From First-Year Dreams to Sixth-Year Realities: A Repeat Cross-Sectional Study of Medical Students’ Specialty Preferences
by
, , , , , and
Yael Hollander
1,†
,
Nir Amitai
1,†,
Shimrit Salem Yaniv
1,2,
Itamar Ben Shitrit
1,
Anat Horev
1,3
,
Inbal Golan Tripto
1,4 and
Amir Horev
1,5,* 1
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
2
Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva 8410101, Israel
3
Neurology Department, Soroka University Medical Center, Beer Sheva 8410101, Israel
4
Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva 8410101, Israel
5
Pediatric Dermatology Service, Soroka University Medical Center, Beer Sheva 8410101, Israel
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Educ. Sci. 2025, 15(11), 1545; https://doi.org/10.3390/educsci15111545
Submission received: 17 October 2025
/
Revised: 8 November 2025
/
Accepted: 12 November 2025
/
Published: 17 November 2025
Abstract
Medical students often begin their studies with preconceived notions about specialties, which may evolve as they gain clinical experience. This study aimed to assess changes in specialty preferences over six years of medical training and to compare two cohorts of first-year students. A repeat cross-sectional design was used, analyzing survey data from the 2019 class during preclinical (first–second year) and clinical (sixth year) stages, and from the 2024 first-year cohort. A total of 367 students participated. Comparing preclinical and clinical students revealed a significant increase in interest in ophthalmology (2.9% vs. 11%, p = 0.012), along with non-significant upward trends in obstetrics and gynecology and family medicine. Declines were observed in psychiatry, oncology, neurosurgery, and surgery. The 2024 cohort included a higher proportion of students with a prior medical background compared with the 2019 cohort (43% vs. 23%, p = 0.002), but no other demographic or specialty preference differences were identified. These findings suggest that specialty preferences among medical students may shift during clinical training, while initial preferences appear relatively consistent across cohorts. Understanding how medical education influences career development may guide curricular strategies to balance specialty distribution and address workforce needs.
1. Introduction
Choosing a medical specialty is a pivotal decision that greatly shapes a physician’s career and life trajectory. This choice is influenced by a complex interplay of factors including mentorship, potential salary (McDonald et al., 2021), workload and reputation (Grasreiner et al., 2018), domestic circumstances (Soethout et al., 2004), work–life balance, interaction with patients (Ie et al., 2018) and personal interest (Mohamed et al., 2015). Such considerations are present even in early medical training (Dikici et al., 2008). Approximately 60% of medical students reportedly change their specialty preferences during their clinical years (Rachoin et al., 2023), highlighting the interplay between career choices and clinical exposure.
In Israel, there are currently four universities offering six-year direct-entry medical programs. Medical education primarily follows a six-year curriculum, similar to the European model. This curriculum is divided into three years of preclinical studies focusing on foundational sciences, and three years of clinical training involving hospital rotations. Graduates then complete a one-year internship before residency applications. In contrast, the U.S. model typically involves four years of undergraduate medical education following a prior bachelor’s degree, with an emphasis on pre-medical coursework and standardized entrance exams (McOwen et al., 2020). This educational composition occurs within a system that, over the past 20 years, has seen a significant increase in medical student enrollment, with the number of students admitted to six-year programs rising from 403 in 2010 to 538 in 2021. Notably, Ben-Gurion University’s medical school accounted for 160 of these students in 2021 (~30% of six-year program admissions that year), compared to 76 in 2010 (~19% of six-year program that year) (Levaillant et al., 2020). Residency program selection in Israel occurs within a largely free-market approach, operating within a predominantly public healthcare system. While a recent Israeli study found that medical students in 2020 were significantly less likely to prioritize high-paying potential compared to those in 2010 (Schroeder et al., 2024), the public system’s structure still influences physician salaries, often resulting in lower compensation than in private settings. This financial reality can contribute to imbalances in specialty distribution. Interestingly, Israeli students, particularly women, are strongly influenced by family and residential location when choosing their residency (Avidan et al., 2018; Weissman et al., 2012, 2013). Consequently, some specialties remain highly competitive, while others struggle with staffing shortages.
Understanding how specialty preferences change throughout medical education could offer valuable insights for addressing these imbalances. As students advance from preclinical to clinical years, their exposure to different medical fields expands, introducing them to specialties they may not have previously considered. With these insights, medical schools and healthcare systems can better allocate resources to possibly make underrepresented fields more appealing to students.
Therefore, this study aimed to examine how specialty preferences changed within one cohort from preclinical to clinical years and to compare the initial preferences of two separate first-year cohorts.
2. Materials and Methods
2.1. Study Design
This study followed one cohort of medical students over time (class of 2019) and compared their initial specialty preferences with a cross-sectional survey of a separate first-year cohort (class of 2024). Specialty preferences were surveyed anonymously at three time points for the 2019 cohort- during their first, second and sixth years of medical school. For analysis, the first- and second-year responses were combined into a single ‘preclinical’ group to reflect students with limited or no clinical exposure, and compared with the same cohort’s sixth-year (‘clinical’) responses. The 2024 cohort was surveyed solely in their first year. The questionnaire was developed for this study. An English version is provided as Supplementary File S1. By comparing responses across these cohorts, this study aimed to explore changes in specialty preferences among students at different stages of their medical training.
