Personality Traits and Sex-based Differences in Surgical Career Choice

Personality Traits and Sex-based Differences in Surgical Career Choice | 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 Personality Traits and Sex-based Differences in Surgical Career Choice Amila Dedovic, Anna Mantas, Johann Moritz Kaths, Eugen Malamutmann, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8638440/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: The surgical workforce is facing a projected shortage, partly driven by declining interest in surgical careers among medical students. While structural and lifestyle factors have been widely studied, the role of individual personality traits in shaping career interest remains incompletely understood. This study examined the association between personality traits, sex differences, prior surgical experience, and interest in pursuing a surgical career among medical students. Methods: In this single-center, cross-sectional observational study, fourth-year medical students completing a two-week surgical clerkship were invited to participate. Personality traits were assessed using the Big Five Inventory (BFI). Students completed questionnaires before and after the clerkship evaluating perceptions of surgery, self-assessed skills, and career interest. Group differences and associations were analysed using t tests, ANOVA, paired-samples t tests, and correlation analyses. Results: Seventy-three students (63% female) were included. Students interested in a surgical career scored significantly higher on extraversion and lower on agreeableness compared with those without surgical interest. Female students demonstrated higher agreeableness, whereas male students scored higher on extraversion. Perceived personality fit for surgery was strongly associated with surgical career interest (ρ = .646, p < .001). Prior surgical experience was significantly associated with greater interest in surgery, and overall interest increased following completion of the clerkship (p = .034). Conclusions: Personality traits, particularly extraversion and agreeableness, as well as perceived personality fit and prior surgical exposure, are significantly associated with medical students’ interest in pursuing a surgical career. Early clinical exposure and educational strategies addressing perceived mismatches between personality traits and surgical identity may support more inclusive recruitment into surgery. Medical Education Surgery Personality Big Five Inventory Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The surgical profession is projected to face a significant workforce shortage in the coming decades 1 – 3 . A key contributor to this trend is a declining number of trainees entering surgical training programs, compounded by substantial attrition during residency 4 5 . Negative stereotypes surrounding the surgical profession, such as long working hours, high stress levels, and limited work-life balance, further deter medical students from pursuing a surgical career 5 6 . In the context of evolving generational values, it is increasingly relevant to consider whether differences in work ethics, career expectations, and professional priorities influence career choice in medicine 7 . Beyond structural and cultural factors, individual characteristics may play an important role in shaping career intentions. 8 In this regard, personality traits have been proposed as a potentially influential yet underexplored determinant of specialty selection. It is plausible that certain personality profiles may predispose individuals toward a surgical career, which requires working under high levels of stress, whereas others may be associated with reduced interest in surgery 9 10 . Systematic assessment of personality traits may therefore provide valuable insights into the mechanisms underlying career choice and help to inform targeted recruitment and retention strategies within surgery. Personality can be assessed using various validated instruments. Among these, the Big Five Inventory (BFI) is one of the most widely used frameworks, capturing five core dimensions of personality and demonstrating robust reliability and cross-cultural comparability 11 12 . The instrument assesses five personality dimensions: extraversion, reflecting assertiveness and sociability; agreeableness, describing cooperativeness and empathy; conscientiousness, referring to organization and goal-directed behavior; neuroticism, capturing emotional instability, negative emotionality, and sensitivity to stress; and openness to experience, representing intellectual curiosity, creativity, and openness toward novel ideas and experiences. 13 14 15 The present study investigates the relationship between personality traits, sex-based differences, and interest in pursuing a surgical career among medical students. Methods Between 1st of February and 30th November 2025, fourth-year medical students completing their two-week surgical clerkship in the Department of General Surgery at the University Hospital Essen were invited to participate in this study. Participation was voluntary and anonymous, and no identifying information was collected. All students enrolled in the surgical clerkship were eligible, and no exclusion criteria were applied. The study utilized a cross-sectional observational design with a pre–post component to primarily examine associations between personality traits and students’ interest in pursuing a surgical career. The study was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen, Vote number 24-12161-BO. Data collection occurred at two time points. Before beginning the surgical clerkship, students completed the pre-clerkship questionnaire consisting of 32 items, as well as basic demographic information. The items were grouped into four domains: previous surgical experience, general perceptions of surgery, self-assessed surgical skills, perceptions of surgery at the University Hospital Essen. Personality characteristics were assessed using a standardized Big Five Inventory measuring extraversion, agreeableness, conscientiousness, openness to experience, and neuroticism. After completing the rotation, students responded to the post-clerkship questionnaire containing 36 items, grouped into three domains: General perceptions of surgery, Self-assessed surgical skills, Perceptions of surgery at the University Hospital Essen. All items across both questionnaires were rated on a 6-point Likert scale (1 = strongly agree, 6 = strongly disagree). The questionnaires used in this study were specifically developed for this project and have not been previously published. The full questionnaires are provided in the supplementary files “Questionnaire_pre” and “Questionnaire_post.” Although Likert-scale data are ordinal by definition, aggregated Likert-scale scores with five or more response options are commonly treated as approximately continuous in medical education research. Parametric analyses (t tests and ANOVA) were therefore applied to scale-level variables, given their robustness to moderate deviations from normality and the approximately symmetric distribution of scores 16 . Statistical analyses were conducted using IBM SPSS and Python. Descriptive statistics were calculated for all variables. Group differences were examined using t tests and one-way ANOVA where appropriate. Pre–post changes were analyzed using paired-samples t tests. Associations between categorical variables were assessed using Spearman rank-order correlations, and correlations were examined using Pearson’s r or Spearman’s ρ. Statistical significance was set at α = .05. Results A total of 73 medical students (63% female) participated in the study. Most participants were between 21 and 25 years of age (64.4%), whereas 11% were older than 31 years. Some previous surgical experience was reported by 39 students (53.4%), extensive by seven students (9.6%) and none by 27 students (37%). In terms of the type of previous experience, clerkships were most common (46.5%), followed by medical internships (35.2%), medical training (12.7%), and research (5.6%). (Table 1 ) Table 1 Information on the study cohort N = 73 N % Sex male 27 37.0 female 46 63.0 Age 21–25 47 