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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1814444
Research Article

Influence of Early Exposure and Educational Gaps on Medical Students: A Career-Driven Strategy for Aspiring Neurosurgeons

Authors

  • Mainak Sinha    *

    1   Department of General Surgery, All India Institute of Medical Sciences, Patna, Bihar, India

  • Rijhul Lahariya    *

    2   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India

  • Anand Kumar Das 

    2   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India

  • Saraj Kumar Singh 

    2   Department of Neurosurgery, All India Institute of Medical Sciences, Patna, Bihar, India
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Abstract

Objective

Neurosurgery is a high-demand specialty in medicine, yet the factors influencing medical students' decision to pursue it remain underexplored. This study aimed to evaluate the demographics, academic year-wise interest, motivating and deterring factors, and the role of undergraduate exposure in influencing students' intentions to pursue neurosurgery.

Materials and Methods

A cross-sectional survey of 503 Bachelor of Medicine, Bachelor of Surgery (MBBS) students across India was conducted. The survey assessed demographics, academic year, interest in neurosurgery, motivating and deterring factors, and perceptions of neurosurgical exposure during undergraduate education.

Statistical Analysis

Statistical analyses, including chi-square and multinomial logistic regression, were applied to determine significant associations between variables.

Results

The study revealed that interest in neurosurgery was highest among first- and second-year students, with a sharp decline observed by the internship year. Primary motivators included personal interest in neuroscience and the prestige of the field. Significant deterrents were limited exposure to neurosurgery and concerns about work-life balance. A gender disparity was found, with males showing greater interest in neurosurgery, mirroring national trends in the specialty. Half of the respondents believed that neurosurgery was underrepresented in the MBBS curriculum, and most supported its inclusion as a mandatory subject. Additionally, students expressed a preference for practicing neurosurgery in India, citing familial and financial considerations as key factors.

Conclusion

The findings emphasize the importance of early exposure, mentorship, and curriculum improvements in shaping students' career decisions. Addressing regional and gender disparities, alongside ensuring robust neurosurgical training, is essential for fostering a motivated, diverse workforce in the field of neurosurgery.


Keywords

career choice - early exposure - medical education - neurosurgery - undergraduate training

Introduction

Neurosurgery is a very competitive field that needs long training and deals with serious brain conditions such as tumors, injuries, and blood vessel problems.[1] [2] With fast progress in brain imaging, robotic surgery, and less invasive methods, neurosurgery has become a cutting-edge field with great scope for research and innovation.[3] [4] Early and structured exposure to neurosurgery—through concepts, mentorship, and clinical experience—builds student interest and confidence, encourages engagement with professionals, and offers insight into the specialty's challenges and rewards.[5] [6] [7] [8]

However, despite its progress and promise, a global shortage of neurosurgeons remains a critical issue. More than 5 million essential neurosurgical cases go unmet each year—especially in low- and middle-income countries—due to an inadequate workforce.[9] [10] In many regions, the neurosurgeon-to-patient ratio is alarmingly low, underscoring the need for more young doctors to enter the field.[11] For example, in India, there are only ∼3,700 neurosurgeons for a population of 1.35 billion, which is much lower compared with developed countries.[12] This means there is approximately one neurosurgeon for every 365,000 people.[12] Each year, around 482 students are trained in neurosurgery, and the number of training positions has doubled in the past 5 years.[12] However, many seats still remain vacant. In the recent Institute of National Importance Super-Specialty (INI-SS) neurosurgery entrance examination, which is conducted for premier institutes such as the All India Institute of Medical Sciences (AIIMS), around 24 neurosurgery seats were left unfilled.[13] Therefore, we believe that encouraging interest in neurosurgery among medical students is more important than simply increasing the number of training positions. Interest in neurosurgery among medical students has decreased, mainly due to concerns about work-life balance (76%) and the intense, competitive training process (56%).[14] [15] [16] Limited undergraduate exposure significantly contributes to this trend. In many medical schools, neurosurgery is either underrepresented or embedded within general surgery or neurology rotations, denying students direct and meaningful engagement with the specialty.[17]

