This manuscript summarizes the introduction, evolution and current outcomes for preference signaling in Urology as well as its use in other medical specialties. Overapplication plagues the residency recruitment process and PS has emerged as a process to improve the bottleneck of the interview selection process.

PS has been shown to be associated with a higher likelihood of interview among many subspecialties. Applicants and programs report satisfaction with the process.

Further solutions are needed to increase transparency of program information and selection criteria to applicants so that critical decisions on which programs an applicant should apply to can be data driven.