2.2. Study Population
The study population comprises medical students enrolled in the six-year Doctor of Medicine (MD) program at Ben-Gurion University of the Negev, Beer-Sheva, Israel. Soroka Medical Center, a teaching hospital affiliated with the Faculty of Health Sciences at Ben-Gurion University, serves as the primary clinical training site for these students. Exclusion criteria included students enrolled in the four-year or international MD programs, students who had taken a leave of absence that altered the standard course of their studies, and students who transferred to Ben-Gurion University after the second year of medical school.
2.3. Data Collection
Data collection involved distributing online surveys sent to the students via email and text messages, ensuring participant anonymity. In 2019, two surveys were administered to first-year medical students: a demographics survey and a specialty preference survey that were designed for this study. The demographics survey included criteria such as age, gender, birth order and personal and familial background in medicine. In the specialty preference survey, students either selected a single specialty from a list of twenty-eight predefined specialties in Israel, such as obstetrics and gynecology (OBGYN), pediatrics, internal medicine, and family medicine, or indicated that they were undecided.
The specialty preference survey was administered again to the 2019 cohort in their second and sixth year of medical school, to observe group-level changes in specialty interests over time. In 2024, a combined demographics and specialty preference survey was distributed to the newly enrolled first-year students, allowing for a comparison of initial specialty preferences between the two cohorts.
The first-year 2019 cohort survey was distributed during the first semester of the academic year, prior to the COVID-19 pandemic, providing context for interpreting any changes in specialty preferences during this period. The second-year survey for the same cohort and the sixth-year survey were both conducted during the first semester of their respective academic years. Similarly, the first-year 2024 cohort survey was distributed during the first, or fall, semester.
2.4. Data Management and Statistical Analysis
All data was collected using Google Forms, with strict anonymity maintained throughout. The study was reviewed by the Institutional Review Board of Soroka University Medical Center and granted an exemption because the responses were anonymous, voluntary and did not include identifying information.
Continuous variables were described using means and standard deviations (SDs), while categorical variables were presented as frequencies and percentages. Univariate analysis was conducted to explore the differences between the groups. All statistical tests were two-tailed, with significance set at a p-value less than 0.05. For comparisons where one or more cells contained a zero count, p-values were not reported because the assumptions for valid statistical inference were not met. The analyses were performed using R software, version 4.3.1.
3. Results
A total of 367 students participated in the specialty preference survey, including the 2019 cohort’s first year (n = 85), second year (n = 86) and sixth year (n = 98), as well as the 2024 cohort’s first year (n = 98). The 2019 demographic survey was filled out by n = 124 students. These correspond to response rates of 69% for the first-year 2019 survey, 69% for the second-year survey, 79% for the sixth-year survey (out of 124 students), and 61% for the first-year 2024 survey (out of 160 students). For the purpose of analysis, first- and second-year students from the 2019 cohort were combined into a single ‘preclinical’ group (n = 171), which was compared to the sixth-year (‘clinical’) group to examine differences in specialty preferences over the course of medical training.
The characteristics of medical students from the 2019 and 2024 cohorts as seen in Table 1 show generally similar demographic and background profiles, with only minor changes. Female representation saw a modest increase from 57% to 69% (p = 0.064). The most significant demographic change between the cohorts was the increase in students with a medical background including combat medics, paramedics and Israel’s Red Cross movement volunteers (23% to 43%, p = 0.002), while other factors remained unchanged.
Table 2 presents the distribution of specialty preferences comparing the preclinical (first and second years) group with the clinical group (sixth year) within the 2019 cohort. Statistically significant increases in interest were observed for Ophthalmology (2.9% vs. 11%, p = 0.012). Other specialties showed meaningful trends despite not reaching statistical significance. Anesthesiology rose from 0% to 4.1%, family medicine increased from 3.5% to 6.1% (p = 0.5), and OBGYN increased from 13% to 19% (p = 0.3). The proportion of students reporting they were undecided also grew from 8.8% in the preclinical group to 13% in the clinical year (p = 0.3). In contrast, some specialties showed declining trends: neurosurgery dropped from 3.5% to 1.0% (p = 0.4), oncology decreased from 8.8% to 2.0% (p = 0.054), psychiatry declined from 8.2% to 4.1% (p = 0.3), and students selecting “surgery- undecided” fell from 9.9% to 5.1% (p = 0.2).
Table 3 presents the distribution of specialty preferences by gender and medical background among first-year students in the 2024 cohort. Female students showed a higher preference OBGYN (28% of females vs. none of the males, p = 0.003). Male students showed numerically, although not statistically significant, higher interest in oncology (10% vs. 2.9%) and orthopedic surgery (6.7% vs. 1.5%). The proportion of undecided students was comparable between genders (12% vs. 17%, p = 0.7). Since the only statistically significant demographic difference between the 2019 and 2024 cohorts was the higher prevalence of a medical background in the 2024 cohort, such as prior experience as paramedics or Red Cross volunteers, we examined whether this factor influenced specialty choice within the 2024 cohort. Thus, Table 3 also presents medical students’ specialty preferences from the 2024 cohort, divided into two groups based on their medical background. The analysis involved 56 students without and 42 with a medical background. Overall, the analysis showed no statistically significant difference in specialty choices.
Further analysis of the 2024 first-year cohort was conducted, dividing specialty preferences by age, parental medical background, birth order, and whether a parent was a physician. However, no statistically significant differences were found in any of these demographic factors, except for gender as mentioned above.
