The Power of Preference Signaling: A Monumental Shift in the Orthopaedic Surgery Application Process

Introduction: Orthopaedic surgery has consistently been one of the most competitive specialties in the US residency selection process. This is due in part to the steady upward trend in average applications received per program and average applications submitted per applicant, which is of growing concern. With the implementation of the Preference Signaling Program, the total number of applications has now dropped for the first time in many years, indicating signaling may improve the application process. The hypothesis is that signaling has led to a decrease in applications sent by applicants and a decrease in applications received by programs. Methods: A 7-question survey regarding their interview and match statistics was sent to orthopaedic surgery residency programs that participated in the Electronic Residency Application Service during the 2023-2024 application cycle. A response from the program director/administrator was then recorded. Results: Our program search yielded 159 programs with 106 respondents (66.7%). 82 programs (78.8%) solely interviewed applicants who signaled their program. 92.7% of current interns signaled the program where they matched, and 88 programs (84.6%) matched only applicants who signaled. 95 programs (89.6%) revealed that implementing signaling has improved the application process. Conclusion: Most of the programs only interviewed applicants who also signaled, and nearly all matched orthopaedic surgery applicants from the 2022-2023 cycle signaled their matching program. Orthopaedic surgery applicants should consider only applying to 30 programs and using all 30 available signals. Applicants should also be more confident knowing that beyond the 30 signals they use, there is limited support to say that they will receive an interview outside of these 30 applications. Orthopaedic surgery programs will also now have the ability to allocate more time to applicants most interested in their program, given the reduction of applications.