MSRA and interview scores and consequently had lower odds of receiving a CST offer. Applicants requesting interview adjustments also had lower odds of an offer. CONCLUSION: MSRA performance was positively associated with interview and offer outcomes, supporting its role as an objective component of CST selection. Continued monitoring across recruitment cycles is required to ensure the process remains equitable, transparent, and aligned with surgical training needs.