Abstract
OBJECTIVE: Otolaryngology (OTO) remains one of the most competitive surgical specialties, with limited residency positions. In 2021, a 25-program preference signaling system was introduced to enhance communication between applicants and programs. This study evaluates how signaling affects application metrics. STUDY DESIGN: Retrospective database study. SETTING: Texas Seeking Transparency in Application to Residency (STAR) program, 2021 to 2024. METHODS: Statistical analysis in R (v4.3.3) included descriptive statistics, ANOVA for comparing continuous variables across match years, and T-tests to assess differences between matched and unmatched groups. RESULTS: From 2021 to 2024, there were 393 respondents, representing 26.77% of all OTO positions. Preference signaling use among matched applicants rose from under 25% in 2021 to 95.7% in 2024. Nonsignaling applicants had more publications (6.31 ± 3.74 vs 5.30 ± 3.78, P < .01) and volunteer experiences (7.82 ± 3.15 vs 6.00 ± 3.42, P < .001) than signaling applicants. Step 2 scores were similar between groups. Applications per applicant declined from 75.93 ± 31.79 in 2021 to 48.16 ± 23.55 in 2024. CONCLUSION: Applicants with fewer traditional strengths, such as research and volunteering, were more likely to match using preference signaling. Strategic signaling may improve chances of matching into OTO. The decline in application numbers suggests growing trust in the signaling process from both applicants and programs.