Gender Differences in Medical Career Choices: A Mixed-Method Study on Factors Influencing Surgical vs. Conservative Decisions

Gender Differences in Medical Career Choices: A Mixed-Method Study on Factors Influencing Surgical vs. Conservative Decisions | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Gender Differences in Medical Career Choices: A Mixed-Method Study on Factors Influencing Surgical vs. Conservative Decisions Inola Koop, Wolfgang Öchsner, Achim Schneider, Andreas Allgöwer, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7308963/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: The percentage of female medical students is steadily increasing, yet women remain underrepresented in most surgical specialties. This study aimed to identify the factors that influence the decision to pursue a surgical versus a non-surgical career, with particular attention to gender-specific influences and potential untapped opportunities in medical education. Methods: A monocentric mixed methods approach was employed. A total of 200 medical students at the University of Ulm completed an online questionnaire. Subsequently, semi-structured guideline-based interviews were conducted with 20 of the participants (10 female, 10 male). The interviews were transcribed and analysed using qualitative content analysis as described by Kuckartz & Rädiker. Results: Among the participants, 22.2% of male and 23.4% of female students indicated a preference for a surgical specialty. The most relevant factors explaining the variance were identified as prioritization of private life over career (B = -0.596, p = 0.009), the number of surgical internships completed (B = 0.714, p = 0.007), current semester (B = -0.683, p = 0.009), and self-confidence in surgical skills (B = 0.576, p < 0.001). Gender itself showed no statistically significant influence (B = 0.146, p = 0.745). However, female students reported significantly more negative experiences in the operating room (OPR) (χ² = 13.795, p = 0.001). The interviews also revealed a strong desire among students for more practical training during medical school and highlighted the substantial influence of teaching staff in fostering interest in particular specialties. Discussion: Throughout medical education, instructors have a significant—partially gender-specific—influence on specialty choice through their role-modelling and teaching approaches. The quality of practical training, perceived competence in surgical skills, and experiences in the OPR all play crucial roles in shaping career decisions. Figures Figure 1 Background Even though the proportion of female surgeons has increased over the past four decades (1969–2018), a persistent underrepresentation remains. This becomes particularly evident when comparing the medical student population—of which more than half are female—with the fact that only about a quarter of surgeons are women ( 1 ). Interestingly, female surgeons themselves identify potential reasons for this discrepancy. A study from the Association of Surgeons of Great Britain and Ireland showed, that female surgeons not only perceive surgery as a male-dominated field, but 59% of 81 respondents also reported having faced discrimination. Furthermore, a lack of flexibility in working hours and insufficient support regarding motherhood and family life were frequently criticized. Male colleagues are often perceived as failing to adequately consider this double burden ( 2 ). In addition, various factors influence students’ specialty choices even before they begin practicing as physicians. Positive influences include interest in the subject, flexible working hours, and encouraging experiences. In contrast, lack of interest, high workload, long duration of residency, and negative experiences tend to have a discouraging effect ( 3 ). Clinical clerkships in a specific, freely chosen specialty were identified as an important influencing factor in career choice across all specialties - except for general practice ( 4 ). These are only the most commonly mentioned factors; individual preferences and circumstances also play an important role. It is also known that motivational factors - part of the broader category of influencing factors - vary depending on the chosen specialty and the students' semester level, in line with the development of specialty preferences over time. In the final semesters, students interested in surgical specialties ranked salary and prestige as more influential, whereas those preferring conservative specialties placed greater emphasis on family-related and location-based factors ( 5 ). This study aims to identify the current factors influencing German medical students at Ulm University in their choice of specialty, with particular focus on personal motivations and deterrents, explored through additional interviews. Notably, it is the first German study to address this topic using data collected exclusively in the post-COVID-19 era. Furthermore, it is among the first studies to apply a mixed methods approach to this subject while specifically excluding students in their practical year. The goal is to uncover specific reasons that either encourage or discourage students from choosing a surgical specialty over a conservative one, and whether these differ between male and female students. Ultimately, the findings may contribute to developing educational recommendations aimed at promoting female participation in surgical training and improving overall surgical education at the university level. Methods A monocentric cross-sectional study was conducted using a mixed-methods approach, combining a questionnaire and semi-structured interviews. Both survey instruments were developed by the authors based on a review of the current literature. Quantitative data acquisition: A self-designed, non-validated, piloted questionnaire consisting of 24 items was developed to assess medical students’ specialty preferences, influencing factors, and character traits. (Original in German, translated version in English in the supplement) The questionnaire was based on findings from current literature (partly cited in the background section) related to specialty choice. The survey was conducted in May 2024 at the Ulm University by distributing a survey link via WhatsApp and Telegram groups. Participation was voluntary, and a €15 City voucher was offered as an incentive. Without a formal sample size calculation, the number of participants was set at 200, which was considered sufficient for descriptive and multivariate analyses due to the exploratory nature of the study and practical limitations related to participant recruitment and incentives. Prior to distribution, two pilot tests were conducted with interview-based feedback from a small group of four respondents each outside the target cohort to improve clarity and relevance. Inclusion criteria required participants to be in their 7th to 10th semester to ensure sufficient exposure to a variety of specialties, enabling an informed decision-making process. The questionnaire covered demographic information, specialty choice and its development, potential influencing factors, suggestions for improving university education, and personality traits. Quantitative data analysis: All data were analysed descriptively using SPSS software version 29.0.1.0. For further analysis, specialties were categorized into three groups: surgical specialties, semi-surgical specialties (obstetrics and gynaecology, ENT, ophthalmology, dermatology, and urology), and conservative (non-surgical) specialties. The semi-surgical and conservative specialties were then combined into a "non-surgical" group for binary logistic regression to identify the factors that influence the decision to pursue a surgical versus a non-surgical career. This categorization was chosen because, in the questionnaire, the decision to pursue a semi-surgical specialty was often justified by the perceived opportunity to work in a medical practice more easily than in a fully surgical specialty. Chi-square tests were applied to compare categorical variables between groups. The assumption of at least five expected observations per cell was fulfilled. In cases where this condition was not met, Fisher’s Exact Test was used as an alternative. A p-value < 0.05 was considered statistically significant. One participant identifying as gender-diverse was excluded from statistical tests because no evaluation is possible here. Qualitative data acquisition: To capture the personal and subjective aspects of specialty decision-making, a qualitative approach was added in the form of semi-structured, guideline-based interviews. The interview guide included four thematic areas: specialty choice, perceptions of surgery, medical education, and internships/role models. These themes were derived from the questionnaire topics to allow for deeper exploration. The interview was scheduled to last approximately 20 minutes. A total of 20 participants (10 female, 10 male) were purposefully selected based on their specialty preferences (10 surgical, 10 conservative) and any reported changes in preference. Participation was voluntary, and a €44 City voucher was offered as an incentive. The interviews were conducted between July and October 2024. Qualitative data analysis: The interview recordings were transcribed using MAXQDA Online Transcription and subsequently proofread. Qualitative content analysis as described by Kuckartz & Rädiker ( 6 ) was then carried out using MAXQDA 2022 software. The goal of qualitative content analysis was to systematically categorize text-based data and reduce complexity. This can be done either inductively (categories emerge from the data) or deductively (categories are based on prior literature or theory) ( 7 ). In this study, a combined inductive and deductive approach was applied, which is common in qualitative research to ensure both data-driven insight and theoretical alignment. Results The questionnaire: A total of 200 students completed the questionnaire (the number of participants was limited by the number of available incentives). Among them, 54 identified as male, 145 as female, and one as gender diverse (Table 1). The mean age was 24.54 years (21- 40 years), with the majority of students (35%) in their eighth