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Where Should I Signal? A Program-Level Analysis of Preference Signaling in the Orthopaedic Surgery Residency Match.

Phillip Schmitt¹, Kathryn Segal¹, Brad Blankenhorn¹

¹Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.

JB & JS Open Access

|February 23, 2026

Summary

Preference signaling in orthopaedic surgery residency applications reduced overall volume. Signals disproportionately favored community-based, lower-tier programs, offering insights for applicants and programs in the competitive match.

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Area of Science:

Medical Education
Surgical Residency Matching
Health Services Research

Background:

Orthopaedic surgery is a highly competitive US residency specialty.
Preference signaling was implemented in 2023 to manage application volume and enhance efficiency.
The distribution patterns of preference signals across residency programs remain largely unexamined.

Purpose of the Study:

To analyze the impact of preference signaling on orthopaedic surgery residency applications.
To investigate the distribution of preference signals across different program types.
To provide data-driven insights for applicants and programs in the orthopaedic residency match.

Main Methods:

Analysis of Association of American Medical Colleges (AAMC) data from 2021-2025.
Collection of application volumes, program characteristics, signaling percentages, and interview rates.
Calculation of application and signal densities, compared across program tiers (Doximity rankings), settings, sizes, and geographies.

Main Results:

Average application density decreased from 139.18 (2021) to 95.84 (2025) per position.
Average signal density was 61.22 signals per position.
Higher signal and application densities were observed in community-based, lower-tier, smaller, nonmetropolitan programs; lower densities in university-based, higher-tier, larger, metropolitan programs.
Interview rates were 23% for signaling applicants versus 2% for nonsignaling applicants.

Conclusions:

Preference signaling introduction correlates with reduced orthopaedic residency application volume.
Signals are disproportionately directed towards community-based, lower-ranked, smaller, and nonmetropolitan programs.
Findings offer valuable guidance for navigating the evolving orthopaedic residency match landscape.