Preference-Signaling during the Orthopaedic Surgery Residency Application Process

The orthopaedic surgery residency selection process has grown more competitive over recent years, with programs receiving an unprecedented number of applications. As an effort to target applications to programs of interest, the American Orthopaedic Association has announced the introduction of a formal preference-signaling program into the 2022 to 2023 orthopaedic surgery residency selection cycle. This system will allow applicants to assign "signals"to a total of 30 programs. The purpose of this article was to (1) discuss implications of the new preference-signaling program, (2) introduce the framework of the "strategic signaling spear"for applicants to conceptualize the power of all methods of preference-signaling to improve their odds of matching, and (3) describe the role of strong mentorship at all stages of the residency application process.