OTO Open. 2026 Jan 8;10(1):e70190. doi: 10.1002/oto2.70190. eCollection 2026 Jan-Mar.
ABSTRACT
OBJECTIVE: Signaling was introduced to the otolaryngology match in 2021, with 5 signals allotted to applicants in 2021, 4 in 2022, 7 in 2023, and 25 in 2024. This study investigated the modifying effect of signaling volume on the relationship between away rotations and matching in otolaryngology from 2018 to 2024.
STUDY DESIGN: Cross-sectional.
SETTING: National survey of US medical students.
METHODS: We used the Texas Seeking Transparency in Application to Residency (STAR) survey responses of otolaryngology applicants from 2018 to 2024. Using multivariate logistic regression, we determined the odds of matching where away rotations were performed and how these odds varied across the pre-volume (2018-2020), low-volume (2021-2023), and high-volume (2024) signaling eras.
RESULTS: In total, 28.3% (n = 855) of otolaryngology applicants from 2018 to 2024 completed the Texas STAR survey. Using multivariate logistic regression, adjusting for applicant characteristics, and including an interaction term between performing away rotations and signaling time period, applicants in the high-volume signaling era were found to be significantly less likely to match at programs where away rotations were performed (odds ratio [OR]: 0.56, 95% CI: 0.33-0.95; P < .05) compared to the pre-signaling era. The same trend was seen in the low-volume signaling era, though not statistically significant (OR: 0.76, 95% CI: 0.47-1.22, P = .24). The most impactful factor on matching across all study years was performing an away rotation (OR: 12.1, 95% CI: 9.0-16.5, P < .001).
CONCLUSION: The introduction of signaling and the recent increase in signal number are associated with decreased likelihood of matching at a program where an away rotation was performed compared to the pre-signaling era.
LEVEL OF EVIDENCE: V.
PMID:41523886 | PMC:PMC12780956 | DOI:10.1002/oto2.70190
