Preference Signaling in the General Surgery Residency Match: The Applicant Perspective

In recent years, the general surgery residency match has experienced "application inflation"; applicants are submitting more applications, burdening applicants and program directors. To address this, preference signaling was introduced, allowing applicants to express targeted interest in a select number of programs. While preference signaling has been implemented in other specialties, its impact on general surgery applicants' experiences, perceptions, and Match outcomes is underexplored. This study surveyed general surgery residency applicants to evaluate their experience with preference signaling in the 2024 to 2025 match cycle.

We distributed a cross-sectional, anonymous survey to general surgery residency applicants who applied to a cohort of 12 New England programs. Survey responses captured demographics, signaling use, mentorship, and satisfaction with preference signaling. Quantitative data were analyzed using descriptive and inferential statistics. Qualitative responses underwent inductive coding followed by thematic analysis.

12 New England general surgery residency programs.

General surgery residency applicants.

Of 107 respondents: 57.9% were female, 41.1% were underrepresented in medicine (URiM), and 34.9% were international medical graduates (IMGs). The median number of signals used was 15 (maximum). U.S. MDs averaged 13.7 interviews while IMGs averaged 4.5 (p < 0.001). Overall, 52.3% matched to a signaled program. Less than half (44.9%) believed that signaling helped secure interviews, and 59.8% wished they had signaled different programs. Furthermore, 63.6% regretted some of the signals they sent. While 57.9% found the 15-signal limit to be adequate, the process carried an emotional toll, with 43.0% reporting increased stress. Regarding equity, perceptions were split; URiM and non-URiM applicants perceived equity benefits at similar rates (27.3% vs. 25.9%), while IMGs perceived lower equity overall. Qualitative themes included unclear strategy, inconsistent mentorship, and calls for greater transparency regarding how individual programs incorporate signals into their review process.

Applicant perspectives on preference signaling were mixed to negative; many found it highly stressful, only moderately effective, and laden with postmatch regret. Perceived equity varied significantly among applicant types. These findings suggest a pressing need for clarity, stronger mentorship, and potential adjustments in how programs value and communicate signals to reduce applicant burden.