Abstract
Background
In recent years, there has been a noticeable decline in medical students’ interest in pursuing surgical specialties. While various factors such as lifestyle expectations, training length, and mentorship have been implicated internationally, limited data are available from Türkiye. This study aimed to assess the perspectives of preclinical and clinical Turkish medical students on surgical specialties and to identify the factors that influence their decisions when choosing a specialty.
Methods
A cross-sectional survey was conducted among 380 medical students at Ankara University School of Medicine between June 2023 and January 2024. The questionnaire explored demographic characteristics, interest in surgical fields, traineeship experiences, observation of surgeons’ working conditions, and perceptions of professional challenges. Statistical analyses included Chi-square, Fisher’s exact, and Mann-Whitney U tests.
Results
Among participants, 50.8% expressed a desire to specialize in surgical fields. Year of study (p = 0.008) and the opportunity to observe surgeons’ working conditions (p = 0.008) were significantly associated with surgical preference. While 54.9% of students who had undergone surgical traineeship expressed a preference for surgery, this was not statistically significant (p = 0.212). Mentorship, a positive training environment, and hands-on observation were reported as encouraging factors. Conversely, high patient load, malpractice concerns, emergency case stress, and perceived lack of work-life balance emerged as major deterrents.
Conclusion
The findings highlight that clinical exposure and observation of real surgical practice significantly influence students’ interest in surgical specialties. Early mentorship and structured surgical experiences may enhance interest, while systemic factors such as workload and litigation fears continue to pose barriers. These insights can inform educational and socio-economic strategies—such as improving work-life balance, reducing excessive workload, and addressing malpractice concerns—to sustain interest in surgery among future physicians.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12909-025-08400-3.
Keywords: Career choice, Education, Medical students, Mentorship, Surgery, Surgical training
Introduction
The medical profession constitutes a cornerstone of healthcare systems. Consequently, the specialty preferences of medical students shape the future workforce distribution and, indirectly, the quality of care provided to populations. Analyzing the factors that influence the specialty preferences of medical students is crucial for gathering critical data about the health system and the country’s conditions from various viewpoints [1, 2]. Previous research has demonstrated that these choices are influenced by many factors, including personal values, lifestyle expectations, perceived financial rewards, social status, mentorship influences, and gender [2, 3]. Furthermore, psychological characteristics, such as conscientiousness and agreeableness, have also been found to play a role in shaping specific specialty choices [4]. Across many nations, practical concerns are increasingly becoming important in career preferences rather than passion or long-term personal interests [5].
General surgery plays a fundamental role in the operation of healthcare systems. General surgeons are crucial in both emergency and routine care facilities and they contribute significantly to hospital workflow and the health outcomes of people. Unfortunately, despite this important role, recent trends around the world, including in Türkiye, show a decrease in general surgery preferences among medical students [6]. For instance, in the United States, interest in general surgery has been decreasing by approximately 5% every year in medical education [7]. Similar trends have been observed in Australia and North America, where the studies also indicate a significant shortage of surgeons if the current trend continues [8, 9].
This descending trend in surgical preferences is attributed to many factors like long education period, poor work-life balance, demanding schedules, and stressful work environments [8, 10, 11]. Exposure to surgical rotations and being subject to high-stress conditions in the field can further decrease the student’s interest [12]. While global studies offer a comprehensive analysis of this problem, specific data from Türkiye remain limited. The lack of this data emphasizes the need for understanding how Turkish medical students form their thoughts about surgical careers and which related factors shape these preferences. Unlike some countries where general surgery continues to be popular, Türkiye seems to be following global patterns of reduced interest. However, this phenomenon remains underexplored.
The aim of this work is to evaluate the behavior of Turkish medical students concerning surgical specialties, especially general surgery, and to determine the main reasons affecting their preferences.
Methods
Ethical considerations
The study was approved by the Ankara University School of Medicine Undergraduate Student Research Ethics Committee (Approval number: E-73488049-824.01.01.03–1117629).
Development of the study tool
The development of the questionnaire began with an extensive literature review of studies examining medical students’ perceptions of surgical specialties and career preferences. An initial item pool was generated collaboratively by the research team to comprehensively address these themes. The draft questionnaire was subsequently reviewed by five general surgeons experienced in medical education to assess content validity, relevance, and clarity. A pilot test was then conducted with ten preclinical and clinical medical students, and based on their feedback, minor revisions were made to improve the clarity and structure of the items. The final version consisted of 39 questions.
