Signaling in Otolaryngology Resident Matching

Preference signaling continues to gain prominence during the medical and surgical residency selection process. In the signaling process, applicants identify residency programs of highest interest to them and send programs one of a defined number of signals, thus allowing programs to give special consideration to applicants who express this heightened interest.

The template for using signaling originally came from economics literature, which showed that signaling resulted in a better pairing of job applicants to job opportunities. Within medical and surgical specialties, there had been a longstanding concern that residency applicants were applying to increasing numbers of programs, resulting in increased financial and time cost burdens both to applicants and to residency programs. There were also concerns that the “arms race” in continually increasing applications could be contributing to disparities in medical specialty recruitment.

Within otolaryngology, a group of leaders from the Otolaryngology Program Directors’ Organization (OPDO) Council made the decision to start preference signaling with the 2021 residency match cycle. Initially, a “low signal” approach of five signals per applicant was used. Over time, this transformed into the current “high signal” approach of up to 25 program signals. Application numbers per applicant continued to rise with the low signal approach; however, once the high signal approach commenced, applications per applicant within otolaryngology declined. A similar trend occurred across multiple specialties that have instituted a high signal approach as well, including orthopedic surgery (the first to use this approach), urology, dermatology, and neurosurgery.

A maximum of 25 signals for otolaryngology was determined based on examining other specialty program signal numbers and using a similar ratio of signals to the total number of residency programs. Based on available Association of American Medical Colleges (AAMC) data, otolaryngology had an average of 72 applications per applicant in 2021, and this dropped to an average of 44 applications per applicant in 2026. Similarly, the average number of applications per residency program has dropped, with programs receiving an average of 390 applications in 2021 and 228 in 2026. For the 2025-2026 Electronic Residency Application Service (ERAS) and National Resident Matching Program (NRMP) application cycle, otolaryngology offered 394 resident positions and had 666 total applicants. Greater than 99.5% of applicants signaled residency programs during the 2025-2026 cycle, showing that the message and value of preference signaling have become ubiquitous.

Discussion and Outcomes of Signaling

During the 2025 SUO/OPDO/AADO (Society of University Otolaryngologists/Otolaryngology Program Directors Organization/Association of Academic Departments of Otolaryngology) meeting, a panel on preference signaling included a very robust discussion from both panelists and the audience. Panelists discussed that data within the medical literature, and specifically within the otolaryngology literature, have suggested that signaling benefits applicants by providing a higher likelihood of receiving interview offers at their programs of choice and by improving the distribution of interview offers among both top-level and less competitive applicants. Programs benefit from the knowledge of the particular interests of applicants, allowing heightened scrutiny of associated applications. Ultimately, satisfaction rates with signaling from both applicants and programs approached 90% based on survey data from OPDO Council personnel.

As signaling evolves across specialties with variable application dynamics, a variety of approaches are being used, including the original low-signal approach, a tiered approach incorporating gold and silver signals to identify pools of interest, and the high-signal approach. For the foreseeable future, the OPDO Council has decided to continue with the 25-signal (high) approach because of the positive feedback and high satisfaction of the involved parties.

Data suggests that more than half of residency applicants end up within geographic proximity of their home. From a program standpoint, it has traditionally been difficult to determine which applicants had a legitimate interest in a program and which applicants were simply applying to a high volume of programs primarily to limit the risk of going unmatched. The panelists discussed that while it is difficult to quantify the signaling effect on new residency programs, signaling has allowed smaller and newer programs to identify interested applicants from various parts of the country that the program may otherwise not have distinguished from their applications. Signaling may help some programs obtain a wider geographic distribution of residents, which in turn can be leveraged for faculty recruitment in the future.

Strategy for Signaling

Applicant strategy for signaling remains an area of active discussion. While all otolaryngology residency positions are competitive, panelists recommended that applicants think carefully about signaling programs that may be most likely to strongly consider their applications and avoid prioritizing signals solely to top-ranked, highly competitive programs.

Current AAMC data suggest that applicants have less than a 1% chance of receiving an interview offered to a program at which they did not signal and a 34% chance of receiving an interview offer with a signal; therefore, each signal carries significant value in terms of interview opportunities. Medical student applicants and medical student directors are encouraged to be very thoughtful about a strategy for using the signals based on the strengths and interests of each applicant. Students are encouraged to signal their home programs and away-visited programs if they desire an interview.

In summary, preference signaling, as intended, has increased the likelihood of interview offers at signaled programs, decreased the time burden on application committees, improved the distribution of offers across applicants of all calibers, and decreased the number of applications per applicant. Unintended consequences include increasing complexity for applicants and their mentors, as signaling requires an early decision from applicants about programs of interest. Despite these challenges, preference signaling has significantly improved the application process for both applicants and programs. With broad support after its initial implementation within otolaryngology, signaling has spread such that all major residency specialties now use some form of preference signaling in their application process. The OPDO Council uses an iterative process to examine the data provided by the AAMC each year and to determine the need for any adjustments in the signaling format and maximum signal numbers. For the time being, otolaryngology will continue to use a 25-signal system per applicant. 

 

 

 

 

Dr. Comer is the vice chair for education and the otolaryngology residency program director at the University of Kentucky in Lexington, and the chair of OPDO. Dr. Seim is the director of otolaryngology medical student education at The Ohio State University in Columbus. Dr. Ito is the vice chair for education and the otolaryngology residency program director at the University of Massachusetts in Worcester. Dr. Richmond is a PGY-2 otolaryngology resident at Georgetown University in Washington, D.C. Dr. Pletcher is the otolaryngology residency program director at the University of California, San Francisco, the immediate past chair of OPDO, and has been integral in the development of the signaling process within otolaryngology.