What Shapes the Future Orthopaedic Surgeon? A Systematic Review of Influences on Orthopaedic Subspecialty Decisions.

Abstract

Understanding the factors that influence the choice of subspecialty for training is essential for guiding residents, optimizing training curricula, and addressing workforce distribution. A systematic review was conducted in accordance with PRISMA guidelines. Databases searched were PubMed, EMBASE, and Google Scholar. Those studies that analysed factors influencing orthopaedic resident`s subspecialty preferences were included. Data on study characteristics, influencing variables, gender differences, and geographic variations were extracted and analysed. The most frequently cited influences on subspecialty choice were mentorship, intellectual stimulation, lifestyle considerations, and future job opportunities. Gender differences were significant; female residents more commonly chose paediatric orthopaedics and hand surgery, while male residents preferred arthroplasty and sports medicine. Trends revealed that mentorship and academic culture were key drivers in high-income countries while in low- and middle-income countries, lifestyle, training cost, and local job possibilities were more important factors. Orthopaedic subspecialty choice is a complex, multifactorial process. Efforts to promote structured mentorship and provide broad subspecialty exposure are crucial to support resident career development and also a balanced orthopaedic workforce distribution. The online version contains supplementary material available at 10.1007/s43465-025-01662-5.