Thanks for the Signal-Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment

John M Woodward; Connie Y Gan; Darci C Foote; Tasha Posid; Nicole M Santucci; Noosha D Deravi; Caitlin Silvestri; Kirstyn E Brownson; Erika Simmerman Mabes; Rondi Gelbard; Milanie Milan; Nina Zhao; Dylan R Nieman; Martha Godfrey; Benjamin D Ferguson; Joseph L'Huillier; Colleen McDermott; Prajjwol Luitel; Olabisi Sheppard; Emma G Burke; Jennifer H Chen; Jenny M Guido; LaDonna Kearse; Jonathan Davies; Trenton Foster; Sarah Lund

doi:10.1016/j.jsurg.2026.104061

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Thanks for the Signal-Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment

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Thanks for the Signal-Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment

John M Woodward, Connie Y Gan, Darci C Foote, Tasha Posid, Nicole M Santucci, Noosha D Deravi, Caitlin Silvestri, Kirstyn E Brownson, Erika Simmerman Mabes, Rondi Gelbard, …

Journal of surgical education, Vol.83(9), 104061

09/2026

DOI: 10.1016/j.jsurg.2026.104061

PMID: 42418853

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Abstract

We aimed to explore general surgery program director (PD) experiences with and perspectives on preference signaling in a 15-signal system. We performed qualitative analysis of de-identified transcripts from semi-structured interviews of general surgery PDs. General surgery PDs across the United States. All general surgery PDs in the spring of 2025 were invited to participate. Fifteen PDs volunteered to participate in semi-structured interviews (73% university-based, 53% programs with <8 residents/class). PDs highlighted that signals saved time when utilized as a screening tool, which gave PDs more time for holistic review of applications. PDs also felt signaling increased equity by improving interview distribution among applicants and reducing prestige bias. PDs wanted future changes to signaling to be data-driven; they felt that, if signal number is modified in the future, a balance must be struck between limiting signals sufficiently to ensure they convey real interest and allotting enough signals to ensure application screening efficiency. Additionally, PDs highlighted that greater transparency in program structure, culture, and specific application review practices would allow applicants to better assess their "fit" with a program before signaling. When considering additions to the current system, PDs felt that postinterview signaling could help formalize and standardize letters of intent from applicants. PDs endorsed signaling as a tool that enhances efficiency and equity in residency selection. However, they called for deliberate, evidence-based optimization, emphasizing that program transparency regarding how signals are being used can improve signaling effectiveness.

General surgery

Preference signaling

Graduate medical education

Residency recruitment

Details

Title: Subtitle: Thanks for the Signal-Now What? Program Director Perspectives on How Preference Signals Are Shaping General Surgery Residency Recruitment
Creators: John M Woodward - University at Buffalo, State University of New York
Connie Y Gan - Oregon Health & Science University
Darci C Foote - Michigan State University
Tasha Posid - The Ohio State University Wexner Medical Center
Nicole M Santucci - Washington University in St. Louis
Noosha D Deravi - Indiana University School of Medicine
Caitlin Silvestri - NewYork–Presbyterian Hospital
Kirstyn E Brownson - Huntsman Cancer Institute
Erika Simmerman Mabes - Augusta University
Rondi Gelbard - University of Alabama at Birmingham
Milanie Milan - Duke Medical Center
Nina Zhao - University Hospitals of Cleveland
Dylan R Nieman - Rutgers, The State University of New Jersey
Martha Godfrey - University of Iowa
Benjamin D Ferguson - University of Michigan
Joseph L'Huillier - Department of Surgery, University at Buffalo, Buffalo, New York
Colleen McDermott - University of Utah
Prajjwol Luitel - Tribhuvan University Teaching Hospital
Olabisi Sheppard - WellStar Kennestone Hospital
Emma G Burke - Baylor College of Medicine
Jennifer H Chen - Baylor College of Medicine
Jenny M Guido - University of South Dakota
LaDonna Kearse - The University of Texas MD Anderson Cancer Center
Jonathan Davies - Southwestern Medical Center
Trenton Foster - Mayo Clinic
Sarah Lund - Mayo Clinic in Florida
Resource Type: Journal article
Publication Details: Journal of surgical education, Vol.83(9), 104061
DOI: 10.1016/j.jsurg.2026.104061
PMID: 42418853
NLM abbreviation: J Surg Educ
ISSN: 1878-7452
eISSN: 1878-7452
Publisher: Elsevier
Grant note: National Center for Advancing Translational Sciences of the National Institutes of Health: TL1TR00234
Funding: NMS was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR00234. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This research otherwise did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Language: English
Electronic publication date: 07/08/2026
Date published: 09/2026
Academic Unit: Surgery
Record Identifier: 9985180969902771

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