64.4 26–30 18 24.7 31–35 8 11.0 Previous surgical experience Some 39 53.4 Extensive 7 9.6 None 27 37.0 Type of prior experience Clerkship 33 46.5 Medical training 9 12.7 Internship 25 35.2 Research 4 5.6 Regarding personality traits, participants scored relatively high across all five dimensions assessed by the Big Five Inventory (BFI). Female students scored significantly higher agreeableness scores than male students (94.2 ± 10.5 versus 82.1 ± 9.5, p<.001). In contrast, male participants scored significantly higher on Extraversion (81.9 ± 10.7 versus 76.4 ± 10.5, p = .036). No significant sex-based differences were observed for conscientiousness, openness to experience, or neuroticism. For an overview on personality traits and differences between male and female students see Table 2 and Fig. 1 . Table 2 Personality traits assessed with the Big Five Inventory (BFI) in the study cohort. Mean (SD) total (n = 73) female (n = 46) male (n = 27) p-value Big Five Test Conscientiousness 91.3 (10.7) 92.7 (9.9) 88.9 (11.7) 0.148 Agreeableness 89.7 (11.7) 94.2 (10.5) 82.1 (9.5) < 0.001 Openness to Experience 82.7 (12.2) 83.3 (13.2) 81.6 (10.4) 0.55 Extraversion 78.5 (10.8) 76.4 (10.5) 81.9 (10.7) 0.036 Neuroticism 64.8 (12.6) 65.6 (13.2) 63.4 (11.5) 0.47 Independent-samples t-tests were conducted to compare personality trait scores between students with and without an interest in becoming surgeons (divided by points 1–3 and 4–6 on the Likert scale). Extraversion was significantly higher among participants who wanted to become surgeons (82.7 ± 9.05) than among those who did not (75.9 ± 11.03), p=.008. Agreeableness was significantly higher among students who did not aspire to a surgical career (92.65 ± 11.18) compared with those who did (84.78 ± 11.01), p=.005. Differences in neuroticism, openness to experience and conscientiousness were not statistically significant (p>.05). Students who believed their personality was well suited for a surgical profession were substantially more likely to express interest in becoming surgeons with a strong positive correlation (Spearman’s ρ = .646, p<.001) (Fig. 2 ). Similarly, students who stated that their personality suited a surgical career scored higher on extraversion (83.86 ± 9.38) than those who did not (73.47 ± 9.64, p<.001). Conversely, students who believed that their personality was not suitable for surgery scored higher on agreeableness (94.34 ± 7.82) compared with those who felt suited to surgery (84.74 ± 13.17, p<.001) (see Fig. 3 ). One-way ANOVA assessed whether participants’ interest in pursuing a surgical career varied across the three levels of experience. The results showed a significant effect of experience on interest in becoming a surgeon, F(2, 70) = 20.72, p<.001. Participants with a high level of experience reported the greatest interest in becoming a surgeon (mean 1.3), whereas participants with no experience reported the lowest interest (mean 5.3). Across multivariable linear regression analyses adjusting for sex and prior surgical experience, personality traits showed distinct and trait-specific associations with interest in pursuing a surgical career. Agreeableness emerged as the most strongly and consistently associated trait: Female students scored significantly higher on agreeableness than male students (B = 11.9, β = .54, p < .001), and higher agreeableness was independently associated with lower interest in a surgical career (B = 1.76 per Likert point, β = .31, p = .003). Extraversion and conscientiousness were not independently associated with career interest but were positively associated with prior surgical experience, with higher levels of exposure corresponding to higher extraversion and conscientiousness scores (extraversion: B = 2.84, p = .046; conscientiousness: B = 3.32, p = .014). Sex and career interest were not independent predictors of these traits after adjustment. Neuroticism and openness to experience showed no significant associations with sex, experience, or career interest. Collectively, these findings suggest that while agreeableness appears to differentiate students by surgical career interest, extraversion and conscientiousness are more closely related to experiential factors, underscoring the importance of clinical exposure in shaping personality expression and perceived fit with surgical careers. Overall interest in pursuing a surgical career increased modestly following completion of the surgical clerkship (p = .034). Preferences regarding future workplace and employment model remained largely unchanged. After the clerkship, hospital employment (41.8%) and private practice (43.6%) were the most frequently preferred work settings, and full-time employment remained the most preferred working model (64.9%), followed by part-time employment (18.2%) (see Figs. 5 and 6). Discussion The declining interest in surgical careers among medical graduates has prompted increasing attention to the factors underlying this trend 2 17 . Beyond structural and lifestyle considerations, generational differences in work expectations and individual personality traits may play an important role 18 . This study examined the role of personality in choosing a surgical career and provides insight into how personality traits, individual characteristics and prior experience shape medical students’ interest in surgery. Overall, the findings highlight that personality traits, particularly extraversion and agreeableness, play a meaningful role in differentiating students who are attracted to surgery from those who are not. At the same time, experiential factors such as prior surgical exposure and clerkship participation remain influential in strengthening or reshaping career intentions. However, this relationship may also be bidirectional, as a pre-existing interest in surgery could have motivated students to seek out earlier surgical experiences. A central finding of this study is the association between extraversion and interest in pursuing a surgical career. However, after adjustment for previous surgical experience, this effect was attenuated. This might point towards a role of extraversion for early self-selection into surgical exposure rather than an independent driver of career interest. This also aligns with the association of self-perceived alignment of the own personality with a surgical career that we found to be associated with surgical career interest in this study. A connection between extraversion and surgical career interest has been drawn in several previous studies 10 19 20 . One study that assessed differences in low- and high performing surgical residents even noted extraversion as a specific trait in high-performing surgeons 8 . In contrast, higher agreeableness was observed among the students who did not aspire to a surgical career and who felt that their personality was not suited to surgery, especially in male students. This might point towards still existing negative stereotypes of the surgical profession, that only extraverted and less agreeable graduates qualify for surgical training 21 . No significant differences however emerged for neuroticism, conscientiousness and openness to experience, suggesting that these traits may be less influential in distinguishing interest in surgical versus non-surgical specialties among medical students. Notably, this study identified sex-based differences in personality traits among medical students. Female students scored higher in agreeableness and lower in extraversion compared with male students. However, female students expressing an interest in surgery demonstrated higher levels of extraversion. This pattern mirrors the personality profile observed in students aspiring to a surgical career, distinguishing them from those without such interest. In line with our findings, Blohm et al. reported sex-related differences in personality traits among practicing surgeons, with female surgeons exhibiting higher levels of extraversion, conscientiousness, agreeableness, and neuroticism compared to their male colleagues. 