Preference Signaling: Does It Work? A MultispecialtyReview of the Data.

Background: Preference signaling was introduced in 2021 to address application inflation and improve applicant-program alignment in residency selection. This study examined its impact on residency application data across several specialties. Methods: Data from the Electronic Residency Application Service and the National Resident Matching Program for presignaling (2020-2022) and postsignaling (2022-2024) eras were analyzed. Metrics, including number of applicants, applications per applicant, signals offered, and match rates, were compared using mean differences. Results: Among specialties offering 10 or more signals, ear, nose, and throat and neurosurgery had the highest reductions in the mean number of applications per applicant (-23.8% and -12.8%, respectively), whereas orthopedics and dermatology had the lowest reduction (-7.8% and -0.1%, respectively). Anesthesiology and obstetrics and gynecology both saw increases in the number of applications per applicant (+5.8% and +2.2%, respectively). Ear, nose, and throat; anesthesiology; orthopedic surgery; and neurosurgery all had a concurrent increase in match rates over the same period. Among specialties offering fewer than 10 signals, plastic surgery showed the largest reduction (-18.2%) in applications per applicant, followed by emergency medicine (-14.7%), family medicine (-7.6%), and pediatrics (-0.4%). Internal medicine and general surgery saw increases in applications per applicant (+7.2% and +9.7%, respectively). Plastic surgery, pediatrics, and family medicine all had concurrent increases in match rates over the same period. Conclusions: Preference signaling may have reduced application inflation and improved match rates, however, shifts in application trends following the COVID-19 pandemic may have confounded these. Ultimately, time and how programs choose to use preference signaling will determine how preference signaling reshapes these application data.