Who Chooses the Scalpel? Vietnamese Study Probes Why Medical Students Pick Surgery

When a medical student writes down the specialty they hope to pursue, they are making one of the most consequential decisions of their professional life. That decision ripples far beyond the individual, shaping the future distribution of physicians across fields that are often chronically understaffed. Surgery sits squarely in that category in many parts of the world, including Vietnam, where the surgical workforce remains limited and every student who turns away from the operating theater represents a gap that may take years to fill. A new cross-sectional study from a private, not-for-profit medical school in Hanoi now offers a detailed, statistically careful portrait of which students say they want to become surgeons, and which influences travel with that ambition.

The research, published in BMC Medical Education, was led by Quang Thanh Nguyen and Hien Duy Pham along with colleagues at VinUniversity’s College of Health Sciences. The team drew on the specialty-preference module of a broader institutional survey on career identity and choice, administered between September and November 2024. Rather than asking a single yes-or-no question about surgery, the survey asked students in their second, third, and fourth years to rank three specialty preferences in order. That ranked structure allowed the investigators to distinguish between students whose top choice was surgical and those who merely listed a surgical field somewhere among their three options, a distinction that turns out to matter for how the results should be read.

The response rate was strikingly high. Of 144 eligible students, 131 participated, a 91.0 percent response rate that lends the findings considerable weight for this single institution. Within that group, 49 students, or 37.4 percent, placed a surgical specialty first on their list, while 74 students, or 56.5 percent, included a surgical specialty at any of the three ranks. In other words, roughly one in three students at this school named surgery as their dream destination, while more than half kept it on their shortlist. Those figures provide a useful baseline for a country where surgical capacity is a persistent concern, and they suggest that interest in surgery is far from absent among Vietnamese medical trainees.

Before running any models, the researchers asked students to rate the perceived influence of a wide range of factors, from lifestyle considerations and income expectations to stereotypes about different specialties. Because they were testing many item-level comparisons at once, the team applied the Benjamini-Hochberg procedure, a statistical correction designed to control the false discovery rate when multiple hypotheses are tested simultaneously. Across 33 such comparisons, none of the item-level differences between students who preferred surgery and those who did not survived the correction threshold of q less than 0.05. That null result is itself informative: it suggests that no single perceived influence, measured in isolation, cleanly separates aspiring surgeons from their peers, and it cautions against overinterpreting any one survey item.

The heart of the analysis lay in exploratory regression modeling. The investigators used Firth regression, a variant of logistic regression specifically designed for situations where outcomes may be imbalanced or sample sizes modest, as was the case here with 131 participants. Firth’s method applies a penalty that reduces the small-sample bias that can distort ordinary maximum-likelihood estimates, making it a defensible choice for an exploratory study of this scale. The primary outcome was a first-ranked surgical preference, and the model included gender, permanent residence, cohort year, and two numerical ratings: the perceived importance of administrative or leadership roles, and the perceived importance of research or teaching in a future career.

Two associations emerged from the primary model. First, male students had substantially higher odds of ranking a surgical specialty first than female students, with an odds ratio of 2.46 and a 95 percent confidence interval of 1.14 to 5.46. Because that interval excludes 1.0, the association is statistically meaningful, though the wide range reflects the uncertainty inherent in a modest sample. The finding echoes a pattern documented repeatedly in international literature on surgical career choice, where gender disparities in surgical specialties remain stubbornly persistent across many countries and training systems. Its appearance in a Vietnamese private medical school suggests the phenomenon is not confined to any single educational culture.

Second, students who rated administrative and leadership roles as more important to their future careers were more likely to prefer surgery. In the model specification that treated the rating as a continuous numerical score, each one-point increase in the rating was associated with an odds ratio of 1.62, with a 95 percent confidence interval of 1.17 to 2.33. This is an intriguing signal, because it hints that students drawn to surgery may also be drawn to positions of institutional authority, whether as department heads, hospital administrators, or leaders of surgical teams. However, the authors are careful to note that categorical analyses of the same variable did not establish a linear gradient, meaning the data do not prove that each incremental increase in the rating produces a proportional increase in surgical preference.

The study’s most important contribution may be its methodological honesty. The authors explicitly state that the estimates describe concurrent associations conditional on the selected model, not antecedent determinants. In plain terms, students rated their perceived influences after they had already stated their preferences, so the ratings capture how aspiring surgeons see their future rather than factors that demonstrably caused the preference. A student who dreams of surgery may, in retrospect, inflate the importance of leadership because surgeons lead teams; the survey cannot disentangle that direction of influence. Patterns for cohort year and for research and teaching ratings also shifted depending on which outcome definition and model specification was used, underscoring the fragility of exploratory findings in small samples.

That caution extends to the relationship between stated preference and actual career entry. The authors emphasize that a preference expressed in a survey should never be equated with subsequent entry into surgical training. Specialty choices evolve through clinical rotations, mentorship, exposure to role models, examination of lifestyle trade-offs, and the practical realities of residency positions. A student who lists surgery first in year two may abandon it after a demanding rotation, while another who never mentioned surgery may discover a passion for the operating room in year four. Longitudinal designs that follow students from preference to match are needed to establish whether the gender gap and the leadership association observed here predict real training decisions.

Even with those limits, the study offers practical value for educators and policymakers confronting surgical workforce shortages. The high response rate and the ranked-preference design provide a template that other institutions in Vietnam and comparable settings can adapt, and the finding that more than half of students keep a surgical field on their shortlist suggests a reservoir of latent interest that targeted interventions might convert into applications. If the association between leadership orientation and surgical preference holds up in prospective work, mentorship programs could highlight the genuine leadership pathways that surgical careers offer, while simultaneously addressing the gender disparities that continue to steer women away from the operating theater. For now, the study stands as a carefully calibrated snapshot: a single Vietnamese medical school, 131 students, and a statistical framework honest enough to say what the data cannot yet prove.

Subject of Research: Factors associated with medical students' preference for surgical specialties at a Vietnamese medical school

Article Title: Factors associated with medical students’ preference for surgical specialties at a Vietnamese medical school: a cross-sectional study

Article References: Factors associated with medical students’ preference for surgical specialties at a Vietnamese medical school: a cross-sectional study. (n.d.). https://doi.org/10.1186/s12909-026-10627-7

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10627-7

Keywords: medical education, surgical specialties, specialty preference, career choice, medical students, Vietnam, gender disparity, cross-sectional study, Firth regression, surgical workforce, leadership roles, BMC Medical Education