The orthopaedic surgery residency selection process has grown more competitive over recent years, with programs receiving an unprecedented number of applications. As an effort to target applications to programs of interest, the American Orthopaedic Association has announced the introduction of a formal preferencesignaling program into the 2022 to 2023 orthopaedic surgery residency selection cycle. This system will allow applicants to assign "signals" to a total of 30 programs. The purpose of this article was to (1) discuss implications of the new preference-signaling program, (2) introduce the framework of the "strategic signaling spear" for applicants to conceptualize the power of all methods of preference-signaling to improve their odds of matching, and (3) describe the role of strong mentorship at all stages of the residency application process.
Orthopaedic surgery consistently demonstrates one of the lowest residency match rates of any specialty, resulting in many strong applicants going unmatched every March. 1 In contrast to the 92% to 95% match rate for US seniors across other specialties between 2008 and 2018, orthopaedic surgery residency applicants matched at a rate of roughly 75% to 79%. 1,2 The 2021 to 2022 match cycle yielded the lowest match rate to date with 1,737 applicants vying for only 875 positions. 3,4 Among US medical school graduates, the match rate dropped to 64.0% of those who registered for the National Resident Matching Program. 3 The increase in the number of unmatched orthopaedic surgery applicants over the past several years has been attributed in part to the increasing number of applicants-up to 14% since 2021. 4 This increase in competitiveness has led to increasingly broad application submission. From 2008 to 2022, the mean number of applications submitted by US orthopaedic surgery residency applicants increased from 46.5 to 86.1-nearly half of all 203 orthopaedic residency programs were accredited by the Accreditation Council for Graduate Medical Education. 2,5,6 Largely fueled by the fear of going unmatched, many applicants have felt pressure to apply to more programs with the hope that more applications will increase their odds of matching-regardless of an applicant's genuine interest in the program. 2 Certainly, the "opportunity cost" of going unmatched is