Preference Signaling in the Radiology Residency Match: National Survey of Applicants.

Objective: Two-tiered preference signaling has been implemented in the radiology residency application system to reduce congestion in the setting of high-volume applications. Signals are an indicator of strong interest that an applicant can transmit to a limited number of programs. This study assessed the impact of program signaling on interview invitations, how applicants strategically used signals based on their application's competitiveness, and applicants' attitudes toward the current signaling system.

Methods: A survey was sent to radiology residency applicants registered with TheRadRoom during the 2024 application cycle. We queried the applicants' background, applications, signal distribution, and interview outcome depending on the type of signal sent. We also asked whether respondents received an interview invitation from a hypothetical "comparator nonsignaled program" if they had one additional signal to use. Group differences were assessed using nonparametric Wilcoxon signed rank test.

Results: A total of 202 applicants completed the survey (28% response rate). Most applied to diagnostic radiology (81%). Nearly all respondents used all six gold (98%) and six silver (96.5%) signals. Interview invitation rates were significantly higher for signaled programs (59.8% ± 27.4%) than nonsignaled (8.5% ± 8.5%); the invitation rate at the comparator nonsignaled programs was 37%. Gold-signaled programs had significantly higher interview rates (67.8% ± 29.3) than silver (51.8% ± 31.3%). Respondents used 49.2% (±21.7%) of their signals for "likely to match" programs, 33.1% (±20.9%) for "aspirational" programs, and 17.6% (±15.8%) for "safety" programs. Most respondents (146; 76%) supported continuing the signaling system for future cycles.

Conclusion: Signaling programs significantly enhanced interview invitation rates, with gold signals being more effective than silver. The applicants used about six total signals for "likely-to-match" programs, two for "aspirational" programs, and about four for "safety" programs.