semester. The most commonly selected specialties were obstetrics and gynaecology, anaesthesiology, and trauma surgery/orthopaedics, each chosen by 11.5% of participants. In 39.0% of cases, the current specialty preference was identical to the one held prior to the beginning of medical studies. The left chart illustrates the students' specialty interests prior to entering medical school, including those who were undecided and excluding those whose current specialty preference remained unchanged. The right chart displays the current specialty preferences of students, grouped into surgical, semi-surgical, and conservative categories. Both charts show absolute frequencies and percentage. Negative experiences in the OPR were not found to have a significant impact on specialty choice (χ² = 1.095, p = 0.578). However, female students reported such experiences significantly more often (χ² = 13.795, p = 0.001). The most frequently cited positive and negative factors influencing students' specialty choices are summarized in Table 2. When asked about the influence of artificial intelligence (AI), the majority of students (54.5%) stated that it had little influence on their specialty choice, while 34.5% reported no influence at all. The perception of surgery as a male-dominated field was not significantly associated with specialty choice (Fisher´s exact test, p=0.535). Nevertheless, 24.5% of participants agreed and 67.5% somewhat agreed with this perception. The female Gender was a significant predictor of perceiving surgery as male-dominated (Fisher´s exact test, p=0.042). Regarding the teaching of surgical specialties at university, students most frequently expressed a desire for preparatory seminars prior to surgical internships (58.5%), more mandatory training sessions for surgical skills (46.0%), and greater empathy and enthusiasm from professors and physicians regarding their specialty (45.5%). No significant differences were observed between female and male responses (Table 3). The interviews: The 20 participants selected for interviews consisted of 10 women and 10 men. Each gender group included 5 students pursuing a surgical specialty and 5 pursuing a non-surgical specialty. The mean age was 24.25 years. The average interview duration was 27 minutes (18:42–44:56 minutes). In total, five main categories comprising 31 subcategories were identified through the qualitative content analysis. The five main categories are outlined below. Specialty Choice Study participants reported a wide range of specialty preferences, shaped by various positive and negative factors. These included internships, university courses, personal interests, and experiences prior to medical school. Man, surgical: “I’ve always been kind of interested in doing things with my hands. […] And then, especially during my studies, the intensive teaching weeks on surgery had a really positive impact on me. It was just really well organized, and you got some cool insights..” For some students, deeper insight into a specialty during medical school led to a change in direction. Often, getting to know a field more closely helped them realize it might not be the right fit, prompting them to explore other options. Woman, conservative: “I started medical school thinking I’d definitely go into psychiatry. […] And then over time that kind of shifted a bit. And I somehow realized that I think I’d also like to work a bit more somatically.” Perception of Surgery Comparing students with surgical versus conservative preferences revealed opposing views of surgery. Terms like interesting, exhausting, manual, and hierarchical were frequently used. Many students mentioned challenges in the OPR, such as rigid hierarchies and feeling undervalued as a student. Man, surgical: “I think it would be better if, in general, the communication between doctors, teachers, and students was improved — before and during an operation. […] Maybe you could just get a sense of where the student is in terms of knowledge or skills and then integrate them accordingly — what they can do, what they’re allowed to do. […] Or at least when you’re holding something, that you don’t just get orders but also get things explained. […] Just being a bit more part of it all.” Role Models When discussing female role models in surgery, opinions varied. While some students had never noticed a gender imbalance, others had directly observed the challenges women face in surgical careers. Woman, conservative: “But when I was in the OPR, I saw other women being talked to in a weird or rude way. Like questioning why a woman would study medicine at all. And saying that if you take parental leave, you're harming society and stuff like that. So, I kind of feel like opinions like that are still more common there than in other specialties, where you don’t hear those kinds of comments.” In general, role models were seen as valuable sources of inspiration and guidance, offering students realistic insights into potential career paths. Man, conservative: “I think someone who takes a lot of time and just has a strong character — where you think, hey, I want to take more from this person later on because I like their way of thinking or what they do — that definitely plays a role. […] It kind of strengthens what you already wanted to do anyway.” University Influence Students named a wide range of curricular formats they perceived as especially successful. These often shared characteristics such as enthusiastic instructors, clinical relevance, and active student participation. Woman, conservative: “The lecturer was really just well prepared. You could tell he really knew what he was talking about clinically. He always had patients ready. And it was just such good teaching because he really involved us. […] The patient would come in and describe the symptoms they had when they came to the clinic. […] And really, each one of us had to examine. And I thought it was so good because he actually watched us. […] And I really think I learned so much.” Many students felt that the surgical curriculum at the Ulm University — consisting of two semesters of lectures and a three-week internship — was insufficient given the complexity and scope of the subject. Personal Factors Personal traits and life plans also played a significant role in specialty choice. Many students envisioned their professional future outside of the hospital environment, prioritizing work-life balance and considering the option of working in private practice. Woman, surgical: “When you’re thinking more in terms of family and so on, then unfortunately you might just not have the time anymore to handle everyday life in the clinic. And then the life in a private practice, with more regular working hours, just seems more attractive in the long run.” When asked about the emotional weight of the decision, some students were open-minded, while others felt that the choice of specialty strongly shaped their identity. No gender differences were identified in how this challenge was perceived. Woman, surgical: “I really have to say that this is something that’s been on my mind a lot. […] I think choosing a specialty really becomes a big part of your identity somehow. […] You’ll be spending most of your time in the hospital, then it’s just a really serious decision. And of course, we all want to be happy, or at least content. And that’s why I feel like it’s really a decision with a lot of weight.” Discussion This study identified key factors that influence medical students at a German University in their choice of specialty. Among the most frequently reported positive influences on specialty choice were clinical internships, individual career plans, and perceived personal abilities. In contrast, expected working hours, the reputation or perceived image of certain specialties, and the behaviour of lecturers were among the most commonly cited negative influences on speciality choice. Notable distinctions emerged in the context of surgical specialties. A higher number of surgical internships and greater confidence in one’s surgical skills were significant positive predictors for choosing a surgical specialty. Conversely, advancing in academic semesters and a stronger preference for work-life balance were associated with a decreased likelihood of choosing surgery. In general, the results of the questionnaire and the interviews were consistent. One notable exception was the role of negative experiences in the OPR: while these had no statistically significant influence in the quantitative data, students interviewed who had chosen non-surgical specialties frequently cited disappointing or discouraging experiences in surgical settings. Overall, the majority of findings did not reveal significant gender differences. However, the data offer important implications for the design and improvement of surgical education at the university level. A better understanding of how practical exposure, mentorship, and didactic approaches influence students can help develop targeted interventions—particularly to increase interest in surgical careers and to ensure gender-equitable access to them. International and National Context The factors influencing medical students’ specialty choice in this German study are largely consistent with international findings. For example, Madden et al. identified interest in the field, flexibility in working hours, and positive experiences as key motivators, while lack of interest, heavy workload, length of residency, and negative experiences were common deterrents ( 3 ). Similar findings were reported at the University of Jena, another German medical faculty, where “reconciliation of work and family life,” “workload,” and “career prospects” were identified as the most frequently cited influencing factors ( 8 ). When comparing internal medicine and surgery, students aiming for a career in internal medicine were more strongly influenced by the “extent of patient contact,” while career-related factors played a less significant role. In contrast, students interested in surgical specialties were more influenced by “career prospects” and less by concerns related to “work–life balance” or “family life” ( 8 ). These tendencies are further supported by Goetz et al., who identified “working as a senior physician in