Program Signaling in Emergency Medicine: Applicant Trends and Outcomes From the 2023 and 2024 Match

Program signals were introduced to the emergency medicine (EM) residency application process during the 2022-2023 and 2023-2024 application cycles, allowing applicants to express interest in specific programs. Despite widespread adoption, the relationship between signal usage and applicant outcomes remains poorly understood. This study evaluates patterns of signal utilization and their association with interview offers and match outcomes during the initial implementation in EM.

We conducted a retrospective analysis of the Texas Seeking Transparency in Application to Residency (Texas STAR) database, examining US allopathic and osteopathic senior medical students applying to EM residency programs during two application cycles (2022-2023 and 2023-2024). We analyzed program signal (PS) distribution patterns using χ ² testing and employed multivariable logistic regression to assess the relationship between PS usage and both interview offers and match outcomes.

The study included 967 EM applicants across two application cycles (478 in 2022-2023, 489 in 2023-2024), who sent 1919 signals in 2022-2023 and 3170 in 2023-2024. Signal distribution was highly concentrated, with the top 10% of programs receiving 35% of all signals in both application cycles. Interview yield was higher at signaled programs (2023 cycle: 76.3%, 2024 cycle: 78.9%) compared to programs overall (2023 cycle: 51.3%, 2024 cycle: 43.5%). In logistic regression analysis, sending a program signal was associated with increased odds of receiving an interview offer (2023 cycle: OR 4.40, 95% CI 3.90-4.92; 2024 cycle: OR 3.79, 95% CI 3.42-4.14), and matching after interviewing (2023 cycle: OR 5.13, 95% CI 4.08-6.47; 2024 cycle: OR 4.94, 95% CI 3.98-6.15).

Program signals are associated with improved odds of receiving interviews and matching at EM programs. Future studies should investigate how signals affect the likelihood of receiving interview offers for applicants across different levels of competitiveness.