Preference Signaling in the National Resident Matching Program

Abstract

To the Editor In their Viewpoint, Salehi et al 1 proposed a "star system" in which otolaryngology residency applicants can indicate particular interest in programs, similar to a "rose-sending system" previously suggested in orthopedic surgery. 2 In the economics literature, these systems are known as preference signaling mechanisms and have been successfully implemented in the American Economic Association (AEA) job market for economics graduate students since 2006. Its rationale, design, and outcomes should inform the current proposal. 3 Residency placement involves 2 phases: information sharing via electronic applications and interviews, then matching the preferences of interviewees and programs. The latter phase is accomplished by an algorithm that the National Resident Matching Program ("the Match") administers. This algorithm was a basis for awarding the 2012 Nobel Prize in Economics to Lloyd Shapley and Alvin Roth. Roth notes that the former phase, however, is congested in that not all interested candidates can be adequately considered. 2 Medical students submit excessive applications, inundating faculty who have limited time to read files. Interviewing is costly for both programs and applicants and thus a scarce opportunity. To avoid unfilled positions in the Match, resource-limited programs must consider at the preinterview stage not simply whether an applicant is attractive, but also whether she is attainable.Signaling can mitigate interview congestion. 2 For example, a strong applicant who has an unexpected geographic preference may choose to signal to an average program in that locale who might otherwise have dismissed the applicant as out of their league. 3 Ensuring a limited number of signals provides credibility. 4 Salehi et al 1 suggested that applicants be allowed to send stars to a maximum of 10 programs, 1 but this is likely too high to be effective. Roth helped design the AEA job market to limit applicants to 2 signals each so that their scarcity provides stronger informative value. 2 Moreover, a limit of 2 signals should reassure applicants that programs would not erroneously infer unattainability from the absence of a signal. After all, about one-third of US MD students match outside of their top 2 ranks. 5 Limited signaling mechanisms are shown to increase the chance of receiving a preferred interview. 3,4 If implemented correctly, signaling may play a valuable role in optimizing the resident selection process.

Ideas and Innovations to Improve the Otolaryngology–Head and Neck Surgery Residency Application and Selection Process

“…Signaling may also minimize interview congestion and hoarding, which could decrease application costs. 1,55,56 In addition, this system may reward applicants for their interest in specific programs, as programs may employ different screening filters (eg, provide consideration to applicants with lower US Medical Licensing Exam [USMLE] scores) for students who “star” their program. In response to the “Star System,” Chen et al 56 suggested that “if implemented correctly, signaling may play a valuable role in optimizing the resident selection process.” In further support of signaling, a 2019 study created a computer simulation model of the OTO-HNS Match and concluded, “Offering applicants an option to provide program preference improves the practical number of interview invitations.…”

“…1,55,56 In addition, this system may reward applicants for their interest in specific programs, as programs may employ different screening filters (eg, provide consideration to applicants with lower US Medical Licensing Exam [USMLE] scores) for students who “star” their program. In response to the “Star System,” Chen et al 56 suggested that “if implemented correctly, signaling may play a valuable role in optimizing the resident selection process.” In further support of signaling, a 2019 study created a computer simulation model of the OTO-HNS Match and concluded, “Offering applicants an option to provide program preference improves the practical number of interview invitations. This enables programs to review applicants holistically—instead of using single objective parameters such as USMLE scores—which facilitates a selection of applicants who will be successful in residency.” 39 Holistic evaluations of applicants include more comprehensive reviews of applicants with the goal of assessing factors (eg, unique experiences, diversity, integrity) that are not measurable via objective characteristics.…”

“…57 Moreover, signaling has been shown to relieve interview congestion and improve odds of applicants receiving preferred interviews. 39,56,58…”

“…1,53,55,56 Potential drawbacks to this system include applicants being discriminated against for not signaling a program, difficulties coordinating logistics (eg, number of stars) among programs, and certain highly desirable programs receiving a disproportionate amount of ''stars.'' 1,55,56,58 Regional and Web-Based Interviews Regional interviews (RIs) and web-based interviews (WBIs) have been proposed to streamline the interview process and minimize costs. 37 RIs require multiple programs in the same geographic proximity coordinating interview days, so that applicants can travel to that location only once.…”

“…57 Moreover, signaling has been shown to relieve interview congestion and improve odds of applicants receiving preferred interviews. 39,56,58 Implementing this system would be straightforward. The OPDO could create an online form that allows each applicant to select the programs they wish to flag.…”