J Grad Med Educ. 2026 Aug;18(4):489-494. doi: 10.4300/JGME-D-25-01024.1. Epub 2026 Aug 14.
ABSTRACT
BACKGROUND: Preference signaling in the residency application process was introduced in the 2021 application cycle and, as of the 2026 residency Match cycle, is used by 27 specialties. Originally intended to help applicants indicate genuine interest in programs, its role has expanded to include mitigating overapplication.
OBJECTIVE: To assess how the number of signals allotted influences application numbers across specialties.
METHODS: We performed a cross-sectional analysis of US Electronic Residency Application Service (ERAS) data from 22 signaling specialties between 2022 and 2026. Specialties were grouped by number of signals allotted: high (≥20), medium (8-19), low (≤7). The primary outcome was change in average applications per applicant within specialty. The secondary outcome was estimated financial impact using the ERAS tiered fee schedule.
RESULTS: Among 70 111 applicants across 22 specialties (high n=6; medium n=8; low n=8), high-signal specialties uniformly reduced applications per applicant (mean, -28.3; range, -47.4 to -2.15). Medium and low tiers showed mixed effects, with an increase in applications per applicant in several specialties. Overall, signaling was associated with an estimated net cost reduction of $7,387,754 across all participating specialties. All high-signal specialties generated cost reduction ($2,991,059 total), whereas 8 medium- and low-signal specialties incurred net cost increases.
CONCLUSIONS: Substantial reductions in application volume and costs have occurred following implementation of preference signaling, with the high-signal approach reliably leading to a decrease in applications submitted.
PMID:42603005 | PMC:PMC13475771 | DOI:10.4300/JGME-D-25-01024.1
