UNASSIGNED: This study assesses the effects of the recent changes to the urology residency match process.
UNASSIGNED: We emailed an anonymous, multiple-choice survey to each candidate who applied to any of our 3 urology programs for the 2024 Urology Residency Match.
UNASSIGNED: Of the 433 candidates invited, 146 (33.7%) completed the survey. Of the 133 respondents who matched, 38.3% matched where they did an away subinternship (sub-I), 20.3% matched with their home program, and 91.0% matched with a program where they sent a preference signal (PS); only 8 respondents (6.0%) matched with a program where they did not complete a sub-I or send a PS. Of the 4 candidates who did not take Step 2 before submitting their application, only 1 matched. The 126 applicants who completed 3 or more sub-Is, including the home sub-I, had a higher match rate (95.2%) than the 20 applicants who completed 1 or 2 (65.0%, P < .0005). Disclosing any geographic preferences was associated with a decreased probability of matching (relative risk = 0.89, P < .05).
UNASSIGNED: Taking Step 2 before submitting applications and completing 3 or more sub-Is were both correlated with a higher match rate. Geographic signaling was correlated with a lower match rate. There was little benefit to applying to programs outside of those where the applicant had completed a sub-I or sent a PS. Future candidates should consider these findings early in the application process. These findings should be taken into consideration when making future changes to the application process.

OBJECTIVE: This manuscript summarizes the introduction, evolution and current outcomes for preference signaling in Urology as well as its use in other medical specialties. Overapplication plagues the residency recruitment process and PS has emerged as a process to improve the bottleneck of the interview selection process.
RESULTS: PS has been shown to be associated with a higher likelihood of interview among many subspecialties. Applicants and programs report satisfaction with the process. Further solutions are needed to increase transparency of program information and selection criteria to applicants so that critical decisions on which programs an applicant should apply to can be data driven.

UNASSIGNED: The orthopaedic surgery residency match is becoming increasingly more competitive with a disproportionate number of applicants to positions. As the residency application process has become more competitive, applicants have resorted to applying broadly to improve their chance of a successful match. Preference signaling was implemented for orthopaedic surgery for the 2022-2023 match cycle which allowed applicants to \"signal\" 30 programs of their choosing.
UNASSIGNED: The purpose of this study was to assess the impact of preference signaling on orthopaedic surgery applicant experiences and outcomes in the 2023 residency application cycle and match. An anonymous electronically based survey study developed using Research Electronic Data Capture (REDCap) was send to 895 applicants to a single orthopedic residency program. 148 applicants filled out some portion of the survey for a 16.5% response rate.
UNASSIGNED: 51% of applicants applied to 61-100 programs. Applicants received more interview offers from programs they signaled compared to programs they did not signal. 50% of applicants responded that the number of allotted signals was \"just right\", with more applicants responding that the number of signals allotted was \"too many\" rather than \"too few\". 62% of applicants agreed that signaling increased his/her chances of receiving an interview offer at a signaled program, 66% were satisfied with the results of the match, and 50% thought signaling had a positive impact on the application process.
UNASSIGNED: Overall, preference signaling was well received by applicants and may help to connect applicants with residency programs they are specifically interested in. Level of Evidence: III.

BACKGROUND: We aim to evaluate the impact of recent changes in the residency matching process on surgical specialties\' applicants and programs to offer recommendations on residency selection and matching processes.
METHODS: We utilized five databases while employing a Boolean query to search for studies from 2015 to March 2024. The search selection focused on factors and recent changes influencing residency match results across surgical specialties, including USMLE Step 1 pass/fail, research productivity, interview structure, and preference and geographic signaling.
RESULTS: The shift of the USMLE Step 1 to a pass/fail scoring system revealed a consensus among surgical program directors (PDs) and applicants not in favor of the change due to the emphasis on additional application elements. Research productivity was identified as a significant factor, especially in neurosurgery (with an average of 18.3 publications per applicant) and vascular surgery (8.3 publications), indicating a positive correlation between the number of publications and match outcomes. The adoption of virtual interviews has been well-received by both applicants and PDs, leading to an increase in the number of interviews offered and applicants. The implementation of preference and geographic signaling mechanisms has improved interview rates for applicants who utilize them.
CONCLUSIONS: The transition to a pass/fail USMLE Step 1 has raised concerns among surgical specialties, necessitating a greater focus on Step 2 scores and research productivity. Virtual interviews and signaling have improved the accessibility and reach of the residency application process, however, the full impact of these changes on the perception of applicant-program fit remains unclear.