In terms of specific specialties, distinct trends emerged, illustrating shifts in student interest over time. Figure 1 illustrates the biggest trends in specialty preferences among first-year and sixth-year students, with notable increases in OBGYN and Ophthalmology and a decline in Psychiatry. Ophthalmology exhibited the only statistically significant increase in interest
4. Discussion
This study observed a significant increase in interest in ophthalmology between preclinical and clinical students, alongside additional trends suggesting shifts in other specialty preferences among medical students. Specifically, modest upward trends were observed for specialties such as OBGYN and family medicine, as well as a higher proportion of students reporting they were undecided later in training. In contrast, trends toward decreased interest were seen for neurosurgery, oncology, psychiatry, and surgery undecided. Aside from ophthalmology, these trends were not statistically significant. Importantly, no notable differences were found when comparing the first-year students of the 2019 and 2024 cohorts, suggesting that initial specialty interests seem stable, and may be shaped by a range of factors that were not directly assessed in this study. Together, these findings indicate that while early specialty interests appear consistent across cohorts, shifts in certain fields may emerge during clinical training, possibly reflecting exposure and evolving perceptions as students progress through medical school. Consistent with this, previous research demonstrates that clinical exposure during medical school significantly shapes specialty preferences (Burack et al., 1997; Maiorova et al., 2008; Querido et al., 2016). Studies indicate that direct experience in clinical settings encourages students to pursue careers in those specialties, and positive evaluations of work-intrinsic factors strongly influence career choices, demonstrating how clinical exposure during the later years of medical education might provide students with firsthand experience of the work–life balance and career stability associated with different specialties. These findings may suggest that clinical exposure plays a role in shaping specialty choices; however, our study did not directly examine this factor, and further research is warranted to confirm this potential influence.
Female representation in the student cohorts saw a modest increase from 2019 to 2024. This trend aligns with broader observations of increasing female participation in medicine (Haklai et al., 2013). Previous research suggests that gendered experiences, such as discrimination, limited role models, perceptions of male-dominated specialties, and lifestyle considerations, could possibly steer female medical students toward fields like family medicine, pediatrics, and OBGYN, and away from areas such as surgery and internal medicine (Khan, 2023). These tendencies often emerge early in medical school and remain relatively stable through graduation (Burkhardt et al., 2021). Although our study did not examine these underlying factors directly, the gender differences we observed may reflect similar influences. The increase in interest for specialties like ophthalmology, OBGYN, family medicine, and internal medicine in the clinical year, could reflect, in part, that although fields such as ophthalmology have historically been male dominated, recent trends show that the proportion of female residents is now comparable to their representation in the overall medical graduate pool (Israeli et al., 2025).
Beyond demographic differences, behavioral and experiential factors may also influence changes in specialty interest. Elements such as mentorship, exposure to positive role models, and alignment between personal values and specialty culture could shape evolving preferences during training (Yang et al., 2019). Furthermore, the teaching faculty and clinical mentors may influence students’ specialty interests. Engaging and enthusiastic educators can inspire curiosity toward their field, while uninspiring instruction might deter students. In our setting, however, the core teaching staff remained largely consistent across cohorts, suggesting that any such influence would have been similar for all groups studied.
When comparing the first-year preferences of the 2019 and 2024 cohorts, surprisingly, no statistically significant differences were found. This lack of change is unexpected, as the COVID-19 pandemic might reasonably be thought to influence students’ specialty interests. Studies show COVID-19 impacted career perspectives. One study indicated the pandemic influenced students’ interest in respiratory medicine and infectious diseases (Deng et al., 2021). Similarly, another study revealed that the pandemic influenced many students’ residency choices (Lee et al., 2021). The fact that initial specialty interests remained largely unchanged in our study may suggest that other factors, potentially external to medical training, may play a role, although this was not directly examined in our study and warrants further research. First-year medical students often enter their studies with preconceived notions of medicine, which can be influenced by popular culture and medical television dramas such as Grey’s Anatomy (Czarny et al., 2008; Hoffman et al., 2022). These portrayals frequently emphasize high-stakes, dramatic scenarios in specialties like general surgery, thoracic surgery, pediatrics, and OBGYN that are well represented in the preclinical specialty preferences. However, as students progress through their medical training, exposure to the realities of various specialties reshapes their preferences. The declining interest in specialties such as psychiatry, neurosurgery and general surgery is consistent with trends observed in other research (Sierles & Taylor, 1995; Mazeh et al., 2010).
The 2023 OECD report on medical education in Israel emphasizes international healthcare policies, aligning with other EU countries in promoting the expansion of primary care specialties, such as family medicine, to address community health needs. Nevertheless, In Israel, family medicine remains a rather understaffed specialty (Lafortune, 2023). Our study observed a modest increase in interest in family medicine within the 2019 cohort, with more students selecting it in their clinical year compared to their preclinical years. This trend suggests that clinical exposure may encourage students to consider family medicine, but it is insufficient compared to the national demand.
When further comparing the national workforce data for new residents in Israel (Lafortune, 2023) to our findings, the trends observed in this study align with some workforce patterns while highlighting potential mismatches in others. For example, ophthalmology showed the largest increase in student preference and was chosen by 11% of sixth-year students, compared to only about 3% of new residents nationwide. Similarly, OBGYN was selected by 19% of students, which is more than double its share of actual residency intake (~8%). In contrast, family medicine and internal medicine, which together account for over 30% of new residents in Israel, were chosen by only 6% and 9% of students, respectively. This gap may suggest a continued need for targeted career guidance or incentives to encourage students to consider fields with persistent workforce demand.
