The Surgical Mindset: A Systematic Review of Personality Influences on Career Choice in Medicine

Objectives: The relationship between personality traits and surgical career choice has been widely studied, but methodological limitations in existing literature raise questions about the validity of findings. This review synthesizes evidence while critically evaluating these constraints. Methods: This systematic review adhered to PRISMA 2020 guidelines. In March 2025, we searched PubMed (using MeSH terms: "schools, medical," "career choice," "personality"), Embase, Scopus, and PsycINFO databases with keywords: "career," "medical students," "personality," and "surgery." Inclusion criteria: English-language studies (post-2000) employing validated personality assessments to compare surgically-oriented (general surgery and subspecialties) versus nonsurgically-oriented medical students. Two reviewers independently assessed full texts, with conflicts resolved by a third reviewer. Study quality was evaluated using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Results: From 342 initial records, 19 cross-sectional studies met the inclusion criteria. All the included studies revealed consistent personality differences among surgically-oriented medical students, including lower agreeableness and higher neuroticism on the Big Five Inventory, greater impulsivity and aggression on the Zuckerman-Kuhlman questionnaire, and significantly higher grit scores, particularly in demanding surgical subspecialties. The HEXACO inventory showed surgical students to be more extraverted and socially bold but less fearful and modest than peers. Additional findings highlighted their lower harm avoidance, greater need for exhibition, and reduced tolerance for ambiguity. All included studies demonstrated good methodological quality, supporting the reliability of these psychological profiles. Conclusions: This systematic review demonstrates that medical students pursuing surgical careers exhibit distinct personality profiles characterized by resilience, assertiveness, and tolerance for high-pressure environments. These findings suggest personality assessments could serve as valuable tools for surgical career counseling, helping identify students who may select surgical specialties.