Objective  This article characterizes perspectives of ophthalmologists involved in the residency selection process regarding the potential impact of preference signaling on the ophthalmology residency match. Methods  An anonymous online questionnaire generated from SurveyMonkey was approved by the Association of University Professors of Ophthalmology (AUPO) Data Resource Committee for distribution to 391 individuals from the AUPO Departmental Chairs, Program Directors, and Directors of Medical Student Education email listservs in August 2022. Results  A total of 96 (24.6%) ophthalmology faculty completed the questionnaire. The majority ( n  = 76, 79.2%) agreed or strongly agreed that preference signaling should be implemented in the ophthalmology residency application system. Most respondents agreed or strongly agreed that preference signaling will allow for more holistic reviews of applications ( n  = 55, 57.3%), agreed or strongly agreed that it will benefit applicants who do not have connections to home programs or faculty that can reach out to desired programs ( n  = 81, 84.4%), and agreed or strongly agreed that it will improve the distribution of interviews to applicants ( n  = 76, 79.2%). Participants agreed or strongly agreed that applicants who have signaled interest in their program will receive preference when offering interviews ( n  = 59, 61.5%), and those signals will be used as a tiebreaker for similar applications ( n  = 75, 78.1%). The majority of participants believed that the ideal number of preference signals\' applicants should be given three to four signals ( n  = 35, 36.0%) or five to six signals ( n  = 29, 30.2%). Conclusion  A majority of ophthalmology faculty surveyed support the integration of preference signaling into the ophthalmology residency match.

OBJECTIVE: Rooted in economics market strategies, preference signaling was introduced to the Plastic Surgery Common Application (PSCA) in 2022 for integrated plastic surgery residency applicants. This study surveyed program and applicant experience with preference signaling and assessed how preference signals influenced likelihood of interview invitations.
METHODS: Two online surveys were designed and distributed to all program directors and 2022-2023 applicants to integrated plastic surgery. Opinions regarding the utility of preference signaling were solicited, and the influence of preference signals on likelihood of interview offers was assessed.
METHODS: All integrated plastic surgery programs.
METHODS: All 88 program directors and 2022-2023 applicants to integrated plastic surgery.
RESULTS: A total of 45 programs and 99 applicants completed the survey (response rates, 54.2% and 34.2%, respectively). Overall, 79.6% of applicants and 68.9% of programs reported that preference signals were a useful addition to the application cycle. Programs reported that 41.4% of students who sent preference signals received interview offers, compared to 84.6% of home students, 64.8% of away rotators, and 7.1% of other applicants; overall, students who signaled were 5.8 times more likely to receive an interview offer compared to students who were not home students and did not rotate or signal. After multivariable adjustment, programs with higher Doximity rankings, numbers of away rotators, and numbers of integrated residents per year received more preference signals (all p < 0.05).
CONCLUSIONS: Applicants and programs report that preference signaling was a useful addition to the integrated plastic surgery application cycle. Sending preference signals resulted in a higher likelihood of interview offers among nonrotators. Preference signaling may be a useful tool to reduce congestion in the integrated plastic surgery application cycle.

OBJECTIVE: To evaluate the impact of the recent changes to the urology residency application process on the criteria utilized by residency program directors (PDs) for interview invitations and their perspectives concerning these changes.
METHODS: One hundred thirty-seven urology residency PDs were invited to participate in an anonymous survey to explore interview selection criteria and the impact of the increase in preference signals (PS) per applicant.
RESULTS: Fifty-eight PDs (42.8%) completed the survey. The highest-ranked criteria were letters of recommendation (LoR) and successful sub-internship (sub-I) at the PD\'s institution, without statistically significant differences between these 2. Gender, ethnicity, and medical school prestige were the lowest rated criteria, without significant differences between these 3. Compared to before the increase in the number of PS per applicant, 80.7% of PDs reported that not receiving a PS from an applicant this cycle would more negatively impact the chances of offering an interview to that applicant. Moreover, 12.2% stated they would not interview any applicants who did not send a PS. Finally, 62.1% of PDs believed recent changes worsened the process.
CONCLUSIONS: Recent changes impacted PDs applicant evaluation, with the highest ranked criteria being LoRs and sub-I. Paradoxically, the increase in the number of PS per applicant has increased their importance as applicants are much less likely to receive interview offers from programs they have not signaled. Lastly, most PDs believe changes have worsened the evaluation process.

