Aim of the study: Only a minority of fourth year medical students participate in surgical large lectures. The underlying causes are unknown. Strategies to ensure students´ participation are lacking. The aim of our investigation was to evaluate why students do not participate large lectures in order to develop strategies to bring them back to the lecture hall.Methods: Students and teachers of the Surgical Department of the medical University of Marburg were interviewed by a standardized questionnaire. Causes of absence and suggestions for improving the participation at the lectures were suggested for choice using a 7 point Likkert scale ranging from "very low" to "very high" agreement. In addition, interviews were animated to give free text answers. Additionally, an internal benchmarking with the best utilized lecture at the medical university was performed. To exclude low acceptance of lectures as a local problem, a survey among representative students from 27 of 35 German medical universities was also performed.Results: Overall results showed a good agreement between students and teachers concerning their perceptions at surgical lectures. All 22 putative causes which may explain the low participation rate and all 16 but one suggested improvements showed no differences between students and teachers greater than two points on the Likkert scale. Both groups, the students and the teachers, are convinced that surgical lectures should be maintained. They recommended that excellent teaching should be rewarded. Several organizational nuisances, for example overlapping lectures, are pointed out to be the leading cause for to missing surgical lectures in Marburg. While students hesitate, teachers decided clearly that examinations are an essential part of the teaching strategy. The main differences between surgical and benchmarked lectures were attendance sheets and final examinations. According to information from other medical universities in Germany empty lecture halls are common.Conclusion: Low participation in surgical lectures is a general problem. Nevertheless, lectures are desired by students and teachers. The interview of students and teachers of the Surgical Department of the medical University of Marburg outlined that the improvement of participation in surgical lectures has several conditions. In face of the introduction of the new approbation guidelines organisational nuisances should be avoided and joins of lectures of different departments is needed to avoid redundancies. Excellent teaching should be rewarded. The contents of surgical lectures need to be examined.