ERAS may not open until September, but I’ve already started getting questions from residency applicants about preference signaling. So many questions, actually, that I decided to make a video to answer them all.
Fair warning: this is a 1-hour video. I thought about cleaving it up into more digestible 15-20 minute chunks, but then I thought – nah, I’m saving this advice for my real ride-or-dies.
Nonetheless, for the TikTok crowd, I’ll briefly hit some of the high points here.
PRINCIPLES OF STRATEGIC PROGRAM PREFERENCE SIGNALING:
1. Put yourself in the program director’s shoes.
Programs want applicants who are a) qualified and b) interested. Signals are therefore best spent at programs where you’re qualified – maybe even overqualified – but your interest isn’t clear, or at programs where you’re qualified but an interview offer isn’t certain and an expression of interest could make the difference.
2. For applicants, a signal’s value depends on its ability to increase the probability of an interview offer.
Will some programs use preference signaling to determine an applicant’s final rank? Sure. But if you don’t get your foot in the door with an interview, anything that happens at the ranking meeting is irrelevant.
3. You only win if you get something you want.
I can’t emphasize this one strongly enough.
If you develop a clever strategic play that earns you an interview at a program you don’t actually want to go to, you didn’t game the system – you gamed yourself.
4. Consider what other applicants are doing.
In specialties that use low signal numbers (</= 7), the “top” programs will receive enough signaled applications that they can reasonably focus their attention on all the birds in their hand rather than rooting around for the birds in the bush that haven’t signaled – and you may need a signal for your application to get serious consideration.
If you’re applying in a specialty with high signal numbers (>7), this will apply to almost all programs, and your odds of getting interviews from non-signaled applications is very low.
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ADVICE FOR STRATEGIC PROGRAM PREFERENCE SIGNALING
1. List, in order, the programs you want to attend.
(See Principle #3 above.)
2. Assess the probability of receiving an interview offer without sending a signal.
You’re wasting a precious resource if you signal programs where your probability of receiving an interview without a signal is very high or very low.
3. Review your list strategically.
If you’re on the fence, recognize that a signal will mean more to undersubscribed programs than oversubscribed ones, so zig when other applicants zag. Align your preference signals with your own risk tolerance – but please, please, please show some signaling love to your safety.
4. Signal.
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A final piece of advice for program signaling…
Consider applying to multiple specialties.
The AAMC has chosen to allow applicants to use preference signaling in any specialty to which they apply.
That means that an applicant who dreams of being, say, a neurosurgeon can still submit 5 preference signals to general surgery programs. And when she does, her application will be indistinguishable from applicants whose heart’s desire is to train in general surgery.
Dual applying isn’t for everyone (tapping sign for Principle #3). But many applicants would be foolish not to choose this strategy.
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ADVICE FOR STRATEGIC GEOGRAPHIC PREFERENCE SIGNALING
General advice:
You’re allowed to signal up to 3 regions – and there’s no advantage in signaling less than that (unless all your programs fit neatly into 1-2 regions). Similarly, there’s absolutely no advantage in opting out of this section. The only real choice is between signaling 3 regions or claiming that you have no geographic preference.
If you have a geographic preference:
Signal that. (See Principle #3.)
If you don’t have a geographic preference:
It may still be a more strategic move to signal 3 regions – and focus your applications there. When you do, note that the ERAS regions do not contain equal numbers of programs, nor do the regions attract equal numbers of applicants.
When you signal a region, you’ll be invited to explain why. Many of the regions are large – so make sure your explanation is both compelling and broad enough to encompass all the programs to which you’re applying in that region.
Q. Should you send program signals within the geographic regions you signaled, or different regions?
In general, I say double down, and send program signals in the same geographic regions you signaled. I say because most applicants a) have a true geographic preference and b) can fit their program preference signals within the geographic regions they favor.
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Q. What about couples matching?
IMHO, couples should align their signals, not send them to disparate places hoping that a signal from one partner will lead to an opportunity for the other. There’s no data to guide us here… but my experience talking with unmatched couples is that most couples need a couple of programs that really like them, not a bunch that kinda like them.
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If you want more, watch the video or message me. Good luck to all applicants!
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Preference Signaling: Winners & Losers Edition
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