Impact of Preference Signaling on Residency Interview Distribution Among Otolaryngology-Head and Neck Surgery Applicants

Elsevier

Available online 19 October 2022

Journal of Surgical EducationObjective

This study investigates interview offer distribution among applicants of varying levels of competitiveness in a residency application cycle with and without preference signaling.

Design and Setting

Self-reported applicant survey data evaluating the 2021-2022 Otolaryngology-Head and Neck Surgery residency signal experience was used to investigate the current distribution of interview offers among applicants. These data then informed a model to assess the distribution of interview offers without signaling in place.

Participants

260 (47% response rate) Otolaryngology-Head and Neck Surgery residency applicants who responded to the survey.

Results

Applicants were divided into four quartiles based on their overall interview offer rate (self-reported number of interviews/self-reported number of applications submitted). Applicants in the top quartile received fewer interview offers while applicants in all other quartiles received more interview offers when signaling was introduced.

Conclusions

Our data demonstrate that when signaling is introduced, interviews are more evenly distributed among applicants.

Section snippetsINTRODUCTION

In the 2021-2022 residency application cycle, Otolaryngology-Head and Neck Surgery applicants had the opportunity to participate in preference signaling.1 Applicants were allotted a fixed number of signals which they could send to residency programs of their choosing prior to application submission. Although the implementation of this concept in residency application was novel, the idea of preference signaling has existed for some time2, 3, 4 and was first described in the economics literature.

MATERIAL AND METHODS

Otolaryngology-Head and Neck surgery residency applicants were allotted four signals to send to programs of their choosing prior to submitting their residency applications in the 2021-2022 application cycle. Applicants were not allowed to signal their home program or a program where they physically attended a visiting SubInternship rotation (SubI). To evaluate the impact of preference signaling, applicants were sent a 31-item electronic survey during Match week in March 2022 (n=559) (the full

Demographics

The survey sent to applicants achieved a 47% (263/559) response rate. For the sake of simplicity, the 9 regions that were outlined in the supplemental ERAS application guide (New England, Middle Atlantic, East North Central, West North Central, South North Central, South Atlantic, East South Central, West South Central, Mountain, and Pacific) were grouped together as defined by the United States Census Bureau (Northeast, Midwest, South, and West). Survey responses were comparable among regions

DISCUSSION

Recent data suggest the minority of stakeholders find the residency application and selection process equitable in its current state.17 Suggested efforts to improve these inequities include application caps and interviews caps;17 however, such measures may be restrictive and require a regulatory body to oversee and enforce them. Our data demonstrate that preference signaling helps to alleviate some of the inequities that exist in residency interview distribution. In our model, applicants from

CONCLUSION

Preference signaling results in a more even distribution of interview offers among applicants. Specifically, applicants in the top quartile based on interview offer rate receive fewer interview offers while applicants in all other quartiles received more interview offers with the introduction of signaling. Future work should look to investigate how these data vary across demographic groups and how varying the number of signals may impact interview offer rates.

ACGME Competencies

Systems Based Practice

Funding/support

We have no funding or financial support disclosures to report.

Declarations of interest

None

ACKNOWLEDGMENTS

We wish to thank the members of the Otolaryngology Program Directors Organization, Society of University Otolaryngologists, Association of Academic Departments of Otolaryngology as well as our administrative support team, Emily Maurer and Katie Fitzgerald, for supporting the implementation of this initiative.

REFERENCES (22)SD Pletcher et al.The otolaryngology residency program preference signaling experience

Acad Med

(2022)

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© 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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