22 . Although the underlying mechanisms cannot be determined from the present data, these findings suggest that sex may influence the relationship between personality traits and interest in a surgical career. It remains unclear whether female students perceive lower extraversion as a barrier to pursuing surgery, or whether self-selection into surgical career pathways is driven by extraversion-related traits. Another important finding of this study is the strong positive association between students’ perceived personality fit and their interest in pursuing a surgical career. Students who believed that their personality aligned with the demands of surgical work were significantly more likely to express interest in becoming surgeons, supporting the idea that perceived alignment between one`s traits and a professional environment is a key determinant of specialty choice. This positive relationship reflects the importance of self-assessed personal characteristics in the formation of career intentions. Beyond personality, prior surgical experience emerged as an additional factor strongly associated with interest in a surgical career. Students with extensive or moderate surgical experience expressed substantially greater interest in a surgical career compared with those without prior exposure. While we did not explicitly address generational influences on interest in pursuing a surgical career, there are strong links indicating such an influence. Only around 65% of participants in this study indicated a plan to work full-time in the future and only 42% reported plans concerning working in a hospital. Taken together, these findings reinforce the importance of early, structured opportunities for students to engage with surgical practice. Such exposure likely enhances self-efficacy, increases familiarity with the surgical environment, and provides more realistic insights into surgical work; factors known to influence medical career choice. This study also has several implications for surgical education. First, providing early and meaningful exposure to surgical practice may be crucial for sustaining students’ interest in surgery. Second, targeted mentorship and interventions that address perceived mismatches between personality traits and surgical identity may help expand the range of students who consider surgical careers. Several limitations should be considered. The modest sample size and single-institution design may restrict generalizability, and the use of self-reported measures introduces the possibility of social desirability bias. Furthermore, although the clerkship design allowed pre–post comparisons, a longer follow-up period would be necessary to assess whether these changes in perception lead to actual career choices. Conclusion In conclusion, the results highlight the combined influence of personality traits, prior experience, and clerkship exposure on medical students’ interest in surgical careers. Enhancing early surgical experiences and addressing perceived barriers may help attract and retain motivated students in the surgical field. By understanding how personal and experiential factors interact, surgical education programs can better support students in making well-informed career choices. Recognizing the role of personality may help surgical educators in creating more inclusive pathways into surgery. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen, Vote number 24-12161-BO. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Participation was voluntary and anonymous, and informed consent was obtained from all participants prior to participation. Consent for publication Not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding No financial support was received for the research. Authors' contributions AD: Conceptualization, Study design Methodology, Investigation, Data curation, Writing – Original Draft, Project Administration, Statistical analysis, Data curation, Writing – original draft, Writing – review & editing. AM: Investigation, Data Curation, Writing – Review & Editing. JMK: Methodology, Formal Analysis, Writing – Review & Editing. EM: Formal Analysis, Visualization, Writing – Review & Editing. SH: Methodology, Writing – Review & Editing. AO: Investigation, Writing – Review & Editing. TFU: Supervision, Writing – Review & Editing. UPN: Supervision, Writing – Review & Editing. SMS: Conceptualization, Study design, Supervision, Writing – original draft, Writing – review & editing, Statistical analysis, Project Administration. All authors critically revised the manuscript for important intellectual content and approved the final version. Acknowledgements The authors would like to thank the participating medical students for their contribution to this study and the administrative staff of the Department of General, Visceral, Vascular and Transplantation Surgery at University Hospital Essen for their support in coordinating data collection. References Yang J, Jayanti MK, Taylor A et al. The Impending Shortage and Cost of Training the Future Plastic Surgical Workforce. Ann Plast Surg 2014;72(2). Takami H, Kodera Y, Eguchi H, et al. The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society. Surg Today. 2024;54(1):41–52. 10.1007/s00595-023-02697-7 . Thomas A, Murtaza AN, Michael Spiers HV, et al. Declining interest in general surgical training - Challenging misconceptions and improving access at undergraduate level. Annals Med Surg. 2019;40:3–8. [published Online First: 20181110]. Czopek P, Dranka-Bojarowska D, Mrowiec S. Why don't young doctors want to be surgeons? Pol Przegl Chir. 2020;92(6):28–31. 10.5604/01.3001.0014.4209 . [published Online First: 2021/01/08]. Yeo H, Bucholz E, Ann Sosa J, et al. A national study of attrition in general surgery training: Which residents leave and where do they go? Ann Surg. 2010;252(3):529–34. 10.1097/SLA.0b013e3181f2789c . Radunz S, Hoyer DP, Kaiser GM, et al. Career intentions of female surgeons in German liver transplant centers considering family and lifestyle priorities. Langenbeck's archives Surg. 2017;402(1):143–48. 10.1007/s00423-016-1434-z . [published Online First: 20160421]. Sanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM, et al. Influences on medical student career choice: gender or generation? Arch Surg. 2006;141(11):1086–94. 10.1001/archsurg.141.11.1086 . discussion 94. Hughes BD, Perone JA, Cummins CB, et al. Personality Testing May Identify Applicants Who Will Become Successful in General Surgery Residency. J Surg Res. 2019;233:240–48. 10.1016/j.jss.2018.08.003 . [published Online First: 20180903]. Sier VQ, Schmitz RF, Schepers A, et al. Exploring the surgical personality. surgeon: J Royal Colleges Surg Edinb Irel. 2023;21(1):1–7. 10.1016/j.surge.2022.01.008 . [published Online First: 20220228]. Preece RA, Cope AC. Are Surgeons Born or Made? A Comparison of Personality Traits and Learning Styles Between Surgical Trainees and Medical Students. J Surg Educ. 2016;73(5):768–73. 10.1016/j.jsurg.2016.03.017 . [published Online First: 20160512]. Schmitt DP, Allik J, McCrae RR, et al. The Geographic Distribution of Big Five Personality Traits: Patterns and Profiles of Human Self-Description Across 56 Nations. J Cross-Cult Psychol. 2007;38(2):173–212. 10.1177/0022022106297299 . Sier VQ, Schmitz RF, Putter H, et al. The big five: Studying the surgical personality. Surgery. 2022;172(5):1358–63. 10.1016/j.surg.2022.08.003 . [published Online First: 20220903]. Neyer FJ, Asendorpf JB, Asendorpf JB. Methodik. In: Neyer FJ, Asendorpf JB, editors Psychologie der Persönlichkeit. Berlin, Heidelberg: Springer Berlin Heidelberg 2018:81–133. John OP, Srivastava S, Pervin L et al. The Big Five Trait Taxonomy: History, Measurement, and theoretical Perspectives. 1999. Danner D, Rammstedt B, Bluemke M et al. Die deutsche Version des Big Five Inventory 2 (BFI-2) [Download via http://doi.org/10.6102/zis247]2016 Norman G. Likert scales, levels of measurement and the laws of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625–32. 10.1007/s10459-010-9222-y . [published Online First: 2010/02/11]. Oslock WM, Satiani B, Way DP, et al. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. Am J Surg. 2022;223(1):28–35. https://doi.org/10.1016/j.amjsurg.2021.07.033 . Bell MA, Wales PS, Torbeck LJ, et al. Do personality differences between teachers and learners impact students' evaluations of a surgery clerkship? J Surg Educ. 2011;68(3):190–3. 