The role of the surgical clerkship in the curriculum has often been debated. This study highlights its function in the students' decision making process. Junior students (N = 164) were measured on interest in surgery before and after the clerkship and divided into groups that changed significantly in a positive or negative direction, or that remained essentially unchanged. Background factors, learning styles of the students, and their evaluations of the clerkship showed that students who changed negatively (12%), compared with those who changed positively (44%), did not learn as well from clinical experiences and evaluated certain aspects of the clerkship, related to time and clinical demands, less positively. The unchanged group resembled the positive change students. Performance in the clerkship did not differ significantly among the three groups. The group that changed positively had none interested in surgery as a career before the clerkship, 15% who chose surgery afterward, and who later entered a surgical residency. The negative change group entered with high, perhaps unrealistic, levels of interest, left with none selecting surgery, and a third entering nonclinical type residencies. The surgical clerkship appears to have a unique role to help students make decisions about future careers based on their underlying personalities and learning styles.