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

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.