From Adoption to Optimization: APCCMPD Recommendations for PCCM Program Signaling

Program signaling was introduced to address application inflation in graduate medical education (GME) by providing applicants with a structured mechanism to express genuine program interest. While signaling has been widely adopted across specialties, evidence-based guidance specific to fellowship recruitment in Pulmonary and Critical Care Medicine (PCCM), Critical Care Medicine (CCM), and Pulmonary Medicine is lacking. The Association of Pulmonary and Critical Care Medicine Program Directors (APCCMPD) Recruitment Committee developed specialty-specific signaling recommendations, drawing on a comprehensive literature review, a national benchmarking survey of program directors (n=108), and through consultation with ERAS representatives. Our literature review confirmed that signaling increases interview yield across specialties, with the strongest gains observed among MD graduates compared with DO and international medical graduate (IMG) applicants. The benchmarking survey revealed that 92.8% of programs participated in signaling, over half reported reduced application review time, and most programs used gold and silver signals identically. Key deliberative considerations included the unique cross-applicant dynamics among PCCM, CCM, and Pulmonary pathways, the structural inability of ERAS to distinguish CCM tracks within PCCM programs, equity implications for IMG applicants, and the relationship between signal number and signal value. Based on these findings, we recommend transitioning to a non-tiered signaling system, allocating 15 signals for PCCM, 10 for CCM, and 2 for Pulmonary, and maintaining separate signal pools with continued monitoring. We also provide specific guidance for both applicants and programs to promote transparency, equity, and holistic review. These recommendations will be reviewed iteratively as applicant behaviors and match outcome data evolve.