Preference Signaling in General Surgery: A Qualitative Study of Program Director Perspectives

Area of Science:

• Medical Education
• Surgical Residency Selection
• Applicant Evaluation

Background:

• Large-scale surveys provide some data on preference signal usage in general surgery programs.
• Little is known about how program directors (PDs) interpret and apply these signals in practice.
• Understanding PDs' perspectives is crucial for optimizing the resident selection process.

Purpose of the Study:

• To gather in-depth insights from PDs on their perspectives of preference signaling.
• To understand how PDs interpret and apply preference signals in the resident selection process.
• To explore the impact of preference signals on general surgery residency applications.

Main Methods:

• Semi-structured virtual interviews were conducted with 14 PDs from diverse general surgery programs.
• Interviews explored PDs' perceptions, impact, benefits, challenges, and recommendations regarding preference signals.
• Transcripts were analyzed thematically to identify trends in signal interpretation and application.

Main Results:

• Preference signals are perceived to reflect genuine applicant interest and help borderline candidates stand out.
• PDs use signals for interview selection but not post-interview ranking; their absence doesn't always signal lack of interest.
• Increasing the number of signals is supported by PDs to potentially reduce overapplication and enhance signal utility.

Conclusions:

• Preference signaling can foster a more applicant-centric review process, particularly for less competitive applicants.
• Variability in PDs' signal interpretation presents challenges for equitable advising.
• Standardization and transparency are needed as general surgery transitions to more signals to ensure equitable outcomes.