Limited exposure to neurosurgery in the Bachelor of Medicine, Bachelor of Surgery (MBBS) curriculum is a key factor influencing students' career preferences, shaping their interest and applications to the specialty.[6] Many medical schools lack dedicated neurosurgical teaching, often integrating neurosurgical concepts into general surgery or neurology rotations.[18] A survey of 155 U.S. medical schools found that early neurosurgery exposure led to higher match rates and shorter preclinical training, while the lack of mandatory rotations limits student access and makes the field seem less attainable.[19] An increasing number of students from low- and middle-income countries pursue neurosurgery abroad for research, advanced technology, and mentorship—not financial gain—raising concerns about “brain drain” and weakening neurosurgical care in their home country.[20] [21]

This study aims to analyze the role of early exposure in shaping students' neurosurgical career preferences in India. India has 818 medical schools with 123,445 seats, mostly in states such as Tamil Nadu, Telangana, and Maharashtra. Studying observerships, mentorship, and curriculum aims to identify what drives or limits student interest in neurosurgery.[22] The objective of the study was to examine the association between undergraduate students' interest in neurosurgery and factors such as their year of study, previous exposure to the specialty, and personal motivation. The findings may inform educational reforms aimed at sustaining and strengthening the future neurosurgical workforce.


Materials and Methods

This study was first in India, designed as a multicenter, cross-sectional, questionnaire-based survey aimed at exploring the perceptions of undergraduate medical students toward pursuing neurosurgery as a career. The study, conducted from February 1 to April 30, 2025, included 503 MBBS students (first year to interns) from various Indian medical colleges, recruited via purposive and convenience sampling through digital platforms and student networks. Participation was entirely voluntary, and digital informed consent was obtained prior to survey submission. All data were anonymized to maintain confidentiality.

The questionnaire consisted of 19 structured, close-ended items categorized into five domains: demographic information, exposure to neurosurgery, influencing factors for career selection, perceptions regarding neurosurgical work-life balance, and its representation in undergraduate medical education. The questionnaire, based on literature and validated surveys, included multiple-response items to capture detailed student views. Reviewed by two neurosurgeons for validity and relevance, it was piloted with 15 students, and minor adjustments were made based on their feedback. The final version of the questionnaire was disseminated using a secure online platform (Google Forms), and all responses were anonymized and securely compiled for analysis.

Statistical Analysis

Data were exported to Microsoft Excel (version 2021) and analyzed using IBM SPSS Statistics (version 26.0). Descriptive statistics were employed to summarize demographic data and response distributions. Continuous variables were represented as mean ± standard deviation or median and interquartile range (IQR). Associations between key variables—such as neurosurgical exposure (clinical rotations, observerships, research experience) and interest in pursuing neurosurgery—were evaluated using chi-square tests. Binary logistic regression was performed to identify predictors of neurosurgical career intent. Subgroup analyses were conducted based on academic year and preferred future practice location (India vs. abroad). The Kruskal–Wallis' test was used to compare differences in nonnormally distributed continuous variables across multiple groups. Multinomial logistic regression was used to assess the factors influencing students' perceptions of neurosurgery coverage in the undergraduate curriculum and their views on whether neurosurgery should be a mandatory rotation/subject during MBBS. A p-value of < 0.05 was considered statistically significant.

For visual representation, a choropleth map of India was generated using Python (version 3.10.12) with libraries such as Plotly, Geopandas, and Matplotlib to display the state-wise distribution of participants. A line graph was created to illustrate the gender distribution across MBBS batches, utilizing Matplotlib for plotting and Seaborn for improved styling and visual appeal. Additionally, categorical comparisons and proportions were depicted using bar and pie charts created in Microsoft Excel, enhancing interpretability and supporting data-driven conclusions.


Ethical Approval

We distributed the questionnaire through a secure online platform, collecting anonymous and voluntary responses. As no personal data were involved, ethical approval was not required for low-risk survey-based research.



