Preference Signaling for Orthopaedic Surgery Residency Applications

Updated March 2024

For the Electronic Residency Application Service® (ERAS®) 2024-2025 cycle, orthopaedic surgery residency programs may request applicants to complete the ERAS Program Signaling option in addition to the MyERAS application. This option has been endorsed by the AOA/CORD.

Details and information for both residency programs and applicants are described below.

Purpose: Signaling allows applicants a reliable and equitable approach to demonstrate a sincere interest in specific residency programs. Residency programs may choose to consider signals as they select applicants to interview.  This process is intended to add value to both applicants and programs, resulting in a more equitable, reproducible, efficient, and mutually optimal Match.

Background:  Over the past decade the number of applications to Orthopaedic Surgery residency programs has climbed to over 85 applications per applicant.  This has not improved match rates and has resulted in application congestion.  Application congestion results in a flood of applications to programs and may result in programs filtering applications using metrics that may not identify the best residents for their program such as USMLE Step Scores, clerkship grades, and reputation of medical schools.  This process also exacerbates issues of equity, diversity and inclusion, which already were significant issues within the specialty.  Many applicants, faculty, and deans directly contact program directors to indicate applicant’s interest, a process not equally available to all applicants. A more transparent, equitable and reliable system for communicating applicant preferences to residency programs is critical.

Process:  The signaling program is voluntary. Both applicants and programs must opt in to ERAS Program Signaling.  Applicants who participate in the signaling will assign up to thirty (30) preference signals of equal weight to residency programs of their choosing.  Signals will be visible within each applicant’s ERAS application.  The absence of a signal does not indicate disinterest, as there will be no way for programs to discern if an applicant chose not to signal a particular program or whether that applicant chose not to participate in Program Signaling.  Signals are not presented in any particular order. For updated and time-sensitive information, visit the AAMC ERAS website.


Applicant Guidelines

  1. The signaling program is a voluntary program. While many believe that signaling is beneficial to both applicants and programs, applicants and programs’ participation is entirely voluntary.  Applicants will indicate their participation in program signaling, at the time of submitting their ERAS application. There are no anticipated downsides to participating in signaling as programs will not know if an applicant did not signal them or just opted out of signaling.
  2. Applicants should signal all programs in which they have both a strong interest and where they have a reasonable ability to receive an interview INCLUDING their home programs and subinternship / away rotation programs if they are interested in them. Applicants are strongly encouraged to consider their personal values and goals, consult faculty advisors, and utilize resources to explore residency programs such as the AOA Orthopaedic Residency Information Network (ORIN), individual program websites, AMA FREIDA, AAMC Residency Explorer, and any other resources they would typically use.  The applicant’s goal should be to find the programs that best align with their goals and where they are most likely to be competitive.
  3. Given the large number of signals available for Orthopaedic Surgery applicants, applicants SHOULD signal their home programs as well as programs where they may have completed a sub-internship if those programs are among their preferred programs. Applicants should plan to use all their signals. There is no advantage to not using all their available signals.
  4. Programs will receive a list of applicants who have signaled them. Programs will not know which other programs an applicant may have signaled.
  5. If applicants have no geographic preference, they should indicate “no geographic preference” in lieu of leaving that field blank within the ERAS application.

Program Guidelines

  1. Program Signaling is intended to add depth to applicants’ applications by providing information about their individual preferences and is explicitly not intended to be used as a screening tool. Programs should choose how to incorporate the information from Program Signaling results into their preexisting application review process.  AAMC and AOA/CORD recommend that programs should perform a holistic review of the entire application and make decisions based upon the merit of the application.  The signal is one of many tools to be utilized when deciding to whom interviews will be offered.
  2. The signaling program is a voluntary program. While many believe that widespread participation in this program is beneficial for applicants and programs, programs must OPT IN to the Supplemental Application, which includes signaling, by indicating their participation at the time of ERAS enrollment.  Applicants will then see that program appear on the list of programs they may signal.
  3. Programs SHOULD NOT:
    1. Require a signal to review and offer an interview to applicants
    2. Disclose the names, AAMC registration number or any identifiable information of applicants who have signaled their program to any individual outside their residency selection committee
    3. Ask interviewees to disclose the names or number of programs that they have signaled. It is a violation of the NRMP match agreement prohibiting programs from asking applicants where they have applied for residency
    4. Disclose the number of signals they have received

