The Evolution and Impact of Preference Signaling on Orthopaedic Residency After Two Years

Residency programs have begun to offer preference signaling as a method for applicants to demonstrate commitment to programs. Orthopaedic surgery, which began signaling in 2022, allows applicants to use up to 30 signals. Early studies have evaluated the effects of signaling, demonstrating decreased application volume, varying effects on interviews, and high levels of applicant and faculty satisfaction. While the effects of signaling are beginning to be studied, multiple year evaluations are absent from the literature. The purpose of this study was to explore the impacts of signaling on the orthopaedic surgery match over its first two years.

We performed a retrospective cohort study using a prospectively collected Texas Seeking Transparency in Application to Residency database. The database contains survey data from 2017 to 2024 including applicants' demographics, academic performance, and application data. Applicants were first placed into cohorts comparing presignaling and postsignaling data. A second analysis organized applicants into the first year and second year of signaling. Cohorts were compared using descriptive statistics, chi-square tests, and independent samples t-tests.

There were 1786 orthopaedic surgery applicants from 2017 to 2024. In the first two years of signaling, the mean applications decreased by 23 (p < 0.001), interview offers decreased by three (p < 0.001), publications increased by one (p < 0.001), and volunteer experiences decreased by one (p < 0.001). When compared with the first year, the second year of signaling decreased applications by 15 (p < 0.001), decreased interviews by one (p = 0.030), decreased volunteer experiences by four (p < 0.001), and decreased publications by one (p = 0.015). There was no significant difference in match rate.

Orthopaedic surgery preference signaling after two years significantly decreased mean applications, interview opportunities, and extracurricular experiences of applicants without affecting match success. These findings suggest that preference signaling continues to be an effective method at reducing application volume for programs and applicants while creating equitable opportunities for applicants after two years.

Level III-Retrospective Cohort Study. See Instructions for Authors for a complete description of levels of evidence.