Results

A total of 503 medical students across different MBBS batches participated in the survey. The median age was 21 years (IQR: 19–22), with a male preponderance (55.7%). Demographic distribution and overall response characteristics are summarized in [Table 1]. [Fig. 1] illustrates the state-wise distribution of respondents across India. A substantial portion of the sample (40.4%) was from Chhattisgarh, followed by Bihar, which contributed 32.8%. Participants from the South, West, and North regions also made up a significant portion, with each region contributing around 2 to 3% of the total respondents. The Northeast region, including Manipur and Assam, accounted for a smaller percentage, ∼1 to 2%. Overall, the distribution reflects broad geographic representation, with some regions contributing more heavily to the sample than others. [Fig. 2] shows that males were consistently more represented across MBBS batches, with the gender gap being narrowest in the second year. Although an overall trend of male predominance was observed, the difference did not reach statistical significance (p = 0.056).

Table 1

Demographic distribution and characteristics of the respondents

Characteristics

Total participants (n = 503)

Want to become neurosurgeon (n = 137)

Do not want to become neurosurgeon (n = 152)

Not yet decided (n = 214)

p-Value

Demographics

Age (y)

20.9 ± 3.2

20.7 ± 1.9

21.3 ± 1.9

20.9 ± 4.3

0.002[a]

Gender

 Male

280 (55.7%)

78 (56.9%)

90 (59.2%)

112 (52.3%)

0.4

 Female

223 (44.3%)

59 (43.1%)

62 (40.8%)

102 (47.7%)

MBBS batches

 First year

173 (34.4%)

44 (32.1%)

41 (27.1%)

88 (41.1%)

<0.001[a]

 Second year

167 (33.2%)

57 (41.6%)

46 (30.2%)

64 (29.9%)

 Third year

93 (18.5%)

25 (18.3%)

30 (19.7%)

38 (17.8%)

 Fourth year

26 (5.2%)

5 (3.6%)

7 (4.6%)

14 (6.5%)

 Internship

44 (8.7%)

6 (4.4%)

28 (18.4%)

10 (4.7%)

Interest in pursuing neurosurgery among interested students

 If want to pursue neurosurgery, what inspires you?

 High income

<0.001[a]

  Yes

–

34

–

–

  No

103

–

–

 Personal interest in neuroscience

  Yes

–

90

–

–

  No

–

47

–

–

 Neurosurgical intervention

  Yes

–

52

–

–

  No

–

85

–

–

 If want to pursue neurosurgery, how do you perceive the work-life balance in neurosurgery?

 Hectic, but I can manage

–

108

–

35

<0.001[a]

 Not at all hectic

–

29

–

32

 If you want to become neurosurgeon, have you had any exposure to neurosurgery?

 Clinical rotation

–

–

–

–

<0.001[a]

 Yes

–

19

–

–

  No

117

 Research experience

–

–

–

–

  Yes

–

15

–

–

  No

–

121

–

–

 Observership

–

–

–

–

  Yes

–

14

–

–

 No

–

122

–

–

  No exposure

–

–

–

–

  Yes

–

93

–

–

  No

–

43

–

–

 If you don't want to become a neurosurgeon, why?

 Poor outcome of patient

0.004[a]

  Yes

–

–

39

–

  No

–

–

113

–

 Long standing surgeries

  Yes

–

–

53

–

  No

–

–

99

–

 Poor work-life balance

  Yes

–

–

51

–

  No

–

–

101

–

 Lack of exposure or mentorship

  Yes

–

–

69

–

 No

–

–

83

–

Motivating and deterring factors

 What motivates you to pursue this specialty?

 Movies or web series

–

33

17

–

0.253

 Peer influence

–

15

16

–

 Personal experience and exposure

–

60

34

–

 Teachers and mentors

–

22

20

–

 What position or responsibilities do you hope to take on in neurosurgery?

 Clinician

<0.001[a]

  Yes

–

98

–

–

  No

–

35

–

–

 Academician

 Yes

–

13

–

–

  No

–

120

–

–

 Researcher

  Yes

–

43

–

–

  No

–

90

–

–

 Administrative

  Yes

–

11

–

–

  No

–

122

–

–

 What do you consider to be the most rewarding aspect of neurosurgery?

