Preference Signals and Interview Invitations: Insight Into Recent Updates to the Oto-HNS Residency Application Process.

Objective: While students in the 2023 Otolaryngology-Head and Neck Surgery (Oto-HNS) residency match were allowed 7 preference signals, this number increased to 25 for the 2024 match with the goal of reducing the overall application volume. We sought to understand the impact of this change to application volume and interview patterns. Study Design: Cross-sectional survey. Setting: Program directors of US Oto-HNS residency programs were invited to participate in an anonymous, electronic survey. Methods: An anonymous REDCap questionnaire was sent via email to all current Oto-HNS program directors in January 2024. Data were analyzed using R Version 4.3.1. Results: Forty-four program directors completed the survey. While programs received a median [interquartile range] of 400 [363, 445] applications last year, this year they reported receiving 295 [233, 339] applications of which a median of 110 applicants (40%) signaled the program. While the median percent of applicants who were interviewed by a program was 16%, the percent of interviews among applicants who had signaled the program was 37%. Of all interviews, nearly all (median 100% [91, 100]) were of applicants who had signaled the program. Finally, 40 (91%) of program directors reported that signaling played an important role in deciding to interview a candidate. Conclusion: Preference signals play an important role in a residency program's decision to interview a candidate. Our findings suggest that the implementation of preference signals successfully decreased the average number of applications received by each program and that medical students applying to more programs than available signals may experience diminishing returns.