Comparing Israel to other healthcare systems around the world provides valuable insights into how medical training structures, cultural influences, and financial incentives shape specialty preferences. Medical education in Germany and Israel follows a similar 6-year structure, making comparisons between student specialty preferences more meaningful. A repeated cross-sectional study conducted in Jena, Germany examined specialty preferences among first- to sixth-year medical students (Grasreiner et al., 2018). Since the German study grouped specialties into five broader categories, we recalculated our data using the same categorization to allow for a direct comparison. When applying this grouping, our sixth-year cohort showed 35.7% preference for internal medicine, much lower than the 48.4% reported in Germany. Surgical specialties were selected by 44.8% of Israeli students, notably higher than the 27.3% reported in Germany, indicating a stronger preference for surgical fields in Israel. This difference is particularly pronounced in OBGYN, where a notably higher proportion of Israeli students selected the specialty compared to their German counterparts. This discrepancy may be influenced by cultural factors, including a strong emphasis on OBGYN in Israel. The country’s high fertility rates, which exceed the OECD average, reflect a reproductive-focused culture that may contribute to greater interest in this field (Davies et al., 2024). Diagnostic specialties accounted for only 2%, compared to 4.9% in the German study. Psychiatry was chosen by 4.1%, similarly to 3.3% of students in Germany. Finally, 13% of Israeli students remained undecided, slightly lower than the 15.9% reported in Germany. These differences may reflect variations in healthcare system structures, specialty exposure, or residency selection processes between the two countries.
When comparing the specialty preferences of our 6th-year medical students to the U.S. physician workforce (U.S. physician workforce data dashboard, n.d.), notable differences arise. OBGYN was the preferred specialty among Israeli students (19%), much higher than the U.S. national representation (5.7%). Ophthalmology also garnered high interest in Israel (11%), contrasting with its smaller workforce share in the U.S. However, internal medicine (9.2%) and family medicine (6.1%) showed lower interest compared to their prominence in the U.S. workforce (13.1% and 12.9%, respectively). Salary differences may help explain the variation in specialty preferences between Israel and the U.S. The Israeli Ministry of Treasury report provides gross monthly salaries for hospital-employed specialists (Rotem, 2023), while U.S. data reflects lifetime earnings (Leigh et al., 2012), making direct comparison imperfect but still indicative of trends. In the U.S., high-paying fields like orthopedic surgery ($5.1 M lifetime) and ophthalmology ($4.4 M) attract more interest, while family medicine ($3.1 M) and internal medicine ($3.6 M) are less favored. In contrast, Israel’s salary gap between specialties is smaller, with family medicine (approximately $3.8 M lifetime) and ophthalmology (approximately $3.6 M) earning similarly. While financial differences may lessen the disadvantage of primary care in Israel, specialty preferences are complex. In the U.S., high liability insurance for specialties such as OBGYN also plays a role, which may be a lesser factor in Israel (Glaser et al., 2017). In conclusion, each country has unique factors influencing specialty choice.
This study has several notable strengths. The inclusion of a comparative analysis between the 2019 and 2024 cohorts provides an examination of potential temporal shift or lack thereof on specialty preferences, while gaining an understanding of the stability of initial preferences. Conducted within the Israeli medical education system, the study provides locally relevant findings, and by comparing our results to specialty preference trends in Germany and the U.S., we highlight how structural, cultural, and financial factors may shape medical students’ career choices across different healthcare systems.
However, this study also has limitations. First, although the analysis used a single cohort, the surveys at each time point were cross-sectional and may not include the exact same students, which could introduce sampling variation. We believe the relatively high response rates at all time points mitigate this risk but cannot fully eliminate it. Second, due to small cell sizes for some specialties, we grouped first- and second-year students into a single preclinical category to ensure sufficient numbers for comparison; however, this approach may mask subtle year-to-year shifts. Relatedly, specialties with very low or zero counts limited the ability to perform valid statistical tests for some comparisons. The study’s sample is derived from a single medical school, with a sample size of 367, which may restrict the generalizability of the findings to other institutions or regions. However, given Israel’s relatively small size and the fact that in 2021, Ben-Gurion University’s six-year medical program accounted for 160 out of the 538 students enrolled in such programs nationwide, the sample represents a substantial portion of the country’s medical student population. Although this study was conducted at a single university, the cohort represents a geographically diverse student population, including 58.1% from central Israel, 21% from the north, and 21% from the south. As Israeli medical schools commonly draw students nationwide, the diversity within our sample reflects the heterogeneity present across institutions. Nevertheless, a future multi-institutional study would further strengthen the generalizability of these findings. With the implementation of the Yatziv reform in 2025, which will shift the reliance on the medical workforce toward Israeli-trained graduates rather than foreign-trained ones, this study gains even greater significance. Notably, the Ben-Gurion cohort represents a substantial portion of this workforce, as the 2019 cohort is set to graduate precisely as this reform takes effect. As the data were self-reported, there is potential for bias, such as recall inaccuracies, although this bias is likely non-differential across study cohorts, minimizing its impact. Additionally, while demographic factors were largely consistent between cohorts, differences such as a higher proportion of students with prior medical backgrounds in the 2024 cohort could act as confounders. Finally, the cross-sectional design limits our ability to establish causality.
Despite these limitations, the study provides a valuable foundation for understanding the dynamics of specialty preference among medical students and highlights key areas for future research.