10.1016/j.jsurg.2011.01.003 . [published Online First: 20110312]. Bansal R, Mathew KA, Jith A, et al. A comparison of personality traits, learning style, and perceived stress among surgical and nonsurgical residents in a tertiary care hospital in India. Ind Psychiatry J. 2021;30(2):329–34. 10.4103/ipj.ipj_93_21 . [published Online First: 20211123]. Drosdeck JM, Osayi SN, Peterson LA, et al. Surgeon and nonsurgeon personalities at different career points. J Surg Res. 2015;196(1):60–6. 10.1016/j.jss.2015.02.021 . [published Online First: 20150218]. Fong JB, Thomason HA, Sorensen MJ. Cutting Through Stereotypes: A Scoping Review of Preclinical Medical Student Perceptions of Surgery. J Surg Educ. 2025;82(4):103438. 10.1016/j.jsurg.2025.103438 . [published Online First: 2025/02/02]. Blohm M, McGrath A, Mukka S et al. Swedish female and male general surgeons differ in personality traits. Scandinavian J surgery: SJS : official organ Finnish Surg Soc Scandinavian Surg Soc 2024:14574969241299472. 10.1177/14574969241299472 [published Online First: 2024/11/20]. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 23 Feb, 2026 Editor invited by journal 30 Jan, 2026 Submission checks completed at journal 28 Jan, 2026 First submitted to journal 28 Jan, 2026 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-8638440","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":596247534,"identity":"0365689b-2d88-4e89-bcee-0e74ead28870","order_by":0,"name":"Amila Dedovic","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYFACxsYDDAzMDAwHQKiCwQAu3oBbSwOSljNEaQErhmhhYGwjQgv/tMMNB34wWMvxHe8xPPBz3mFjBvb2xx8+7mCQ7cehReJ2YsPBHoZ0Y8kzZwwO9m47bMbAc8ZMcuYZBuOZuKwBajnAw3A4ccONtITDjNsO29jfyGFj5m1jSNxwALsOeZAtfxgO10O0zDlswyD//PHnv0At+3FoMQBqOQy0JcHgRvKBw4wNQIdJMBhIM4JsweEuQ5AWGYN0w5lnDh842HMs3ZiBJ8dMsrdNwngGDlvkbqc/fPimwlqe73hj84cfNdaGDezHH3/42WYj24/L+xDnYQpJ4FM/CkbBKBgFo4AAAAApNWfTo7sx3wAAAABJRU5ErkJggg==","orcid":"","institution":"Essen University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Amila","middleName":"","lastName":"Dedovic","suffix":""},{"id":596247535,"identity":"60488a8a-63e2-4a1f-9136-782e2b47e77a","order_by":1,"name":"Anna Mantas","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Mantas","suffix":""},{"id":596247536,"identity":"573895a7-56ea-44a8-bca0-197f30c94ca8","order_by":2,"name":"Johann Moritz Kaths","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Johann","middleName":"Moritz","lastName":"Kaths","suffix":""},{"id":596247537,"identity":"9066f3a9-094b-4695-8281-f0784fe8d02a","order_by":3,"name":"Eugen Malamutmann","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eugen","middleName":"","lastName":"Malamutmann","suffix":""},{"id":596247538,"identity":"6b0296ba-12d4-4976-9ea9-057d3185d5d6","order_by":4,"name":"Stephanie Herbstreit","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"","lastName":"Herbstreit","suffix":""},{"id":596247539,"identity":"6de5b891-cbb4-4da2-bcdb-3bb14aa05b45","order_by":5,"name":"Arzu Oezcelik","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Arzu","middleName":"","lastName":"Oezcelik","suffix":""},{"id":596247541,"identity":"de18ce70-105f-43eb-8a92-9d3962e18c48","order_by":6,"name":"Tom Florian Ulmer","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tom","middleName":"Florian","lastName":"Ulmer","suffix":""},{"id":596247543,"identity":"d7c5d3b6-dee6-48b1-83dd-491eb5fb72ac","order_by":7,"name":"Ulf Peter Neumann","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ulf","middleName":"Peter","lastName":"Neumann","suffix":""},{"id":596247545,"identity":"54d06af0-2d20-482f-84b7-fc481437dd49","order_by":8,"name":"Sophia Marie-Therese Schmitz","email":"","orcid":"","institution":"Essen University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sophia","middleName":"Marie-Therese","lastName":"Schmitz","suffix":""}],"badges":[],"createdAt":"2026-01-19 10:38:57","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8638440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8638440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103585126,"identity":"d3257405-9c5f-4a0a-9ebf-07a89922d18f","added_by":"auto","created_at":"2026-02-27 11:02:08","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":297183,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBig Five personality traits by sex and interest in surgery.\u003c/strong\u003eMean scores for neuroticism, extraversion, openness, agreeableness, and conscientiousness are shown stratified by sex and level of interest in pursuing a surgical career (Likert scale 1–6).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/7cb95306efb57d93e5793898.jpeg"},{"id":103585123,"identity":"10859556-22dc-41c2-833f-a7b6d7308864","added_by":"auto","created_at":"2026-02-27 11:02:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":128874,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between surgical career interest and perceived personality suited for surgery.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/425d556cfd11088521b05891.png"},{"id":103585127,"identity":"d5ccced7-ad2d-4eb1-939c-699c2d165df5","added_by":"auto","created_at":"2026-02-27 11:02:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":130835,"visible":true,"origin":"","legend":"\u003cp\u003eBig Five Personality Traits according to perceived alignment with surgery.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/5cbf51ac3582b0faec898437.png"},{"id":103585125,"identity":"978003f6-7e55-4bf6-8c16-fb9dcc8ba23e","added_by":"auto","created_at":"2026-02-27 11:02:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":136079,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation between prior surgical experience and surgical career aspirations. Participants rated their interest in pursuing a surgical career on a 6-point Likert scale (1 = absolutely, 6 = not at all).\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/9321df97c4433d3861fc0f71.png"},{"id":103585124,"identity":"ecd2ad17-8c62-4b6b-9bf3-8df986fd70ca","added_by":"auto","created_at":"2026-02-27 11:02:08","extension":"jpeg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":264315,"visible":true,"origin":"","legend":"\u003cp\u003eand 6 Desired future working models and workplace settings of students participating in this study\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/f1cde0596a07c5faaa75cfea.jpeg"},{"id":104398381,"identity":"beb89bb4-f9a1-463d-8ad9-6e48a1cd7ea2","added_by":"auto","created_at":"2026-03-11 12:02:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1421125,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8638440/v1/eee24821-75f7-4433-bfc8-0b7657402e87.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Personality Traits and Sex-based Differences in Surgical Career Choice","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe surgical profession is projected to face a significant workforce shortage in the coming decades\u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. A key contributor to this trend is a declining number of trainees entering surgical training programs, compounded by substantial attrition during residency\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Negative stereotypes surrounding the surgical profession, such as long working hours, high stress levels, and limited work-life balance, further deter medical students from pursuing a surgical career\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the context of evolving generational values, it is increasingly relevant to consider whether differences in work ethics, career expectations, and professional priorities influence career choice in medicine\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Beyond structural and cultural factors, individual characteristics may play an important role in shaping career intentions.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e In this regard, personality traits have been proposed as a potentially influential yet underexplored determinant of specialty selection.