The Impact of Preference Signaling on Orthopedic Surgery Residency Interviews

This study examines whether the effectiveness of preference signaling in obtaining interview offers for orthopedic surgery residency varies by program type and size.

We conducted a retrospective cohort study of orthopedic surgery applicants in 2024 using the Association of American Medical Colleges (AAMC) Residency Explorer Tool. The primary outcome was the "interview offer rate," defined as the number of interviews given to applicants who signaled the program divided by the number of signals sent. Programs were analyzed by type (academic or community) and size (small = ≤5 residents, medium = 6-8, large = ≥ 9). Data were evaluated via Kruskal-Wallis and Dunn post hoc tests.

This study was performed at Duke University Medical School in Durham, North Carolina. There was no clinical care provided.

We incorporated data from all MD, DO, IMG, and non-IMG applicants invited to interview at orthopedic surgery residency programs in 2024. Inclusion criteria were residency programs in the AAMC database which reported the rates of interviews offered to applicants who did and did not send a preference signal (120 programs total).

Of 210 programs, 90 were excluded due to incomplete data, leaving 120 (57.1%). Across all institutions, applicants who signaled a program were significantly more likely to receive an interview offer (median 22% versus 1%, p < 0.001). For applicants who sent a signal, there was no significant difference in interview offer rate by program type, size, or type and size combined. There were also no significant differences across these metrics for applicants who did not signal a program.

Interview rates for signals were consistent across program types and sizes, suggesting similar effects wherever signals are sent. All programs were unlikely to interview applicants who did not signal, highlighting the importance of careful signal selection.