Purpose <p>The impact of medical students’ third-year rotation operative exposure on career choice is unknown. We conducted a single-institution study to evaluate the effect of operative involvement on third-year medical students’ interest in surgery.</p> Methods <p>Six cohorts of third-year medical students who completed surgical rotations in 2023–2024 at a single academic medical center were given a survey to assess baseline perceptions and changes in interest in surgery as a career.</p> Results <p>35 out of 78 eligible students responded. Interest in surgery as a career increased from 2.06 pre-rotation to 2.91 post-rotation (<i>p</i> = 0.008). Students on the emergency general surgery (EGS) service showed an increase in interest from 2.18 pre-rotation to 3.45 post-rotation (<i>p</i> = 0.021). Students on an elective service reported a lesser increase from 2.00 to 2.67 (<i>p</i> = 0.100). Students who scrubbed-in &lt; 8 times per week showed an increase in interest from 1.94 pre-rotation to 2.53 post-rotation (<i>p</i> = 0.214). Meanwhile, students who scrubbed in ≥ 8 times per week showed a significant increase in interest from 2.17 to 3.28 (<i>p</i> = 0.015). Key factors affecting interest included faculty engagement, resident engagement, perceptions of wellness/lifestyle, and types of operations involved.</p> Conclusion <p>Actively engaging third-year medical students as members of the surgical team during their surgery rotation enhanced their interest in pursuing a career in surgery, underscoring the importance of hands-on experience in students’ career aspirations. The number of cases students participated in during their rotation and surgical service was positively correlated with their interest in surgery.</p>