Evaluating the role of preference signaling on female representation in successful applicants in the orthopaedic surgery national resident match

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Background: The American Orthopaedic Association’s Council of Orthopaedic Residency Directors implemented a preference signaling program for the 2022-2023 orthopaedic residency application cycle, which allows applicants to send up to 30 “signals” that indicate their specific interest in a program. The stated purpose of the implementation of signaling is to produce “a more equitable, reproducible, efficient, and mutually optimal Match,” and to decrease barriers for applicants from groups that have been underrepresented in orthopaedic surgery. Particularly with the elimination of the USMLE Step 1 score, preference signaling has now become one of the most important factors considered by residency programs when extending interview invitations. This study thus aims to identify any significant effects of signaling on addressing the issue of female representation in successful orthopaedic surgery residency applicants. Methods: Using publicly available data, the gender distribution of orthopaedic surgery residents was obtained for the classes of 2023, 2024, 2025, 2026, 2027, and 2028 for 176 of the 199 (88.44%) recognized US orthopaedic residency programs. Results: When comparing the gender distribution of orthopaedic surgery residents after the implementation of preference signaling, there was no significant change in the proportion of female residents comprising the residency class (P=0.495). Conclusions: In its first year, preference signaling did not demonstrate a statistically significant impact on female representation of successful applicants to orthopaedic surgery residency programs. Therefore, other methods of increasing representation in orthopaedic surgery are necessary.