a hospital” and the “importance of manual work” as factors significantly associated with the choice of a surgical specialty ( 9 ). This corresponds with findings from the present study, where work–life balance and family considerations were also more commonly cited by students favouring conservative (non-surgical) specialties. Ladha et al. further support the notion that influencing factors evolve over the course of medical training. They observed that the importance of lifestyle and personal interest increased by Year 4 compared to Year 1. Moreover, the specialty preferences themselves shifted considerably, with fourth-year students being 2.5 times less likely to express interest in a surgical career ( 5 ). The Impact of Role Models The importance of teaching physicians as role models was the only factor to appear both in the top five positive and top five negative influences in the questionnaire, underlining its significance. This was also strongly reflected in the interviews. The importance of role models is supported by the data of Yoon et al., where exposure to a surgical role model was found to be a significant predictor of choosing a surgical specialty. In their study, 87% (370 of 427) of students reported exposure to a physician role model during medical school, and 25% (106 of 427) even prior to it ( 10 ). Similar trends are documented in other studies ( 3 ). However, to address the gender gap in surgery, an increase in the visibility of female role models is needed. Their current underrepresentation is perceived as a barrier for women entering surgical fields. Hull et al. further identify the surgical stereotype and perceived male dominance—particularly in orthopaedics—as additional barriers ( 11 ). This corresponds with findings from the present study, where the majority of students described surgery as a male-dominated field. Although this perception did not significantly correlate with the actual specialty choice, the stereotype remains persistent. The Surgical Stereotype and Exposure Interview data from this study reflected a nuanced image of surgery, with students describing it as interesting, exhausting, manual, and hierarchical. Hill et al. expand this perception by adding descriptors such as confident and intimidating for surgeons, and competitive, masculine, and sacrificing for the field itself ( 12 ). Despite such stereotypes, Hull et al. also report that direct exposure to a specialty is associated with increased interest in pursuing it. However, this exposure alone may not be sufficient to alter the stereotype of surgical fields. In their study, for example, exposure to orthopaedics and trauma surgery did not significantly change students’ perceptions of these fields ( 11 ). Similarly, in the present study, the number of surgical internships and confidence in performing surgical tasks were significant positive predictors of choosing a surgical career—highlighting the importance of exposure and practical engagement. These two factors also ranked among the top general influences on specialty choice (internships as #1, own abilities as #3), independent of surgical focus. This aligns with Brügge et al., who reported that surgical training had a positive influence on the specialty decision in 45.3% of their participants ( 13 ). Gender, Negative Experiences, and Contradictory Trends Although female students in this study reported negative experiences in the OPR significantly more often, these experiences did not have a statistically significant impact on specialty choice. If they had, one would expect a lower proportion of women choosing surgical specialties, which was not observed in this cohort. This contrasts with national trends showing a persisting disparity, where only 25% of surgeons are female. In 2013, just 13% of all female physicians in Germany were working in surgical specialties ( 14 ). Current research confirms that women more frequently encounter negative experiences in surgical settings. For example, Sobel et al. found that women reported significantly more microaggressions than men, such as being interrupted or having their opinions less respected by colleagues and patients ( 15 ). However, other studies report exceptions to this trend, finding a more balanced gender distribution regarding negative experiences in contact with surgical fields ( 16 ). Interestingly, the influence of practical experiences may differ by gender. Coffeng et al. demonstrated that men were significantly more likely to pursue surgical careers after exposure to surgical clerkships, whereas this effect could not be replicated in the female subgroup ( 17 ). This suggests that beyond structural barriers, gender-specific motivational mechanisms may play a role in specialty decisions. Limitations Not all gender disparities identified in previous research could be confirmed by the present study. This may be partly explained by certain methodological limitations. Firstly, the study was conducted at a single centre (Ulm University), which limits the generalizability of the findings. Secondly, participation in the survey was voluntary, without any selection criteria beyond the semester requirement. As a result, approximately three-quarters of respondents were women, potentially introducing selection bias and overrepresentation of certain perspectives. A well-known phenomenon in survey research is volunteer bias: individuals who choose to participate in studies often differ systematically from those who do not. Notably, women tend to participate more frequently than men in voluntary research settings—a trend also observed by Guo et al., who reported an adjusted odds ratio of 3.1 for female participation ( 18 ). This observation is supported by other studies addressing similar themes, which consistently report higher response rates among female participants in self-selected survey cohorts ( 4 , 8 , 9 , 16 ). Furthermore, the qualitative interviews were conducted using purposeful sampling. While this approach is common in qualitative research, it carries the risk of introducing bias through the chosen selection criteria and may limit the diversity of perspectives represented. Conclusion In conclusion, the analysis of the collected data reveals relationships between key influencing factors and specialty choice. Among these, the role of educators—as both teachers and role models—emerged as particularly impactful. Their behaviour, attitude, and teaching style can significantly shape students’ perceptions and career preferences. Raising awareness among educators about their potential influence and possibly offering targeted training on how to engage with students effectively, could be a meaningful step forward. Moreover, expanding practical learning opportunities and fostering a more inclusive and supportive environment—particularly for female students in surgical settings—would respond directly to the expressed needs of medical students. These measures may contribute to a more balanced and motivating educational experience and ultimately help address the persistent gender disparities in surgical specialties. Outlook Given the continuous generational shifts, the topic under investigation remains of ongoing relevance. To provide representative data that reflect changing generational perspectives, repeated and longitudinal data collection is essential. Additionally, multicentric studies including a more balanced gender ratio and varied institutional cultures could help to confirm whether the trends observed here hold true on a national or international level. In particular, longitudinal studies that track students' attitudes and career paths over time would offer valuable insights into how preferences develop and change. Furthermore, evaluating the impact of targeted educational interventions - such as mentorship programs, improved surgical training modules, or gender-sensitive teaching workshops - could help determine best practices for guiding medical students toward fulfilling and well-informed career choices. Addressing these aspects not only supports the individual development of future physicians but also contributes to a more equitable and effective healthcare workforce. Declarations Conflict of interest statement: The authors declare that there is no conflict of interest regarding this publication. Funding: The study was financially supported by the Teaching and Research Funding (LF-2) of the Ulm University. Availability of data and material: The authors confirm that most of the data supporting the findings of this study are available within the article and further data are available on request from the corresponding author. The questionnaire used in the study was developed for this study and has not previously been published elsewhere. The English language version is provided as supplementary file and cited in the manuscript. Authors' contributions: JH and TKH conceived of the presented idea. JH and WO developed the methodical approach. IK, AS and JH developed the questionnaire and interview. TKH supervised the project. IK performed the statistical analysis supervised by AA. IK wrote the manuscript with support from JH and JV. IK contacted and included the students. All authors discussed the results and contributed to the final manuscript. Ethics approval and consent to participate: On March 25, 2024, the ethics committee of the University of Ulm determined that the study did not require ethics approval. The authors confirm that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its amendments. Before providing informed consent, all participants were thoroughly informed about the study’s purpose, procedures, content, as well as the analysis and publication of the data. All participants provided digital informed consent at the beginning of the survey. Consent for publication: Not applicable. Acknowledgements: Not applicable. References Linscheid LJ, Holliday EB, Ahmed A, Somerson JS, Hanson S, Jagsi R. u. a. Women in academic surgery over the last four decades. PLoS One 16 Dezember. 2020;15(12):e0243308. Bellini MI, Graham Y, Hayes C, Zakeri R, Parks R, Papalois V. A woman’s place is in theatre: women’s perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open 7 Januar. 