How To Boost Your Residency Match with Preference Signals

How to Use Preference Signaling to Improve Your Residency Match Chances

Residency applications are one of the most stressful parts of medical school. With ERAS making it easy to apply to dozens of programs in just a few clicks, competition has reached record levels. Many programs now receive thousands of applications for a handful of spots, leaving qualified applicants struggling to stand out.

If you’re asking yourself, “How do I make sure programs actually notice me?” you’re not alone. The answer lies in preference signaling, one of the most important recent developments in the Match process. This blog breaks down what preference signaling is, why it matters, and how to use it strategically to maximize your interview chances.

Why Preference Signaling Exists

Before ERAS, applications were paper-based, which created natural limits. Students only applied to programs they genuinely wanted. Once applications moved online, that barrier disappeared. Suddenly, applicants could apply to 80 or even 100 programs, overwhelming program directors and making it difficult to know who was truly interested.

For example, Yale’s internal medicine residency once received nearly 4,000 applications for just 38 spots. Even with filters, it’s impossible for programs to thoroughly review that many files.

Preference signaling was introduced to solve this problem. By giving applicants a limited number of “signals,” programs can more easily identify students who are both qualified and genuinely interested in training there.

What Is Preference Signaling?

Preference signaling allows you to send a limited number of “signals” to residency programs. These signals act as a strong indicator of interest and can increase your chance of being invited for an interview.

• Competitive specialties like ENT, orthopedics, urology, and neurosurgery may allow 25–30 signals.

  
  



• Less competitive specialties like pediatrics or family medicine typically allow fewer.

  
  



• Some fields, like internal medicine, even use gold and silver signals to show levels of interest.

  
  

In highly competitive specialties, not signaling a program often means no chance of an interview. In others, a signal may not be required but can still make a difference.

PMSS helps you long before ERAS season, so that by the time you’re applying (and signals open), you already know where you stand and can strategize accordingly.

Step 1: Target the “Sweet Spot”

The first principle of signaling is knowing where it actually matters.

• If you’re almost certain to receive an interview, don’t waste a signal.

  
  



• If you’re clearly unqualified for a program, a signal won’t change the outcome.

  
  



• The sweet spot is where you are competitive but not guaranteed. This is where your signal can move you from “maybe” to “yes.”

  
  

Step 2: Consider Program Popularity

Not all signals carry equal weight.

• Top programs in big cities (New York, Boston, San Francisco, Los Angeles) receive hundreds of signals. To even be considered, you’ll likely need to use a signal here.

  
  



• Less-subscribed programs in regions with fewer applicants (Rust Belt, colder states, or less popular cities) may receive far fewer signals. In these cases, your signal carries much more influence.

  
  

This means applicants should decide whether to play it safe or take risks. If you’re aiming for top programs, you may need to spend signals there, but also consider targeting programs where your signal will have more impact.

Step 3: Balance Risk and Safety

A critical part of signaling is matching your risk tolerance.

• High-risk strategy: Spend most signals on the biggest-name programs, hoping for a high-reward match. The danger is going unmatched.

  
  



• Risk-averse strategy: Focus on mid-tier or undersubscribed programs where your signals are more likely to secure interviews.

  
  



• Safety signals: Regardless of your approach, always dedicate at least 1–2 signals to programs where you are highly competitive and would be happy to match. The cost of going unmatched far outweighs the cost of feeling “undermatched.”

  
  

Step 4: Consider Dual Applying

Another strategic option is dual applying. Because signals are not limited across specialties, you can signal programs in multiple fields. For example, you could apply to dermatology and anesthesia, or plastic surgery and general surgery.

This approach can increase your safety net, especially for applicants in highly competitive specialties or IMGs applying broadly. However, it comes with challenges:

• You’ll need separate personal statements and letters.

  
  



• You must avoid “double-dipping” at the same institution in multiple specialties.

  
  



• You should only pursue this route if you would genuinely be happy in either field.

  
  

Step 5: Use Geographic Preference Signaling

In addition to program signals, applicants can also select up to three geographic regions and indicate whether they prefer urban, suburban, or rural settings. Programs can see if you listed their region, said “no preference,” or left them out.

While geographic signals don’t carry as much weight as program signals, they can still improve your chances:

• Aligning with a program’s region increases interview invitations.

  
  



• Saying “no preference” is neutral.

  
  



• Not listing a region may slightly hurt your chances.

  
  

In some specialties, geographic signaling improves interview numbers significantly. For example, general surgery applicants who strategically selected regions received 15 interviews on average compared to 10 for those who didn’t, which is a boost that raised match probability from 86% to 94%.

Tips for geographic signals:

• Never leave this section blank.


• If your program list fits within three regions, list them all.


• If not, balance the boost of alignment with the risk of excluding others.


• Undersubscribed regions (like the Great Lakes, South Atlantic, and Mid-Atlantic) may give you an advantage.


• When asked to explain your geographic preferences, provide credible reasons such as family ties, a partner’s career, or long-term professional goals.

Step 6: Special Considerations for IMGs and DOs

Preference signaling can be especially valuable for IMGs and DO applicants, who often face higher barriers to interviews.

A well-placed signal may be the difference between being filtered out and being seriously considered. Programs that might otherwise pass on an application often take a second look when genuine interest is shown.

Step 7: Be Honest and Credible

Ultimately, preference signaling only works if you use it honestly. Programs can usually tell when reasons are insincere or generic. Before sending a signal, ask yourself: “Would I actually want to train here?”

Remember, the goal is not to maximize the number of interviews, but to maximize your chances of matching at a program you’d be happy with.

Strategy Creates Certainty

The residency match is full of unknowns, but preference signaling lets you shift the odds in your favor. When used wisely, signals turn chance into strategy, helping you move from simply hoping to be noticed to clearly showing programs where you belong.

In the end, success isn’t about sending the most applications, but sending the right signals. The same principle applies to exam prep, where using Predict My Step Score can give you the certainty of knowing how prepared you really are.