Understanding Intersectional Barriers Among Medical Students Pursuing Surgical Specialties

Many surgical subspecialties continue to demonstrate disparities in gender and racial/ethnic representation despite increasing diversity within medical education and surgical training. While prior studies have examined demographic factors individually, few have evaluated how intersecting identities influence medical students' interest in surgical careers. This study examined the association between intersecting social identities, educational experiences, and interest in surgical specialties among U.S. medical students.

A multi-institutional, cross-sectional survey was administered to medical students from five U.S. medical schools to evaluate factors associated with interest in surgical specialties. The 45-item survey assessed demographic and socioeconomic characteristics, educational experiences, mentorship, identity-related perceptions, and specialty preferences throughout medical training. Group comparisons were performed using chi-square, Fisher's exact, and Mann-Whitney U tests, while multivariable logistic regression was used to identify factors independently associated with surgical interest.

A total of 95 respondents provided specialty preference data at matriculation, of whom 93 had classifiable preferences and were included in the primary analysis. At matriculation, 46.2% (n = 43) expressed interest in a surgical specialty and 53.8% (n = 50) expressed interest in a nonsurgical specialty. In multivariable analysis, underrepresented minority status was independently associated with lower odds of surgical interest (adjusted odds ratio 0.18; 95% confidence interval [CI] 0.05-0.64, P = 0.008), while greater encouragement before medical school was associated with higher odds of surgical interest (adjusted odds ratio 1.98; 95% CI, 1.26-3.11, P = 0.003). Each additional marginalized identity was associated with lower odds of surgical interest (odds ratio 0.45; 95% CI, 0.27-0.74, P = 0.001). Students interested in surgery also reported greater access to surgical research opportunities before and during medical school (P < 0.05).

Intersecting marginalized identities were associated with lower interest in surgical specialties, while encouragement and mentorship were associated with greater interest and persistence in surgery. These findings highlight potential targets for interventions aimed at improving diversity within the surgical workforce.