2019;9(1):e024349. Madden S, Martin N, Clements J, Kirk S. Factors influencing future career choices of Queen’s University Belfast Medical students. Ulster Med J Mai. 2023;92(2):71–6. 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Factors influencing the choice of specialization - a cross-sectional study with civilian medical students and prospective medical officers in Germany. BMC Med Educ 17 Oktober. 2024;24:1161. Yoon JD, Ham SA, Reddy ST, Curlin FA. Role Models’ Influence on Specialty Choice for Residency Training: A National Longitudinal Study. J Grad Med Educ April. 2018;10(2):149–54. Hull B, Pestrin O, Brennan CM, Hackney R, Scott CEH. Women in Surgery Events Alone do not Change Medical Student Perceptions of Gender Bias and Discrimination in Orthopaedic Surgery. Front Surg 25 Mai. 2022;9:905558. Hill EJR, Bowman KA, Stalmeijer RE, Solomon Y, Dornan T. Can I cut it? Medical students’ perceptions of surgeons and surgical careers. Am J Surg November. 2014;208(5):860–7. Brügge S, Günther V, Cascorbi I, Maass N, Ruchay Z, Fischer MR. u. a. Encouraging medical students to become surgeons? Impact of psychological and surgical factors on career choice at medical school. 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Volunteer Participation in the Health eHeart Study: A Comparison with the US Population. Sci Rep 16 Mai. 2017;7:1956. Tables Table 1: Respondents demographics. gender number Age 1 Semesters 2 7 th 8 th 9 th 10 th male 54 25.1 (24; 2.89) 5 (9.3) 21 (38.9) 10 (18.5) 18 (33.3) female 145 24.3 (23; 2.84) 29 (20) 48 (33.1) 21 (14.5) 47 (32.4) divers 1 25.0 (25; NA) 0 (0) 1 (100) 0 (0) 0 (0) 1 in years: mean (median; SD) 2 absolute frequencies (percentage) Table 2: Most frequently cited, positive and negative influencing factors (five each). Top 5 positive Top 5 negative 1.Voluntary internship or self-selected clerkship 1. Expected working hours 2. Individual career plans (e.g., possibility to work in private practice vs. hospital) 2.Statements / stories from others / “reputation” of the specialty 3. Own abilities / talents 3.Lecturers / instructors / physicians from the respective specialty 4. Individual personal plans (e.g., family planning, place of residence) 4. Theoretical lecture content 5. Lecturers / instructors / physicians from the respective specialty 5. Individual personal plans (e.g., family planning, place of residence) Table 3: Preferred Measures to Improve Surgical Teaching – Comparison by Gender Participants were asked to select teaching-related interventions that could increase their motivation to pursue a surgical specialty. The table shows the proportion of male and female students who selected each option. No statistically significant gender differences were observed (Fisher’s exact test). Actions in teaching Total 1 Male 1 Female 1 p-value 2 Preparatory seminars before surgical internships 58.5 53.7 60.7 0.419 More required hands-on training opportunities for surgical skills 46.0 42.6 47.6 0.632 The lecturers themselves (more empathy, enthusiasm for their specialty, etc.) 45.5 35.2 49.0 0.109 More scheduled internships in surgical specialties integrated into the curriculum 43.5 38.9 45.5 0.456 Earlier introduction to surgical subjects during studies (e.g., during the preclinical phase) 26.5 33.3 24.1 0.209 1 in % 2 Fisher´s exact test Additional Declarations No competing interests reported. Supplementary Files Supplement.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Sep, 2025 Reviewers agreed at journal 13 Sep, 2025 Reviewers invited by journal 12 Sep, 2025 Editor assigned by journal 10 Sep, 2025 Editor invited by journal 20 Aug, 2025 Submission checks completed at journal 20 Aug, 2025 First submitted to journal 20 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7308963","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":515062044,"identity":"b3a81f6f-fa17-4f9a-a0ee-8e13339770e1","order_by":0,"name":"Inola Koop","email":"","orcid":"","institution":"Ulm University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Inola","middleName":"","lastName":"Koop","suffix":""},{"id":515062045,"identity":"5f6fe664-27ca-4d99-aadc-94c6ea04a223","order_by":1,"name":"Wolfgang Öchsner","email":"","orcid":"","institution":"Ulm University Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Wolfgang","middleName":"","lastName":"Öchsner","suffix":""},{"id":515062046,"identity":"15c7e227-b88b-4092-a509-ed6d429a34be","order_by":2,"name":"Achim Schneider","email":"","orcid":"","institution":"Ulm University","correspondingAuthor":false,"prefix":"","firstName":"Achim","middleName":"","lastName":"Schneider","suffix":""},{"id":515062047,"identity":"b6ff8fa9-5220-4d33-abb0-a6572fffe5a0","order_by":3,"name":"Andreas Allgöwer","email":"","orcid":"","institution":"Ulm University","correspondingAuthor":false,"prefix":"","firstName":"Andreas","middleName":"","lastName":"Allgöwer","suffix":""},{"id":515062048,"identity":"701a69d5-ce50-439d-9f83-9e4b5938d676","order_by":4,"name":"Thomas K. 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02:27:39","extension":"html","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":76648,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7308963/v1/e47c66a8dc6a4b01ffcd5938.html"},{"id":91930927,"identity":"cf0fa517-43e3-4b16-8668-355e8556c2c2","added_by":"auto","created_at":"2025-09-23 02:27:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52389,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of Specialty Preferences Before and During Medical Studies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe left chart illustrates the students' specialty interests prior to entering medical school, including those who were undecided and excluding those whose current specialty preference remained unchanged. The right chart displays the current specialty preferences of students, grouped into surgical, semi-surgical, and conservative categories. \u0026nbsp;Both charts show absolute frequencies and percentage.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7308963/v1/1c58b00ce4a41e74e4bc4932.png"},{"id":91937580,"identity":"adeac766-11b8-483b-a51f-5a8ecb566249","added_by":"auto","created_at":"2025-09-23 02:59:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":560807,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7308963/v1/95ad4dc5-3f7b-4fe3-a199-1ba11f34f11b.pdf"},{"id":91930926,"identity":"d1dac0d6-8d0f-40c3-816a-e45c68d7041a","added_by":"auto","created_at":"2025-09-23 02:27:38","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27227,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-7308963/v1/ae92ba174e73fdd141213d04.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Gender Differences in Medical Career Choices: A Mixed-Method Study on Factors Influencing Surgical vs. Conservative Decisions","fulltext":[{"header":"Background","content":"\u003cp\u003eEven though the proportion of female surgeons has increased over the past four decades (1969\u0026ndash;2018), a persistent underrepresentation remains. This becomes particularly evident when comparing the medical student population\u0026mdash;of which more than half are female\u0026mdash;with the fact that only about a quarter of surgeons are women (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInterestingly, female surgeons themselves identify potential reasons for this discrepancy. A study from the Association of Surgeons of Great Britain and Ireland showed, that female surgeons not only perceive surgery as a male-dominated field, but 59% of 81 respondents also reported having faced discrimination. Furthermore, a lack of flexibility in working hours and insufficient support regarding motherhood and family life were frequently criticized. Male colleagues are often perceived as failing to adequately consider this double burden (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn addition, various factors influence students\u0026rsquo; specialty choices even before they begin practicing as physicians. Positive influences include interest in the subject, flexible working hours, and encouraging experiences. In contrast, lack of interest, high workload, long duration of residency, and negative experiences tend to have a discouraging effect (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Clinical clerkships in a specific, freely chosen specialty were identified as an important influencing factor in career choice across all specialties - except for general practice (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These are only the most commonly mentioned factors; individual preferences and circumstances also play an important role.\u003c/p\u003e\u003cp\u003eIt is also known that motivational factors - part of the broader category of influencing factors - vary depending on the chosen specialty and the students' semester level, in line with the development of specialty preferences over time. In the final semesters, students interested in surgical specialties ranked salary and prestige as more influential, whereas those preferring conservative specialties placed greater emphasis on family-related and location-based factors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aims to identify the current factors influencing German medical students at Ulm University in their choice of specialty, with particular focus on personal motivations and deterrents, explored through additional interviews. Notably, it is the first German study to address this topic using data collected exclusively in the post-COVID-19 era. Furthermore, it is among the first studies to apply a mixed methods approach to this subject while specifically excluding students in their practical year. The goal is to uncover specific reasons that either encourage or discourage students from choosing a surgical specialty over a conservative one, and whether these differ between male and female students. Ultimately, the findings may contribute to developing educational recommendations aimed at promoting female participation in surgical training and improving overall surgical education at the university level.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA monocentric cross-sectional study was conducted using a mixed-methods approach, combining a questionnaire and semi-structured interviews. Both survey instruments were developed by the authors based on a review of the current literature.