J Neurosurg. 2025 Jul 18:1-13. doi: 10.3171/2025.3.JNS2583. Online ahead of print.
ABSTRACT
OBJECTIVE: Applications to neurosurgical residency programs have progressively increased, both in applicant numbers and programs applied to per applicant. The adoption of signaling, beginning with 8 signals in the 2022-2023 cycle and increasing to 25 in the 2023-2024 cycle, has the potential to improve the match process and reduce applicant costs. This study analyzed trends in the neurosurgery residency match from 2017 to 2024 to evaluate the impact of signaling.
METHODS: The Texas STAR (Seeking Transparency in Application to Residency) is a survey administered annually to US applicants following the match. Data included neurosurgery applicants from 2017 to 2024 and were categorized into pre-COVID-19 (2017-2020), COVID-19 (2021-2022), and signaling (2023-2024) cohorts. Applicant-reported characteristics associated with matching were assessed. For the 2023 and 2024 cycles, signal yield (interviews at signaled programs divided by total signals), signal-to-interview ratio (percentage of interviews at signaled programs), and nonsignal yield (interviews at nonsignaled programs divided by nonsignaled applications) were calculated. Comparative statistics and regression models were applied.
RESULTS: Among 418 applicants (127 from 2023-2024 with signaling data), those in recent cycles submitted fewer applications (73.9 pre-COVID-19 vs 74.7 COVID-19 vs 64.3 signaling, p = 0.01) and received fewer interview offers (24.7 vs 23.0 vs 18.9, p < 0.001). In the 2023-2024 cycles, matched applicants had more abstracts, posters, presentations (8.65 vs 9.58 vs 10.47, p < 0.001) and publications (5.78 vs 7.71 vs 7.91, p < 0.001), with fewer total applications (72.62 vs 75.03 vs 62.26, p < 0.001) and interviews offered (25.85 vs 23.40 vs 21.02, p = 0.004), compared with matched applicants from previous cycles. A multivariable model showed that fewer applications was associated with greater match likelihood for 2023-2024 applicants (OR 0.87, 95% CI 0.77-0.99). Signal yield (54.0% vs 19.1%, p < 0.001), signal-to-interview ratio (71.5% vs 38.0%, p < 0.001), and nonsignal yield (22.4% vs 8.6%, p = 0.02) were higher among matched applicants versus unmatched applicants in 2024. The signal-to-interview ratio increased for matched applicants from 2023 to 2024 (18.2% vs 71.5%, p < 0.001), while the nonsignal yield decreased (33.7% vs 22.4%, p = 0.005), in line with increases in number of signals.
CONCLUSIONS: Signaling has changed the landscape of the neurosurgery residency match process, with fewer applications submitted and fewer interviews offered per applicant. Signals seemingly result in increased interview likelihood and may hone the selection process to more efficiently align applicant and program preferences.
PMID:40680308 | DOI:10.3171/2025.3.JNS2583