 Cognitive enhancement

132 (26.2%)

38 (27.7%)

42 (27.6%)

52 (24.3%)

0.464

 Compensation

37 (7.4%)

7 (5.1%)

12 (7.9%)

18 (8.4%)

 Prestige

86 (17.1%)

25 (18.2%)

31 (20.4%)

30 (14.1%)

 Saving lives

248 (49.3%)

67 (48.9%)

67 (44.1%)

114 (53.2%)

Undergraduate education and exposure to neurosurgery

 Do you feel neurosurgery is adequately covered during undergraduate education?

 Yes, adequately represented

83 (16.5%)

27 (19.7%)

25 (16.4%)

31 (14.5%)

0.041[a]

 Neutral

174 (34.6%)

37 (27%)

47 (30.9%)

90 (42.1%)

 No, underrepresented

246 (48.9%)

73 (53.3%)

80 (52.6%)

93 (43.5%)

 Do you think neurosurgery should be a mandatory rotation/subject during MBBS?

 Agree

258 (51.3%)

96 (70.1%)

101 (47.2%)

61 (40.1%)

<0.001[a]

 Neutral

201 (40%)

34 (24.8%)

98 (45.8%)

69 (45.4%)

 Disagree

44 (8.7%)

7 (5.1%)

15 (7%)

22 (14.5%)

Career preference and future aspects of practice

 Where do you see yourself practicing neurosurgery in the future?

 India

–

83 (61%)

–

114 (71.7%)

0.052

 United States of America

–

29 (21.3%)

–

23 (14.5%)

 United Kingdom

–

14 (10.3%)

–

15 (9.4%)

 United Arab Emirates

–

10 (7.4%)

–

7 (4.4%)

 If in India, why?

 Cost-effective

<0.001[a]

  Yes

–

15

–

–

  No

–

95

–

–

 Family factors

  Yes

–

42

–

–

  No

–

68

–

–

 High patient load

  Yes

–

58

–

–

  No

–

52

–

–

 Providing cost-effective services to the people

  Yes

–

33

–

–

  No

–

77

–

–

 If in abroad, why?

 Advanced technology

0.006[a]

  Yes

–

37

–

–

  No

–

34

–

–

 Healthy work-life balance

  Yes

–

25

–

–

  No

–

46

–

–

 Better research exposure

  Yes

–

32

–

–

  No

–

39

–

–

 Higher compensation

  Yes

–

18

–

–

  No

–

53

–

–

Abbreviation: MBBS, Bachelor of Medicine, Bachelor of Surgery.


Note: a refers to statistically significant.


Zoom
Fig. 1 State-wise distribution of respondents across India.
Zoom
Fig. 2 Gender-wise distribution across different Bachelor of Medicine, Bachelor of Surgery (MBBS) batches.

Among the various MBBS batches, a statistically significant association was found between academic year and students' interest in pursuing neurosurgery as a career (p < 0.001). Students from the earlier years, particularly the first year (32.1%) and second year (41.6%), constituted the majority of those expressing interest in neurosurgery. In contrast, those not interested were more frequently from the internship batch (18.4%). Furthermore, the highest proportion of undecided students was from the first and second years or the early stage of the medical school.

Interest in Pursuing Neurosurgery among Students

Among students interested in neurosurgery (n = 137), 65.7% were driven by a passion for neuroscience, while only 24.8% cited income. Despite strong interest, 68% lacked clinical exposure, revealing a major gap. Though many saw neurosurgery as hectic, 79% found the workload manageable. For those uninterested, the top deterrents were lack of exposure or mentorship (45.4%), followed by concerns about surgical demands and outcomes.


