A Review of Program Signaling Effects, Perceptions, and Trends for Medical Residencies.

Program signaling is a relatively new tool in the residency application process, introduced to help applicants express genuine interest in programs amid rising application numbers. While its use has rapidly expanded across specialties, the number and type of signals vary. Limited cross-specialty analysis hinders identification of best practices, leaving applicants and programs without standardized guidance about how to use signaling to achieve specific goals. This review summarizes the quantitative effects of program signaling on application volume and interview yield, stakeholder perceptions, and evolving trends in signaling use. A systematic search on 3 databases was conducted from January 2021 through May 2024. Four independent reviewers screened studies for original, empirical data on program signaling. A narrative review synthesized findings on outcomes and stakeholder opinions. Of 98 studies screened, 31 (32%) met inclusion criteria. Data from multiple specialties showed that signaling increased interview yield, though benefits did not scale with the number of signals offered. Allowing more signals was associated with fewer applications per program in some specialties. Both applicants and program directors generally viewed signaling positively. Applicant satisfaction was higher in specialties with fewer signals. Over time, there has been a trend toward increasing signals and implementing tiered models. Program signaling is associated with increased interview yield across specialties. Most program directors and applicants support its continued use. Applicants desire greater transparency in how programs use signals.