In conclusion, medical schools and policymakers should consider how clinical exposure may influence specialty preferences, to ensure a diverse and well-distributed physician workforce, as it is intended to grow over the next few years. Further longitudinal studies are needed to pinpoint when and why these shifts occur during medical training.
Supplementary Materials
The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/educsci15111545/s1, File S1: English Version of First-Year Demographic and Specialty Preference Questionnaire.
Author Contributions
Y.H. and N.A. have equally contributed to the manuscript; Y.H., Data collection; Y.H., Writing—Original Draft Preparation; N.A., S.S.Y. and A.H. (Amir Horev), Methodology; N.A. and I.B.S., Software; N.A., Formal Analysis; S.S.Y., data curation; I.G.T. and A.H. (Amir Horev), Conceptualization; Y.H., N.A., S.S.Y., I.B.S., A.H. (Amir Horev), I.G.T. and A.H. (Anat Horev), Writing—Review and Editing; A.H. (Amir Horev), Project Administration. All authors are accountable for their contributions and the integrity of the work. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
This study protocol received approval from the Ethics Committee of Soroka University Medical Center (SUMC) with exemption from Helsinki Declaration and informed consent requirements, as it involved solely anonymous survey data. However, all participants received a clear written disclaimer at the beginning of the questionnaire stating that participation was voluntary, anonymous, and for research purposes only, and that they could withdraw at any time without any consequences.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The data presented in this study are available on request from the corresponding author due to institutional policy and participant anonymity.
Acknowledgments
We would like to thank Yair Amar for his assistance in distributing the questionnaires to the 2024 cohort.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Avidan, A., Weissman, C., Elchalal, U., Tandeter, H., & Zisk-Rony, R. Y. (2018). Medical specialty selection criteria of Israeli medical students early in their clinical experience: Subgroups. Israel Journal of Health Policy Research, 7(1), 20. [Google Scholar] [CrossRef] [PubMed]
- Burack, J. H., Irby, D. M., Carline, J. D., Ambrozy, D. M., Ellsbury, K. E., & Stritter, F. T. (1997). A study of medical students’ specialty-choice pathways. Academic Medicine, 72(6), 534–541. [Google Scholar] [CrossRef]
- Burkhardt, J., DesJardins, S., & Gruppen, L. (2021). Diversity of the physician workforce: Specialty choice decisions during medical school. PLoS ONE, 16(11), e0259434. [Google Scholar] [CrossRef]
- Czarny, M. J., Faden, R. R., Nolan, M. T., Bodensiek, E., & Sugarman, J. (2008). Medical and nursing students’ television viewing habits: Potential implications for bioethics. The American Journal of Bioethics, 8(12), 1–8. [Google Scholar] [CrossRef]
- Davies, L., de Wildt, G., Benyamini, Y., Ramkumar, A., & Adams, R. (2024). Exploring the experiences of English-speaking women who have moved to Israel and subsequently used Israeli fertility treatment services: A qualitative study. PLoS ONE, 19(8), e0309265. [Google Scholar] [CrossRef]
- Deng, J., Que, J., Wu, S., Zhang, Y., Liu, J., Chen, S., Wu, Y., Gong, Y., Sun, S., Yuan, K., Bao, Y., Ran, M., Shi, J., Wing, Y. K., Shi, L., & Lu, L. (2021). Effects of COVID-19 on career and specialty choices among Chinese medical students. Medical Education Online, 26(1), 1913785. [Google Scholar] [CrossRef]
- Dikici, M. F., Yaris, F., Topsever, P., Filiz, T. M., Gurel, F. S., Cubukcu, M., & Gorpelioglu, S. (2008). Factors affecting choice of specialty among first-year medical students of four universities in different regions of Turkey. Croatian Medical Journal, 49(3), 415–420. [Google Scholar] [CrossRef]
- Glaser, L. M., Alvi, F. A., & Milad, M. P. (2017). Trends in malpractice claims for obstetric and gynecologic procedures, 2005 through 2014. American Journal of Obstetrics and Gynecology, 217(3), 340.e1–340.e6. [Google Scholar] [CrossRef] [PubMed]
- Grasreiner, D., Dahmen, U., & Settmacher, U. (2018). Specialty preferences and influencing factors: A repeated cross-sectional survey of first- to sixth-year medical students in Jena, Germany. BMC Medical Education, 18(1), 103. [Google Scholar] [CrossRef] [PubMed]
- Haklai, Z., Applbaum, Y., Tal, O., Aburbeh, M., & Goldberger, N. F. (2013). Female physicians: Trends and likely impacts on healthcare in Israel. Israel Journal of Health Policy Research, 2(1), 37. [Google Scholar] [CrossRef]
- Hoffman, B. L., Wolynn, R., Sidani, J. E., & Donovan, A. K. (2022). Using fictional medical television programs to teach interprofessional communication to graduating fourth-year medical students. Southern Medical Journal, 115(12), 870–873. [Google Scholar] [CrossRef] [PubMed]
- Ie, K., Murata, A., Tahara, M., Komiyama, M., Ichikawa, S., Takemura, Y. C., & Onishi, H. (2018). What determines medical students’ career preference for general practice residency training?: A multicenter survey in Japan. Asia Pacific Family Medicine, 17(1), 2. [Google Scholar] [CrossRef] [PubMed]