Motivating and Deterring Factors

Among students interested in neurosurgery, personal experience or exposure was the top motivator (43.8%), especially among early-year students—44.7% from second year, 33% from first year, 14.9% from third year, and 7.4% from internship. The second most common motivator was media influence (24.1%), mainly affecting first-year (38%) and second-year (34%) students, with fewer from advanced years. Other motivators included guidance from teachers or mentors (16.1%) and peer influence (10.9%), though not statistically significant (p = 0.253). Most students aimed to be clinicians (71.5%), followed by roles in administration (31.4%), academia (9.5%), and research (7.7%), with a significant association (p < 0.001). Research interest was highest in early years—40.3% in first year and 35.8% in second year—declining in later years. The most rewarding aspect of neurosurgery was cited as saving lives (49.3%), followed by cognitive growth (26.2%), prestige (17.1%), and compensation (7.4%), with no significant difference (p = 0.464).


Undergraduate Education and Exposure to Neurosurgery

Nearly half of respondents (48.9%), mostly second-year (32.1%) and third-year (24%) students, felt neurosurgery was underrepresented in the MBBS curriculum; 34.6% were neutral, and only 16.5%—mainly second-year (45.8%) attending clinical postings—thought it was adequately covered. Students interested in neurosurgery were significantly more likely to perceive it as underrepresented (53.3%, p = 0.041*). When asked if neurosurgery should be a mandatory MBBS rotation or subject, 51.3% agreed, 40.0% were neutral, and 8.7% disagreed. Agreement was highest among those interested in neurosurgery (70.1%) versus undecided (47.2%) and not interested (40.1%), showing a significant association (p < 0.001*).

Multinomial logistic regression showed that students who see neurosurgery as underrepresented are significantly more likely to be undecided about pursuing it compared with those with a neutral view (odds ratio [OR] = 1.65, p = 0.034*). No significant differences were found between those who saw it as adequately versus underrepresented, or between interested and not interested students (p > 0.05) ([Table 2]). Analysis showed that students who supported making neurosurgery mandatory in MBBS were more likely to pursue it or remain undecided. They were 4.95 times more likely to choose neurosurgery (OR = 4.946, p < 0.001*) and 2.43 times more likely to be undecided (OR = 2.428, p = 0.017*) than those who disagreed. Neutral students were also more likely to be undecided (OR = 2.083, p = 0.047*), though to a lesser extent ([Table 3]).

Table 2

Univariate multinomial logistic regression between “adequate presentation during UG” and “want to become neurosurgeon”

Want to become a neurosurgeon?

Adequately presented during UG?

Odds ratio

95% CI

p-Value

Yes

Yes, adequately presented

1.18

0.63–2.22

0.6

Neutral

0.86

0.51–1.47

0.589

No, underrepresented

1

–

–

Not decided

Yes, adequately presented

1.07

0.58–1.95

0.835

Neutral

1.65

1.04–2.62

0.034[a]

No, underrepresented

1

–

–

No

–

1

–

–

Abbreviations: CI, confidence interval; UG, undergraduate.


Note: a refers to statistically significant.


Table 3

Univariate multinomial logistic regression between “mandatory during MBBS” and “want to become a neurosurgeon”

Want to become a neurosurgeon?

Mandatory during MBBS?

Odds ratio

95% CI

p-Value

Yes

Agree

4.95

1.99–12.28

<0.001[a]

Neutral

1.55

0.61–3.98

0.364

Disagree

1

–

–

Not decided

Agree

2.43

1.17–5.04

0.017[a]

Neutral

2.08

1.01–4.31

0.047[a]

Disagree

1

–

–

No

–

1

–

–

Abbreviations: CI, confidence interval; MBBS, Bachelor of Medicine, Bachelor of Surgery.


Note: a refers to statistically significant.



Career Preferences and Future Aspects of Practicing Neurosurgery

Most students (71.7%) planned to practice neurosurgery in India, mainly due to family and cost-effectiveness (p < 0.001*). In contrast, those aiming to work abroad were driven by access to advanced technology and better work-life balance, with significant associations (p = 0.006*).



