Impact of applicant and program factors on preference signaling outcomes in otolaryngology

Objectives: To assess the impact of applicant and program characteristics on preference signaling outcomes during the 2021 and 2022 application cycles in otolaryngology. Methods: The Texas Seeking Transparency in Applications to Residency survey was used for otolaryngology applicants during the 2021 and 2022 match years. The primary outcome of interest was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics, geographic connections to programs, and program reputation were assessed. Results: On average 59.5% of signals resulted in an interview (signal yield). There was a positive correlation between the number of signals sent to a program with a reported geographic connection and signal yield, with each additional signal resulting in a 3.4% increase in signal yield (p =.03). Signal yield was positively associated with number of publications (p <.001); number of abstracts, posters, and presentations (p =.04); and whether the applicant took a research year (p =.003). Applicants with higher USMLE Step 1 (p =.01) and Step 2 (p =.003) scores, publications (p =.03), volunteer (p =.008) and leadership (p =.001) experiences received a lower percentage of their total interviews from signaled programs whereas applicants from the 3rd (p <.001) and 4th (p =.03) cumulative class ranked quartiles received a higher percentage of their total interviews from signaled programs. Conclusions: Signal yield appears to have a significant association with geographic connections to programs and applicant competitiveness. This study may help applicants, advisors, and programs maximize the benefit of the preference signaling system. Levels of evidence: Level 4.