\u003c/p\u003e\u003cp\u003eQuantitative data acquisition:\u003c/p\u003e\u003cp\u003eA self-designed, non-validated, piloted questionnaire consisting of 24 items was developed to assess medical students\u0026rsquo; specialty preferences, influencing factors, and character traits. (Original in German, translated version in English in the supplement) The questionnaire was based on findings from current literature (partly cited in the background section) related to specialty choice.\u003c/p\u003e\u003cp\u003eThe survey was conducted in May 2024 at the Ulm University by distributing a survey link via WhatsApp and Telegram groups. Participation was voluntary, and a \u0026euro;15 City voucher was offered as an incentive. Without a formal sample size calculation, the number of participants was set at 200, which was considered sufficient for descriptive and multivariate analyses due to the exploratory nature of the study and practical limitations related to participant recruitment and incentives. Prior to distribution, two pilot tests were conducted with interview-based feedback from a small group of four respondents each outside the target cohort to improve clarity and relevance.\u003c/p\u003e\u003cp\u003eInclusion criteria required participants to be in their 7th to 10th semester to ensure sufficient exposure to a variety of specialties, enabling an informed decision-making process. The questionnaire covered demographic information, specialty choice and its development, potential influencing factors, suggestions for improving university education, and personality traits.\u003c/p\u003e\u003cp\u003eQuantitative data analysis:\u003c/p\u003e\u003cp\u003eAll data were analysed descriptively using SPSS software version 29.0.1.0. For further analysis, specialties were categorized into three groups: surgical specialties, semi-surgical specialties (obstetrics and gynaecology, ENT, ophthalmology, dermatology, and urology), and conservative (non-surgical) specialties. The semi-surgical and conservative specialties were then combined into a \"non-surgical\" group for binary logistic regression to identify the factors that influence the decision to pursue a surgical versus a non-surgical career. This categorization was chosen because, in the questionnaire, the decision to pursue a semi-surgical specialty was often justified by the perceived opportunity to work in a medical practice more easily than in a fully surgical specialty.\u003c/p\u003e\u003cp\u003eChi-square tests were applied to compare categorical variables between groups. The assumption of at least five expected observations per cell was fulfilled. In cases where this condition was not met, Fisher\u0026rsquo;s Exact Test was used as an alternative. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. One participant identifying as gender-diverse was excluded from statistical tests because no evaluation is possible here.\u003c/p\u003e\u003cp\u003eQualitative data acquisition:\u003c/p\u003e\u003cp\u003eTo capture the personal and subjective aspects of specialty decision-making, a qualitative approach was added in the form of semi-structured, guideline-based interviews. The interview guide included four thematic areas: specialty choice, perceptions of surgery, medical education, and internships/role models. These themes were derived from the questionnaire topics to allow for deeper exploration. The interview was scheduled to last approximately 20 minutes.\u003c/p\u003e\u003cp\u003eA total of 20 participants (10 female, 10 male) were purposefully selected based on their specialty preferences (10 surgical, 10 conservative) and any reported changes in preference. Participation was voluntary, and a \u0026euro;44 City voucher was offered as an incentive. The interviews were conducted between July and October 2024.\u003c/p\u003e\u003cp\u003eQualitative data analysis:\u003c/p\u003e\u003cp\u003eThe interview recordings were transcribed using MAXQDA Online Transcription and subsequently proofread. Qualitative content analysis as described by Kuckartz \u0026amp; R\u0026auml;diker (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) was then carried out using MAXQDA 2022 software.\u003c/p\u003e\u003cp\u003eThe goal of qualitative content analysis was to systematically categorize text-based data and reduce complexity. This can be done either inductively (categories emerge from the data) or deductively (categories are based on prior literature or theory) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In this study, a combined inductive and deductive approach was applied, which is common in qualitative research to ensure both data-driven insight and theoretical alignment.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe questionnaire:\u003c/p\u003e\u003cp\u003eA total of 200 students completed the questionnaire (the number of participants was limited by the number of available incentives). Among them, 54 identified as male, 145 as female, and one as gender diverse (Table 1). The mean age was 24.54 years (21- 40 years), with the majority of students (35%) in their eighth semester. The most commonly selected specialties were obstetrics and gynaecology, anaesthesiology, and trauma surgery/orthopaedics, each chosen by 11.5% of participants. In 39.0% of cases, the current specialty preference was identical to the one held prior to the beginning of medical studies.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe left chart illustrates the students' specialty interests prior to entering medical school, including those who were undecided and excluding those whose current specialty preference remained unchanged. The right chart displays the current specialty preferences of students, grouped into surgical, semi-surgical, and conservative categories. Both charts show absolute frequencies and percentage.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eNegative experiences in the OPR were not found to have a significant impact on specialty choice (χ\u0026sup2; = 1.095, p\u0026thinsp;=\u0026thinsp;0.578). However, female students reported such experiences significantly more often (χ\u0026sup2; = 13.795, p\u0026thinsp;=\u0026thinsp;0.001). The most frequently cited positive and negative factors influencing students' specialty choices are summarized in Table\u0026nbsp;2.\u003c/p\u003e\u003cp\u003eWhen asked about the influence of artificial intelligence (AI), the majority of students (54.5%) stated that it had little influence on their specialty choice, while 34.5% reported no influence at all.\u003c/p\u003e\u003cp\u003eThe perception of surgery as a male-dominated field was not significantly associated with specialty choice (Fisher\u0026acute;s exact test, p=0.535). Nevertheless, 24.5% of participants agreed and 67.5% somewhat agreed with this perception. The female Gender was a significant predictor of perceiving surgery as male-dominated (Fisher\u0026acute;s exact test, p=0.042).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable border=\"1\"\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRegarding the teaching of surgical specialties at university, students most frequently expressed a desire for preparatory seminars prior to surgical internships (58.5%), more mandatory training sessions for surgical skills (46.0%), and greater empathy and enthusiasm from professors and physicians regarding their specialty (45.5%). No significant differences were observed between female and male responses (Table\u0026nbsp;3).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe interviews:\u003c/p\u003e\u003cp\u003eThe 20 participants selected for interviews consisted of 10 women and 10 men. Each gender group included 5 students pursuing a surgical specialty and 5 pursuing a non-surgical specialty. The mean age was 24.25 years. The average interview duration was 27 minutes (18:42\u0026ndash;44:56 minutes). In total, five main categories comprising 31 subcategories were identified through the qualitative content analysis. The five main categories are outlined below.\u003c/p\u003e\u003cp\u003eSpecialty Choice\u003c/p\u003e\u003cp\u003eStudy participants reported a wide range of specialty preferences, shaped by various positive and negative factors. These included internships, university courses, personal interests, and experiences prior to medical school.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMan, surgical: \u0026ldquo;I\u0026rsquo;ve always been kind of interested in doing things with my hands. [\u0026hellip;] And then, especially during my studies, the intensive teaching weeks on surgery had a really positive impact on me. It was just really well organized, and you got some cool insights..\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFor some students, deeper insight into a specialty during medical school led to a change in direction. Often, getting to know a field more closely helped them realize it might not be the right fit, prompting them to explore other options.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWoman, conservative: \u0026ldquo;I started medical school thinking I\u0026rsquo;d definitely go into psychiatry. [\u0026hellip;] And then over time that kind of shifted a bit. And I somehow realized that I think I\u0026rsquo;d also like to work a bit more somatically.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ePerception of Surgery\u003c/p\u003e\u003cp\u003eComparing students with surgical versus conservative preferences revealed opposing views of surgery. Terms like interesting, exhausting, manual, and hierarchical were frequently used. Many students mentioned challenges in the OPR, such as rigid hierarchies and feeling undervalued as a student.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMan, surgical: \u0026ldquo;I think it would be better if, in general, the communication between doctors, teachers, and students was improved \u0026mdash; before and during an operation. [\u0026hellip;] Maybe you could just get a sense of where the student is in terms of knowledge or skills and then integrate them accordingly \u0026mdash; what they can do, what they\u0026rsquo;re allowed to do. [\u0026hellip;] Or at least when you\u0026rsquo;re holding something, that you don\u0026rsquo;t just get orders but also get things explained. [\u0026hellip;] Just being a bit more part of it all.