OBJECTIVE: The objective of this study is to analyze a high-signal approach for otolaryngology-head and neck surgery (OHNS) residency applicants and calculate cost savings for programs and applicants.
METHODS: Data from both the 2022-2024 Electronic Residency Application Service (ERAS) and a data model were used to demonstrate cost savings with a high-signal approach. Modeled data assumed that the number of applications per applicant would be equal to the number of signals allowed. Predicted and real-world cost savings across the five other specialties participating in a high-signal approach were calculated.
RESULTS: ERAS data cost savings for the entire OHNS applicant pool amounted to $365,950. In the modeled data, cost savings amounted to $825,921. When extrapolated to include all five high-signal specialties, total cost savings amounted to $2,570,464 (ERAS data) and $6,359,478 (modeled data). Otolaryngology programs were predicted to experience significant time savings, resulting in cost savings of $437,883 and $1,113,342 for ERAS data and modeled data, respectively.
CONCLUSIONS: The study highlights the advantages of a high-signal approach, including financial advantages or increased time for programs to engage in holistic review and diversify the pool of interview candidates. Cost savings in this study were shown to be significant when extrapolated across all specialties using a high-signal approach. Further research is needed to optimize the signaling system and confirm the favorable interview distribution and equity data from the low-signal OHNS experience with a high-signal approach.
METHODS: N/A Laryngoscope, 134:2684-2688, 2024.

Preference signaling was introduced for general surgery in the 2021-2022 virtual recruitment cycle. Despite guidance from the Association of American Medical Colleges, how applicants and programs used and interpreted signals varied greatly. We set out to assess how applicants utilized their allotted signals.
An institutional review board-approved anonymous online survey was distributed to applicants interviewing at a single large academic institution for the Match 2022. Using Likert-type scales, applicants were asked to rate their agreement with a variety of statements regarding perceptions of fit for signaled and nonsignaled programs.
44 survey responses were received (37% response rate), and 50% (n = 22) came from applicants using fit for guide their preference signaling. 36% of applicants signaling for fit agreed that virtual recruitment improved their perceptions of fit for signaled programs versus 32% of applicants not signaling for fit (P = 0.751). Regarding nonsignaled programs, 50% of applicants signaling for fit agreed that virtual recruitment improved their perceptions of fit versus 23% of applicants not signaling for fit (P = 0.060). More applicants not signaling for fit disagreed that their perceptions of fit for nonsignaled programs improved throughout the cycle compared to applicants signaling for fit (32% versus 5%, P = 0.019).
Perceptions of fit for signaled and nonsignaled programs improved for applicants who based their signaling on fit, but not necessarily for applicants using other strategies. Signaling is an important tool for applicants as it increases their odds of being interviewed; further research is needed to fully understand its role in recruitment for general surgery and to best advice applicants.

OBJECTIVE: To assess whether the geographic region where medical students complete an away rotation predicts the same site, region-specific, or overall interview offers and match success in otolaryngology.
METHODS: Cross-sectional.
METHODS: US medical schools.
METHODS: We queried the Texas Seeking Transparency in Application to Residency database to analyze outcomes of otolaryngology applicants during the 2018 to 2020 and 2022 match cycles. Outcomes included a number of interviews offered, geographic location of interviews, and match results, including region-specific and overall match success rate.
RESULTS: Of 455 otolaryngology applicants, 402 (90.3%) completed an away rotation. Among these, 368 (91.8%) were offered an interview and 124 (30.9%) matched to the program where they completed an away rotation. Applicants who completed away rotations outside their home region received more interview offers from that region than those who did not (Northeast: 4.2 vs 2.9; South: 4.3 vs 3.0; Central: 4.8 vs 3.0; West: 3.8 vs 1.6, P < .01 for all). Completing a remote away rotation increased the odds of receiving an interview from and matching within that region. After excluding programs where an away rotation was completed, a remote away rotation increased the odds of receiving an interview in the central and western regions (Central: odds ratio [OR]: 1.2 [1.1, 1.5]); West OR: 1.9 [1.7, 2.2]; and the odds of matching in the western region (OR: 2.9 [1.2, 7.4], all P < .01).
CONCLUSIONS: Away rotations are associated with increased odds of interviewing and matching at that away program, with possible associations across the region, most evident for the West coast.