Trends across all specialties have shown an increase in the number of applications submitted per student over the years. These trends are even more accentuated for students applying into competitive surgical sub-specialties like urology. This is expensive and stressful for applicants and overwhelming for programs facing an indiscriminate number of applications to review in an extremely compressed time frame, many of which ultimately use filters that inherently perpetuate bias and represents a structural barrier to holistic review which is a no-win situation. The interview selection process is a bottleneck in the congested applicant interview market. The uncertainty and inefficiency that surrounds the process leads to interview hoarding which has been improved by the national coordinated synchronized interview release date process initiated in the 2020-2021 Match cycle. For programs, this may lead to not interviewing candidates with the most interest. For applicants, this may result in not interviewing at places of credible interest.

In the era prior to over-application and congestion, indeed the act of applying was a credible signal that a student was interested in a residency program. This is simply no longer the case when an applicant casts a net multiples times larger than the number needed to obtain greater than ten or so interviews to successfully match.

Informal signaling methods currently used:

• reading between the lines of personal statements
• letters of recommendation
• perceived geographic preferences (whether true or not)
• email and phone call overtures (whose credibility can be in question and are subject to both privilege and bias based on network selectivity and resource allocation)
• away rotations (limited both by COVID in 2021 and by CoPA in 2022) and prior to this by scarcity, logistical scheduling, free for all application system

There is both noise, bias, and privilege in these informal methods. Applicants currently utilize several strategies to increase their chances of attaining in interview: over-application, solicitation of mentors/advisors to communicate on their behalf, performing an excess of away-rotations, and direct communication with uncertain intent.

Preference Signaling (PS) is initiated and controlled by the applicant, facilitating a credible, formal, and equitable process for applicants to express interest to a program. Signals are a finite resource and thus maintain their value. The number of signals provided to each applicant is a known equal and equitable quantity.

Fair and equitable distribution of interviews can optimize interview distribution and potentially match outcomes. Consolidation of a majority of interviews to a minority of candidates is detrimental to the match marketplace regardless of the perceived tier of applicant or program. Both applicants and programs benefit from the transparency introduced by PS. The overarching goal is to allow applicants a credible, formal, and equitable process to express interest. This is initiated and controlled by the applicant and programs can thereby better utilize scarce interview resources.

Application limits have been debated and investigated across multiple specialties, including the SAU Board. Though there is potential to improve organizational processes by limiting applications, the theoretical risk and liability of restriction of trade or individual autonomy has prohibited execution of such application caps.

Programs are better able to discern potential interest and fit. Signals are a clear marker of sincerity signals but are not a substitute for application review. Programs should review all applications received regardless of whether accompanied by a signal or not. Signals may provide further insight into applicant interest and may spark further holistic review. However, given the low number of signals provided to each applicant, programs should not rely on signals as a screen for application review.

The SAU Match Code of Conduct requires maintain applicant privacy throughout the Match Process.

Residency Program Code of Conduct

• Programs shall NOT disclose identification of applicants who have signaled.
• Programs shall NOT ask interviewees where they have signaled.
• Programs shall NOT disclose the number of signals they have received.

Neither the SAU, AUA, ERAs or NRMP prohibit applicants to express interest in a program prior to interviews. Applicants and programs may express their interest in each other, however, they shall not solicit verbal or written statements implying a commitment.

Applicants are provided 30 signals, all with equal weight. Programs will only see a list of applicants who have sent them signals. The program is optional for applicants, and all programs are automatically included. Applicants should signal both home and away programs.

Applicants and programs will continue to be surveyed post-Match to assess outcomes.

 Programs are automatically included in the Preference Signaling process through ERAS. The signaling window opens when ERAS opens to applicants. On the day applications are released to programs, programs will be able to identify applicants who have signaled them in ERAS with the word “Yes” on this portion of the ERAS application.

For more information regarding preference signaling, please visit the AAMC website.