Where Should I Signal? A Program-Level Analysis of Preference Signaling in the Orthopaedic Surgery Residency Match.

Background: Orthopaedic surgery is among the most competitive specialties in the US residency match. Preference signaling was introduced in 2023 with hopes of reducing application volume and improving efficiency. While overall applications have declined, little is known about how signals are distributed across programs. Methods: Data from the Association of American Medical Colleges Residency Explorer Tool were analyzed. Application volumes from 2021 to 2025, program characteristics, percentage of applicants signaling, and interview invitation rates were collected for each program. Program tier quintiles were determined using Doximity rankings. Application and signal densities (applications or signals per available position) were calculated for each program, and averages were compared across program tier, setting, size, and geography. Results: Average application density decreased from 139.18 applications per position in 2021 to 95.84 in 2025, despite an increase in applicants. The average signal density was 61.22 signals per position. Signal and application densities were highest in community-based, lower-tier, smaller nonmetropolitan programs and lowest in university-based, higher-tier, larger, metropolitan programs. Interview rates averaged 23% for signaling applicants and 2% for nonsignaling applicants. Conclusions: The introduction of preference signaling has coincided with reduced application volume to orthopaedic residency programs. Program-level data suggest a trend of disproportionate signaling to community-based, lower Doximity rank, smaller, and nonmetropolitan programs, providing insight for applicants and programs navigating the evolving orthopaedic residency match.