14. The Power of a Signal: The Impact of Preference Signaling on Matching in the Top 10 Most Competitive Specialties

PURPOSE: This study investigates the impact of preference signaling on match outcomes in highly competitive specialties. METHODS: Data was obtained from the Texas STAR survey, focusing on applicants of the top 10 most competitive specialties that utilized signaling between 2021 and 2024. Applicants without signals were excluded. Group differences were assessed with Wilcoxon signed-rank and chi-squared tests. RESULTS: Among 4,469 applications, number of signals did not affect match rates (p=0.08). More signals increased match rates at a signaled institution (p<0.001). Conversely, in specialties with ≥20 signals, the match rates at non-signaled institutions were lower. Multivariate logistic regression adjusting for potential confounders highlighted these significant predictors: away rotations (OR 9.25), signaling gold (OR 7.74), geographic connection (OR 4.12), and signaling program (OR 3.38). This model ranked away rotations as the most important factor (β=2.23), followed by gold signal (β=2.05), geographic connection (β=1.42), and program signal (β=1.22). CONCLUSION: While specialties with higher number of signals were more likely to match individuals to signaled programs, the effectiveness of each signal decreased with signal quantity. For applicants who want to match at specific programs, the best way to do so is to utilize the most impactful signals, such as away rotations or gold signal.