Assessment of Factors and Deterrents Influencing Medical Students in Pursuing a Career in Surgical Disciplines: Gender-Based Perceptions From a Teaching Hospital in India

Abstract

Introduction

Gender disparity within the health care profession, specifically in surgical fields, continues to be a subject of discussion. Understanding these gender-specific determinants is key to fostering inclusivity in surgery. This study investigates gender-related perspectives on pursuing a career in surgical disciplines and assessess the perceived challenges among medical students in India.

Methods

A cross-sectional survey was conducted at a teaching hospital. Third through fifth-year medical students were invited to fill a semi-structured questionnaire investigating career preferences and the influencing factors. The data was collected through a survey and analyzed. Likert-scale type responses and open-ended questions were analyzed separately. Appropriate statistical tests were used to compare the gender-based responses.

Results

231 complete responses were analyzed. Of these, 61.5% were females. Interest in pursuing surgery was found to be similar in both genders (P = .61). Both male and female students cited concerns about work-life balance as the major factor (41.6%) influencing their interest in pursuing surgery, followed by personal interest in anatomy and surgical techniques (39%), and exposure to surgical procedures (36.4%). Female students perceived limited opportunities in surgical training (M = 7.8%, F = 21.1%, P = .007) and gender bias in surgical disciplines (M = 34.8%, F = 50%, P = .02) as a significant challenge as compared to their male counterparts. Approximately 1/3rd females reported a lack of female surgical role models.

Conclusion

This comprehensive analysis illuminates the evolving gender dynamics in a developing nation, reflecting a burgeoning interest in surgical specialties among female students. Creating targeted training opportunities and gender-conducive environments for female students can catalyze this positive shift.

Keywords

women in surgery gender disparity inclusivity in surgery surgical education career barriers

Key Takeaways

• This study addresses a critical knowledge gap about the gender-based factors that influence female medical students in pursuing surgery.

• It shows an increased interest of females in a surgical career, signaling hope for an inclusive and diverse surgical workforce in a developing nation.

• It highlights that despite similar interests, females perceive significant challenges as compared to their male counterparts. This underscores the need for targeted interventions for promoting this favorable shift.

Introduction

Gender disparity in the health care profession, particularly within surgical disciplines, remains a pressing global issue. Multiple international studies point to several factors—such as the demanding nature of surgical training, lifestyle constraints, lack of female role models, and familial responsibilities—that disproportionately affect female students’ career choices in surgery.^1-3 While these barriers are well documented globally, there is a limited understanding of how these factors manifest within the distinct socio-cultural landscape of India.

In India, despite a significant increase in female enrollment in medical colleges, their representation in surgical specialties remains strikingly low. The Association of Surgeons of India (ASI) reports that out of 32,000 members, only 4160 (12.5%) are women. A 2016 report highlighted that in Hyderabad’s corporate hospitals, merely 10% of surgeons were women, with most specializing in obstetrics and gynecology.^4,5 This underrepresentation is even more pronounced in certain specialties; for instance, women make up only about 1% of orthopedic surgeons in India.⁶ This data indicates a significant gender disparity in the surgical field.

Comparatively, in Canada, females constitute 29.3% of practicing surgeons across surgical specialties.⁷ In the United States, AAMC physician workforce data from 2023 shows that women accounted for 24.9% of general surgeons, while they made up 38.1% of the overall physician workforce.⁸ These figures indicate that while gender disparities in surgical fields are a global issue, the gap is notably wider in India.

Female medical students often report challenges unique to their gender, including limited mentorship opportunities, strong societal pressures, and a general lack of encouragement to pursue surgical training.^9,10 These barriers are particularly pronounced in environments where traditional expectations and limited support for working females add further complexity to career choices. Studies show that these challenges are compounded by the perception of surgery as a male-dominated specialty, which exacerbates concerns over work-life balance, career satisfaction, and managing prolonged training periods.^11,12

While there is extensive research on these factors in Western contexts, findings from low- and middle-income countries like India are limited and underexplored, where unique socio-cultural dynamics may play a significant role in shaping career decisions.^13,14 This creates a critical knowledge gap regarding gender-based challenges in surgical career pathways for Indian medical students.

Our study addresses this gap by examining gender-based perceptions and deterrents specific to medical students at a teaching hospital in India. Through this, we aim to identify the unique challenges that female students face compared to their male counterparts, from both logistical and experiential perspectives. By assessing the influence of mentorship, role models, and practical exposure through surgical rotations and workshops, this study seeks to provide actionable insights into creating an inclusive environment in surgical fields. Our objective is to not only illuminate the challenges but also to identify strategies that may encourage more women to consider and pursue careers in surgery, ultimately contributing to a diverse and resilient surgical workforce in India.

