Abstract
Orthopaedic surgery remains the least gender diverse surgical specialty in Aotearoa New Zealand, despite gender parity among medical school graduates. While existing literature has highlighted structural and cultural barriers within surgery, less is known about how medical students form early perceptions of orthopaedic surgery or how these perceptions evolve with clinical exposure. This study explored medical students’ perceptions and experiences of orthopaedic surgery, and how these experiences shape the decision to pursue, or not pursue, a career in the specialty. It utilised a qualitative study design, underpinned by a critical realist philosophical stance, and informed by constructivist learning theory and the Figured Worlds theoretical framework. Eight first year surgical registrars took part in semi-structured interviews reflecting on their experiences as medical students. Data were analysed using reflexive thematic analysis. The analysis showed that students’ initial impressions were shaped largely by stereotypes and hidden curriculum messaging rather than direct experience. Clinical placements offered opportunities to reconsider these assumptions, with participants describing supportive teams, meaningful involvement and positive teaching. A sense of belonging was identified as central to how participants interpreted their experiences and whether they could imagine a place for themselves within the specialty. Belonging was shaped by day-to-day team culture and interactions with registrars, who played a pivotal role in teaching and inclusion. While all registrars carried significant responsibility for shaping the student experience, female registrars encountered additional expectations as visible examples of women in surgery. These findings illustrate how early impressions, clinical culture and experiences of belonging intersect to shape students career decisions. They highlight the need for supportive teaching structures that recognise the pivotal role registrars play. Strengthening inclusive team cultures and increasing opportunities for meaningful involvement may help broaden participation and support greater diversity within orthopaedic surgery.