- Israeli, A., Blumenthal, E. Z., Nemet, A., Zayit-Soudry, S., Pizem, H., & Mezer, E. (2025). Have gender and ethnic disparities in ophthalmology disappeared? Insights from a workforce-based study in Israel (2006–2021). Israel Journal of Health Policy Research, 14(1), 2. [Google Scholar] [CrossRef]
- Khan, S. (2023). The impact of gendered experiences on female medical students’ specialty choice: A systematic review. The American Journal of Surgery, 225(1), 33–39. [Google Scholar] [CrossRef]
- Lafortune, G. (2023). Medical education and training in Israel. OECD. [Google Scholar]
- Lee, K. E., Lim, F., Silver, E. R., Faye, A. S., & Hur, C. (2021). Impact of COVID-19 on residency choice: A survey of New York City medical students. PLoS ONE, 16(10), e0258088. [Google Scholar] [CrossRef]
- Leigh, J. P., Tancredi, D., Jerant, A., Romano, P. S., & Kravitz, R. L. (2012). Lifetime earnings for physicians across specialties. Medical Care, 50(12), 1093–1101. [Google Scholar] [CrossRef]
- Levaillant, M., Levaillant, L., Lerolle, N., Vallet, B., & Hamel-Broza, J.-F. (2020). Factors influencing medical students’ choice of specialization: A gender based systematic review. eClinicalMedicine, 28, 100589. [Google Scholar] [CrossRef] [PubMed]
- Maiorova, T., Stevens, F., Scherpbier, A., & van der Zee, J. (2008). The impact of clerkships on students’ specialty preferences: What do undergraduates learn for their profession? Medical Education, 42(6), 554–562. [Google Scholar] [CrossRef]
- Mazeh, H., Mizrahi, I., Eid, A., Freund, H. R., & Allweis, T. M. (2010). Medical students and general surgery—Israel’s national survey: Lifestyle is not the sole issue. Journal of Surgical Education, 67(5), 303–308. [Google Scholar] [CrossRef]
- McDonald, C., Henderson, A., Barlow, P., & Keith, J. (2021). Assessing factors for choosing a primary care specialty in medical students; A longitudinal study. Medical Education Online, 26(1), 1890901. [Google Scholar] [CrossRef]
- McOwen, K. S., Whelan, A. J., & Farmakidis, A. L. (2020). Medical education in the United States and Canada, 2020. Academic Medicine, 95(9S), S2–S4. [Google Scholar] [CrossRef]
- Mohamed, A. A., Khan, W. S., Abdelrazig, Y. M., Elzain, Y. I., khalil, H. O., Elsayed, O. B., & Ibrahim, O. A. (2015). Factors considered by undergraduate medical students when selecting specialty of their future careers. Pan African Medical Journal, 20, 102. [Google Scholar] [CrossRef]
- Querido, S. J., Vergouw, D., Wigersma, L., Batenburg, R. S., De Rond, M. E. J., & Ten Cate, O. T. J. (2016). Dynamics of career choice among students in undergraduate medical courses. A BEME systematic review: BEME Guide No. 33. Medical Teacher, 38(1), 18–29. [Google Scholar] [CrossRef] [PubMed]
- Rachoin, J.-S., Vilceanu, M. O., Franzblau, N., Gordon, S., & Cerceo, E. (2023). How often do medical students change career preferences over the course of medical school? BMC Medical Education, 23(1), 596. [Google Scholar] [CrossRef] [PubMed]
- Rotem, A. (2023). Report on salary expenditures in the healthcare system—Public hospitals for the year 2021. Israel Ministry of Finance, Wages and Labor Agreements Division. Available online: https://www.gov.il/BlobFolder/dynamiccollectorresultitem/salary-supervisor-report-health-system-2021/he/salary-supervisor-reports_supervisor-report-health-system-2021-accessible-version.pdf (accessed on 11 November 2025).
- Schroeder, H., Shacham, A., Amar, S., Weissman, C., & Schroeder, J. E. (2024). Comparison of medical students’ considerations in choosing a specialty: 2020 vs. 2009/10. Human Resources for Health, 22(1), 5. [Google Scholar] [CrossRef]
- Sierles, F. S., & Taylor, M. A. (1995). Decline of U.S. medical student career choice of psychiatry and what to do about it. American Journal of Psychiatry, 152(10), 1416–1426. [Google Scholar] [CrossRef]
- Soethout, M. B. M., ten Cate, T. J., & van der Wal, G. (2004). Factors associated with the nature, timing and stability of the specialty career choices of recently graduated doctors in european countries, a literature review. Medical Education Online, 9(1), 4360. [Google Scholar] [CrossRef]
- U.S. physician workforce data dashboard. (n.d.). Available online: https://www.aamc.org/data-reports/report/us-physician-workforce-data-dashboard (accessed on 25 January 2025).
- Weissman, C., Tandeter, H., Zisk-Rony, R. Y., Weiss, Y. G., Elchalal, U., Avidan, A., & Schroeder, J. E. (2013). Israeli medical students’ perceptions of six key medical specialties. Israel Journal of Health Policy Research, 2(1), 19. [Google Scholar] [CrossRef]
- Weissman, C., Zisk-Rony, R. Y., Schroeder, J. E., Weiss, Y. G., Avidan, A., Elchalal, U., & Tandeter, H. (2012). Medical specialty considerations by medical students early in their clinical experience. Israel Journal of Health Policy Research, 1(1), 13. [Google Scholar] [CrossRef] [PubMed]
- Yang, Y., Li, J., Wu, X., Wang, J., Li, W., Zhu, Y., Chen, C., & Lin, H. (2019). Factors influencing subspecialty choice among medical students: A systematic review and meta-analysis. BMJ Open, 9(3), e022097. [Google Scholar] [CrossRef]
Figure 1.