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eRole Models\u003c/p\u003e\u003cp\u003eWhen discussing female role models in surgery, opinions varied. While some students had never noticed a gender imbalance, others had directly observed the challenges women face in surgical careers.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWoman, conservative: \u0026ldquo;But when I was in the OPR, I saw other women being talked to in a weird or rude way. Like questioning why a woman would study medicine at all. And saying that if you take parental leave, you're harming society and stuff like that. So, I kind of feel like opinions like that are still more common there than in other specialties, where you don\u0026rsquo;t hear those kinds of comments.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn general, role models were seen as valuable sources of inspiration and guidance, offering students realistic insights into potential career paths.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMan, conservative: \u0026ldquo;I think someone who takes a lot of time and just has a strong character \u0026mdash; where you think, hey, I want to take more from this person later on because I like their way of thinking or what they do \u0026mdash; that definitely plays a role. [\u0026hellip;] It kind of strengthens what you already wanted to do anyway.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eUniversity Influence\u003c/p\u003e\u003cp\u003eStudents named a wide range of curricular formats they perceived as especially successful. These often shared characteristics such as enthusiastic instructors, clinical relevance, and active student participation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWoman, conservative: \u0026ldquo;The lecturer was really just well prepared. You could tell he really knew what he was talking about clinically. He always had patients ready. And it was just such good teaching because he really involved us. [\u0026hellip;] The patient would come in and describe the symptoms they had when they came to the clinic. [\u0026hellip;] And really, each one of us had to examine. And I thought it was so good because he actually watched us. [\u0026hellip;] And I really think I learned so much.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eMany students felt that the surgical curriculum at the Ulm University \u0026mdash; consisting of two semesters of lectures and a three-week internship \u0026mdash; was insufficient given the complexity and scope of the subject.\u003c/p\u003e\u003cp\u003ePersonal Factors\u003c/p\u003e\u003cp\u003ePersonal traits and life plans also played a significant role in specialty choice. Many students envisioned their professional future outside of the hospital environment, prioritizing work-life balance and considering the option of working in private practice.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWoman, surgical: \u0026ldquo;When you\u0026rsquo;re thinking more in terms of family and so on, then unfortunately you might just not have the time anymore to handle everyday life in the clinic. And then the life in a private practice, with more regular working hours, just seems more attractive in the long run.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eWhen asked about the emotional weight of the decision, some students were open-minded, while others felt that the choice of specialty strongly shaped their identity. No gender differences were identified in how this challenge was perceived.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWoman, surgical: \u0026ldquo;I really have to say that this is something that\u0026rsquo;s been on my mind a lot. [\u0026hellip;] I think choosing a specialty really becomes a big part of your identity somehow. [\u0026hellip;] You\u0026rsquo;ll be spending most of your time in the hospital, then it\u0026rsquo;s just a really serious decision. And of course, we all want to be happy, or at least content. And that\u0026rsquo;s why I feel like it\u0026rsquo;s really a decision with a lot of weight.\u0026rdquo;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study identified key factors that influence medical students at a German University in their choice of specialty. Among the most frequently reported positive influences on specialty choice were clinical internships, individual career plans, and perceived personal abilities. In contrast, expected working hours, the reputation or perceived image of certain specialties, and the behaviour of lecturers were among the most commonly cited negative influences on speciality choice.\u003c/p\u003e\u003cp\u003eNotable distinctions emerged in the context of surgical specialties. A higher number of surgical internships and greater confidence in one\u0026rsquo;s surgical skills were significant positive predictors for choosing a surgical specialty. Conversely, advancing in academic semesters and a stronger preference for work-life balance were associated with a decreased likelihood of choosing surgery.\u003c/p\u003e\u003cp\u003eIn general, the results of the questionnaire and the interviews were consistent. One notable exception was the role of negative experiences in the OPR: while these had no statistically significant influence in the quantitative data, students interviewed who had chosen non-surgical specialties frequently cited disappointing or discouraging experiences in surgical settings.\u003c/p\u003e\u003cp\u003eOverall, the majority of findings did not reveal significant gender differences. However, the data offer important implications for the design and improvement of surgical education at the university level. A better understanding of how practical exposure, mentorship, and didactic approaches influence students can help develop targeted interventions\u0026mdash;particularly to increase interest in surgical careers and to ensure gender-equitable access to them.\u003c/p\u003e\u003cp\u003eInternational and National Context\u003c/p\u003e\u003cp\u003eThe factors influencing medical students\u0026rsquo; specialty choice in this German study are largely consistent with international findings. For example, Madden et al. identified interest in the field, flexibility in working hours, and positive experiences as key motivators, while lack of interest, heavy workload, length of residency, and negative experiences were common deterrents (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Similar findings were reported at the University of Jena, another German medical faculty, where \u0026ldquo;reconciliation of work and family life,\u0026rdquo; \u0026ldquo;workload,\u0026rdquo; and \u0026ldquo;career prospects\u0026rdquo; were identified as the most frequently cited influencing factors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhen comparing internal medicine and surgery, students aiming for a career in internal medicine were more strongly influenced by the \u0026ldquo;extent of patient contact,\u0026rdquo; while career-related factors played a less significant role. In contrast, students interested in surgical specialties were more influenced by \u0026ldquo;career prospects\u0026rdquo; and less by concerns related to \u0026ldquo;work\u0026ndash;life balance\u0026rdquo; or \u0026ldquo;family life\u0026rdquo; (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These tendencies are further supported by Goetz et al., who identified \u0026ldquo;working as a senior physician in a hospital\u0026rdquo; and the \u0026ldquo;importance of manual work\u0026rdquo; as factors significantly associated with the choice of a surgical specialty (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This corresponds with findings from the present study, where work\u0026ndash;life balance and family considerations were also more commonly cited by students favouring conservative (non-surgical) specialties.\u003c/p\u003e\u003cp\u003eLadha et al. further support the notion that influencing factors evolve over the course of medical training. They observed that the importance of lifestyle and personal interest increased by Year 4 compared to Year 1. Moreover, the specialty preferences themselves shifted considerably, with fourth-year students being 2.5 times less likely to express interest in a surgical career (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Impact of Role Models\u003c/p\u003e\u003cp\u003eThe importance of teaching physicians as role models was the only factor to appear both in the top five positive and top five negative influences in the questionnaire, underlining its significance. This was also strongly reflected in the interviews. The importance of role models is supported by the data of Yoon et al., where exposure to a surgical role model was found to be a significant predictor of choosing a surgical specialty. In their study, 87% (370 of 427) of students reported exposure to a physician role model during medical school, and 25% (106 of 427) even prior to it (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similar trends are documented in other studies (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHowever, to address the gender gap in surgery, an increase in the visibility of female role models is needed. Their current underrepresentation is perceived as a barrier for women entering surgical fields. Hull et al. further identify the surgical stereotype and perceived male dominance\u0026mdash;particularly in orthopaedics\u0026mdash;as additional barriers (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This corresponds with findings from the present study, where the majority of students described surgery as a male-dominated field. Although this perception did not significantly correlate with the actual specialty choice, the stereotype remains persistent.