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Preference Signaling and Interview Invitations in the First 15-Signal General Surgery Cycle: A National Analysis of
Niranjna Swaminathan1, Jacquelyn Elise Fitzgerald1, Chandler Mcleod1
1Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama.
Background:
Designed to align applicant intent with program selection, residency signaling has been studied mostly through individual program outcomes. This study shifts focus to the national level, analyzing how signaling influences interview invitations after adjusting for program characteristics.
Methods:
We queried all Accreditation Council for Graduate Medical Education-accredited general surgery programs from the Residency Explorer database. The 2024 to 2025 application cycle was analyzed, representing the first year that applicants received 15 signals. To evaluate the impact of signaling on interview invitations, we performed a single-predictor logistic regression and mixed-effects multivariable logistic regression with a program-level random effect, adjusting for program characteristics. Signaling status was modeled categorically, and program-level covariates included setting, region, cohort size, and accreditation. The signaling rate was defined as the proportion of signaled applications resulting in an interview.
Results:
Of 363 programs, 252 (69.4%) reported signaling information, encompassing 275,765 applications and 58,851 signals. The overall signaling rate was 21.3% (median 18%, 14.5-24.0). In a single-predictor logistic regression, signaled applications had a 23.7% interview rate compared with 5.0% for nonsignaled applications (odds ratio [OR] 5.95, 95% confidence interval [CI] 5.79-6.12, p < 0.001). After adjusting for signaling status, university programs were less likely to offer interview invitations than community programs (OR 0.94, 95% CI 0.91-0.98, p = 0.001). Programs in the Pacific (OR 1.45, 95% CI 1.38-1.52), Mountain (OR 1.36, 95% CI 1.30-1.43), and West North Central (OR 1.41, 95% CI 1.33-1.49) regions had increased odds to offer interviews overall, independent of signaling, whereas larger programs (>6 residents) were less likely to do so (OR 0.88, 95% CI 0.82-0.94). In multivariable analysis, signaling remained the strongest predictor of interview offers (OR 6.63, 95% CI 6.44-6.82, p < 0.001), with regional and program-type variation persisting.
Conclusions:
Signaling was the strongest predictor of interview offers. The adjusted odds of receiving an interview invitation were 6.6 times higher for signaled than nonsignaled applications, corresponding to observed interview rates of 23.7% and 5.0%, respectively.