Neurosurgery aspirants in UK medical schools: a national cross-sectional analysis of demographics, motivations, and confidence (FAST study)

BACKGROUND: Neurosurgery is among the most competitive specialties in the UK, yet national data on who aspires to it and why are limited. Using the FAST study, we compared medical students who selected neurosurgery with peers choosing other specialties, examining demographics, extracurricular activity, certainty, confidence, and knowledge of the training pathway. METHODS: Secondary analysis of the FAST cross-sectional survey of UK medical students conducted December 2023 to March 2024. Responses were collected via an online questionnaire covering demographics, education, extracurricular activity, certainty, confidence, knowledge of training pathways, and factors influencing specialty choice. We compared neurosurgery aspirants with the remaining cohort using descriptive statistics and logistic regression to estimate odds ratios with 95% confidence intervals. Bonferroni corrections were applied where appropriate. RESULTS: Of 8,395 respondents, 212 students selected neurosurgery as their preferred specialty (2.53%). Interest declined sharply with seniority, from 4.5% of first-year students to 0.6% of final-year students. Compared with the national cohort, aspirants were more often male and from non-White ethnic groups. Private schooling was more frequent 29.7% vs 26.0% but not significant. Aspirants reported greater certainty about career choice (OR 2.43, p < 0.0001) and higher self-reported knowledge of the neurosurgery pathway. Confidence in securing a training post was low (20.8% confident) and the odds of low confidence were higher than the national cohort adjusted OR 1.37, p = 0.04. Males reported higher knowledge 67.3% vs 42.7% in females and greater confidence. Factors more strongly associated with choosing neurosurgery included intellectual challenge (OR 2.56, p < 0.0001), research opportunities (OR 4.07, p < 0.0001), and interest in specific conditions (OR 3.12, p < 0.0001). Lifestyle considerations were less influential than in peers: work-life balance (OR 0.33, p < 0.0001), compatibility with family life (OR 0.37, p < 0.0001), and job stress (OR 0.41, p < 0.0001). CONCLUSION: Despite high levels of certainty and pathway knowledge, neurosurgery aspirants reported low confidence in securing a training post, with marked gender and socioeconomic disparities. Interest declines steeply with seniority, suggesting that early enthusiasm often fades due to limited exposure and perceived inaccessibility. Targeted early interventions, including early and sustained exposure, and visible mentorship, may help ensure informed, sustained interest among those best suited to the field.