Specialty choices among UK medical students: certainty, confidence and key influences-a national survey (FAST Study)

Abstract

Objective: To explore factors influencing UK medical students' specialty choices and examine variations in these influences across demographic groups and stages of training.

Design: National, cross-sectional online survey.

Setting: All 44 UK medical schools recognised by the General Medical Council.

Participants: 8,395 medical students.

Primary and secondary outcomes: The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.

Results: General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p<0.0001) and privately educated students (OR 1.18, CI 1.03 to 1.35, p=0.02). Males were also more certain about their career choices (OR 1.19, 95% CI 1.07 to 1.31, p<0.0001). Confidence in securing a training place was positively associated with extracurricular achievements, including having a PubMed-indexed publication (OR 1.67, 95% CI 1.39 to 2.00, p<0.0001).

Conclusions: This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.

Keywords: Health Education; Health Services; Medical Education & Training.

Figure 1. Top 20 specialty preferences among final-year medical students (%).

Figure 2. Specialty-specific factors influencing career choice among final-year medical students. Each student rated 28 individual factors on a 5-point Likert scale (not at all influential=0, fairly uninfluential=1, neutral=2, fairly influential=3, very influential=4). These factors were grouped into five domains: (1) characteristics of the specialty; (2) personal and lifestyle considerations; (3) professional growth and interests; (4) previous experiences and interactions; (5) demographic preferences. For each student’s selected specialty, a mean score for each domain was calculated, producing a specialty-specific profile of priorities. Radar plots illustrate the average importance assigned to each domain by students pursuing different specialties.