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Guide to Preference Signaling in Medical Residency

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by Himanshu Jindal in Residency

Are you confused about residency preference signaling? Are the the specialties you’re applying to participating in signaling? How should you know when or when not to signal? What even is a preference signal? We will cover all these questions and explain why preference signaling could be the biggest change to residency applications in the last decade and WHY this is good for you.

Table of Contents

What is Preference Signaling?

In the present scenario, US Medical Residency programs are overwhelmed with applications. This has led to the match process becoming increasingly chaotic over the years. Program Directors are crushed under the huge deluge of applications. They are left perplexed as to who to invite for interviews given the incredible number of applications they have to scrutinize.

Program signaling or interview signaling, more commonly referred to as Preference signaling, then comes to the rescue. Preference signaling allows residency applicants to highlight their interest in a particular program during the application process. It allows them to reach out to specific programs where they have some vested interests.

The application of preference signaling is variable across different specialties. otorhinolaryngology and dermatology were among the first specialties to adopt preference signaling for their programs a few years back. Since then, multiple other specialties have adopted it for their programs. However, there exist mixed reactions. Read as we delve deeper into the topic and dissect the key concepts.

Origins of Preference Signaling

ENT/Otorhinolaryngology was the first specialty to implement preference signaling back in the 2020-21 application season. Applicants were given five tokens to signal their preference for ENT programs. The Program directors received lists of applicants who sent preference signals on the opening day of the ERAS recruitment season.

Following a successful pilot test in ENT, preference signaling was subsequently adopted by other specialties including Urology, Internal Medicine, General Surgery, and Dermatology in the optional ERAS Supplemental application. As of today, several other specialties have joined the list.

Why has Preference Signaling been introduced?

The introduction of preference signaling in the Supplemental ERAS application is an answer to the age-old practice of program directors’ over-reliance on USMLE scores and other convenience metrics. Such an over-reliance hinders the equitable distribution of interviews among match applicants leaving some well-qualified applicants with a paucity of interviews.

Added to this was the increasing number of applications being received by programs. As a result of all this, the program directors struggled to sieve applicants with a sincere interest in their program from the rest of the pool. Preference signaling is thus a double-edged sword; firstly, it lets applicants highlight their applications in the vast application pool. Secondly, it allows program directors to narrow down their choice of interview invitations.

Is Preference Signaling Beneficial for the Applicants?

According to the results of the NRMP Program Directors Survey of 2022, applicants’ perceived interest in the program has been rated as a very important factor in interview decisions.

Preference signaling helps applicants draw attention to their applications, stand out in the competitive process, and demonstrate enthusiasm for the program. It helps programs manage the large number of applications they receive as the signals of interest assist programs in offering interviews. Program Directors are more likely to offer interviews to applicants who have manifested a genuine interest in their program.

It can, therefore, enhance the chances of securing interviews from residency programs and ultimately a match. So, is preference signaling beneficial for you? It’s a big YES!

Snapshot from the NRMP Program Director Survey Results, 2022 [All specialties Combined] shows aplicants' interest is a major factor

Snapshot from the NRMP Program Director Survey Results, 2022 [All specialties Combined] shows aplicants’ interest is a major factor

When Should You NOT Use Preference Signaling?

If you are a US IMG, you should not signal programs at institutions where you attended your medical school or did an away rotation. In fact, the American Association of Medical Colleges (AAMC) has provisions such that programs do not penalize applicants for not signaling to such programs. Most specialties allow up to five programs to be signaled except dermatology which allows for only three programs.

Which Programs Have Adopted Preference Signaling? 

As per the data available on the AAMC website, currently, the following list of specialties allows preference signaling for their programs. As can be inferred from the table below, internal medicine and psychiatry have the least number of tokens for signaling-2. Orthopedic surgery has the most (30) followed by otorhinolaryngology (25) and neurological surgery (25).

SpecialtyNumber of Program Signals
Anesthesiology5 (gold), 10 (silver)
Child Neurology & Neurodevelopmental Disabilities3
Dermatology3 (gold), 25 (silver)
Diagnostic Radiology and Interventional Radiology6 (gold), 6 (silver)
Emergency Medicine7
Family Medicine5
General Surgery5
Internal Medicine7
Internal Medicine & Psychiatry2
Neurological Surgery25
Obstetrics and Gynecology3 (gold), 15 (silver)
Orthopedic Surgery30
Physical Medicine and Rehabilitation5
Public Health and General Preventive Medicine3
Thoracic Surgery3

How Should You Use Your Signals?

It is recommended that you use program signaling cautiously and strategically. You should send signals to programs where your interest is significant and sincere. You should try avoiding signaling programs at your medical school or programs where you have rotated since they already know you in their program.

Your decision to signal programs should factor in application strength and competitiveness. You must also consider your career goals and their alignment with the program. Geographic preferences and the mission of programs should guide your selection of programs to be signaled.

Benefits of Preference Signaling for IMGs

Preference signaling can prove to be a very advantageous tool for IMGs. Strategic use of preference signaling can bring more interviews to IMGs and thus substantially improve their chances of matching successfully.

Can Programs See Other Programs You Have Signaled?

No. Anonymity is protected in preference signaling. Residency programs can only see if you signaled their program, and interviewers are not allowed to ask what programs you signaled.


The world of medical residency application has evolved, and Preference Signaling has emerged as a pivotal strategy for both applicants and program directors. With the deluge of applications inundating residency programs, Preference Signaling allows applicants to stand out by showcasing genuine interest and enthusiasm for specific programs.

This dynamic approach not only helps applicants secure more interviews but also aids program directors in streamlining their selections. While it offers numerous benefits, it’s essential to exercise strategic discretion, signaling only to programs that align with your aspirations and strengths.

As the landscape continues to shift, Preference Signaling remains a potent tool, bridging the gap between applicants and their desired medical residencies, particularly offering a valuable edge to IMGs seeking successful matches.

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Cardiology is key for impressive USMLE scores. Master cardiology from a Harvard-trained anesthesiologist who scored USMLE 270 with these 130+ high-yield flash cards. You’ll be begging for cardio questions - even if vitals make you queasy.