Thanks for the Signal—Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment

OBJECTIVE: We aimed to explore general surgery program director (PD) experiences with and perspectives on preference signaling in a 15-signal system. DESIGN: We performed qualitative analysis of de-identified transcripts from semi-structured interviews of general surgery PDs. SETTING: General surgery PDs across the United States. PARTICIPANTS: All general surgery PDs in the spring of 2025 were invited to participate. Fifteen PDs volunteered to participate in semi-structured interviews (73% university-based, 53% programs with <8 residents/class). RESULTS: PDs highlighted that signals saved time when utilized as a screening tool, which gave PDs more time for holistic review of applications. PDs also felt signaling increased equity by improving interview distribution among applicants and reducing prestige bias. PDs wanted future changes to signaling to be data-driven; they felt that, if signal number is modified in the future, a balance must be struck between limiting signals sufficiently to ensure they convey real interest and allotting enough signals to ensure application screening efficiency. Additionally, PDs highlighted that greater transparency in program structure, culture, and specific application review practices would allow applicants to better assess their "fit" with a program before signaling. When considering additions to the current system, PDs felt that postinterview signaling could help formalize and standardize letters of intent from applicants. CONCLUSIONS: PDs endorsed signaling as a tool that enhances efficiency and equity in residency selection. However, they called for deliberate, evidence-based optimization, emphasizing that program transparency regarding how signals are being used can improve signaling effectiveness.