From leadership research to district action: Why orthopaedics and trauma surgery loses part of its future workforce – a cross-sectional study of gender differences in medical students’ specialty choice

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Evidence and transfer

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Original authors’ abstract, reproduced under the source license:

Background As patient volumes rise and the workforce ages, medical specialties face mounting pressure to attract and retain new talent. Despite women making up the majority of medical students in Germany, their representation in surgical fields, especially orthopaedics and trauma surgery (O&T), remains comparatively low and has shown little improvement over the past decade. To ensure the future of surgical care, it is essential to understand how medical students – particularly women – perceive O&T and what factors shape their specialty choices. Methods In this prospective cross-sectional survey, 676 medical students from 32 medical faculties in Germany and Austria completed a questionnaire to assess specialty preferences, career motivations, educational experiences, and attitudes toward potential reforms in specialty training. Descriptive statistics, group comparisons, and regression analyses were used to examine gender differences and trends across stages of medical education. Results O&T was selected as a preferred specialty by 11.5% of respondents, with no significant gender difference at baseline (p = 0.213). However, female interest declined significantly throughout medical school, while male interest remained stable (p = 0.028). The most important influencing factors were subject-related interest, work environment, and practical clinical experiences. Female students rated work–life balance, part-time options, and gender representation significantly higher than male peers (all p < 0.01). Only 67.9% of students considered O&T a suitable field for women. More than half reported having been actively discouraged from entering the field—frequently by O&T physicians themselves (accounting for 30% of reported discouragement). Conclusion This study reveals a persistent gap between early interest in O&T and the structural realities that may shape students’ long-term career decisions. This disconnect does not appear to stem from a lack of interest or ability but may be linked to perceived barriers such as rigid hierarchies, limited female representation, and exclusionary workplace cultures. Supporting future talent may therefore require attention to sustainable career paths, inclusive leadership, and visible efforts toward structural change. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-025-08320-2.

Study methods

This prospective cross-sectional study examined the determinants of specialty choice among medical students, with a particular focus on gender differences and the field of O&T. The survey targeted undergraduate medical students from all years of study at medical faculties in Germany and Austria. Recruitment was conducted through both analogue and digital channels, including posters in lecture halls and libraries, as well as targeted outreach via university-specific social media groups, faculty websites, and medical societies. Participation was entirely voluntary, anonymous, and without compensation. Ethical approval was obtained from the Ethics Committee of the Technical University of Munich (Reference No.: 2024-321-S-SB). A clinical trial number was not applicable.

Limitations

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A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one recurring leadership practice described in the source. Map its participants, incentives and constraints to a district setting, then design a small reversible staff pilot with an accountable owner. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Record implementation fidelity, staff review time, task quality and unintended burdens against a baseline. Use a comparison team where feasible and document alternative explanations before expanding. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Conrad Ketzer; Amelie Sinz; Gregor Bielesch; Carolin Müller; Andrea Achtnich; Peter Biberthaler; Marc Hanschen; Olivia Bohe. Why orthopaedics and trauma surgery loses part of its future workforce – a cross-sectional study of gender differences in medical students’ specialty choice. BMC Medical Education (2025-11-22). https://doi.org/10.1186/s12909-025-08320-2

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.