Mentoring and Career Advising Guidelines

  1. Advice to applicants on which programs to signal should be based upon individual review of the applicant’s overall application package, including alignments with the program’s requirements and values. There are multiple resources that exist to advise students on their alignment with programs such as the AOA Orthopaedic Residency Information Network (ORIN), individual program websites, AMA FREIDA, and AAMC Residency Explorer.
  2. Applicants SHOULD signal only programs to which they desire to interview and from whom they believe they have a reasonable chance of receiving an interview offer.
  3. Applicants SHOULD signal home programs and programs where they have participated in sub-internship / away rotations if they are interested in interviewing at those programs.
  4. Mentors should provide honest advice based upon a holistic review of the applicant’s entire application package when advising.
  5. Applicants ultimately must make the final decision on which programs to signal.


What is the benefit to an applicant to signal a residency program?

Signaling allows an applicant to demonstrate a genuine interest in a residency program.  Increasingly high numbers of applications mean many applicants do not undergo holistic review.  A signal is an equitable approach to indicate interest in a program and increase an applicant’s visibility to a program, encouraging holistic review of their application. The signals allow applicants to be noticed by programs regardless of their “competitiveness.”

Has signaling been useful in other fields?

Yes.  Signaling has been utilized in other specialties.  Otolaryngology conducted a pilot study of signaling in the 2020-21 Match cycle.  They demonstrated that applicants who signaled a program were more likely to get an interview at that program. Preference signaling was also used in a pilot program in three specialties for the 2021-22 recruiting season.  Program Directors reported that signaling identified candidates who they would not have otherwise reviewed.

Is signaling in conflict with the NRMP Match Agreement?

No.  As long as all NRMP Match rules are obeyed, there is no violation of the Match agreement.  In fact, section 6.2 of the Match Participation Agreement for Applicants and Programs allows applicants and programs to express interest to each other.  They may NOT solicit verbal or written statements indicating commitment.  Programs cannot ask applicants to reveal the names, specialties, or other identifying information about programs to which they have applied or interviewed.  The Supplemental Application Agreement expressly forbids programs from asking or receiving any information about applicants’ signals.

The signaling program does, however, provide an equitable and inclusive way to indicate interest in a program.  Currently, many back channels, such as emails, phone calls, and other personal communications are completed by faculty, deans, and applicants to indicate interest in programs.  While this is NOT a Match violation, applicants do not have uniform access to these extra channels.  The signaling program provides the same opportunity for all applicants who voluntarily choose to participate.

If a program doesn’t receive a signal, does that mean an applicant won’t get an interview?

Each program can choose which applicants to interview and may not rely on preference signaling to determine interview offers. It is clear from the Otolaryngology signaling pilot that applicants who signaled a program were more likely to receive an interview offer.   The application itself indicates interest in a residency program, and programs may offer interviews to applicants who have not signaled them. Signaling offers a transparent and reliable method of communicating very high program interest, but programs will use other factors to inform decisions around interview offers.

Do I have to participate in the signaling program?

No.  The signaling program is a voluntary program.  Signaling is meant to provide an equitable opportunity for applicants to indicate high interest to a program, and for programs to identify and holistically review applicants. This is an OPT IN program. It may be to your benefit to participate in Program Signaling, because programs will not know whether an applicant has not signaled them or has opted to not participate in signaling.

Will there be additional costs to participate in program signaling?

No.  There are NO additional fees for applicants or programs who opt-in Program Signaling.

How many signals will I receive?

Applicants will be able to submit up to 30 signals of equal weight.

Can I only apply to programs that I have signaled?

No.  Applicants can apply to as many programs as they desire.  It is recommended to consult with an advisor in Orthopaedic Surgery to determine the right number of programs to which to apply based upon your individual application package.

How do I decide which programs to signal?

Similar to deciding to which programs to apply, each applicant will need to reflect on their application and their alignment with programs.  It is recommended that you consult with Orthopaedic Surgery advisor in reviewing your ENTIRE application, your goals in training, and other factors that may influence where you want to train (community vs. university-based, geography, etc).  Several tools such as the AOA Orthopaedic Residency Information Network (ORIN), individual program websites, AMA FREIDA, and AAMC Residency Explorer can aid both applicants and advisors in choosing which programs are best choices for application and signaling.

Don’t signals only benefit programs?

