Advising Through the Noise: Medical Student Advisor Perspectives on How Preference Signals Have Influenced Surgical...

The implementation of preference signals in the general surgery match added another layer of complexity to an already intricate system, challenging medical student advisors in effectively guiding their students. This study aimed to explore advisors' experiences counseling applicants about signaling to inform improvements to the signaling process and improve applicant advising.

Qualitative analysis of de-identified transcripts from semi-structured interviews of medical student advisors was performed.

All interviews were conducted using a video conferencing platform.

Eleven formal medical student advisors to general surgery applicants in the 2024 to 2025 application cycle were interviewed. Participants (55% male) included deans (n = 4), clerkship directors (n = 4), and program directors (n = 3) from across the US.

Overall, advisors perceived signaling positively, believing that signaling improved applicant equity by decreasing interview hoarding and prestige bias. Advisors recounted common applicant mistakes, including applicants only signaling reach programs, signaling based on prestige instead of "fit," and misjudging their competitiveness for a program. Advisors felt that applicants should focus on signaling programs they are both interested in and competitive for, which requires an individualized strategy based on a balance of professional goals, geographic preferences, and program fit. Advisors noted several challenges they faced, including a lack of transparency regarding how programs use signals, uncertainty in advising students without clear data, and difficulty judging an applicant's competitiveness.

While advisors generally acknowledged the positive influence of signals on residency recruitment, the lack of information about the purpose and use of signals limited their ability to provide actionable advice to their students. To effectively guide their students, advisors seek clear communication and evidence-based guidance from national organizations regarding both how signals are supposed to be used by applicants and how signals are used by programs.