\u003c/p\u003e\u003cp\u003eThe Surgical Stereotype and Exposure\u003c/p\u003e\u003cp\u003eInterview data from this study reflected a nuanced image of surgery, with students describing it as interesting, exhausting, manual, and hierarchical. Hill et al. expand this perception by adding descriptors such as confident and intimidating for surgeons, and competitive, masculine, and sacrificing for the field itself (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite such stereotypes, Hull et al. also report that direct exposure to a specialty is associated with increased interest in pursuing it. However, this exposure alone may not be sufficient to alter the stereotype of surgical fields. In their study, for example, exposure to orthopaedics and trauma surgery did not significantly change students\u0026rsquo; perceptions of these fields (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSimilarly, in the present study, the number of surgical internships and confidence in performing surgical tasks were significant positive predictors of choosing a surgical career\u0026mdash;highlighting the importance of exposure and practical engagement. These two factors also ranked among the top general influences on specialty choice (internships as #1, own abilities as #3), independent of surgical focus. This aligns with Br\u0026uuml;gge et al., who reported that surgical training had a positive influence on the specialty decision in 45.3% of their participants (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGender, Negative Experiences, and Contradictory Trends\u003c/p\u003e\u003cp\u003eAlthough female students in this study reported negative experiences in the OPR significantly more often, these experiences did not have a statistically significant impact on specialty choice. If they had, one would expect a lower proportion of women choosing surgical specialties, which was not observed in this cohort. This contrasts with national trends showing a persisting disparity, where only 25% of surgeons are female. In 2013, just 13% of all female physicians in Germany were working in surgical specialties (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCurrent research confirms that women more frequently encounter negative experiences in surgical settings. For example, Sobel et al. found that women reported significantly more microaggressions than men, such as being interrupted or having their opinions less respected by colleagues and patients (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, other studies report exceptions to this trend, finding a more balanced gender distribution regarding negative experiences in contact with surgical fields (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eInterestingly, the influence of practical experiences may differ by gender. Coffeng et al. demonstrated that men were significantly more likely to pursue surgical careers after exposure to surgical clerkships, whereas this effect could not be replicated in the female subgroup (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This suggests that beyond structural barriers, gender-specific motivational mechanisms may play a role in specialty decisions.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eNot all gender disparities identified in previous research could be confirmed by the present study. This may be partly explained by certain methodological limitations. Firstly, the study was conducted at a single centre (Ulm University), which limits the generalizability of the findings. Secondly, participation in the survey was voluntary, without any selection criteria beyond the semester requirement. As a result, approximately three-quarters of respondents were women, potentially introducing selection bias and overrepresentation of certain perspectives. A well-known phenomenon in survey research is volunteer bias: individuals who choose to participate in studies often differ systematically from those who do not. Notably, women tend to participate more frequently than men in voluntary research settings\u0026mdash;a trend also observed by Guo et al., who reported an adjusted odds ratio of 3.1 for female participation (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). This observation is supported by other studies addressing similar themes, which consistently report higher response rates among female participants in self-selected survey cohorts (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, the qualitative interviews were conducted using purposeful sampling. While this approach is common in qualitative research, it carries the risk of introducing bias through the chosen selection criteria and may limit the diversity of perspectives represented.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the analysis of the collected data reveals relationships between key influencing factors and specialty choice. Among these, the role of educators\u0026mdash;as both teachers and role models\u0026mdash;emerged as particularly impactful. Their behaviour, attitude, and teaching style can significantly shape students\u0026rsquo; perceptions and career preferences. Raising awareness among educators about their potential influence and possibly offering targeted training on how to engage with students effectively, could be a meaningful step forward.\u003c/p\u003e\u003cp\u003eMoreover, expanding practical learning opportunities and fostering a more inclusive and supportive environment\u0026mdash;particularly for female students in surgical settings\u0026mdash;would respond directly to the expressed needs of medical students. These measures may contribute to a more balanced and motivating educational experience and ultimately help address the persistent gender disparities in surgical specialties.\u003c/p\u003e\n\u003ch3\u003eOutlook\u003c/h3\u003e\n\u003cp\u003eGiven the continuous generational shifts, the topic under investigation remains of ongoing relevance. To provide representative data that reflect changing generational perspectives, repeated and longitudinal data collection is essential. Additionally, multicentric studies including a more balanced gender ratio and varied institutional cultures could help to confirm whether the trends observed here hold true on a national or international level. In particular, longitudinal studies that track students' attitudes and career paths over time would offer valuable insights into how preferences develop and change.\u003c/p\u003e\u003cp\u003eFurthermore, evaluating the impact of targeted educational interventions - such as mentorship programs, improved surgical training modules, or gender-sensitive teaching workshops - could help determine best practices for guiding medical students toward fulfilling and well-informed career choices. Addressing these aspects not only supports the individual development of future physicians but also contributes to a more equitable and effective healthcare workforce.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eConflict of interest statement: The authors declare that there is no conflict of interest regarding this publication.\u003c/p\u003e\n\u003cp\u003eFunding: The study was financially supported by the Teaching and Research Funding (LF-2) of the Ulm University.\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: The authors confirm that most of the data supporting the findings of this study are available within the article and further data are available on request from the corresponding author. The questionnaire used in the study was developed for this study and has not previously been published elsewhere. The English language version is provided as supplementary file and cited in the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: JH and TKH conceived of the presented idea. JH and WO developed the methodical approach. IK, AS and JH developed the questionnaire and interview. TKH supervised the project. IK performed the statistical analysis supervised by AA. IK wrote the manuscript with support from JH and JV. IK contacted and included the students. All authors discussed the results and contributed to the final manuscript.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: On March 25, 2024, the ethics committee of the University of Ulm determined that the study did not require ethics approval. The authors confirm that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its amendments. Before providing informed consent, all participants were thoroughly informed about the study\u0026rsquo;s purpose, procedures, content, as well as the analysis and publication of the data. All participants provided digital informed consent at the beginning of the survey.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLinscheid LJ, Holliday EB, Ahmed A, Somerson JS, Hanson S, Jagsi R. u. a. Women in academic surgery over the last four decades. PLoS One 16 Dezember. 2020;15(12):e0243308.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBellini MI, Graham Y, Hayes C, Zakeri R, Parks R, Papalois V. A woman\u0026rsquo;s place is in theatre: women\u0026rsquo;s perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open 7 Januar. 2019;9(1):e024349.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMadden S, Martin N, Clements J, Kirk S. Factors influencing future career choices of Queen\u0026rsquo;s University Belfast Medical students. Ulster Med J Mai. 2023;92(2):71\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeutritz T, Krauthausen M, Simmenroth A, K\u0026ouml;nig S. Factors associated with medical students\u0026rsquo; career choice in different specialties: a multiple cross-sectional questionnaire study at a German medical school. BMC Med Educ 24 Juli. 2024;24:798.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLadha FA, Pettinato AM, Perrin AE. 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Factors influencing the choice of specialization - a cross-sectional study with civilian medical students and prospective medical officers in Germany. BMC Med Educ 17 Oktober. 2024;24:1161.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoon JD, Ham SA, Reddy ST, Curlin FA. Role Models\u0026rsquo; Influence on Specialty Choice for Residency Training: A National Longitudinal Study. J Grad Med Educ April. 2018;10(2):149\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHull B, Pestrin O, Brennan CM, Hackney R, Scott CEH. Women in Surgery Events Alone do not Change Medical Student Perceptions of Gender Bias and Discrimination in Orthopaedic Surgery. Front Surg 25 Mai. 2022;9:905558.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHill EJR, Bowman KA, Stalmeijer RE, Solomon Y, Dornan T. Can I cut it? Medical students\u0026rsquo; perceptions of surgeons and surgical careers. Am J Surg November. 