Parts of the study tool
The questionnaire consisted of 39 questions covering several domains:
Demographic information,
Interest in surgical specialties,
Educational stage (study year, surgical traineeship experience),
Observation of surgeons’ working conditions (physical environment, occupational exposures, duty and working time, emergencies, surgical stress, teamwork, superior–subordinate relations, patient loss, interactions with patients’ relatives),
Working conditions in Türkiye (payment, patient burden, malpractice), and.
Social concerns.
The full questionnaire is provided in Supplementary Material S1.
Distribution of the tool
Data for this cross-sectional study were collected through a questionnaire distributed online via Google Forms® between June 2023 and January 2024. To maximize participation, the survey was also administered during face-to-face sessions using QR codes, which students could scan to directly access the online form. During in-person distribution, researchers were available to clarify any questions.
This survey was conducted with 380 preclinical and clinical medical students studying at Ankara University School of Medicine.
Statistical analysis
The sample size was calculated based on a Mann-Whitney U test to compare preclinical and clinical term students in terms of their scoring of willingness for the surgical field. A minimum of 368 students was calculated to include in the study to determine a small to medium effect (Cohen’s d = 0.3) between groups, with a two-tailed Mann Whitney U test, and an alpha level of 0.05 to achieve %80 statistical power. The sample size was calculated with G*Power 3.1.3 software [13].
Numerical data were summarized as mean ± standard deviation along with median (minimum-maximum), while frequency and percentage were used for categorical data. The Shapiro-Wilk test was used to determine whether the numerical data were normally distributed. Student’s t-test or Mann-Whitney U test was used to compare groups regarding a numerical variable, while Chi-Square or Fisher’s Exact test for categorical variables. P < 0.05 was considered statistically significant. All statistical data were analyzed with the use of SPSS 15.0 (IBM Corp., Armonk, NY, USA).
Results
In the survey, 380 answers were received with a response rate of 92.2%. The median age was 21 years (range 17–28 years); 52% were female. Overall, 50.8% expressed interest in surgical specialties (Table 1).
Table 1.
Demographic characteristics and specialty preferences of participating students (n = 380)
| Variables | n = 380 |
|---|---|
| Age, years | 21 (17–28) |
| Gender, n (%) | |
| Female | 198 (52.1%) |
| Male | 182 (47.9%) |
| Study year | 0.008 |
| Term 1 | 69 (18.2%) |
| Term 2 | 69 (18.2%) |
| Term 3 | 72 (18.9%) |
| Term 4 | 69 (18.2%) |
| Term 5 | 50 (13.2%) |
| Term 6 | 51 (13.4%) |
| Specialty preferences | |
| Surgical branches | 193 (50.8%) |
| Internal branches | 155 (40.8%) |
| Basic medical sciences | 22 (5.8%) |
| Do not consider | 10 (2.6%) |
Comparative analyses revealed that study year (p = 0.008) and having a surgeon among close relatives (p = 0.008) were significantly associated with surgical preference, whereas gender and prior traineeship experience were not (Table 2). The proportion of students favoring surgery was high in the first year (63.8%), declined steadily until the fourth year (39.1%), and increased again during later clinical years, reaching 64.7% in the sixth year (Fig. 1).
Table 2.
Comparative analysis of student characteristics and views according to surgical versus non-surgical specialty preference
| Surgical branches (n = 193) |
Non-surgical branches (n = 187) |
p value | |
|---|---|---|---|
| Gender | 0.079 | ||
| Female | 92 (46.5%) | 106 (53.5%) | |
| Male | 101 (55.5%) | 81 (44.5%) | |
| Study year | 0.008 | ||
| Term 1 | 44 (63.8%) | 25 (36.2%) | |
| Term 2 | 32 (46.4%) | 37 (53.6%) | |
| Term 3 | 30 (41.7%) | 42 (58.3%) | |
| Term 4 | 27 (39.1%) | 42 (60.9%) | |
| Term 5 | 27 (54.0%) | 23 (46.0%) | |
| Term 6 | 33 (64.7%) | 18 (35.3%) | |
| Any surgical traineeship experience? | 0.212 | ||
| No | 115 (48.3%) | 123 (51.7%) | |
| Yes | 78 (54.9%) | 64 (45.1%) | |
| Any surgeon acquaintance? | 0.008 | 0.008 | |
| No | 139 (47.1%) | 156 (52.9%) | |
| Yes | 54 (63.5%) | 31 (36.5%) | |
| Working conditions of surgeons in Türkiye? | 0.141 | ||
| Extremely negative | 48 (42.1%) | 66 (57.9%) | |
| Negative | 97 (57.1%) | 73 (42.9%) | |
| Neutral | 33 (50%) | 33 (50%) | |
| Positive | 10 (45.5%) | 12 (54.5%) | |
| Extremely positive | 5 (62.5%) | 3 (37.5%) |
Fig. 1.