\u003c/p\u003e \u003cp\u003eIt is plausible that certain personality profiles may predispose individuals toward a surgical career, which requires working under high levels of stress, whereas others may be associated with reduced interest in surgery\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Systematic assessment of personality traits may therefore provide valuable insights into the mechanisms underlying career choice and help to inform targeted recruitment and retention strategies within surgery.\u003c/p\u003e \u003cp\u003ePersonality can be assessed using various validated instruments. Among these, the Big Five Inventory (BFI) is one of the most widely used frameworks, capturing five core dimensions of personality and demonstrating robust reliability and cross-cultural comparability\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The instrument assesses five personality dimensions: extraversion, reflecting assertiveness and sociability; agreeableness, describing cooperativeness and empathy; conscientiousness, referring to organization and goal-directed behavior; neuroticism, capturing emotional instability, negative emotionality, and sensitivity to stress; and openness to experience, representing intellectual curiosity, creativity, and openness toward novel ideas and experiences.\u003csup\u003e13 14 15\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study investigates the relationship between personality traits, sex-based differences, and interest in pursuing a surgical career among medical students.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e Between 1st of February and 30th November 2025, fourth-year medical students completing their two-week surgical clerkship in the Department of General Surgery at the University Hospital Essen were invited to participate in this study. Participation was voluntary and anonymous, and no identifying information was collected. All students enrolled in the surgical clerkship were eligible, and no exclusion criteria were applied.\u003c/p\u003e \u003cp\u003eThe study utilized a cross-sectional observational design with a pre\u0026ndash;post component to primarily examine associations between personality traits and students\u0026rsquo; interest in pursuing a surgical career. The study was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen, Vote number 24-12161-BO.\u003c/p\u003e \u003cp\u003eData collection occurred at two time points. Before beginning the surgical clerkship, students completed the pre-clerkship questionnaire consisting of 32 items, as well as basic demographic information. The items were grouped into four domains: previous surgical experience, general perceptions of surgery, self-assessed surgical skills, perceptions of surgery at the University Hospital Essen. Personality characteristics were assessed using a standardized Big Five Inventory measuring extraversion, agreeableness, conscientiousness, openness to experience, and neuroticism.\u003c/p\u003e \u003cp\u003eAfter completing the rotation, students responded to the post-clerkship questionnaire containing 36 items, grouped into three domains: General perceptions of surgery, Self-assessed surgical skills, Perceptions of surgery at the University Hospital Essen. All items across both questionnaires were rated on a 6-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly agree, 6\u0026thinsp;=\u0026thinsp;strongly disagree). The questionnaires used in this study were specifically developed for this project and have not been previously published. The full questionnaires are provided in the supplementary files \u0026ldquo;Questionnaire_pre\u0026rdquo; and \u0026ldquo;Questionnaire_post.\u0026rdquo;\u003c/p\u003e \u003cp\u003eAlthough Likert-scale data are ordinal by definition, aggregated Likert-scale scores with five or more response options are commonly treated as approximately continuous in medical education research. Parametric analyses (t tests and ANOVA) were therefore applied to scale-level variables, given their robustness to moderate deviations from normality and the approximately symmetric distribution of scores\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStatistical analyses were conducted using IBM SPSS and Python. Descriptive statistics were calculated for all variables. Group differences were examined using t tests and one-way ANOVA where appropriate. Pre\u0026ndash;post changes were analyzed using paired-samples t tests. Associations between categorical variables were assessed using Spearman rank-order correlations, and correlations were examined using Pearson\u0026rsquo;s r or Spearman\u0026rsquo;s ρ. Statistical significance was set at α\u0026thinsp;=\u0026thinsp;.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 73 medical students (63% female) participated in the study. Most participants were between 21 and 25 years of age (64.4%), whereas 11% were older than 31 years. Some previous surgical experience was reported by 39 students (53.4%), extensive by seven students (9.6%) and none by 27 students (37%). In terms of the type of previous experience, clerkships were most common (46.5%), followed by medical internships (35.2%), medical training (12.7%), and research (5.6%). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInformation on the study cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;73\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePrevious surgical experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtensive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eType of prior experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClerkship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResearch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding personality traits, participants scored relatively high across all five dimensions assessed by the Big Five Inventory (BFI). Female students scored significantly higher agreeableness scores than male students (94.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5 versus 82.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5, p\u0026lt;.001). In contrast, male participants scored significantly higher on Extraversion (81.9\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7 versus 76.4\u0026thinsp;\u0026plusmn;\u0026thinsp;10.5, p =\u0026thinsp;.036). No significant sex-based differences were observed for conscientiousness, openness to experience, or neuroticism. For an overview on personality traits and differences between male and female students see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePersonality traits assessed with the Big Five Inventory (BFI) in the study cohort.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003etotal (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emale\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eBig Five Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConscientiousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.3 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.7 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.9 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgreeableness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.7 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82.1 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpenness to Experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.7 (12.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.3 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.6 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtraversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.5 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.4 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81.9 (10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuroticism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.8 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.6 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63.4 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIndependent-samples t-tests were conducted to compare personality trait scores between students with and without an interest in becoming surgeons (divided by points 1\u0026ndash;3 and 4\u0026ndash;6 on the Likert scale). Extraversion was significantly higher among participants who wanted to become surgeons (82.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.05) than among those who did not (75.