Understanding the Ranking and Matching Behaviors During the 2023 and 2024 General Surgery Match Cycles: A Program Signaling Approach

Abstract

Objective: General Surgery (GS) employed a static signaling practice with five signals per applicant in the 2022 to 2024 application cycles. Previous research demonstrated that signaling enhances a GS applicant's likelihood of being granted a residency interview. To understand the relationship between program signaling and ranking and matching outcomes in GS.

Design: The analysis from the 2023 and 2024 Match data examined the relationship between signaling and three primary outcomes-inclusion on a program's rank order list (ROL), inclusion on the competitive portion of program ROLs, and matching. A multilevel model was utilized to explore how different factors impact an applicant's odds of being included on a program's ROL.

Setting: This study is a collaboration between the NRMP, AAMC and NBME.

Participants: Participants are medical residents who participated in the 2023 (N = 3903) and 2024 (N = 5057) Match cycles.

Results: Signaling increases the odds of being ranked, and applicants who signaled had higher percentages of being ranked competitively and matching; however, the majority of those on the ROL and who matched did not send a signal. The odds of being ranked increase when the applicant signals a program (OR = 5.63, 95% CI [5.31, 5.98]), is from the same state as the program (OR = 3.52, 95% CI [3.35, 3.70]) or has a Step 1 score one standard deviation above the mean (OR = 1.77, 95% CI [1.74, 1.81]). The odds of being ranked are lower for programs with a high signal-to-application ratio (OR = 0.76, 95% CI [0.71, 0.80]) and for Doctor of Osteopathic Medicine (DO) (OR = 0.50, 95% CI [0.48, 0.53]) or international medical graduates compared (US IMGs: OR = 0.11, 95% CI [0.10, 0.13]; Non-US IMGs: OR = 0.11, 95% CI [0.09, 0.12]) to U.S. MDs, though all applicants benefit from the use of signals.

Conclusions: Although signaling is not a requirement to be ranked, ranked competitively, or matched to a program in GS, those who signaled were ranked and matched at a higher percentage, with signals having the strongest effect on ROL inclusion.

Keywords: general surgery; graduate medical education; matching; medical residency; program signaling; ranking.