Introduction

Urology, a close-knit field that participates in the early Match system, has adopted the use of preference signals. Therefore, it is important for applicants to understand what inspired its inception and how to utilize the program to make informed decisions regarding their application. Our goal is to discuss the development of preference signaling, the impact on applications thus far, and provide advice from fourth-year medical students at the Medical College of Georgia, the Society of Academic Urologists (SAU), the AUA, and the Association for American Medical Colleges (AAMC).

Development of Preference Signaling in Urology

The number of applications per medical student has been increasing, an issue that the SAU states has reduced time for application review and diluted the significance of an application as a signal of interest.¹ In 2021, the last year before preference signaling, urology applicants applied to 77 programs and accepted 12 interviews; programs received an average of 282 applications compared to 243 the year prior. This issue was reflected across other specialties as well, which prompted the initial development of preference signals by otolaryngology in 2020. The pilot year of preference signaling in otolaryngology demonstrated a 58% likelihood of an interview offer from a signaled program vs a 14% likelihood from a nonsignaled program. Urology implemented preference signaling in 2022, initially with 5 signals, which has now increased to 30. The SAU explained that the preference signals functioned to take the place of previous “informal signaling methods,” specified as “reading between the lines on personal statements,” letters of recommendation, perceived geographic preference, and communication from influential persons, which enabled bias and privilege in the Match.² One study of all applicants from the 2022 Match found that preference signals were the most significant factor associated with an applicant receiving an interview invite but were not associated with applicants being ranked higher on a program’s rank order list.³ Data from the most recent 2024 Match showed that each student applied to an average of 67 residency programs, a decrease from 77 on average prior to the development of the signal preference program. The average number of interviews accepted per applicant stayed constant at 12, showing no decrease in interviews per applicant despite the decrease in applications sent.

Medical College of Georgia Students

The Medical College of Georgia matched all 8 urology applicants in the 2024 Match. Of these 8 matched applicants, 4 agreed to answer questions regarding their Match experience. Half said the ability to send signals “greatly affected” the number of programs they applied to, while the other half stated it had a small impact. Half of the students reported no impact of signals on the geographic regions they applied to, while one reported a moderate impact, and the fourth stated there was a small impact. One student commented that the greatest impact of signals on their application was the ability to emphasize their region of interest, with another stating that “instead of applying everywhere, having 30 signals made me do more research and choose programs I truly wanted to go to.” All students stated they signaled every program they did an away rotation at. Three of the 4 students stated they interpret signal preferences to be greatly important to residency programs’ decisions. Students stated they turned to urology faculty, family members, and current urology residents for advice regarding preference signaling. Regarding interviews, one student stated that almost all of their interview offers came from programs to which they had sent a preference signal. In summary, student feedback was consistent with the stated goal of streamlining interview invites to programs the applicant is most interested in. After a successful Match cycle, the students reported they each matched at a program they signaled.

Institutional Advice and Impact to Date

While an applicant is likely to turn to mentors for advice, there is also formal guidance from the AUA, SAU, and AAMC. Participation in preference signaling is optional although strongly encouraged. The SAU and AAMC advise applicants to signal their home urology program and programs at which they completed a visiting rotation. A 2023 AAMC survey found that 75% of program directors agreed that signals helped identify applicants they would have overlooked. Although the AAMC has instructed programs not to use signals as a screening tool, this same survey found that 88% of responding program directors reported using signals to screen before doing a thorough review of the application. Sixty-one percent of responding programs stated they sent interview invitations to every applicant who signaled their program.⁴ Students should be prepared to explain their decision to signal a program during their interview, as 64% of responding programs said they utilized the interview to learn more about that subject. As of 2021, applicants can also emphasize their geographic presence with geographic signals, allowing the selection of 3 preferred regions.⁵

Conclusions

The preference signaling system was developed to address the increasing breadth of residency applications while providing an avenue for applicants to express their interest to top programs. The presence of signaling has led to students receiving applications at programs they are most interested in and reduced the number of applications per student. Medical students reflect that the ability to send 30 signals in the 2024 Match significantly affected their interview offers.