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The most common questions medical students have about preference signaling in residency applications—answered. Kathleen Kashima, PhD, senior associate dean of students, at University of Illinois College of Medicine provides an overview of residency program signaling and how students can best use it to stand out. American Medical Association CXO Todd Unger hosts.
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Speaker
- Kathleen Kashima, PhD, senior associate dean of students, University of Illinois College of Medicine
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're answering the most common questions medical students have about preference signaling in residency applications. Joining me today is Dr. Kathleen Kashima, senior associate dean of students at the University of Illinois College of Medicine in Chicago. I'm Todd Unger, AMA's chief experience officer, also in Chicago. Dr. Kashima, welcome.
Dr. Kashima: Thank you, Todd, and to the AMA for hosting so many informational sessions about important topics such as this one.
Unger: We know it's top of mind for students out there. And let's get right to the topic of preference signaling. It's pretty new, just introduced in the 2020-2021 residency application cycle. So it's still new to students, still getting used to it—a lot of questions out there. Why don't we just start with a top-level explanation of what preference signaling is and why it was introduced.
Dr. Kashima: Sure, preference or program signaling is a system that allows applicants to indicate interest in a limited number of residency programs at the time of application. And you said why—why was this introduced? Well, some residency programs are receiving a larger number of applications, especially in this highly competitive landscape, so it's been challenging for programs to determine which applicants are the most interested. And it is designed to be one of many data points for programs to decide interview offers.
Excellent. And we are hearing from a lot of students. They're putting in a lot of applications. So this is an important way to show that signal. As they learn about preference signaling, students have just basic logistical questions about, number one, how many signals are they allowed and how to send them? And if each specialty is different, where do students figure out the answers to those questions?
Dr. Kashima: Yeah, and those are great questions. There's a lot going on—ever-changing landscape. So I always say go to the source. Signaling occurs at the time of the application, so it's really important for applicants to know what the current information is about applications. So going to those websites where application information is explained is really important, such as the AAMC MyERAS application program signaling website, the plastic surgery application website, Society for Academic Urologists. And again, within a specialty—I don't know if I mentioned this before—not all programs may be participating in signaling.
Unger: All right that is good to know. Well, determining the best way to use your signals is another challenge, of course. Is it simply that you use all the signals that you're given for your top programs or are there other, more strategic considerations that students should be thinking about?
Dr. Kashima: Yeah, that's a great question. Again, this is, like you said, a relatively new process. And there's actually changes that occurred from when it first started last a couple years ago till now, so it can be really confusing. So as I just stated, go to the source of application information, and then also talk to specialty advisors and deans who are updated about the current specialty and program information to ensure that you understand the guidelines for signaling for the specialty. And, as I mentioned previously, pay attention because not all programs in that specialty will be participating in signaling. And signaling is going to be used with other data points.
So I just want to say, too, for example, a signal does not guarantee an interview in a specialty, and not signaling doesn't necessarily mean that you're not going to get an interview in a specialty at a program. So it really depends on how the program is using the signaling. But as a general guide, signaling programs—you need to align with your training goals and interests as well as a desirable culture and geographic preferences to indicate a strong interest to interview at those programs. So one way to look at signaling is to avoid being overlooked.
And just to mention, too, what makes this more complicated is there's different approaches to signaling. So there's single tier, where there's a small number or even a large number of signals that applicants can use, and then there's two-tiered, with gold and silver—so gold, of course, indicating stronger interest in those programs and silver is interest but not as much. So another factor to consider is the number of signals you have. That's why it's really important that you understand how it works in the specialty.
And with a small number of signals, for example, it's going to indicate a very strong interest in programs because they know you only have two or three. And then, of course, if you have a medium number, then it's going to indicate you have more interest in more programs, and then, of course, with a larger number, it's going to disperse even further. So this is where consulting with knowledgeable advisors is really important for you to do.
Unger: Dr. Kashima, are there any scenarios in which students should not signal at all?
Dr. Kashima: Yeah, well, that's a great question because this is voluntary still for programs as well as for applicants. And so just remember that and how this is used as one data point. We say do not signal a program if you're not interested in it. I mean, that might seem like a fundamental point, but people might feel compelled to do it. Well, do not do that if you're not interested in the program.
You might also feel like I really want to signal a program that's really out of my reach, but it's kind of great reputation ... well, signaling can be good to stand up for programs that are within your reach, but signaling alone won't improve your odds of getting an interview at a program that isn't in your range. So again, use your signals wisely and talk with people to confirm what you're thinking in terms of programs that are within your reach.
Unger: I think that's a really important point I just want to follow up there on that because I'm sure a lot of students are wondering how much of a difference signaling makes. You just kind of gave a guideline there, kind of within some bounds. Does it increase your odds if it is kind of in the right bounds to get an interview?
Dr. Kashima: Yeah, that's a great question, and I know all of our applicants are thinking the same thing. And like I said, this is a relatively new system. So thankfully, research is being published and presented about this question, but my expectation is as more research comes out, things are going to probably continue to change.
I do want to say there's the AAMC MyERAS and program signaling website has an informative recorded presentation titled, "Exploring the Relationship Between Program Signaling, Geographic Preference, and Interview Invitations from the ERAS 2023 cycle," which was last year. So that's helpful just to get a sense of how those things might relate in terms of the data that AAMC collected.
In addition, there's specialties like obstetrics/gynecology or laryngology and urology that have published recent papers on the topic. And I expect there's going to be many more to come. So the medical education community is really in agreement that we need more research on this to make sure that it works well for all stakeholders.
I do have one hint, though, I just want to say, just to add, that programs are receiving signals from many of their applicants or from more applicants than typically interview—may be tempted to use the signal as a requirement for interview invitation. I say "may" again because it depends on the program. So just remember, it's just one data point.
Unger: That is an important hint and part of the strategy of this process. Dr. Kashima, all these insights have been incredibly helpful. If students have additional questions about signaling or the residence application strategy just in general, where is the best place to go for help?
Dr. Kashima: You have to talk with people, and I emphasize, who are knowledgeable about signaling, specialties and program information. They need to be updated because as we just mentioned, within a year, things change. So you may need a team of people to cover all of these areas to be able to talk with them and bounce off your thoughts and ideas—so medical school advisors, residency program directors in places such as residency fairs—I know that there's many sponsors of those that help our applicants—faculty mentors, current residents. Those are some of the people that we suggest for our applicants to talk with.
Unger: Well, this has been great advice, and I know there are a lot of students with these questions, so your hints on strategy are going to be really, really important. It's such a pleasure to have you. One tool that students can use to help their research and refine what programs they'd like to signal is FREIDA that's F-R-E-I-D-A. FREIDA is the AMA's residency and fellowship database that students can find at freida.ama-assn.org. We'll include that link in the description of this episode.
That wraps up today's episode, and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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