Objective To investigate the preferences of medical students for participating in intergenerational programs and the factors influencing their willingness to participate. Methods A convenience sampling method was used to select 321 medical students from four medical colleges in Tianjin between November 2023 and March 2024. A questionnaire survey was then employed to examine their preference characteristics and influencing factors related to participation in intergenerational programs. Descriptive analysis was employed to explore the preference characteristics, and binary logistic regression was used to analyze the influencing factors of medical students' participation willingness. Results A total of 199 (62.0%) medical students expressed willingness to participate in intergenerational programs. For preferences regarding the types of intergenerational activities (multiple choices), the total frequency of selected options was 479, the top three preferred activity types were leisure and recreation (135 persons, 28.2%), arts and culture (124 persons, 25.9%), and educational learning (112 persons, 23.4%). For preferences regarding the choice of service recipients (multiple choices), the total frequency of selected options was 429, the majority were basically healthy older individuals (141 persons, 32.9%) and healthy older individuals (128 persons, 29.8%).Binary logistic regression analysis revealed that nursing students were 2.126 times more likely to participate than non-nursing students (OR=2.126, 95% CI: 1.144-3.953). For each one-point increase in self-worth score, the willingness to participate increased by 11.8% (OR=1.118, 95% CI:1.024-1.221). For each one-point increase in responsibility score, the willingness increased by 1.3% (OR=1.013, 95% CI: 1.002-1.024). Female medical students' willingness to participate was also negatively influenced by social support (OR=0.959, 95% CI: 0.935-0.984). Conclusions Medical students show a high willingness to participate in intergenerational programs, but exhibit a preference for serving healthy older adults. It is recommended to enhance geriatric medicine and humanities education for non-nursing majors, improve medical students' sense of self-worth and responsibility to increase their willingness to participate in intergenerational programs.