The Evolving Effects of Preference Signaling in the Orthopaedic Residency Match

In the inaugural year of preference signaling in the orthopaedic match, our team surveyed applicants and program leaders (program directors, assistant program directors, and program coordinators), with results demonstrating reduced application volume and signal concentration compared with specialties with fewer signals. However, it remained unclear how trends would evolve as both parties became aware of each other's behavior. This study evaluates the evolving effects of preference signaling in its second year. Mixed-method surveys were adapted from our initial study and distributed to American Orthopaedic Association/Council of Orthopaedic Residency Directors member program leaders and applicants registered for the Electronic Standardized Letter of Recommendation following Universal Interview Offer Day 2023 (Fall Survey) and Match Day 2024 (Spring Survey). Ninety-five program leaders (49%) and 311 applicants (28%) completed the Fall Survey, and 119 program leaders (61%) and 365 applicants (30%) completed the Spring Survey. While response rates are aligned with other similar survey studies, results are subject to nonresponder bias. Applicants submitted an average of 61 applications for Match 2024, significantly lower than 84 for Match 2023 (p < 0.001). The number of interviews received per applicant dropped to 10.8 from 11.7 for Match 2023 (p = 0.27). Only 3% of interviews went to nonsignaling, nonrotating students, down from 14% for Match 2023 (p < 0.001). A total of 96% of applicants matched at a signaled institution. There was a decrease in the variance in the number of interview invitations reported by applicants (p = 0.001) and in signal concentration, with 50% of signals concentrated among 32% of programs, compared with 27% for Match 2023. In the second year of signaling, application volume continued to decrease, with modest improvements in signal and interview concentration. Signals are being increasingly used as screening tools, and applicants predominantly interview and match at signaled programs.