With signaling quickly becoming almost as important as step scores, letters of recommendation, and clerkship grades, each signal needs to be carefully thought out. There are three main factors that should go into your signaling decision:

1. Do I want to match at this program?

2. Is this the geographic location I am happy with/want to be?

3. Am I a competitive applicant here?

Let’s break these three things down.

A recent study of matched applicants reports that 98.5% of applicants matched at a program they signaled in 2022-2023! [1] Another recent study suggests that applicants who signaled a program have an approximately 25% chance of receiving an interview compared to less than 1% of those who did not signal. [2] While only 69 orthopedic surgery programs replied to this survey, the authors note that half of these programs responding only interviewed applicants that signaled their program. [2]

While the first question may seem intuitive, you may find yourself coming back to this as you think through 30 signals. Personally, I went through a phase where I thought about signaling places that I thought I would be able to match at (whether because of geographical ties to the program, because I thought I would be a stronger applicant, or because they typically received less applications). While these may seem like good reasons to signal, do not compromise, and signal these places if you wouldn’t be excited to match there.

There is also data to suggest geographic locations may play an increasingly important role in the match whether from hometown, undergraduate location, medical school location, or other connections to the area. If you have ties to a certain area from any of the above and can mention that in your application or personal statement, it may act as a 2-for-1 deal indicating that you are specifically interested in coming to that program. One of the biggest things I heard going to a medical school on the east coast is, “don’t try to go to California unless you have connections there.” Vice versa for other parts of the US. While it may be tempting to use a few signals for California programs if from an east coast school, it may not be the best use of a signal unless it is your dream program.

One of the toughest questions to answer in your signaling process may be: am I a competitive applicant at this program? To answer this, you should reach out to trusted mentors or residents. One way to think about an application was whether this was a “stretch”, “moderate”, or “safe” program in terms of getting an interview, essentially ranking programs on their competitiveness. However, the issue with this approach is that there are no “safe” programs in the orthopedic surgery match. Looking at Doximity [3] and other residency ranking systems such as ORIN from the American Orthopaedic Association [4], then comparing your application to the type of program (academic heavy and favors research on application versus more community based) and geographic connections may be a good starting point. If for example, you are applying to a top 20 program because you want to “take a shot” with 30 signals, but you don’t have much research on your application, it may not be worth signaling.

My strategy:

I went through every orthopedic surgery program on ERAS and determined which programs I would or would not be applying to. From that list I narrowed down which programs I was particularly excited about or had loose geographic connections to. I then sorted this list into tiers of top/stretch, middle/moderate, and low/safe programs. From this list, I tried to signal 10-15 top/reach programs, 10-15 middle/moderate programs, and 5 low/safe programs. As a caveat to this approach, I was the first class to use signaling and did not have any data to back up my decisions.

My recommendations now would be to sort in the same way, but apply to 5 top/reach programs, 20 middle/moderate programs, 5 low/safe programs. As always, the more people you ask on this topic the more answers you will get and ultimately you will have to come up with your own list, so do what you are comfortable with.

 If anyone would like to chat more about their specific signals or had questions relating to this post, please feel free to reach out at fullersa@buffalo.edu. Always happy to help/share my thoughts.

Citations:

[1] Suresh KV, Covarrubias O, Mun F, LaPorte DM, Aiyer AA. Preference Signaling Survey of Program Directors-After the Match. J Am Acad Orthop Surg. Published online January 3, 2024. doi:10.5435/JAAOS-D-23-00579

[2] Sorenson JC, Ryan PM, Ward RA, Fornfeist DS. The Value of Signaling an Orthopaedic Surgery Program: A Survey to Orthopaedic Surgery Programs. J Am Acad Orthop Surg Glob Res Rev. 2023;7(6):e23.00050. Published 2023 Jun 2. doi:10.5435/JAAOSGlobal-D-

23-00050

[3] https://www.doximity.com/residency/programs?specialtyKey=bd234238-6960-4260- 9475-1fa18f58f092-orthopaedic- surgery&sortByKey=reputation&trainingEnvironmentKey=&intendedFellowshipKey=

[4] https://orin.aoassn.org/#/search