Discussion

In recent years, there has been a concerted effort to enhance early exposure to medical specialties, including neurosurgery, through elective postings, observerships, and undergraduate research initiatives. These initiatives aim to provide medical students with practical experiences that can inform their career decisions. A national survey showed that COVID-19 disruptions to clinical rotations reduced neurosurgery exposure for medical students, highlighting the need for early, consistent exposure—especially in high-stakes, underrepresented fields such as neurosurgery—to support informed career choices and workforce planning.[23]

This study's participant pool predominantly hailed from Chhattisgarh (40.4%) and Bihar (32.8%), reflecting regional disparities in medical education access and survey outreach. Overall, the male-to-female ratio in our study was 1.25:1. According to National Eligibility cum Entrance Test—Undergraduate (NEET-UG) 2024 data, female candidates made up a higher proportion of registrations (57.2%). However, during the academic year 2022–23, the number of male students was slightly higher. Similarly, our study reflects a mild male predominance, which aligns with these observed variations.[24] Gender-wise, males consistently outnumbered females across MBBS batches, with the disparity widening in senior years. While the overall difference approached statistical significance (p = 0.056), it underscores a persistent gender imbalance. This trend aligns with national data indicating that women constitute only ∼2.5% of neurosurgeons in India, often deterred by factors such as limited mentorship, societal expectations, and work-life balance challenges.[25] A recent nationwide survey in Pakistan similarly found that female medical students reported higher perceptions of gender bias, limited exposure, and concerns about work-life balance and training duration as barriers to pursuing neurosurgery, highlighting the global and regional challenges for women entering the specialty.[26] Additional evidence from a nationwide survey further shows that most medical students lacked clinical neurosurgery rotations, and that lectures, digital media, and social media shaped perceptions—often reinforcing stereotypes, long working hours, and gendered notions about the specialty, which impeded interest and comprehension.[27] Addressing these gaps requires targeted mentorship and institutional support to create a more inclusive neurosurgical education and practice environment.

In this context, our findings offer further insight into how student interest in neurosurgery evolves during the course of medical training. Specifically, interest was highest among first- and second-year students, with a sharp decline noted by the internship year. This trend is consistent with studies suggesting that early enthusiasm may wane over time due to increasing clinical responsibilities, stress, and exposure to the demanding realities of neurosurgical training.[5] [25] This observation aligns with the large multicenter ScoTtish And iRish medical students' perceptions Towards neurosurgery (STARTS) study, which found that while 73% of students expressed interest in neurosurgery, only a quarter intended to pursue it—highlighting that lack of structured exposure, mentorship, and clinical clerkships were major factors driving the decline with progression through medical school.[28] Hands-on neuroanatomical and neurosurgical learning initiatives—ranging from structured dissections and student-led projects to targeted skills conferences—have been shown to significantly enhance engagement, comprehension, and early interest in neurosurgical and neuroscience careers, effectively countering “neurophobia” and strengthening students' confidence and understanding of training pathways.[29] [30] [31]

Similarly, affordable, student-led neurosurgical simulation events supported by faculty mentorship have demonstrated significant improvements in students' confidence, technical understanding, and awareness of neurosurgical career pathways, while addressing accessibility barriers within traditional curricula.[32] It may also be attributed to limited research opportunities, academic curriculum focus, and lack of mentorship during the undergraduate years.[33] Many interested students reported no direct neurosurgery exposure, highlighting intrinsic motivation—particularly a fascination with neuroscience—as a key driver of early interest. This supports prior findings that initial specialty choices are often based on intellectual appeal rather than experience. However, limited clinical rotations, research, and mentorship may hinder informed decisions, as structured exposure is crucial in shaping specialty intent.[34] [35] Among students not interested in neurosurgery, lack of mentorship and work-life balance concerns were the top deterrents—common barriers noted in surgical career literature.[15] [36] A national survey in Pakistan similarly revealed that students from both public and private medical colleges reported limited exposure to neurosurgery and mentorship, with additional perceived barriers including work-life balance, competitive training environments, and financial burden—underscoring systemic factors influencing career choice.[37]

