Neurodiversity in surgery: Embracing cognitive difference in a demanding profession

BACKGROUND: Neurodiversity encompasses natural variations in cognitive functioning, including autism spectrum disorder, ADHD, and specific learning difficulties. While the concept is increasingly recognised in education and general workplaces, its relevance in medicine and particularly in surgery, remains underexplored. METHODS: We conducted a systematic review in accordance with PRISMA 2020. Searches of PubMed, Embase, Medline, Global Health and PsycINFO databases up to July 2025 identified studies on neurodivergence among surgeons and healthcare professionals. Eligible publications addressed neurodiversity explicitly or reported disability data inclusive of neurodivergent surgeons. Two reviewers independently screened, extracted, and appraised studies using JBI and MMAT tools. Narrative synthesis was organised into five domains: prevalence/disclosure, challenges and attainment, cognitive strengths, workplace supports, and cultural implications. RESULTS: Of 13268 records, four studies met inclusion criteria: two retrospective cohorts, one cross-sectional, and one mixed-methods study from Turkey, Canada, and the UK. Prevalence estimates varied: ADHD symptoms were identified in 31.6 % of included Turkish surgical trainees who participated in the study, while 6-8 % of UK trainees declared disabilities, most commonly specific learning difficulties. Neurodivergent trainees reported challenges with assessments, sensory environments, and professional expectations, with lower pass rates in early postgraduate exams. Strengths including creativity, attention to detail, and resilience were frequently cited. Evidence suggested that supportive interventions and fair recruitment processes can mitigate disadvantage. CONCLUSIONS: Neurodiversity in surgery is under-recognised yet integral to workforce diversity. Neurodivergent surgeons contribute valuable skills but face systemic and cultural barriers. Greater awareness, structured accommodations, and inclusive training frameworks are needed to reduce stigma, promote disclosure, and enable all surgeons to thrive.