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Thanks for the Signal-Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery

John M Woodward¹, Connie Y Gan², Darci C Foote³

¹Department of Surgery, University at Buffalo, Buffalo, New York.

Journal of Surgical Education

|July 8, 2026

Summary

General surgery program directors find preference signaling improves efficiency and equity in residency selection. They advocate for data-driven improvements and greater program transparency to enhance its effectiveness.

Keywords:

General surgery Graduate medical education Preference signaling Residency recruitment

Related Experiment Videos

Area of Science:

Medical Education
Surgical Residency Selection
Graduate Medical Education

Background:

Preference signaling in residency applications aims to improve applicant-program alignment.
General surgery residency programs utilize a 15-signal system for applicant evaluation.

Purpose of the Study:

To explore general surgery Program Directors' (PDs) experiences and perspectives on the 15-signal preference signaling system.
To identify potential improvements and challenges associated with preference signaling in residency selection.

Main Methods:

Qualitative analysis of de-identified transcripts from semi-structured interviews with general surgery PDs across the United States.
Fifteen PDs participated, representing diverse program types (73% university-based, 53% with <8 residents/class).

Main Results:

PDs reported preference signaling saves time by acting as an initial screening tool, allowing more time for holistic application review.
Signaling was perceived to increase equity by improving interview distribution and reducing prestige bias.
PDs emphasized the need for data-driven modifications to the signal system, balancing signal utility with screening efficiency.
Increased transparency in program structure, culture, and review practices was highlighted as crucial for applicant "fit" assessment.

Conclusions:

General surgery PDs endorse signaling as a valuable tool for enhancing efficiency and equity in residency selection.
Deliberate, evidence-based optimization of the signaling system is recommended.
Program transparency regarding signal usage is key to improving signaling effectiveness.