Distribution of surgical and non-surgical specialty preferences across different years of medical education
Among students who completed a surgical traineeship (n = 142), most described their experience as positive or highly positive (54.9%), and 51.4% reported that their interest in surgery was strongly related to this experience. Mentorship and training environment were also perceived as influential, rated as at least moderately effective by 80.9% and 88.0% of students, respectively.
Regarding perceived professional and emotional influences, 79.0% reported that workload and shift frequency had a moderate-to-extreme impact on their surgical interest, while 74.2% found hierarchical structures notably influential. Furthermore, teamwork, patient load, malpractice concerns, and emotional burden—such as exposure to emergencies or patient loss—were frequently cited as discouraging factors (Fig. 2).
Fig. 2.
Influential academic, professional, and emotional factors shaping students’ interest in surgical specialties
Discussion
This cross-sectional survey study has shown that both the length of medical education and the opportunity to witness surgeons’ working conditions have a significant effect on medical students’ preferences of surgical specialties. In contrast, factors such as gender, participation in a surgical traineeship, and perceptions of surgical working conditions in Türkiye were not found to be statistically significant associated with students’ specialty preferences.
Interestingly, while Baschera et al. reported a progressive decline in interest in surgical careers with each advancing year of study [14], our findings showed a divergent trend: interest in surgical branches initially declined until the fourth year, followed by an increase in the subsequent years. This pattern may reflect the positive influence of growing clinical exposure and interaction with surgical role models during later years of medical education. Consistent with prior literature, structured mentorship and early exposure provided through workshops or simulations have been shown to increase students’ interest in surgery [15].
One of the most remarkable findings of this study is the significant impact of observing surgeons’ working conditions, which has not been sufficiently investigated in the existing literature. Among students who had this observation opportunity, 63.5% indicated an interest in surgery, compared to 47.1% among those who did not. This suggests that direct exposure to the surgical workplace may enhance commitment to the field, despite the fact that nearly half of the observers evaluated the working conditions negatively. This paradox may suggest that, despite the challenges of stressful environments, early authentic exposure offers students realistic perspectives that reinforce rather than weaken their commitment to the discipline [16, 17].
Gender remains an important factor in the existing literature although our data did not indicate a statistically significant difference. Baschera et al. have reported that male students are more likely to prefer surgical careers [14]. In Türkiye, sociocultural expectations and the perception of physical strength limitations may discourage female students from selecting physically demanding surgical specialties, such as orthopedics [6]. Such perceptions may help explain the gender imbalance in surgical specialty choices, even if this is not directly reflected in statistical data. Supporting this analysis, other studies have shown that female students tend to prioritize teaching opportunities, stress perception, and familial responsibilities, whereas male counterparts place greater importance on income and prestige [18–20]. This is consistent with findings from the UK, where early-career female doctors identified work–life balance and socio-economic challenges as significant deterrents to pursuing surgical training [21].
In addition to structural and educational factors, psychological characteristics also play a role in shaping medical students’ specialty choices. Previous research [22] has shown that students interested in surgical careers tend to score higher in conscientiousness and extraversion, while showing lower levels of neuroticism, suggesting that personality traits may shape their adaptability to the demands of surgery. Similarly, large-scale studies in Finland have shown that physicians in surgical and other procedure-oriented specialties exhibit distinct personality profiles that may also predict long-term professional satisfaction and well-being [23, 24]. Comparable findings were also reported in an Indian cohort, where students opting for surgical specialties demonstrated higher extraversion and conscientiousness with lower negative emotionality [25]. Qualitative studies further emphasize that specialty choice reflects a complex interplay between personality-driven self-concept and external factors including workload, mentorship, and socio-cultural expectations [26]. Incorporating these psychological dimensions into future research could provide a more comprehensive understanding of the multifactorial determinants influencing interest in surgical careers.
Working conditions appeared to play a significant role in shaping students’ interest in surgical careers. More than three-quarters of participants (79.0%) acknowledged that the number of shifts had at least a moderate influence on their views of surgery, and many reported that frequent and prolonged working hours were discouraging factors. This finding is consistent with previous reports, including Marshall et al. [27], which identified workload intensity and lifestyle limitations as major deterrents to pursuing surgical specialties. Teamwork within surgical settings was generally viewed favorably, with nearly half of the students (47.6%) describing it as a positive or extremely positive influence on their specialty choice. Nevertheless, perceptions varied—some students may have interpreted teamwork as an opportunity for collaboration and skill development, while others viewed it as limited by rigid hierarchies and unequal roles within the operating room. Notably, most participants (74.2%) considered hierarchical dynamics to be moderately to highly influential in shaping their attitudes toward surgery, suggesting discomfort with the traditional, authority-driven structure of surgical teams. Similar concerns have been reported in other countries, such as Pakistan, where strict hierarchies and excessive workload were found to discourage medical students from choosing surgical careers [28].