Methods

Ethical Considerations

This study was approved by the Institutional Ethics Committee of the teaching hospital where the study was conducted. Informed consent was obtained electronically via a secure digital platform prior to participation in the study. No demographic data, such as name, age, and email address, was collected, except for gender. The participants were informed of their right to refuse to participate in the study and to withdraw from the survey at any point.

Study Design

This was a cross-sectional survey aimed to understand the factors influencing medical students in India in pursuing a career in surgical disciplines and to compare these factors between male and female students. The study also looked at the specific challenges and factors that deter female students from pursuing a surgical career and assessed the role of mentorship and exposure to surgery in shaping their choice.

Study Setting

The study was conducted at a teaching hospital in India, which offers 5.5 years of medical school training, earning an MBBS degree. The first 2 years include basic science subjects—anatomy, physiology, biochemistry, pathology, microbiology, and forensic medicine. The third and fourth years include all clinical subjects, with the fifth year being a compulsory pre-graduation rotatory internship prior to earning the degree.

Study Population

Third through fifth year medical students (all genders) were invited to fill out the survey. Students from the first and second years were excluded from the study due to the lack of sufficient clinical exposure, which affected their decision to choose a particular career stream.

Study Tools and Data Collection

A semi-structured questionnaire was designed. It aimed at investigating career preferences and the influencing factors, identified in the literature regarding gender differences and career decision-making in surgical specialties. Face validity was established by seeking feedback from senior surgical faculty members experienced in the field. They evaluated the relevance, clarity, and comprehensiveness of the questions in capturing the study’s objectives. Following this, a pilot study was conducted with 22 participants from the target population to ensure the questionnaire effectively collected data pertinent to the research aims. The pilot data were analyzed to establish the questionnaire’s reliability and validity, allowing for minor revisions before its use in the main study. This questionnaire was administered through the online method of Google Forms. Data was collected after obtaining informed consent.

Statistical Analysis

Descriptive statistics like arithmetic mean were used to analyze basic data like gender and interest in surgery. A Chi-square test was used to compare gender-based responses. IBM SPSS Statistics 29 was used for data analysis. Data was expressed in percentages. P < .05 was considered significant.

Results

231 complete responses were analyzed. Of these, 61.5% (N = 142) were females and 38.5 (N = 89) were males. 36.8% of respondents were from the third year, 18.6% from the fourth year, and 44.6% from the fifth/internship year. Mean interest in pursuing surgery as a specialty, on a scale of 1 to 5, was found to be similar in both genders (F = 3.1971, M = 3.2808, P = .61).

Table 1 summarizes the specialty choices indicated by the respondents, segregated by gender. Participants were offered the choice to select multiple specialties of their interest. Comparing the specialty choice, orthopedic surgery was preferred more by males (M = 14.6%, F = 2.1%, P = .0003), and obstetrics-gynecology (M = 2.2%, F = 15.5% P = .001) and pediatric surgery by females (M = 6.7%, F = 16.2%, P = .03).

Table 1.

Specialty Choices of Study Participants by Gender.

Specialty	Survey Respondents	% Survey Respondents	Females	Males
Specialty	Survey Respondents	% Survey Respondents	N (%)	N (%)
Not interested	40	17.3	24 (16.90)	16 (17.97)
Undecided	44	19	24 (16.90)	20 (22.47)
General surgery	57	24.7	33 (23.23)	24 (26.96)
Cardio-thoracic surgery	48	20.8	31 (21.83)	17 (19.10)
Orthopedic surgery	23	10	5 (3.52)	18 (20.22)
Obs-gynae surgery	24	10.4	22 (15.49)	2 (2.24)
Ophthalmology surgery	25	10.8	18 (12.67)	7 (7.86)
ENT surgery	16	6.9	12 (8.45)	4 (4.49)
Neurosurgery	42	18.2	22 (15.49)	20 (22.47)
Urological surgery	4	1.7	2 (1.40)	2 (2.24)
Vascular surgery	7	3	5 (3.52)	2 (2.24)
Plastic surgery	23	10	15 (10.56)	8 (8.98)
Pediatric surgery	29	12.6	23 (16.19)	6 (6.74)
Surgical oncology	1	0.4	0 (0)	1 (1.12)

Figure 1 reflects the factors cited by participants that have influenced their interest or lack of interest in surgery. Participants were offered the choice to select multiple factors that influenced their interest. Both male and female students cited concerns about work-life balance as the major factor (41.6%) influencing their interest in pursuing surgery, followed by personal interest in anatomy and surgical techniques (39%), and exposure to surgical procedures (36.4%).

Clinical rotations and surgical/simulation workshops were indicated by students to be the most effective ways to increase interest and explore surgical disciplines, with mean effectiveness of 3.197 and 3.107, respectively, on a scale of 1 to 5. Lectures and seminars, and professional conferences were given a mean effectiveness of 2.5 and 2.67, respectively.