2014;208(5):860\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBr\u0026uuml;gge S, G\u0026uuml;nther V, Cascorbi I, Maass N, Ruchay Z, Fischer MR. u. a. Encouraging medical students to become surgeons? Impact of psychological and surgical factors on career choice at medical school. GMS J Med Educ 15 April. 2024;41(2):Doc21.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKlifto KM, Payne RM, Siotos C, Lifchez SD, Cooney DS, Broderick KP. u. a. Women Continue to Be Underrepresented in Surgery: A Study of AMA and ACGME Data from 2000 to 2016. J Surg Educ 1 M\u0026auml;rz. 2020;77(2):362\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSobel AD, Lavorgna TR, Ames SE, Templeton KJ, Mulcahey MK. Interpersonal Interactions and Biases in Orthopaedic Surgery Residency: Do Experiences Differ Based on Gender? Clin Orthop Relat Res Februar. 2023;481(2):369\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHomberg A, Narci\u0026szlig; E, Obertacke U, Sch\u0026uuml;ttpelz-Brauns K. Surgical experiences of final-year undergraduates and the impact on their career aspiration stratified by sex/gender. GMS J Med Educ 17 Juni. 2024;41(3):Doc28.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoffeng LucE, Visscher,Anouck JE, Cate OTJT. The influence of early clinical experiences on career preference of male and female medical students. Med Teacher 1 Januar. 2009;31(7):e323\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo X, Vittinghoff E, Olgin JE, Marcus GM, Pletcher MJ. Volunteer Participation in the Health eHeart Study: A Comparison with the US Population. Sci Rep 16 Mai. 2017;7:1956.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Respondents demographics.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003egender\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cem\u003enumber\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u003cem\u003eAge\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 359px;\"\u003e\n \u003cp\u003e\u003cem\u003eSemesters\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7\u003csup\u003eth\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e8\u003csup\u003eth\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9\u003csup\u003eth\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10\u003csup\u003eth\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003emale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e25.1 (24; 2.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e21 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e18 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003efemale\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e24.3 (23; 2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e29 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e48 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e47 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003edivers\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e25.0 (25; NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003ein years: mean (median; SD)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e absolute frequencies (percentage)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e Most frequently cited, positive and negative influencing factors (five each).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTop 5 positive\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTop 5 negative\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e1.Voluntary internship or self-selected clerkship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e1. Expected working hours\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e2. Individual career plans (e.g., possibility to work in private practice vs. hospital)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e2.Statements / stories from others / \u0026ldquo;reputation\u0026rdquo; of the specialty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e3. Own abilities / talents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e3.Lecturers / instructors / physicians from the respective specialty\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e4. Individual personal plans (e.g., family planning, place of residence)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e4. Theoretical lecture content\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e5. Lecturers / instructors / physicians from the respective specialty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 302px;\"\u003e\n \u003cp\u003e5. Individual personal plans (e.g., family planning, place of residence)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Preferred Measures to Improve Surgical Teaching \u0026ndash; Comparison by Gender\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants were asked to select teaching-related interventions that could increase their motivation to pursue a surgical specialty. The table shows the proportion of male and female students who selected each option. No statistically significant gender differences were observed (Fisher\u0026rsquo;s exact test).\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eActions in teaching\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cem\u003eTotal\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cem\u003eMale\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cem\u003eFemale\u003csup\u003e1\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cem\u003ep-value\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003ePreparatory seminars before surgical internships\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e60.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.419\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eMore required hands-on training opportunities for surgical skills\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e47.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eThe lecturers themselves (more empathy, enthusiasm for their specialty, etc.)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e49.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eMore scheduled internships in surgical specialties integrated into the curriculum\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e45.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.456\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003e\n \u003cp\u003e\u003cem\u003eEarlier introduction to surgical subjects during studies (e.g., during the preclinical phase)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.209\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003ein %\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u0026nbsp;\u003c/sup\u003eFisher\u0026acute;s exact test\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7308963/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7308963/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eThe percentage of female medical students is steadily increasing, yet women remain underrepresented in most surgical specialties. This study aimed to identify the factors that influence the decision to pursue a surgical versus a non-surgical career, with particular attention to gender-specific influences and potential untapped opportunities in medical education.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA monocentric mixed methods approach was employed. A total of 200 medical students at the University of Ulm completed an online questionnaire. Subsequently, semi-structured guideline-based interviews were conducted with 20 of the participants (10 female, 10 male). The interviews were transcribed and analysed using qualitative content analysis as described by Kuckartz \u0026amp; R\u0026auml;diker.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eAmong the participants, 22.2% of male and 23.4% of female students indicated a preference for a surgical specialty. The most relevant factors explaining the variance were identified as prioritization of private life over career (B = -0.596, p\u0026thinsp;=\u0026thinsp;0.009), the number of surgical internships completed (B\u0026thinsp;=\u0026thinsp;0.714, p\u0026thinsp;=\u0026thinsp;0.007), current semester (B = -0.683, p\u0026thinsp;=\u0026thinsp;0.009), and self-confidence in surgical skills (B\u0026thinsp;=\u0026thinsp;0.576, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Gender itself showed no statistically significant influence (B\u0026thinsp;=\u0026thinsp;0.146, p\u0026thinsp;=\u0026thinsp;0.745). However, female students reported significantly more negative experiences in the operating room (OPR) (χ\u0026sup2; = 13.795, p\u0026thinsp;=\u0026thinsp;0.001). The interviews also revealed a strong desire among students for more practical training during medical school and highlighted the substantial influence of teaching staff in fostering interest in particular specialties.\u003c/p\u003e\u003ch2\u003eDiscussion:\u003c/h2\u003e\u003cp\u003eThroughout medical education, instructors have a significant\u0026mdash;partially gender-specific\u0026mdash;influence on specialty choice through their role-modelling and teaching approaches. The quality of practical training, perceived competence in surgical skills, and experiences in the OPR all play crucial roles in shaping career decisions.\u003c/p\u003e","manuscriptTitle":"Gender Differences in Medical Career Choices: A Mixed-Method Study on Factors Influencing Surgical vs. Conservative Decisions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 02:27:34","doi":"10.21203/rs.3.rs-7308963/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-22T15:48:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"258149654406773554486834429786430474294","date":"2025-09-13T13:13:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-12T10:23:51+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-10T05:13:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-20T19:06:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-20T07:26:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-08-20T07:23:45+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d70d4dec-fcbe-4d0e-b8e9-c76fcc79987d","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-23T02:27:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 02:27:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7308963","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7308963","identity":"rs-7308963","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}