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.03), p=.008. Agreeableness was significantly higher among students who did not aspire to a surgical career (92.65\u0026thinsp;\u0026plusmn;\u0026thinsp;11.18) compared with those who did (84.78\u0026thinsp;\u0026plusmn;\u0026thinsp;11.01), p=.005. Differences in neuroticism, openness to experience and conscientiousness were not statistically significant (p\u0026gt;.05).\u003c/p\u003e \u003cp\u003eStudents who believed their personality was well suited for a surgical profession were substantially more likely to express interest in becoming surgeons with a strong positive correlation (Spearman\u0026rsquo;s ρ\u0026thinsp;=\u0026thinsp;.646, p\u0026lt;.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSimilarly, students who stated that their personality suited a surgical career scored higher on extraversion (83.86\u0026thinsp;\u0026plusmn;\u0026thinsp;9.38) than those who did not (73.47\u0026thinsp;\u0026plusmn;\u0026thinsp;9.64, p\u0026lt;.001). Conversely, students who believed that their personality was not suitable for surgery scored higher on agreeableness (94.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.82) compared with those who felt suited to surgery (84.74\u0026thinsp;\u0026plusmn;\u0026thinsp;13.17, p\u0026lt;.001) (see Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOne-way ANOVA assessed whether participants\u0026rsquo; interest in pursuing a surgical career varied across the three levels of experience. The results showed a significant effect of experience on interest in becoming a surgeon, F(2, 70)\u0026thinsp;=\u0026thinsp;20.72, p\u0026lt;.001. Participants with a high level of experience reported the greatest interest in becoming a surgeon (mean 1.3), whereas participants with no experience reported the lowest interest (mean 5.3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAcross multivariable linear regression analyses adjusting for sex and prior surgical experience, personality traits showed distinct and trait-specific associations with interest in pursuing a surgical career.\u003c/p\u003e \u003cp\u003eAgreeableness emerged as the most strongly and consistently associated trait: Female students scored significantly higher on agreeableness than male students (B\u0026thinsp;=\u0026thinsp;11.9, β\u0026thinsp;=\u0026thinsp;.54, p \u0026lt; .001), and higher agreeableness was independently associated with lower interest in a surgical career (B\u0026thinsp;=\u0026thinsp;1.76 per Likert point, β\u0026thinsp;=\u0026thinsp;.31, p = .003).\u003c/p\u003e \u003cp\u003eExtraversion and conscientiousness were not independently associated with career interest but were positively associated with prior surgical experience, with higher levels of exposure corresponding to higher extraversion and conscientiousness scores (extraversion: B\u0026thinsp;=\u0026thinsp;2.84, p = .046; conscientiousness: B\u0026thinsp;=\u0026thinsp;3.32, p = .014). Sex and career interest were not independent predictors of these traits after adjustment. Neuroticism and openness to experience showed no significant associations with sex, experience, or career interest.\u003c/p\u003e \u003cp\u003eCollectively, these findings suggest that while agreeableness appears to differentiate students by surgical career interest, extraversion and conscientiousness are more closely related to experiential factors, underscoring the importance of clinical exposure in shaping personality expression and perceived fit with surgical careers.\u003c/p\u003e \u003cp\u003eOverall interest in pursuing a surgical career increased modestly following completion of the surgical clerkship (p = .034). Preferences regarding future workplace and employment model remained largely unchanged. After the clerkship, hospital employment (41.8%) and private practice (43.6%) were the most frequently preferred work settings, and full-time employment remained the most preferred working model (64.9%), followed by part-time employment (18.2%) (see Figs.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and 6).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe declining interest in surgical careers among medical graduates has prompted increasing attention to the factors underlying this trend\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Beyond structural and lifestyle considerations, generational differences in work expectations and individual personality traits may play an important role\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study examined the role of personality in choosing a surgical career and provides insight into how personality traits, individual characteristics and prior experience shape medical students\u0026rsquo; interest in surgery. Overall, the findings highlight that personality traits, particularly extraversion and agreeableness, play a meaningful role in differentiating students who are attracted to surgery from those who are not. At the same time, experiential factors such as prior surgical exposure and clerkship participation remain influential in strengthening or reshaping career intentions. However, this relationship may also be bidirectional, as a pre-existing interest in surgery could have motivated students to seek out earlier surgical experiences.\u003c/p\u003e \u003cp\u003eA central finding of this study is the association between extraversion and interest in pursuing a surgical career. However, after adjustment for previous surgical experience, this effect was attenuated. This might point towards a role of extraversion for early self-selection into surgical exposure rather than an independent driver of career interest. This also aligns with the association of self-perceived alignment of the own personality with a surgical career that we found to be associated with surgical career interest in this study. A connection between extraversion and surgical career interest has been drawn in several previous studies\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. One study that assessed differences in low- and high performing surgical residents even noted extraversion as a specific trait in high-performing surgeons\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. In contrast, higher agreeableness was observed among the students who did not aspire to a surgical career and who felt that their personality was not suited to surgery, especially in male students. This might point towards still existing negative stereotypes of the surgical profession, that only extraverted and less agreeable graduates qualify for surgical training\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNo significant differences however emerged for neuroticism, conscientiousness and openness to experience, suggesting that these traits may be less influential in distinguishing interest in surgical versus non-surgical specialties among medical students.\u003c/p\u003e \u003cp\u003eNotably, this study identified sex-based differences in personality traits among medical students. Female students scored higher in agreeableness and lower in extraversion compared with male students. However, female students expressing an interest in surgery demonstrated higher levels of extraversion. This pattern mirrors the personality profile observed in students aspiring to a surgical career, distinguishing them from those without such interest. In line with our findings, Blohm et al. reported sex-related differences in personality traits among practicing surgeons, with female surgeons exhibiting higher levels of extraversion, conscientiousness, agreeableness, and neuroticism compared to their male colleagues.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough the underlying mechanisms cannot be determined from the present data, these findings suggest that sex may influence the relationship between personality traits and interest in a surgical career.\u003c/p\u003e \u003cp\u003eIt remains unclear whether female students perceive lower extraversion as a barrier to pursuing surgery, or whether self-selection into surgical career pathways is driven by extraversion-related traits.