Evolving Applicant Priorities in the Signaling Era: Implications for Orthopedic Surgery Residency Recruitment

The Orthopedic surgery residency application process has undergone notable recent changes, including the adoption of preference signaling and increasing emphasis on applicant-program alignment. To recruit top candidates, programs must understand how applicants prioritize program characteristics. While prior research identified general applicant priorities, the influence of signaling on these preferences remains unclear. This study aimed to (1) identify factors prioritized by applicants, (2) assess the impact of signaling, and (3) examine differences among applicant subgroups.

Current orthopedic surgery residents and fourth-year medical students (MS4s) applying to orthopedic surgery completed an electronic survey. Participants ranked factors impacting their residency program selection using a six-point Likert scale and self-reported demographic data. Continuous variables were compared using t-tests or Mann-Whitney tests, depending on distribution, and chi-square tests for categorical variables. Multivariable linear regression was used to examine the association between signaling participation and factor importance scores while adjusting for respondent demographic characteristics.

Electronic survey distributed using the Qualtrics XM Platform.

Active orthopedic residents and residency applicants, defined as fourth-year medical students applying to orthopedic surgery training programs during the 2023-2024 National Resident Matching Program (The Match) cycle.

Out of 151 respondents, 66.3% were active residents, 47.0% identified as women, 76.8% identified as White, and 45.7% were signaling participants. Key factors for all respondents included program atmosphere, inter-resident collegiality, and resident satisfaction. Signaling participants valued support of personal identity (p = 0.001), geographic location (p < 0.001), family-building factors (p = 0.001), resident/faculty demographic composition (p = 0.01), and compensation/benefits (p = 0.004) significantly more than non-signaling participants. Underrepresented and women participants prioritized support of personal identity (p < 0.001), resident/faculty demographic composition (p < 0.001), and patient population diversity (p = 0.02) significantly higher than non-Hispanic White males. After adjustment, signaling remained significantly associated with higher prioritization of support of personal identity (β = 0.62, 95% CI 0.16-1.08; p = 0.008).

Signaling has reduced the number of programs applied to and revealed greater prioritization of program culture and interpersonal support systems. These insights emphasize the need for orthopedic programs to create inclusive and supportive environments.