How is performance at selection to general practice related to performance at the endpoint of GP training?

Background The selection process for entry to speciality training for general practice (GP) in the UK was changed in 2016. Doctors scoring above an agreed threshold in the computer-marked Multi-Specialty Recruitment Assessment (MSRA) were deemed appointable on that score alone and were offered a direct pathway (DP) to training, exempting them from further assessment at the final Selection Centre (SC). The SC was subsequently suspended in response to the COVID-19 pandemic and has yet to be reinstated. We aimed to evaluate the relationship between performance at selection and outcomes of GP training at licensing, to reassess the threshold score in MSRA used to bypass the SC, and to estimate the incremental predictive value of the SC after MSRA. Methods We used a longitudinal design linking selection, licensing and demographic data from doctors applying to enter GP specialty training in 2016. MSRA scores were divided into 12 score bands and SC scores into seven score bands to better identify MSRA or SC scores that corresponded to dffering GP performance on licensing assessments. Multivariable logistic regression models were used to establish the predictive validity of the MSRA scores and score bands for passing or failing the Membership of the Royal College of General Practitioners (MRCGP) licensing assessments including the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA) or Recorded Consultation Assessment (RCA), Workplace Based Assessment - Annual Review of Competence Progression (WPBA-ARCP), and performance overall. The model adjusted for sex, ethnicity, country of qualification, and declared disability. Receiver Operating Characteristic (ROC) curves of MSRA scores against performance outcomes were constructed to determine the optimal MSRA threshold scores for achieving licensing. Results We included 3338 doctors who entered specialty training for general practice in 2016 of different sex (female 63.81% vs male 36.19%), ethnicity (White British 53.95%, minority ethnic 43.04% or mixed 3.01%), ...