Medical student perceptions and career intentions toward neurosurgery: results from an international multicentre study.

Despite neurosurgery's rapid evolution as a speciality, the presence of structured neurosurgical education in medical schools remains limited. There is growing concern that reduced exposure contributes to declining student interest in the field. The ScoTtish And iRish medical students' perceptions Towards neurosurgery (STARTS) study aimed to assess medical students' attitudes, perceptions, and experiences with neurosurgery, identifying factors that influence career interest and intent to pursue the speciality. A cross-sectional survey was distributed to medical students across Scotland, Northern Ireland, and the Republic of Ireland between January and June 2023. The study included all medical schools in these countries. The survey comprised demographic questions, Likert-scale responses, and free-text answers. Predictors of interest and intent to pursue neurosurgery were analysed using binomial generalised linear regression models. Qualitative data were analysed using thematic analysis. A total of 2,795 complete responses were analysed. While 73% of students found neurosurgery interesting, only 25% intended to pursue it as a career. Neurosurgical interest was highest among first-year students and declined as they progressed through medical school. A lack of structured exposure was evident, with 89% of students having never completed a neurosurgical clinical placement and 84% reporting no direct exposure to the speciality. Factors significantly associated with an increased interest, and intention to pursue neurosurgery included membership in a student neurosurgical interest group (OR = 2.14, p < 0.001), attending a neurosurgical conference (OR = 3.15, p < 0.001), an interest in academic medicine (OR = 1.64, p < 0.001), completing a neurosurgical clinical clerkship/mandatory placement (OR= 1.56, p < 0.023), and having a peer-reviewed neurosurgical publication (OR=1.96, p < 0.0017). However, progression through medical school was an independent negative predictor of both interest and intent to pursue neurosurgery. Fascination with neuroanatomy/neurosciences, surgical-neurology, and financial compensation were main attractors. In contrast, a competitive and long training process, poor work-life balance, and an inflexible schedule were major deterrents expressed by medical students. This is the largest study to date assessing medical students' interest in neurosurgery in a Western medical education setting. Our findings indicate that structured exposure-through clinical clerkships, mentorship, and student-led engagement-plays a critical role in fostering interest. The absence of early, formal neurosurgical education may contribute to the attrition of potential trainees. These results highlight an urgent need to integrate neurosurgical teaching into medical curricula, ensuring equitable access to exposure and mentorship. Future studies should explore the long-term impact of these interventions on neurosurgical recruitment and workforce development.