Preparing for Residency

How to effectively use program signaling as a residency applicant

Brendan Murphy , Senior News Writer

An ongoing system for residency applicants to express explicit interest in a program is catching on in more physician specialties—and appears to be yielding the desired results. 

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Program signaling—a system that allows applicants to indicate interest in a limited number of residency programs—will be used by 18 specialties during the 2022–2023 residency-application cycle. Specialties using the system are: adult neurology; anesthesiology; dermatology; diagnostic radiology; interventional radiology; emergency medicine; general surgery; internal medicine (categorical); internal medicine/psychiatry; neurosurgery; obstetrics and gynecology; orthopedic surgery; otolaryngology; pediatrics; physical medicine and rehabilitation; preventive medicine; psychiatry; and urology. This will be the third year in which the system is offered, and it is growing more widespread in specialty usage.

A recent AMA Innovations in Medical Education webinar detailed what medical students seeking residency slots should expect.

The webinar included details about program signaling during this cycle, presented by AMA member Steven Pletcher, MD, director of the residency program in the department of otolaryngology at the University of California, San Francisco (watch recording).

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The specifics of program signaling, like many aspects of the residency selection process, vary by specialty. Generally, the idea is fairly simple. By indicating specific interest in a program, applicants improve their chances to get an interview slot.

Program signaling takes place prior to the release of applications to program directors. Programs can then see which applicants signaled them when they receive the applications. They don’t see which other programs an applicant has signaled.

“In general, if you think about the process as a whole, the vast majority of applicants are screened out prior to interview day. And in the past, there's been no formal method to align applicant and program interests prior to that interview selection time frame, and that's what signals are designed for,” Dr. Pletcher said.

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Dr. Pletcher examined the efficacy of program signaling in otolaryngology, a specialty in which on an annual basis the average individual applicant has applied to more than half the programs in the country.

Using the 2020-2021 Match cycle as a baseline, the overall interview offer rate for otolaryngology was 18% of applicants receiving interviews from programs to which they applied. Applications associated with a signal had a 58% interview offer rate for programs they applied to and used a signal. Signaling also proved to be helpful across the spectrum of applicants—not just that subgroup of students deemed to be the most competitive group.

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The most important point Dr. Pletcher emphasized was to learn how program signals are being used in the physician specialty you are pursuing. The number of signals, for instance, can vary. 

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“How you're going to approach this if you're applying into orthopedic surgery—where you'll be submitting 30 signals—is very different than how you'll approach it if you're applying in adult neurology and submitting three signals,” he said. In terms of where to use signals, Dr. Pletcher urged applicants to consider training goals, culture and geography. He also advocated getting feedback from an adviser on how you plan to use your signals and understanding how competitive you are for the programs you plan to signal.

Dr. Pletcher said that one trap he’s seen students fall into is “over strategizing” the use of their signals.

Applicants have said something to the effect of, “I thought I was a great applicant for that program, and I really wanted to go to that program, but I kind of assume they would interview me anyway. So, I used my signals someplace else,” Dr. Pletcher said.

“From the program director perspective there are times when we look at applications and say: Well, there's a great applicant, seems like a reasonable fit but they didn't signal us—and that means that they're much less likely to get an interview offer.”