Figure 2 represents the perceived challenges or barriers cited by students that discouraged them from pursuing surgery, segregated by gender. Female students perceived limited opportunities in surgical training (M = 7.8%, F = 21.1%, P = .007) and gender bias in surgical disciplines (M = 34.8%, F = 50%, P = .02) as a significant challenge as compared to their male counterparts. Approximately 1/3 females reported a lack of female surgical role models.

In response to an open-ended question regarding gender-specific challenges in surgical disciplines, participants highlighted several recurring themes:

1. Patient Perceptions: Respondents felt that female surgeons were often perceived by patients as less competent compared to their male counterparts. Many patients, especially in culturally conservative settings, preferred male surgeons for procedures they associated with strength or technical precision. This bias was particularly pronounced in specialties like orthopedics and cardiac surgery.

2. Societal Expectations and Stereotypes: Surgical fields are male-dominated, with societal norms discouraging women from pursuing them. Common stereotypes suggest that women pursue specialties like obstetrics and gynecology rather than general surgery or orthopedics. Male students also felt that pursuing a career in obstetrics-gynecology would be difficult for them due to females being uncomfortable with male gynecologists.

3. Challenges Maintaining Work-Life Balance: Respondents noted that the demanding nature of surgery, including long hours and stress, disproportionately impacted women due to societal expectations of concurrently managing family responsibilities. These challenges were compounded by a lack of institutional and familial support.

4. Mentorship and Representation: A scarcity of eminent female surgeons and role models in the field contributed to the limited guidance available for women navigating surgical careers.

5. Physiological Barriers: Concerns about managing long surgeries during menstruation and the physical demands of certain specialties were also mentioned, though these were less frequently cited.

Only 44.6% of students reported receiving sufficient information and exposure to surgical disciplines during their medical education. This left the majority without adequate understanding of surgical career pathways and the realities of the profession. 61.9% of students indicated that they did not receive adequate mentorship and guidance regarding career choices specifically related to surgical disciplines.

Participants suggested that overcoming these challenges required targeted mentorship that will encourage more females to opt for a career in surgery. Additionally, institutional support, access to female surgical role models, and societal change were deemed necessary to catalyze this rise in interest.

Discussion

Our study provides insights into the gender-based perceptions and challenges in pursuing surgical career pathways among medical students in India. While our findings align with some of the global trends, they also highlight distinct patterns shaped by India’s unique socio-cultural context.

One notable finding is that interest in pursuing a surgical career was comparable between male and female students (P = .61), challenging the notion that gender disparity in surgical practice stems from differing levels of interest. Despite both genders expressing similar baseline enthusiasm, female respondents reported significantly greater challenges. Our data reveals that structural and societal barriers disproportionately deter women.

This differs from Western literature, where gender-based differences in initial interest are often more pronounced.^1,2 Data from American medical students suggest that initial interest in surgery among female students may be lower than that of their male counterparts. For instance, a recent study by Lawson et al (2024) found that medical students’ perceptions of family planning and work-life balance considerations during surgical residency influenced their career decisions, particularly among women.¹⁵ This suggests that work-life balance concerns are a universal factor in career choice.

Additionally, while Western studies frequently cite the lack of female surgical role models as a primary deterrent,³ our participants identified gender bias (50% of female respondents) and limited training opportunities (21.1%) as the most significant barriers for women in India. Stressful work environments (37.3%) and difficulty maintaining a good family life (37.3%) were among the other perceived challenges, underscoring that cultural and societal pressures—such as family expectations and traditional gender norms—play a much more substantial role in India. These challenges exacerbate concerns over work-life balance and discourage women from entering surgical disciplines.

In our study, both male and female participants highlighted concerns regarding work-life balance, indicating that these challenges are not exclusive to one gender. This aligns with emerging evidence that work-life balance concerns are part of a broader generational shift in medical professionals’ priorities. Recent research indicates that younger physicians, regardless of gender, place greater emphasis on work-life balance than their older counterparts.¹⁶ This shift may also reflect evolving gender dynamics, where men are increasingly seeking active roles in family life, further reinforcing the importance of flexible work environments.

The gender preferences observed in subspecialty interests, such as the higher proportion of males favoring orthopedic surgery (14.6% vs 2.1%, P = .0003) and females showing a significantly higher preference for obstetrics and gynecology (15.5% vs 2.2%, P = .001) and pediatric surgery (16.2% vs 6.7%, P = .03), reflect deep-rooted stereotypes about gender roles in medicine and cultural perceptions about physical and emotional labor.

The open-ended responses highlighted how institutional barriers, patient perceptions, and cultural norms create unique challenges for aspiring female surgeons, pointing to the need for targeted interventions that address the interplay of societal and structural factors.

