Impact of signaling on interview invitations in the neurological surgery match process

Neurosurgery remains one of the most competitive residency programs with an increasing application volume. Signaling was introduced to allow applicants to express interest in specific programs and streamline program director application review; however, there are limited data on how signaling affects interview invitations in neurosurgery. This study investigates the impact of signaling on interview invitation odds and subsequent residency program selection.

The authors analyzed data from 93 Accreditation Council for Graduate Medical Education-accredited neurosurgery residency programs from the 2024 application cycle, sourced from the Residency Explorer platform. A signal strength index (SSI) was created using two metrics: odds ratio (OR) of receiving an invitation to interview for signaling and nonsignaling applicants and absolute difference in interview rates between these applicant groups. Correlations among SSI, Doximity program rankings, and program location were also examined. Statistical significance was set at an α of 0.05.

Signaling a program significantly influenced interview invitations, with 19 programs (20.4%) inviting only applicants who signaled their institution and 65 programs (69.9%) inviting < 10% of applicants who did not signal the program. Doximity program rankings were weakly correlated with the SSI (Pearson's r = 0.26, p = 0.01) and moderately correlated with a program's OR rank (Pearson's r = 0.44, p < 0.01). After controlling for Doximity rank, program size was negatively correlated with the OR rank (Pearson's r = -0.26, p = 0.01). The geographic location of a program did not correlate with the SSI (p = 0.48).

Signaling plays a key role in neurosurgery residency interview invitations, with its impact varying across programs based on factors like program rank and competitiveness. The SSI represents a comprehensive tool for applicants to assess which programs to signal, optimizing their chances of receiving an offer to interview.