Author: Lambeth Hochwald
Medscape Medical News
For the last 4 years, residency applicants have been given the option to ‘signal’ their top program choices. The goal: Medical students are not submitting (or paying for) as many applications to residency programs as in years past, and program directors can be more laser-focused on recruiting candidates who are genuinely interested in their programs.
This change came about in 2021 when a ‘preference signaling’ pilot was initiated. The goal was to make the process of reviewing apps more efficient, and within a year, the first group of medical students began to signal their most interested programs.
“Over the last decade, the number of applications to residencies has skyrocketed,” Dana Dunleavy, PhD, senior director of admission and selection research and development at the Association of American Medical Colleges, the organization that administers the Electronic Residency Application Service, told Medscape Medical News. “With signaling, students can indicate their true preference for a program, and when the programs know that their institution is a top preference, they don’t have to guess which applicants are the most interested.”
In addition, as of 2025, nearly every major specialty has adopted or expanded tiered signaling (meaning students can rank a program as gold or silver) to help program directors better identify genuine interest, especially in specialties with over 100 applications per seat. However, medical students in those specialties have been reporting some issues with this tiered concept.
“Some students have told us that there’s not always a meaningful difference between gold and silver and that this is causing stress,” Dunleavy said. “We’re not recommending that programs use the two-tiered signaling anymore because of this.”
With Match Day on the horizon, did this ‘make or break’ metric for matching work? Apparently, it depends on who you ask.
“I think signaling is an improvement in the application process in general,” said Holly Cordray, a fourth-year medical student at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, who is applying for residency in plastic and reconstructive surgery. “It’s good for us because we don’t have to do individualized applications for each program and it’s helpful for the programs because it cuts down on application bloat and focuses on the candidates who are serious about their goals and intentions.”
This is especially important in Cordray’s highly competitive specialty, which allows students to indicate the 20 programs they’re most interested in.
“There’s a lot of gamesmanship and strategy to the application process for us because there’s a big supply-demand mismatch in available spots,” she said. “There’s not as great a need for plastic surgeons as there is for internal medicine hospitalists.”
In fact, there are currently 210 available spots across 89 programs nationwide, with the largest programs offering five spots and some offering only one, Cordray said.
“I’ve heard there were 510 applications submitted,” she added. “This means we’ll have a 40% match rate.”
Saving Time and Money on Applications Matters
Before signaling started, medical students were spending enormous amounts of money on residency applications, said Mikhail Bethell, MD, now an orthopedic surgery resident at Duke University School of Medicine in Durham, North Carolina, who went through the matching process a year ago while attending Duke.
“Before signaling, you could be applying to 90-plus programs,” he said. “Now, medical students in my specialty are given 30 signals, and this reduces the over-applying that was in place before.”
What made Bethell’s matching process even more complicated was that he was applying with his wife, also a Duke University School of Medicine graduate. Her specialty, OB/GYN, had half the number of available signals as orthopedic surgery and used gold and silver tiering at the time. However, she ultimately matched at Duke, too.
“This felt like playing a game with institutions you have yet to interview with,” he added. “Do you give five signals to your dream schools but never get to interview with them? Or if you give a silver to a program, will that hurt your chances? It was also complicated given how many signals I had and how few she had.”
In addition, Bethell says it was hard to identify 30 potential residency programs.
“You guess after 20,” he says. “But, for other people who are only given 10 to 15 signals, it’s not as easy. This isn’t uniform, and those students must use those 15 strategically.”
Other Aspects of the Matching Process May Matter More
For applicants, a short section that enables you to add more specifics about why you’re signaling, whether it’s to call out certain components of your training program or a personal reason for wanting to be there, may make all the difference in where you end up matching, Cordray said.
“You should use that section as an opportunity to show your personal connection to the place,” she added. “For example, I grew up in Columbus, Ohio, and when I signaled Ohio State, I was able to make the point of why it would be wonderful to be in the same city as my parents during my residency.”
Besides this, Bethell says it’s up for debate whether the process has improved because of signaling.
“Originally, the signal was supposed to be this way of showing which programs you’re interested in,” he said. “But signals become irrelevant once you’ve done your interviews. So, in my mind, signals are a way to secure your interviews, but not for the actual match itself.”
Ultimately, Meilynn Shi, MD, believes the success of signaling depends entirely on the specialty.
“For some specialties that get more than 10 signals, you might only get an interview if you signal that program,” said Shi, who graduated from Northwestern University’s Feinberg School of Medicine, Chicago, in 2025 and matched there after dual applying for cardiothoracic and general surgery (she got three signals for cardiothoracic and 15 signals for general surgery). “For those specialties that get less than 10, it’s more of a cherry on top and may not make that much of a difference.”
In the end, there are other far more important ways to make your application stand out, noted Shi.
“If you really want to go to a certain program, think about the things that are more memorable than a signal. These include your away rotation, your geographic preference, personal statement, recommendation letters, phone calls, and networking at conferences. I’m not sure signals add much more.”
What remains the most important thing, whether signals are working, is for students to feel happy with the program they end up matching.
“Everyone ends up with a better match if it’s a place where that student really wants to be for their training,” Cordray said. “If a resident will be happier at a particular program, they’ll be more engaged and dedicated.”
That’s good for both the residents and the programs.