A number of additional discouraging factors appeared, including a heavy patient workload and the risk of malpractice. A study of malpractice cases submitted to Türkiye’s Court of Cassation between 2015 and 2020 showed that 77.6% were related to surgical branches. Consistently, the majority of participants in our study reported that the risk of malpractice and its legal consequences negatively affected their interest in surgery. Additional factors such as stress, emergency case management, anxiety over patient mortality, and strained interactions with patients’ relatives were also identified as negative influences. Neglected in much of the prior research, these factors seem to play a key role in affecting students’ specialty choices. Moreover, the strenuous nature of surgical training and the perceived imbalance between professional and personal life continue to discourage many students, as reported in both Australian and United States medical student populations [20, 29].
Beyond reiterating numerical results, these findings highlight the practical importance of structured mentorship and early exposure to surgery. Systematic reviews and intervention studies indicate that observerships, surgical interest groups, and early exposure programs substantially enhance the likelihood of students pursuing surgical careers [16, 17, 30, 31]. Integrating these interventions into preclinical and early clinical curricula may therefore serve as a scalable and effective strategy to sustain student interest in surgery.
At the same time, systemic deterrents—such as workload, malpractice concerns, and work–life balance—require solutions that extend beyond education. Addressing these barriers through health workforce policies—including workload redistribution, flexible training schedules, and medico-legal support frameworks—may be crucial for ensuring a sustainable surgical workforce [21, 28]. Integrating educational interventions with broader workforce policies may offer a complementary pathway to enhance both recruitment and retention in surgery, particularly in settings where interest is declining.
However, it is important to recognize several limitations. The study was conducted at a single institution with a sample size of 380 students, which is relatively modest compared to international studies. Furthermore, the cross-sectional design limits the ability to assess temporal changes in preferences. Additionally, internal consistency testing was not performed for the newly developed questionnaire, as the primary aim was exploratory rather than psychometric validation. Consequently, the results reflect students’ insights at the time of the survey and may not be indicative of their future actions. As with other single-institution studies, the broader generalizability of this study may be subject to limitations. Further research is recommended to validate and extend these findings through multicenter studies involving more heterogeneous and larger medical student populations, in addition to longitudinal study designs.
Conclusion
This study provides valuable insight into the perspectives of Turkish medical students regarding surgical specialties and highlights the complex interplay of factors influencing their career preferences. Among the variables examined, only the year of medical education and the opportunity to observe surgeons’ working conditions were found to have a statistically significant association with the intention to pursue a surgical branch. Although other elements such as traineeship experience, gender, and perceived working conditions in Türkiye were explored, they did not show a significant impact in this cohort. These findings underscore the importance of early and meaningful clinical exposure in shaping students’ perceptions of surgery. By identifying these key determinants, this study contributes to the growing body of literature aimed at understanding and addressing the declining interest in surgical careers, and may inform targeted interventions to sustain the future surgical workforce.
Supplementary Information
Acknowledgements
During the preparation of this study, the authors used ChatGPT (GPT-4o) to optimize the fluency of the written text and improve overall readability and coherence. The authors reviewed and edited all outputs; and take full responsibility for the integrity and accuracy of the work and retain full credit for all intellectual contributions.
Authors’ contributions
**Conceptualization: ** Kaan Sunter, Suleyman Utku Celik, Mehmet Ali Koc, Cihangir Akyol.**Investigation/Data curation: ** Ceren Kaya, Hacer Beyza Uysal, Ozlem Akol, Rasheed Elokka, Seray Mavituna, Sahender Buyukyilmaz.**Formal analysis/Visualization: ** Beyza Doganay, Kaan Sunter.**Writing—original draft: ** Kaan Sunter, Suleyman Utku Celik, Mehmet Ali Koc.**Writing—review & editing: ** Suleyman Utku Celik, Mehmet Ali Koc, Cihangir Akyol, all authors.**Supervision: ** Cihangir Akyol, Mehmet Ali Koc.**All authors read and approved the final manuscript.
Funding
None.
Data availability
All research data are included in the submitted manuscript file.
Declarations
Ethics approval and consent to participate
The study was approved by the Ankara University School of Medicine Undergraduate Student Research Ethics Committee (Approval number: E-73488049-824.01.03-1117629). All procedures were conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrolment. Clinical trial number: not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Supplementary Materials
Data Availability Statement
All research data are included in the submitted manuscript file.