Preference Signaling in Plastic Surgery: A Survey of Applicants' Perceptions and Experience

Integrated plastic surgery residency is among the most competitive specialties. This study explores applicant attitudes and perspectives on the use of preference signaling, including factors influencing signal allocation, perceived effects on interviews and match outcomes, and variables guiding rank list decisions.

Two surveys were distributed to applicants during the 2024-2025 application cycle. The first survey, distributed before interview invitations, assessed applicant demographics, signaling strategies, and perceptions of the signaling process. The second survey, distributed after rank list submission, evaluated factors influencing ranking decisions and the perceived importance of application components in the residency match. Descriptive statistics summarized quantitative data, whereas qualitative responses underwent thematic analysis to identify common patterns and themes in applicant responses.

Eighty-two applicants completed the initial survey (22% response rate), and 50 completed the follow-up survey (14%). Nearly all respondents (97.5%) used all 10 available signals, with geographic location, program culture, and subinternship experience as the most common factors influencing allocation. Half of applicants reported being advised not to signal programs where they had completed a subinternship. Although most viewed signaling as important, uncertainty persisted regarding its impact on interviews and match outcomes. When generating final rank lists, applicants prioritized location, faculty interactions during interview day, and perceived resident happiness and cohesiveness.

Preference signaling is widely used and valued by applicants, but inconsistencies in program expectations and uncertainty regarding its impact persist. Standardized guidelines and transparency are needed to ensure equitable implementation and optimize signaling effectiveness in the integrated plastic surgery match.