Interestingly, although most students viewed neurosurgery as hectic, many still thought it was manageable, showing a more balanced view of the field instead of rejecting it completely. While barriers and deterrents play a significant role, it is equally important to understand the factors that positively influence students toward choosing neurosurgery. Student motivations for pursuing neurosurgery were varied, with personal experience and exposure as the most influential—reflecting literature that highlights the importance of early clinical contact and interactions with neurosurgeons.[5] [38] Interestingly, nontraditional motivators such as media (e.g., movies or web series) also shaped perceptions, reflecting a changing view of surgical specialties among medical students.[39] [40] While peer and mentor influence were less frequently cited, their impact is well-documented as critical in fostering long-term interest in neurosurgery.[39]

Regarding anticipated career roles, the majority of students envisioned themselves as future clinicians, reinforcing the notion that direct patient care remains the primary appeal of neurosurgery.[41] This aligns with global findings that prestige and patient impact, especially the ability to save lives, are strong motivators for choosing high-intensity surgical fields.[42] Crucially, perceptions of inadequate undergraduate exposure were significantly associated with reduced career clarity. Nearly half of the respondents believed that neurosurgery was underrepresented in the MBBS curriculum, particularly those interested in the field. This supports evidence from multiple studies suggesting that specialty representation during medical training influences both exposure and eventual specialty choice.[43] Moreover, the strong preference among aspiring neurosurgeons for neurosurgery to be a mandatory MBBS subject further underscores the role of curriculum design in shaping career trajectories.

Beyond education, students' long-term career choices are shaped by geographic and professional priorities.[44] Our study also highlights how exposure and motivation influence future neurosurgery practice preferences. A significant majority expressed intent to practice in India, driven primarily by family proximity and financial considerations. This aligns with prior research emphasizing the role of familial and socioeconomic factors in shaping medical graduates' career trajectories in low- and middle-income countries.[44] [45] Conversely, those inclined to pursue careers abroad were motivated by access to advanced technologies and improved work-life balance—consistent with global findings where professional opportunities and lifestyle quality strongly influence emigration among health care professionals.[46] [47] [48] These insights highlight the need for Indian neurosurgical programs to improve exposure, infrastructure, and wellness to retain talent and build a sustainable workforce.


Limitations

This study has a few notable limitations. First, the geographic concentration of respondents from Chhattisgarh and Bihar may limit the generalizability of the findings. Second, the cross-sectional design captures student perceptions at a single point in time, which may not reflect evolving interests or experiences as students' progress through training. However, we have included students from different undergraduate years to address this issue. Although the participants are from a single country, the implications of the study's results may be relevant and applicable globally.


Conclusion

This study highlights the importance of early exposure, mentorship, and curriculum design in shaping interest in neurosurgery. Interest peaked in first and second-year students but declined during the internship, mainly due to limited exposure. Key motivators included a passion for neuroscience and neurosurgery's prestige, while lack of mentorship and work-life balance concerns were major deterrents. Regional disparities and gender imbalance also influenced career choices, with students from less-exposed areas showing lower clarity. These findings support the need for mandatory neurosurgical rotations, stronger mentorship, and efforts to address regional and gender gaps to guide informed choices and meet workforce needs.



Conflict of Interest

None declared.

Acknowledgment

The authors acknowledge the professors and consultants in the Department of Neurosurgery for their guidance and assistance.

Authors' Contributions

R.L., S.K.S., and M.S. contributed to the conception and design of this article. M.S., A.K.D., and R.L. were responsible for the methodology and initial draft preparation. Literature search and data collection were conducted by R.L. and M.S.. The final draft was written by R.L. and M. S.. All authors reviewed, revised, and approved the final manuscript. R.L. and M.S. contributed equally to this work. Both S.K.S. and A.K.D. are corresponding authors.


* Both authors contributed equally to this work.



Address for correspondence

Saraj Kumar Singh, MCh
Department of Neurosurgery, All India Institute of Medical Sciences
Phulwari Sharif, Patna, Bihar 801507
India   

Publication History

Article published online:
28 January 2026

© 2026. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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Fig. 1 State-wise distribution of respondents across India.
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Fig. 2 Gender-wise distribution across different Bachelor of Medicine, Bachelor of Surgery (MBBS) batches.