ArticleMedical education online2026
Inaugural year of preference signaling in im subspecialty fellowships: multi-institutional survey about program director perceptions, benefits, and challenges.
Article in Medical education online, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPreference signalling was introduced into internal medicine subspecialty fellowship recruitment in the 2025-2026 cycle, adding a new consideration for applicants, mentors, and fellowship programs. We sought to characterize program director (PD) perceptions of signalling during this inaugural cycle and identify implications for advising.
methodsWe conducted a cross-sectional anonymous survey of PDs in five internal medicine subspecialties at three West Coast academic institutions (University of Washington, Oregon Health & Science University, and University of California, San Francisco) from December 2025 to January 2026. Quantitative responses were summarized descriptively, and free-text responses were analyzed using inductive content analysis.
resultsEleven of 15 PDs responded (73%). Ten of 11 respondents (91%) agreed that signalling helped identify applicants with genuine interest, and 10 of 11 (91%) agreed that it streamlined interview selection. However, signalling was not perceived to reduce overall review burden. Common challenges included interpreting a 'no signal' (7/11, 64%), uncertainty about how much weight to assign signals (5/11, 45%), ambiguity regarding whether home-institution applicants should signal, and inconsistent interpretation of tiered signals across programs. PDs emphasized the importance of transparency and consistency in signalling practices.
conclusionsIn this early multi-institutional experience, preference signalling was valued as a practical screen-in tool, but its interpretation remained variable across programs. For educators, the main challenge is not deciding whether signalling matters but helping applicants navigate how it is used in different subspecialty contexts. More consistent communication about non-signals, home-institution expectations, and tiered signals may improve advising, transparency, and trust in the fellowship recruitment process.
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