Willingness to undergo autonomous robotic surgery in Jordanian medical students: a national multicenter cross-sectional survey.

Abstract

Surgical robots in clinical use operate under continuous human control, yet research systems now perform surgical tasks on their own. Patient willingness may limit adoption, and to our knowledge no study has measured willingness across defined levels of autonomy while holding performance constant. To estimate the willingness of Jordanian medical students to undergo high-autonomy robotic surgery with immediate surgeon oversight and to quantify how willingness changes as autonomy increases. We conducted a national, multicenter, cross-sectional online survey of a convenience sample of undergraduate medical students at eight Jordanian medical schools between 31 August and 17 September 2026. After a standardized vignette, students rated their willingness to undergo their own operation on a five-point scale under five arrangements, from surgeon-controlled robotic surgery (stage 1) to artificial intelligence (AI) operating with no surgeon in the room and none immediately available (stage 5), with regulatory approval and outcome equivalence held constant. The prespecified primary endpoint was willingness at stage 4 (the AI performs the whole operation while a surgeon in the room can take over); the gradient across stages was a prespecified secondary analysis. Cumulative link mixed models accounted for repeated ratings. Among five hundred seventy-four students (59.6% female), 39.7% (95% CI 35.8 to 43.8) reported willingness at stage 4. The proportion willing fell from 76.0% at stage 1 and 77.7% at stage 2 to 47.2% at stage 3 and 18.6% at stage 5 (odds ratio per stage 0.40, 95% CI 0.37 to 0.42). The largest declines followed AI performance of surgical steps (-30.5% points, 95% CI -35.0 to -25.8) and loss of immediate surgeon presence and rescue capability (-21.1 points, 95% CI -25.0 to -17.0). Trust in autonomous systems showed an association with willingness (adjusted odds ratio per SD 2.75, 95% CI 2.14 to 3.54), whereas surgical career intention showed none. The direction of each decline persisted across analyses of university representation and response quality, although the gradient was steeper among higher-quality respondents; stage 4 willingness ranged from 34.9% to 41.7%. Among these Jordanian medical students, willingness declined in steps rather than along a smooth curve, falling most when the machine began to act and when a surgeon was no longer immediately present or able to intervene. A supervised, stepwise introduction of surgical autonomy, with a surgeon able to intervene, would match their stated preferences; the views of patients remain untested.