Objective This longitudinal study aimed to document shifts in specialty preferences, career pathways and intended practice locations among medical students following the implementation of structured career initiatives during the 2023-2024 academic year. Design A longitudinal observational survey study. Setting A private, not-for-profit institution, VinUniversity in Hanoi, Vietnam during the 2023-2024 academic year. Participants All year 2, year 3 and year 4 medical students (n=144 eligible), of whom 105 (73%) completed both baseline and follow-up surveys. Interventions Structured career counselling initiatives introduced at the start of the academic year, including academic mentoring, clinical mentoring, hands-on clinical exposure in year 4 and multiple career counselling activities. Primary and secondary outcome measures The primary outcome was change in specialty preference over time, measured by students’ self-reported first-choice specialty at baseline and follow-up. Secondary outcomes included shifts in factors influencing career decisions (eg, personal interest, income and family expectations), intended practice location (domestic or international) and preferred career pathways (residency, Specialist Level I, master’s degree or direct workforce entry). Results Personal interest remained the strongest influence on specialty choice from baseline to follow-up (mean scores 4.27 vs 4.36 on a 5-point scale). A notable decrease occurred in the importance of income (3.82 to 3.22; p<0.001). Students showed increased openness to both domestic and international practice, while the number of undecided students dropped (17.1% to 1.9%). Internal medicine nearly doubled in popularity (12.4% to 24.8%), and surgery maintained the highest stability in specialty preference over the 1-year period (66.7%). Students also shifted towards advanced training pathways, with more pursuing specialist qualifications or master's degrees instead of immediate workforce entry. Conclusion Noticeable shifts in specialty preferences and career pathways were observed after a series of career initiatives were implemented. Although these trends coincided with the new programmes, further qualitative research is needed to elucidate how and why these career initiatives may have influenced decision-making. Informed by these findings, medical educators can refine interventions to support students' evolving preferences and ultimately strengthen healthcare workforce distribution.
