How to effectively use programmatic signaling as a residency applicant

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How to effectively use programmatic signaling as a residency applicant
How to effectively use programmatic signaling as a residency applicant


The current system for residency applicants to express an explicit interest in a program is taking hold in more medical specialties—and it appears to be having the desired results.

Program Signaling—a system that allows applicants to indicate interest in a limited number of residency programs—will be used by 18 majors during the 2022-2023 residency-application cycle. Majors using the system are: adult neurology; anesthesiology; dermatology; diagnostic radiology; interventional radiology; emergency medicine; general surgery; internal diseases (categorical); internal medicine/psychiatry; neurosurgery; Obstetrics and Gynecology; orthopedic surgery; otolaryngology; pediatrics; physical medicine and rehabilitation; preventive medicine; psychiatry; and urology. This will be the third year the system has been available, and it is becoming more widespread in specialist use.

A recent AMA Innovations in Medical Education webinar described what medical students seeking residency slots should expect.

The webinar included details on programmatic signaling during this cycle, presented by AMA member Stephen Pletcher, MD, director of the residency program in the Department of Otolaryngology at the University of California, San Francisco ( watch recording ).

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The specifics of program signaling, like many aspects of the residency selection process, vary by major. In general, the idea is quite simple. By indicating a specific interest in a program, applicants improve their chances of getting an interview slot.

Program signaling occurs prior to the release of applications to program directors. Programs can then see which applicants flagged them when they receive the applications. They don’t see what other programs a candidate has flagged.

“In general, if you think about the process as a whole, the majority of applicants are screened before interview day. And in the past, there was no formal method of matching the interests of applicants and programs prior to this interview selection time frame, and the signals are designed to do that,” Dr. Pletcher said.

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Dr. Pletcher examines the efficacy of program signaling in otolaryngology, a specialty in which, on an annual basis, the average individual applicant has applied to more than half the programs in the country.

Using the 2020-2021 matching cycle as a baseline, the overall rate of otolaryngology interviews offered was 18% of applicants receiving interviews from programs to which they applied. Signal related applications had a 58% interview offer for programs they applied to and used Signal. Signaling also proved useful for the entire spectrum of applicants—not just that subset of students considered the most competitive group.

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The most important point Dr. Pletcher emphasized was to learn how programming signals are used in the medical specialty you are pursuing. The number of signals, for example, can vary.

“The way you’re going to approach it if you’re applying to orthopedic surgery — where you’re going to submit 30 alerts — is very different than the way you’re going to approach it if you’re applying to adult neurology and you’re submitting three alerts,” he said. on where to use signals, Dr. Pletcher urged applicants to consider learning goals, culture, and geography. He also advocated getting advisor feedback on how you plan to use your signals and understanding how competitive you are for programs , which you plan to signal.

Dr. Pletcher said one trap he’s seen students fall into is “over-strategizing” their use of cues.

Applicants said something like, “I thought I was a great candidate for this program and I really wanted to go to this program, but I’m kind of assuming they’re going to interview me anyway. So I used my cues elsewhere,” Dr Pletcher said.

“From a program director’s perspective, there are times when we look at applications and say, Well, there’s a great candidate, he seems like a reasonable fit, but they haven’t alerted us—and that means they’re much less likely to get an interview offer.”


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