The findings highlight the need for institutional and societal interventions to address gender bias in surgical training. Targeted mentorship programs, increased access to female surgical role models, and initiatives encouraging women surgeons to take leadership roles are critical steps in promoting gender equity. Organizations like the Association of Surgeons of India (ASI) have made strides by establishing the Women in Surgery (ASI-WINS) wing,⁵ which focuses on creating opportunities for female surgeons. However, these efforts must expand to include medical students, fostering interest and confidence from an early stage.

Our study offers valuable insights into the unique factors influencing gender disparities in surgery within a developing country. The comprehensive approach, combining quantitative and qualitative data, enhances the robustness of our findings. By focusing on medical students, our study captures unique perspectives during early career decision-making processes. Additionally, the emphasis on India’s unique socio-cultural context fills an important gap in the existing literature, which often centers on data from high-income countries. These observations will assist in formulating evidence-based recommendations for fostering inclusivity in surgical disciplines.

This study is limited by its single-institution setting, which may restrict the generalizability of its findings across India, where cultural and institutional factors may vary by region. The cross-sectional nature of the study prevents us from exploring how perceptions and challenges evolve over time. Furthermore, response bias, particularly around sensitive topics like gender discrimination, may have influenced the results. Future research should include multi-institutional longitudinal studies to expand our understanding and assess the long-term impact of proposed interventions.

Based on our findings, we recommend several actionable steps:

• Mentorship Programs: Establish structured mentorship opportunities within the medical institution, connecting medical students with experienced surgeons, with a focus on female mentors for female students.

• Role Model Visibility: Promote the achievements of female surgeons through conferences, seminars, and media to inspire students.

• Policy Interventions: Advocate for policies that support work-life balance, such as flexible schedules, a family friendly workplace environment, and childcare support, to alleviate the pressures of balancing professional and personal responsibilities.

• Early Intervention: Implement structured surgical exposure programs during medical school, particularly targeting female students to inspire interest and confidence.

• Empowerment at Student Level: Establish medical student committees to provide a platform for addressing student concerns and fostering leadership development.

• Cultural Competency Training: Implement programs aimed at reducing gender bias among healthcare professionals and patients, focusing on dismantling stereotypes and encouraging inclusivity.

• Research Expansion: Conduct longitudinal studies to assess the impact of mentorship programs and institutional interventions on surgical career pathways.

Conclusion

This study highlights the gender-based barriers medical students face in pursuing surgical careers in India. While interest in surgical careers is gender-neutral, the path to becoming a surgeon remains disproportionately challenging for women due to systemic and socio-cultural barriers. Overcoming cultural, societal, and institutional challenges will require a multifaceted approach. By amplifying initiatives like the ASI-WINS and introducing interventions that address the unique challenges faced by female medical students, we can work toward greater gender equity in the surgical workforce. These efforts are not only essential for promoting diversity but also for strengthening the resilience and inclusivity of the surgical profession.

Supplemental Material

Supplemental Material - Assessment of Factors and Deterrents Influencing Medical Students in Pursuing a Career in Surgical Disciplines: Gender-Based Perceptions From a Teaching Hospital in India

Supplemental Material for Assessment of Factors and Deterrents Influencing Medical Students in Pursuing a Career in Surgical Disciplines: Gender-Based Perceptions From a Teaching Hospital in India by Yashjot Kaur, Ambreen Deol, Sanjeev Mahajan, and Kamal Jyoti in Journal of the American Surgeon™.

Footnotes

Acknowledgments

We would like to express our gratitude to Kunvar Thaman for his valuable feedback and technical assistance in the presentation of our research findings.

Author Contributions

1. Conceptualization: Yashjot Kaur and Ambreen Deol conceptualized the research idea, formulated the hypothesis, and outlined the study objectives. 2. Methodology: Yashjot Kaur designed the study, led the data collection process, and performed the data analysis. Ambreen Deol designed the study questionnaire. Ambreen Deol, Sanjeev Mahajan, and Kamal Jyoti provided support in refining the study design and assisted in data collection and interpretation. 3. Writing and Editing: Yashjot Kaur and Ambreen Deol drafted the initial manuscript. Sanjeev Mahajan and Kamal Jyoti provided critical feedback and revisions to improve intellectual content. Sanjeev Mahajan, as the senior author, conducted the final review and editing to ensure scientific accuracy and clarity. 4. Approval and Accountability: All authors have reviewed and approved the final version of the manuscript. They collectively assume responsibility for the accuracy, integrity, and authenticity of the work.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Statement

ORCID iD

Yashjot Kaur

Data Availability Statement

The data for this study are available on request from the corresponding author.*

Supplemental Material

Supplemental material for this article is available online.

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