Dermatology Match Preference Signaling Tokens: Impact and Implications

Abstract

BACKGROUNDThe dermatology residency application process implemented a new system of preference signaling tokens (PSTs) in the 2021-2022 cycle to allow applicants to express a higher level of interest in specific programs. Limited data are available on the utilization and impact of these tokens.OBJECTIVETo determine the impact of PSTs on the application process and where in the process PSTs had the greatest influence.MATERIALS AND METHODSA 14-question survey was sent to 62 ACGME-accredited dermatology residency programs. Primary outcomes were PST impact on 2021-2022 applications. Variables were evaluated using open-ended questions, yes/no responses, and importance ratings from 0 to 100.RESULTSAn average of 7.1% of applicants were offered interviews, but 21.1% of applicants that submitted PSTs were interviewed versus 3.7% of nonsubmitters. 22.5% of ranked applicants and 19% of matched applicants submitted a PST to that program.LimitationsNot all programs responded, and PST submission restrictions could not be assessed.CONCLUSIONThe greatest PST impact was on the interview decision but had minimal subsequent impact. Given PSTs cannot be submitted to home programs or in-person away rotations, the actual impact was probably greater than found. Programs will continue to implement PSTs in future cycles.

Attending Perceptions on the Use of Preference Signaling in the Ophthalmology Residency Application Process

“… 7 The rate at which applicants received interview offers was significantly higher for programs they signaled compared to nonsignaled programs in the otolaryngology, dermatology, and urology residency match. 7 15 16 These specialties reported that signals were most commonly used as part of the initial application review to extend interviews and as a tiebreaker for similar applications, but not for determining a rank list, which is consistent with our findings. 7 Additionally, orthopaedic PDs surveyed ranked signaling only below away rotation performance and personal knowledge of the applicant in terms of importance for residency selection.…”

“… 7 8 11 13 14 Survey studies in dermatology, otolaryngology, and urology have found considerable advantages to using signaling such as improving the distribution of interview offers among applicants and allowing seriously interested applicants to standout to desired programs. 7 15 16 PDs in otolaryngology reported that signals were used as a tiebreaker for similar applications and as part of the initial application review algorithm. 7 The rate at which applicants received interview offers was significantly higher for programs they signaled compared to nonsignaled programs in the otolaryngology, dermatology, and urology residency match.…”

Perceptions of Preference Signaling in Orthopaedic Surgery: A Survey of Applicants and Program Directors

“…10,13 These opinions are consistent with findings from postmatch analysis of dermatology and ENT data, which both demonstrated a markedly increased likelihood of receiving an interview at a 'signaled' program compared with programs that did not receive a 'signal' designation. 13,16 This notable effect was experienced by applicants across all quartiles of competitiveness, 13 consistent with 61.3% of our PD respondents thinking that the PSP would improve the interview rates of midtier to-low-tier applicants.…”

“…Compared with the 30 signaling tokens allotted to orthopaedic surgery applicants for the 2022 to 2023 match, otolaryngology, urology, dermatology, internal medicine, and general surgery allotted between 3 and 5 tokens for each applicant to preserve the value and intent associated with the 'signal' designation. [10][11][12][13][16][17][18] The broad variation alludes to the uncertainty surrounding the optimal token allotment that would maximize the discrete value while minimizing the likelihood of 'nonsignalers' being perceived as disinterested. The second otolaryngology match using preference signaling allotted four tokens per candidate, a decrease from five tokens during their inceptive cycle.…”

“…Previous economic research suggests that tokens are optimally used if distributed only to programs where an applicant is considered competitive, 19 but survey data of dermatology PDs found that 'signaling' a program improved the likelihood of obtaining an interview when an applicant would otherwise likely not be considered. 16 Guidance from orthopaedic surgery PDs has suggested that applicants spread their tokens across 'reach,' 'possible,' and 'likely' programs, but only after an honest evaluation of the strength of their application. 14 Although the general principles of token distribution may be intuitive, several common, unanswered questions remain.…”