With the residency selection process becoming more competitive and programs receiving unprecedented numbers of applications, some specialties have introduced preference signaling in an attempt to help applicants target programs of interest. In the 2022-2023 application cycle, obstetrics and gynecology (Ob/Gyn) also introduced a two-tiered system with a limited number of gold signals (3) and silver signals (15).
Given the novelty of preference signaling in the Ob/Gyn residency application process, this study aims to 1) assess the impact of signals on interview offers and match, and 2) discuss applicant attitudes toward this preference signaling system.
This was a voluntary, cross-sectional survey study performed in April 2023 that was open to all fourth-year medical students (MS4s) who applied to an Ob/Gyn residency in the United States. Self-reported demographics, signaling, interview, and match data were collected. Students were also asked about attitudes toward signaling on a 5-point Likert scale.
Of the 1507 applicants who entered an Ob/Gyn residency via match or SOAP process, 969 (64.3%) completed the survey. An additional 22 applicants who did not match also responded to the survey. The majority of respondents used all 3 gold tokens (98.3%) and all 15 silver tokens (94.3%). The mean number of applications sent was 74.3±35.1, and the mean number of interviews received per applicant was 12.8±6.6. The interview/token yield was 64.0%±31.5% for gold tokens, 43.8%±23.1% for silver tokens, and 9.8%±10.0% for no token. 340/951 (35.8%) of survey respondents matched to a gold token program, 338/951 (35.5%) matched to a silver token program, and 244/951 (25.7%) matched to a non-token program. 499/951 (52.5%) reported feeling slightly positive or very positive about signaling.
The majority of Ob/Gyn applicants in this survey participated in preference signaling. Gold and silver tokens were associated with high ratios of interview invitations compared to no token. However, the overall number of applications did not decrease in the 2022-2023 cycle, and only half of survey respondents reported feeling positively about the signaling process. These results can inform program directors and students on application number and strategy in upcoming cycles.

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