\u003c/p\u003e \u003cp\u003eAnother important finding of this study is the strong positive association between students\u0026rsquo; perceived personality fit and their interest in pursuing a surgical career. Students who believed that their personality aligned with the demands of surgical work were significantly more likely to express interest in becoming surgeons, supporting the idea that perceived alignment between one`s traits and a professional environment is a key determinant of specialty choice. This positive relationship reflects the importance of self-assessed personal characteristics in the formation of career intentions.\u003c/p\u003e \u003cp\u003eBeyond personality, prior surgical experience emerged as an additional factor strongly associated with interest in a surgical career. Students with extensive or moderate surgical experience expressed substantially greater interest in a surgical career compared with those without prior exposure.\u003c/p\u003e \u003cp\u003eWhile we did not explicitly address generational influences on interest in pursuing a surgical career, there are strong links indicating such an influence. Only around 65% of participants in this study indicated a plan to work full-time in the future and only 42% reported plans concerning working in a hospital.\u003c/p\u003e \u003cp\u003eTaken together, these findings reinforce the importance of early, structured opportunities for students to engage with surgical practice. Such exposure likely enhances self-efficacy, increases familiarity with the surgical environment, and provides more realistic insights into surgical work; factors known to influence medical career choice.\u003c/p\u003e \u003cp\u003eThis study also has several implications for surgical education. First, providing early and meaningful exposure to surgical practice may be crucial for sustaining students\u0026rsquo; interest in surgery. Second, targeted mentorship and interventions that address perceived mismatches between personality traits and surgical identity may help expand the range of students who consider surgical careers.\u003c/p\u003e \u003cp\u003eSeveral limitations should be considered. The modest sample size and single-institution design may restrict generalizability, and the use of self-reported measures introduces the possibility of social desirability bias. Furthermore, although the clerkship design allowed pre\u0026ndash;post comparisons, a longer follow-up period would be necessary to assess whether these changes in perception lead to actual career choices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the results highlight the combined influence of personality traits, prior experience, and clerkship exposure on medical students\u0026rsquo; interest in surgical careers. Enhancing early surgical experiences and addressing perceived barriers may help attract and retain motivated students in the surgical field. By understanding how personal and experiential factors interact, surgical education programs can better support students in making well-informed career choices. Recognizing the role of personality may help surgical educators in creating more inclusive pathways into surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of the Medical Faculty of the University of Duisburg-Essen, Vote number 24-12161-BO. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Participation was voluntary and anonymous, and informed consent was obtained from all participants prior to participation.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support was received for the research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAD: Conceptualization, Study design Methodology, Investigation, Data curation, Writing \u0026ndash; Original Draft, Project Administration, Statistical analysis, Data curation, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing. AM: Investigation, Data Curation, Writing \u0026ndash; Review \u0026amp; Editing. JMK: Methodology, Formal Analysis, Writing \u0026ndash; Review \u0026amp; Editing. EM: Formal Analysis, Visualization, Writing \u0026ndash; Review \u0026amp; Editing. SH: Methodology, Writing \u0026ndash; Review \u0026amp; Editing. AO: Investigation, Writing \u0026ndash; Review \u0026amp; Editing. TFU: Supervision, Writing \u0026ndash; Review \u0026amp; Editing. UPN: Supervision, Writing \u0026ndash; Review \u0026amp; Editing. SMS: Conceptualization, Study design, Supervision, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing, Statistical analysis, Project Administration.\u003c/p\u003e\n\u003cp\u003eAll authors critically revised the manuscript for important intellectual content and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participating medical students for their contribution to this study and the administrative staff of the Department of General, Visceral, Vascular and Transplantation Surgery at University Hospital Essen for their support in coordinating data collection.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYang J, Jayanti MK, Taylor A et al. The Impending Shortage and Cost of Training the Future Plastic Surgical Workforce. Ann Plast Surg 2014;72(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTakami H, Kodera Y, Eguchi H, et al. The shortage of surgeons in Japan: Results of an online survey of qualified teaching hospitals that take part in the surgical training programs for board certification by the Japan Surgical Society. Surg Today. 2024;54(1):41\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00595-023-02697-7\u003c/span\u003e\u003cspan address=\"10.1007/s00595-023-02697-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas A, Murtaza AN, Michael Spiers HV, et al. Declining interest in general surgical training - Challenging misconceptions and improving access at undergraduate level. Annals Med Surg. 2019;40:3\u0026ndash;8. [published Online First: 20181110].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCzopek P, Dranka-Bojarowska D, Mrowiec S. Why don't young doctors want to be surgeons? Pol Przegl Chir. 2020;92(6):28\u0026ndash;31. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5604/01.3001.0014.4209\u003c/span\u003e\u003cspan address=\"10.5604/01.3001.0014.4209\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 2021/01/08].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYeo H, Bucholz E, Ann Sosa J, et al. A national study of attrition in general surgery training: Which residents leave and where do they go? Ann Surg. 2010;252(3):529\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/SLA.0b013e3181f2789c\u003c/span\u003e\u003cspan address=\"10.1097/SLA.0b013e3181f2789c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRadunz S, Hoyer DP, Kaiser GM, et al. Career intentions of female surgeons in German liver transplant centers considering family and lifestyle priorities. Langenbeck's archives Surg. 2017;402(1):143\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00423-016-1434-z\u003c/span\u003e\u003cspan address=\"10.1007/s00423-016-1434-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20160421].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanfey HA, Saalwachter-Schulman AR, Nyhof-Young JM, et al. Influences on medical student career choice: gender or generation? Arch Surg. 2006;141(11):1086\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/archsurg.141.11.1086\u003c/span\u003e\u003cspan address=\"10.1001/archsurg.141.11.1086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. discussion 94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHughes BD, Perone JA, Cummins CB, et al. Personality Testing May Identify Applicants Who Will Become Successful in General Surgery Residency. J Surg Res. 2019;233:240\u0026ndash;48. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jss.2018.08.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jss.2018.08.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20180903].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSier VQ, Schmitz RF, Schepers A, et al. Exploring the surgical personality. surgeon: J Royal Colleges Surg Edinb Irel. 2023;21(1):1\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.surge.2022.01.008\u003c/span\u003e\u003cspan address=\"10.1016/j.surge.2022.01.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20220228].