Evaluating Speciality Preferences and Career Choices Among Nigerian Medical Students, Interns, and Preresidency Doctors: A Systematic Review and Meta-Analysis

Background Specialty selection among medical trainees directly impacts service provision capacity and future clinical workforce in Nigeria, with low physician density and uneven specialty distribution. We synthesised the literature to quantify specialty preferences, timing of decision-making, and the determinants across the different stages of training. Methods Adhering to PRISMA guidelines, a systematic review and meta-analysis of primary quantitative studies involving Nigerian medical students, interns/house officers and pre-residency doctors was performed. PubMed, Google Scholar and hand-searches were conducted to 2025. Eligible cross-sectional surveys that reported the determinants or preferences for specialisation were considered. Quality of study was assessed using AXIS. For meta-analysis, we pooled specialty-specific proportions using random-effects models with Freeman–Tukey double‐arcsine transformation and evaluated heterogeneity using I². Predefined subgroup analyses investigated training stage, region, decade, and study-level gender composition. Results Twenty studies (1992–2025) met the inclusion criteria (pooled participants > 4,000); 14 studies contributed to pooled proportions. Surgery was the most preferred specialty (pooled 28.5%, 95% CI 24.0–33.3%; n ≈ 3,127; I²=88.6%). Obstetrics & Gynaecology 18.1% (95% CI 14.3–22.3%); Paediatrics 13.8% (95% CI 10.1–18.0%); Internal Medicine 11.8% (95% CI 9.3–14.6%). Low-preference fields included Radiology (1.5%, 95% CI 0.6–2. 9%) and Pathology (1.8%, 95% CI 0.9–3.0%). Subgroup analysis: Surgical preference was higher in undergraduates (Tier-1 pooled ≈ 33.0%) compared with interns (Tier-2 ≈ 22.1%). Time: the weighted pooled proportion indicated 57.5% decided during clinical rotations/final years. Determinants (pooled/proxy): personal interest 75.1%, clinical rotations influence ~ 62.2%, work–life considerations ~ 64.2%; ~11–13% remained undecided. Only ~ 34% (in studies reporting guidance; n = 1,453) received any form of career counselling. Between-study heterogeneity was high; most studies had moderate RoB. Conclusions Medical trainees in Nigeria strongly prefer surgical and core clinical specialties, with interest in diagnostic/non-clinical specialties remaining persistently low. The majority of choices consolidate during clinical years and are mainly influenced by personal interest, exposure and perceived prospects. Interventions, including earlier structured career guidance, enhanced exposure and speciality-specific mentorship for under-selected specialities, are required to rebalance the workforce imbalance.