While program signals will help programs know which applicants are highly interested in their programs, it may improve the chances of applicants who have a true interest in a program to be seen by that program regardless of their perceived “competitiveness” or personal connections. In 2021-22, the average program received 172 applications per available residency position, without an ability to determine genuine interest.  Because of this, applicants who do have a genuine interest may be overlooked in the myriad of applications.  Signals will likely allow those applicants with a genuine interest to be considered more closely by those programs.  This concept was validated by data from the 2021-22 AAMC pilot signaling program in three specialties, indicating that program directors reviewed applications that they may have otherwise overlooked.

Should I use my signals on my home program or programs where I have completed a sub-internship?

Yes.  If you are interested in interviewing at a program, it is recommended that you signal that program, including your home program and programs where you completed sub-internship or away rotations.

How will I know that a program received my signal?

The programs will be receiving your signals at the time they review your applications since the signals are submitted with your application.

Am I guaranteed an interview at programs I have signaled?

No.  The signal is for you to indicate interest in the program and your desire to interview.  Programs are encouraged to perform a holistic review of your entire application including any preference signaling.  Ultimately, programs will utilize their own application review process and decide upon whom they wish to interview.

Can I still receive an interview offer at programs I have not signaled?

Yes, as signals are only one factor in the application review process.  Each program can choose which applicants to interview and may not rely on preference signaling to determine interview offers. It is clear from prior signaling pilots that applicants who signaled a program were more likely to receive an interview offer.  Signaling offers a transparent and reliable method of communicating very high program interest, but programs will use other factors to inform decisions around interview offers.

Will my signals be made public? Will other programs know where I signaled?

No.  Applicant signals are confidential.  Programs will receive a list of only the applicants who have signaled them.  They will not know whom you have signaled.

How will I know which programs are participating in signaling?

The signaling program is a voluntary program and programs must OPT IN to participate.  Participation in Program Signaling will also be indicated on the AOA Orthopaedic Residency Information Network (ORIN).  Applicants will see a list of the programs participating in signaling at the time of their ERAS application.

What should I do if I don’t have a geographic preference?

In the Biographic Information section of the ERAS application, applicants who have no geographic preference should indicate “no preference” in lieu of leaving the geographic preference fields blank.

Does my program have to participate in the Orthopaedic Surgery signaling program?

No.  Participation in ERAS Program Signaling is voluntary and requires an opt-in as part of your program’s annual ERAS participation agreement.  To participate in program signaling, programs must indicate their desire for participation at time of ERAS application. Programs may benefit by participating in program signaling by helping to identify interested applicants, fostering a more holistic review of those applications.  There are no anticipated downsides to receiving this information in a more transparent, reliable and equitable way that minimizes the effort of reading and interpreting emails and calls from applicants and their advisors reaching out to convey interest.

Will programs be charged an additional fee to participate in program signaling?

No.  There are NO additional fees for applicants or programs who opt-in for ERAS Program Signaling.

How/When will programs receive signals?

Programs will receive signals with ERAS applications which is typically around the end of September.

How should programs use the signal data?

Programs will need to individually decide how signals are ultimately used in the application review process.  While programs should consider all applications received regardless of an associated signal, signals may be used to assess genuine interest and may identify candidates that programs may not have recognized as a potential recruit.  Applicants are limited to a total of 30 signals, so programs should recognize that many highly qualified and potentially interested applicants will be in the non-signaled group.

Does a program have to offer interviews to all applicants who have signaled them?

No.  Signals are one of many tools for programs to use to assess alignment with their program when conducting their application review and consideration for interview offers.  We anticipate that programs will receive significantly more signals than available interview spots.

What if I do not get enough signals from applicants to fill my interview spots?

Programs can interview any applicants for their program regardless of whether they have shown additional interest using a signal. The application itself communicates interest in the residency program. As applicants are limited in total number of signals, programs should review and expect to offer interviews to applicants who have not signaled their programs. They should consider conducting their application reviews as they have always done in previous years and use the signals as an additional indicator for higher interest from an applicant.

Will applicants who have trained at my home institution or completed a sub-internship signal my program?

Applicants are advised to signal programs, including their home institutions and sites where they have completed a sub-internship, if they are interested in receiving an interview offer from those programs.

Will the number of signals a program receives be made public?

No.  Programs will only receive the list of applicants who have sent them a signal.  Programs, as part of their participation in signaling, have agreed not to share the number of signals they have received.

What if an applicant doesn’t signal my program? Is it because they aren’t interested or because they aren’t participating?

Programs can only tell if an applicant has signaled them. They will not know whether the lack of a signal indicates that the applicant is not participating in signaling or is simply not signaling them.