814 Results and Opinions on the Implementation of a Preference Signaling System in Neurosurgical Residency Applications

INTRODUCTION: The 2022-2023 neurosurgery residency application cycle employed an optional preference signaling system that indicated a focused interest in a particular program. During this first iteration, applicants could signal interest in up to eight participating programs. METHODS: A survey consisting of 28 questions pertaining to the signaling process was distributed via email to all neurosurgery applicants participating in the 2022-2023 cycle. Results were compiled, and descriptive statistics were used to generate results. RESULTS: Of the 361 total applicants, 82 (22.7%) completed the survey; 84.1% attend a US MD program, 1.2% a DO program, 12.2% are international medical graduates, and 2.4% are post-graduates. The mean number of programs applied to was 78 (range 21-116 (all). The median number of interviews received was 17 (range 0 to 57). Notably, 14.6% of individuals signaled their home programs, and 63.4% signaled at least one externship program. 90.2% of applicants utilized all eight signals. Applicants averaged 3.5 interviews from programs they signaled, and 15.6% of applicants matched at a program they signaled. Sixty-five percent of applicants were unsatisfied with the application process, but 53.1% indicated preference signaling should continue. Regarding the number of available signals, 43.75% felt eight was appropriate, 32.5% felt it was too few, 13.75% thought it was too many, and 10% were indifferent. CONCLUSIONS: Preference signaling was implemented in the 2022-2023 applicant cycle to improve interview efficiency and equity. Applicant opinions were mixed about this first iteration. Two consistently noted themes were the desire for improved home and away rotation signaling standardization and the perceived lack of impact on match outcome.