Purpose <p>The intrinsic motivations and concerns of medical students entering their surgical clerkship are of high importance to educators. Prior studies have demonstrated that medical students can harbor preconceived notions of the clerkship or surgical profession that may prevent them from pursuing a surgical career. Improved understanding of student perceptions can facilitate future clerkship curricula development and improve support of surgical learners. We conducted a qualitative analysis of pre-clerkship surveys to understand the concerns and fears of medical students. </p> Methods <p>From 2020 to 2023, a survey was administered to all medical students at a single institution prior to starting their core surgery clerkship. Thematic analysis was performed on open-ended responses from the anonymized survey. Themes were developed inductively and refined iteratively.</p> Results <p>In total, 297 (80.1%) of 371 medical students completed surveys. 152 (51.2%) students reported a strong or moderate interest in pursuing a surgical specialty at the time of the survey. Thematic analysis of survey responses identified four themes of pre-clerkship apprehension: (1) ambiguity of their clerkship experience, (2) surgical culture and stereotypes, (3) sense of belonging and psychological safety, and (4) personal well-being. Students most frequently expressed concerns regarding the amount of time spent in the hospital (61.7%), lack of surgical knowledge or skills (23.9%), contributions to the surgical team (17.5%), mistreatment (16.2%), and physical discomfort (10.8%).</p> Conclusions <p>Concerns about unclear expectations, surgical stereotypes, psychological safety, and well-being are commonly reported concerns of medical students entering their core surgery clerkship. Efforts should be focused on improving student perceptions of the surgical field and ensuring that the surgery clerkship is a safe and inclusive learning environment.</p>