Changes in Specialty Preferences for OBGYN, Ophthalmology, and Psychiatry Between Preclinical and Clinical Medical Students. Caption: This figure illustrates shifts in specialty preferences among medical students from their preclinical to clinical years, focusing on OBGYN, Ophthalmology, and Psychiatry. The percentage of students selecting each specialty is presented for both points. These three specialties are shown as examples of the most notable shifts in student preferences observed over the six-year period.
Figure 1.
Changes in Specialty Preferences for OBGYN, Ophthalmology, and Psychiatry Between Preclinical and Clinical Medical Students. Caption: This figure illustrates shifts in specialty preferences among medical students from their preclinical to clinical years, focusing on OBGYN, Ophthalmology, and Psychiatry. The percentage of students selecting each specialty is presented for both points. These three specialties are shown as examples of the most notable shifts in student preferences observed over the six-year period.
Table 1.
Demographic Comparison Between the 2019 and 2024 cohorts.
| Characteristic | 2019 Cohort (n = 124) 1 | 2024 Cohort (n = 98) 1 | p-Value |
|---|---|---|---|
| Sex | 0.064 | ||
| Female | 71 (57%) | 68 (69%) | |
| Male | 53 (43%) | 30 (31%) | |
| Age | 24.00 (23.00, 25.00) | 24.00 (23.00, 25.00) | 0.3 |
| Ethnicity | 0.2 | ||
| Arab | 5 (4.0%) | 8 (8.2%) | |
| Jewish | 119 (96%) | 90 (92%) | |
| Birth order | 0.5 | ||
| First born | 54 (44%) | 44 (45%) | |
| Last born | 27 (22%) | 26 (27%) | |
| Middle child | 38 (31%) | 27 (28%) | |
| Only child | 5 (4.0%) | 1 (1.0%) | |
| Background in medicine | 29 (23%) | 42 (43%) | 0.002 |
| Fluency in number of languages | 0.4 | ||
| 1 | 9 (7.4%) | 10 (10%) | |
| 2 | 71 (59%) | 63 (64%) | |
| 3 | 38 (31%) | 21 (21%) | |
| 4 | 3 (2.5%) | 4 (4.1%) | |
| Parent is a doctor | 15 (12%) | 12 (12%) | >0.9 |
1 n (%); Median (IQR), Caption: This table presents the demographic characteristics of first-year medical students from the 2019 and 2024 cohorts. Differences between groups were assessed using Pearson’s chi-squared test, Wilcoxon rank sum test, or Fisher’s exact test as appropriate. Statistically significant differences (p < 0.05) are noted in bold. In the 2019 cohort, 124 students completed the demographics survey; 85 completed the specialty preference survey.
Table 2.
Specialty Preferences in the 2019 Cohort: Preclinical vs. Clinical Years.
| Specialty | Preclinical, n = 171 | Clinical, n = 98 | p-Value |
|---|---|---|---|
| Anesthesiology | 0 (0%) | 4 (4.1%) | - |
| Cardiology | 3 (1.8%) | 0 (0%) | - |
| Dermatology | 2 (1.2%) | 0 (0%) | - |
| Emergency Medicine | 3 (1.8%) | 1 (1.0%) | >0.9 |
| ENT | 3 (1.8%) | 3 (3.1%) | 0.8 |
| Family Medicine | 6 (3.5%) | 6 (6.1%) | 0.5 |
| General Surgery | 5 (2.9%) | 1 (1.0%) | 0.6 |
| Internal Medicine | 15 (8.8%) | 9 (9.2%) | >0.9 |
| Neurology | 1 (0.6%) | 1 (1.0%) | >0.9 |
| Neurosurgery | 6 (3.5%) | 1 (1.0%) | 0.4 |
| Nuclear Medicine | 0 (0%) | 0 (0%) | - |
| OBGYN | 23 (13%) | 19 (19%) | 0.3 |
| Occupational Medicine | 0 (0%) | 0 (0%) | - |
| Oncology | 15 (8.8%) | 2 (2.0%) | 0.054 |
| Ophthalmology | 5 (2.9%) | 11 (11%) | 0.012 |
| Orthopedic Surgery | 2 (1.2%) | 3 (3.1%) | 0.5 |
| Pathology | 0 (0%) | 0 (0%) | - |
| Pediatrics | 23 (13%) | 12 (12%) | >0.9 |
| Physical Medicine and Rehabilitation | 2 (1.2%) | 0 (0%) | - |
| Plastic Surgery | 5 (2.9%) | 1 (1.0%) | 0.6 |
| Psychiatry | 14 (8.2%) | 4 (4.1%) | 0.3 |
| Public Health | 0 (0%) | 0 (0%) | - |
| Radiology | 2 (1.2%) | 2 (2.0%) | >0.9 |
| Surgery Undecided | 17 (9.9%) | 5 (5.1%) | 0.2 |
| Thoracic Surgery | 2 (1.2%) | 0 (0%) | - |
| Vascular Surgery | 2 (1.2%) | 0 (0%) | - |
| Urology | 0 (0%) | 0 (0%) | - |
| Undecided | 15 (8.8%) | 13 (13%) | 0.3 |
Ear, Nose, and Throat (ENT); Obstetrics and Gynecology (OBGYN), Caption: This table compares specialty preferences among medical students from the 2019 cohort in their preclinical (first and second) vs. clinical (sixth) years of training. Significant differences can be observed in Anesthesiology and Ophthalmology. The percentage of students choosing each specialty is presented. Changes over time were analyzed using Pearson’s chi-squared test, with a significance threshold of p < 0.05. p-values were omitted for comparisons in which one or more cells contained a count of zero.
