Mixed Signals: General Surgery Residency Applicant Attitudes Toward Preference Signaling

While studies outside general surgery (GS) have investigated applicant experiences with preference signaling, more data are needed regarding GS-specific applicant experiences. We aimed to describe, in the current 15-signal system, (1) how GS applicants allocate signals and (2) the applicant-perceived impact of signaling.

An anonymous, voluntary survey was distributed electronically by the Association of American Medical Colleges to all applicants to GS residency in the 2024 to 2025 cycle (inclusive of applicants from allopathic, osteopathic, Caribbean, and international medical schools). Survey items were developed based on a previous qualitative study of applicant signaling experiences. Descriptive analysis was performed.

Electronic survey was administered to US GS residency applicants.

Overall, 249 applicants to categorical GS programs (58% female, 30% racially under-represented, 53% US MD) from the 2024 to 25 cycle responded to the survey (8.4% response rate).

Program culture and location were applicants' most important considerations when allocating signals. Applicants spread signals out across program competitiveness, signaling a median of 5 target, 5 reach, and 2 safety programs. Of applicants with a home GS program (n = 131), 26% were told to signal their home program to be considered for an interview with 33% actually allocating a signal. Of applicants who completed an away rotation (n = 118), 79% signaled their away institution, but only 45% were instructed by their away program to signal for interview consideration. Applicants attended a median of 6 interviews at signaled programs and 4 interviews at nonsignaled programs. Of matched applicants (n = 188), 68% matched at a signaled program. Although applicants saw signals as significantly more beneficial to programs (median = 8/10, 10 = high benefit) than applicants (median = 6/10, p < 0.001), 83% of applicants felt that signaling should continue. With respect to the future of signaling, applicants reported that a median of 0 programs provided transparency regarding their use of signals, but felt program transparency in the future would be useful (median = 5/5, 5 = extremely useful).

While applicants feel that signaling is more beneficial for programs than applicants, the majority want signaling to continue. Applicants highlight the current lack of and need for transparency from programs regarding how signals are used when reviewing applications.