Abstract
BACKGROUND: Understanding the factors that influence the choice of subspecialty for training is essential for guiding residents, optimizing training curricula, and addressing workforce distribution. METHODS: 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. RESULTS: 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. CONCLUSION: 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-025-01662-5.