Sending a Signal: Evaluating the Impact of Program and Geographic Preference Signaling on the Internal Medicine Residency Match

Background For over a decade, the number of residency applications has surged, a trend known as "application inflation." COVID-19 further intensified this trend, leading the Association of American Medical Colleges (AAMC) to address the issue by introducing a supplemental application in the 2021-2022 cycle, allowing programs to identify applicants with a connection to their program or geographic region. For the 2022-2023 cycle, the number of program signals increased from five to seven. The impact of the supplemental application and the increase in signals on the likelihood of an applicant matching with a program has yet to be evaluated. Methods This retrospective cohort study evaluated the impact of program signaling and geographic preference on the matching likelihood in our internal medicine residency program. Data from MyERAS® and the Supplemental Application for 640 applicants who applied to our large, urban, university-based program in the Southeastern United States during the 2020-2021 and 2022-2023 application cycles were included. Using univariate and multivariate analysis, we examined the correlation between program signal, geographic preference, and final match location. Results Applicants who sent a program signal had nearly three-fold higher odds of matching with our program. Geographic preference was numerically but not statistically associated with higher odds of matching. Both signaling a preference for matching with a program in an urban environment and couples matching correlated with decreased odds of matching with our program. Geography was an important predictor of match location as residing in our AAMC geographic region, our four-state area, and our specific state had increased odds of matching with our program. Conclusions Signaling our program was associated with increased odds of matching with our program. Geographic preferences were less predictive of a match with our program; however, they did predict the likelihood of a match at a program within that region. Future studies are needed to ensure external validity.