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreece RA, Cope AC. Are Surgeons Born or Made? A Comparison of Personality Traits and Learning Styles Between Surgical Trainees and Medical Students. J Surg Educ. 2016;73(5):768\u0026ndash;73. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jsurg.2016.03.017\u003c/span\u003e\u003cspan address=\"10.1016/j.jsurg.2016.03.017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20160512].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchmitt DP, Allik J, McCrae RR, et al. The Geographic Distribution of Big Five Personality Traits: Patterns and Profiles of Human Self-Description Across 56 Nations. J Cross-Cult Psychol. 2007;38(2):173\u0026ndash;212. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0022022106297299\u003c/span\u003e\u003cspan address=\"10.1177/0022022106297299\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSier VQ, Schmitz RF, Putter H, et al. The big five: Studying the surgical personality. Surgery. 2022;172(5):1358\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.surg.2022.08.003\u003c/span\u003e\u003cspan address=\"10.1016/j.surg.2022.08.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20220903].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeyer FJ, Asendorpf JB, Asendorpf JB. Methodik. In: Neyer FJ, Asendorpf JB, editors Psychologie der Pers\u0026ouml;nlichkeit. Berlin, Heidelberg: Springer Berlin Heidelberg 2018:81\u0026ndash;133.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohn OP, Srivastava S, Pervin L et al. The Big Five Trait Taxonomy: History, Measurement, and theoretical Perspectives. 1999.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDanner D, Rammstedt B, Bluemke M et al. Die deutsche Version des Big Five Inventory 2 (BFI-2) [Download via \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi.org/10.6102/zis247]2016\u003c/span\u003e\u003cspan address=\"10.6102/zis247]2016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorman G. Likert scales, levels of measurement and the laws of statistics. Adv Health Sci Educ Theory Pract. 2010;15(5):625\u0026ndash;32. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10459-010-9222-y\u003c/span\u003e\u003cspan address=\"10.1007/s10459-010-9222-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 2010/02/11].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOslock WM, Satiani B, Way DP, et al. A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands. Am J Surg. 2022;223(1):28\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amjsurg.2021.07.033\u003c/span\u003e\u003cspan address=\"10.1016/j.amjsurg.2021.07.033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBell MA, Wales PS, Torbeck LJ, et al. Do personality differences between teachers and learners impact students' evaluations of a surgery clerkship? J Surg Educ. 2011;68(3):190\u0026ndash;3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jsurg.2011.01.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jsurg.2011.01.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20110312].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBansal R, Mathew KA, Jith A, et al. A comparison of personality traits, learning style, and perceived stress among surgical and nonsurgical residents in a tertiary care hospital in India. Ind Psychiatry J. 2021;30(2):329\u0026ndash;34. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ipj.ipj_93_21\u003c/span\u003e\u003cspan address=\"10.4103/ipj.ipj_93_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20211123].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrosdeck JM, Osayi SN, Peterson LA, et al. Surgeon and nonsurgeon personalities at different career points. J Surg Res. 2015;196(1):60\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jss.2015.02.021\u003c/span\u003e\u003cspan address=\"10.1016/j.jss.2015.02.021\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 20150218].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFong JB, Thomason HA, Sorensen MJ. Cutting Through Stereotypes: A Scoping Review of Preclinical Medical Student Perceptions of Surgery. J Surg Educ. 2025;82(4):103438. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jsurg.2025.103438\u003c/span\u003e\u003cspan address=\"10.1016/j.jsurg.2025.103438\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. [published Online First: 2025/02/02].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlohm M, McGrath A, Mukka S et al. Swedish female and male general surgeons differ in personality traits. Scandinavian J surgery: SJS : official organ Finnish Surg Soc Scandinavian Surg Soc 2024:14574969241299472. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/14574969241299472\u003c/span\u003e\u003cspan address=\"10.1177/14574969241299472\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [published Online First: 2024/11/20].\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Medical Education, Surgery, Personality, Big Five Inventory","lastPublishedDoi":"10.21203/rs.3.rs-8638440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8638440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThe surgical workforce is facing a projected shortage, partly driven by declining interest in surgical careers among medical students. While structural and lifestyle factors have been widely studied, the role of individual personality traits in shaping career interest remains incompletely understood. This study examined the association between personality traits, sex differences, prior surgical experience, and interest in pursuing a surgical career among medical students.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eIn this single-center, cross-sectional observational study, fourth-year medical students completing a two-week surgical clerkship were invited to participate. Personality traits were assessed using the Big Five Inventory (BFI). Students completed questionnaires before and after the clerkship evaluating perceptions of surgery, self-assessed skills, and career interest. Group differences and associations were analysed using t tests, ANOVA, paired-samples t tests, and correlation analyses.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eSeventy-three students (63% female) were included. Students interested in a surgical career scored significantly higher on extraversion and lower on agreeableness compared with those without surgical interest. Female students demonstrated higher agreeableness, whereas male students scored higher on extraversion. Perceived personality fit for surgery was strongly associated with surgical career interest (ρ\u0026thinsp;=\u0026thinsp;.646, p \u0026lt; .001). Prior surgical experience was significantly associated with greater interest in surgery, and overall interest increased following completion of the clerkship (p = .034).\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003ePersonality traits, particularly extraversion and agreeableness, as well as perceived personality fit and prior surgical exposure, are significantly associated with medical students\u0026rsquo; interest in pursuing a surgical career. Early clinical exposure and educational strategies addressing perceived mismatches between personality traits and surgical identity may support more inclusive recruitment into surgery.\u003c/p\u003e","manuscriptTitle":"Personality Traits and Sex-based Differences in Surgical Career Choice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 11:02:03","doi":"10.21203/rs.3.rs-8638440/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"308786666330902042336065690197554201746","date":"2026-02-24T10:59:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T08:49:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T10:15:39+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T20:02:29+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-28T11:12:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-28T09:33:54+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":"e127c9b5-f12a-4283-a82c-dcbd4ee2d8b8","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T11:02:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 11:02:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8638440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8638440","identity":"rs-8638440","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}