Table 3.
Specialty Preferences in the 2024 Cohort by Gender and by Medical Background.
| Specialty | Female, n = 68 | Male, n = 30 | p-Value | No Medical Background, n = 56 | Medical Background, n = 42 | p-Value |
|---|---|---|---|---|---|---|
| Anesthesiology | 0 (0%) | 1 (3.3%) | - | 0 (0%) | 1 (2.0%) | - |
| Cardiology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Dermatology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Emergency Medicine | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| ENT | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Family Medicine | 2 (2.9%) | 1 (3.3%) | >0.9 | 1 (2.0%) | 2 (4.1%) | >0.9 |
| General Surgery | 4 (5.9%) | 1 (3.3%) | >0.9 | 4 (8.2%) | 1 (2.0%) | 0.4 |
| Internal Medicine | 2 (2.9%) | 1 (3.3%) | - | 2 (4.1%) | 1 (2.0%) | - |
| Neurology | 0 (0%) | 2 (6.7%) | - | 1 (2.0%) | 1 (2.0%) | - |
| Neurosurgery | 4 (5.9%) | 0 (0%) | - | 2 (4.1%) | 2 (4.1%) | >0.9 |
| Nuclear Medicine | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| OBGYN | 19 (28%) | 0 (0%) | 0.003 | 9 (18%) | 10 (20%) | >0.9 |
| Occupational Medicine | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Oncology | 2 (2.9%) | 3 (10%) | 0.3 | 2 (4.1%) | 3 (6.1%) | >0.9 |
| Ophthalmology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Orthopedic Surgery | 1 (1.5%) | 2 (6.7%) | 0.5 | 2 (4.1%) | 1 (2.0%) | >0.9 |
| Pathology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Pediatrics | 10 (15%) | 4 (13%) | >0.9 | 5 (10%) | 9 (18%) | 0.4 |
| Physical Medicine and Rehabilitation | 0 (0%) | 1 (3.3%) | - | 0 (0%) | 1 (2.0%) | - |
| Plastic Surgery | 1 (1.5%) | 0 (0%) | - | 0 (0%) | 1 (2.0%) | - |
| Psychiatry | 5 (7.4%) | 2 (6.7%) | >0.9 | 3 (6.1%) | 4 (8.2%) | >0.9 |
| Public Health | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Radiology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Surgery Undecided | 6 (8.8%) | 5 (17%) | 0.4 | 8 (16%) | 3 (6.1%) | 0.2 |
| Thoracic Surgery | 4 (5.9%) | 2 (6.7%) | >0.9 | 4 (8.2%) | 2 (4.1%) | 0.7 |
| Urology | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Vascular Surgery | 0 (0%) | 0 (0%) | - | 0 (0%) | 0 (0%) | - |
| Undecided | 8 (12%) | 5 (17%) | 0.7 | 6 (12%) | 7 (14%) | >0.9 |
Caption: This table presents specialty preferences among first-year medical students in the 2024 cohort, comparing between males and females, as well as those with prior medical backgrounds to those without. In the gender analysis, significant gender differences were observed (p = 0.045), particularly in OBGYN (female preference). In the medical background analysis, no statistically significant differences were observed (p = 0.7). Pearson’s chi-squared test was used for the gender analysis, Fisher’s exact test was used for medical background analysis. p-values were omitted for comparisons in which one or more cells contained a count of zero.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Hollander, Y.; Amitai, N.; Salem Yaniv, S.; Ben Shitrit, I.; Horev, A.; Golan Tripto, I.; Horev, A. From First-Year Dreams to Sixth-Year Realities: A Repeat Cross-Sectional Study of Medical Students’ Specialty Preferences. Educ. Sci. 2025, 15, 1545. https://doi.org/10.3390/educsci15111545
AMA Style
Hollander Y, Amitai N, Salem Yaniv S, Ben Shitrit I, Horev A, Golan Tripto I, Horev A. From First-Year Dreams to Sixth-Year Realities: A Repeat Cross-Sectional Study of Medical Students’ Specialty Preferences. Education Sciences. 2025; 15(11):1545. https://doi.org/10.3390/educsci15111545
Chicago/Turabian StyleHollander, Yael, Nir Amitai, Shimrit Salem Yaniv, Itamar Ben Shitrit, Anat Horev, Inbal Golan Tripto, and Amir Horev. 2025. "From First-Year Dreams to Sixth-Year Realities: A Repeat Cross-Sectional Study of Medical Students’ Specialty Preferences" Education Sciences 15, no. 11: 1545. https://doi.org/10.3390/educsci15111545
APA StyleHollander, Y., Amitai, N., Salem Yaniv, S., Ben Shitrit, I., Horev, A., Golan Tripto, I., & Horev, A. (2025). From First-Year Dreams to Sixth-Year Realities: A Repeat Cross-Sectional Study of Medical Students’ Specialty Preferences. Education Sciences, 15(11), 1545. https://doi.org/10.3390/educsci15111545
Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.
Article Metrics
Article metric data becomes available approximately 24 hours after publication online.
