Navigating the ERAS Application: Program Signaling and Geographic Preference

The Electronic Residency Application Service (ERAS) is a pinnacle piece in your application for US medical residency. Two newer categories, Program Signaling and Geographic Preferences, offer applicants the opportunity to notify programs of their interest in a specific program or geographic area. Understanding how to effectively navigate this section can significantly enhance your chances of matching with your preferred residency programs. In this post, we will go over the basics of Program Signaling and Geographic Preferences, as well as explore strategies to optimize these sections for a successful match.

The basics of ERAS program signaling

Program signaling has completely altered the landscape of residency match strategy, at least in some specialties. Program signaling allows applicants to “signal” interest in a limited number of residency programs. It was first introduced in 2020 as part of the Otolaryngology application process, and since then the use of signaling has expanded rapidly, to most specialties and to most residency programs. 

You can find out which programs have opted in for program signaling by visiting the AAMC's website here.

Signaling occurs at the time of the application, as applicants complete the Program Signaling section in ERAS for most specialties. Note the exceptions: obstetrics and gynecology, ophthalmology, and plastic surgery. These use ResidencyCAS, SF Match application, and Central Application, respectively. Signaling in urology occurs through the AUA website. 

Later, when PDs receive the applications, they can see which applicants signaled them. They do NOT see which other programs an applicant has signaled.

Which specialties use program signaling?

During the 2023–2024 residency selection cycle, signaling was used by 22 physician specialties (although not every program within a particular specialty participated in signaling.) In dermatology, for example, the vast majority of programs make use of signals, increasing from 87% in the first year of the program to 91% in the second year.¹

How many signals can you send? 

There’s a wide variability in the number of signals for each specialty. As specialties refine their process, these signal numbers will continue to change. For example, Pediatrics allows for five signals while Orthopedic Surgery allows for 30 signals. 

• Some specialties allow for different tiers of signals. 

• Anesthesiology, for example, allows for 5 gold and 10 silver signals. 

• Gold indicates a high level of interest, while silver indicates a lesser, but still high, level of interest.

What are the number of signals and types of signals that you can send for each specialty?

For the 2026-2027 cycle, the number of signals and types by specialty are noted below.

•  Anesthesiology: 5 gold, 10 silver program signals

• Child Neurology and Neurodevelopmental Disabilities: 3 gold and 6 silver

• Dermatology: 3 gold, 25 silver program signals

• Diagnostic Radiology: 6 gold, 9 silver

• Emergency Medicine: 5 signals

• Family Medicine: 5 signals

• General Surgery: 15 signals

• Internal Medicine: 3 gold, 12 silver

• Internal Medicine/Pediatrics: 5 signals

• Internal Medicine/ Medical Genetics: 3 signals

• Internal Medicine/ Psychiatry: 2 signals

• Interventional Radiology: 8 signals

• Neurodevelopmental Disabilities: 2 signals

• Neurology (adult): 8 signals

• Neurological Surgery: 25 signals

• Obstetrics and Gynecology: 3 gold and 15 silver

• Orthopedic Surgery: 30 signals

• Otolaryngology: 25 signals

• Pathology: 5 signals

• Pediatrics: 5 signals

• Pediatric Medical Genetics: 3 signals

• Pediatrics/Psychiatry/Child & Adolescent Psychiatry: 3 signals   

• Physical Medicine and Rehabilitation: 20 signals

• Plastic Surgery: 20 signals

• Psychiatry: 10 signals

• Public Health and General Preventive Medicine: 3 signals

• Radiation Oncology: 4 signals

• Thoracic Surgery: 4 signals

• Transitional Year: 12 signals      

• Urology: 30 signals

• Vascular Surgery: 3 gold, 12 silver

Do you need to signal a program in order to get an interview?

It usually depends on the specialty. 

• For highly competitive specialties like Orthopedic Surgery, with a large number of signals, in most cases you will need to signal a program to get an interview. Your chances of matching with an unsignaled program are going to be much, much lower.

• In Dermatology, where applicants are given 28 signals, initial data from previous cycles indicated that "there is a near-zero chance of receiving an interview invite at non-signaled programs."² 

• Overall, though, only 3% of PDs stated that they would only interview applicants who signaled their program--meaning that most PDs still remain open to interviewing all applicants. 

  
  

Understand how PDs view signals: they are often used in the screening process and not as often in the ranking process

Program signals were only recently introduced, and it's therefore challenging to use a data-driven approach to signaling strategy. The strategies we outline in this post are based on what we've seen with our own students, as well as data from surveys of PDs. 

In a survey of PDs:

● About 80% of PDs indicated that signaling impacted their initial review/screening of applicants

●  70% said that it impacted their selection of applicants for interviews 

● Only 15.8% said that it impacted their selection for inclusion on their rank order list³

Overall, the data indicate that signals are often used in the screening process, and not used as often in the ranking process.

Program signals can alert programs that may not have otherwise noticed you

Program signaling, while still relatively new, was shown to help applicants who might be overlooked. In the AAMC's 2023-2024 ERAS® Application Cycle: Results of the Program Director Reaction Survey, 71% out of 1,113 respondents indicated that they Agreed or Strongly Agreed that "Program signals helped me identify applicants whom I would have otherwise overlooked."

Why would programs overlook an applicant? One example would be geography. As one PD remarked, the use of signals “leads me to invite out-of-state applicants I would not have otherwise interviewed due to my past experience that there is a much lower likelihood they will match to my program.”³ 

You need to start crafting your signaling strategy in your third year

As you can see, signaling strategy requires significant analysis. It may also require a significant investment of time to investigate different programs across the country. That’s why we recommend that students start thinking about their signaling strategy in their third year.  

• Keep reading for more research and suggestions on signaling strategy. 

• For more on how to research programs and develop your program signal list, please see this post. 

Consider these 3 main factors when crafting your signaling strategy

When it comes to signaling strategy, you need to consider three main factors:

●  How competitive is the specialty?

●  How many signals are available for this particular specialty?

●  How competitive are you for the specialty?

For highly competitive specialties with many signals, you are NOT going to be considered at all programs

In the latest research, dermatology applicants had essentially a zero chance of matching into a program that they had not signaled.  Dermatology provides three gold signals and 25 silver signals, for a total of 28 signals.

• What does this mean? You’re not considered competitive for 150 dermatology programs. 

• Instead, the vast majority of applicants would be considered competitive for, at the most, 28 programs. 

• Once you identify those 28 programs, you need to think about how to identify indicators of fit. 

• As we say throughout our book The Successful Match, the most important factor for a program is how well an applicant fits with a program.

When to use a targeted signaling strategy: high numbers of signals and a highly competitive specialty 

For this dermatology example, you need to think about how to identify and then convey your fit specifically with 28 programs. I call this a “targeted strategy.”

• If you’ve done extensive research in allergic contact dermatitis, then you could work to identify 28 programs that have faculty specializing in this area. 

•  Ideally, you would try to group these 28 programs into three geographic areas. 

• Narrowing down your geographic preferences to three main areas, or less even, is an additional indicator of fit with a particular program. 

• Identifying a setting (urban, rural, suburban) can be an additional indicator of fit.

• In other words, you would signal 28 programs where you “fit” in terms of academic interests, geographic preference, and setting preference.

• You would have very similar considerations if you’re applying to Neurological Surgery (25 signals), Orthopedic Surgery (30 signals), or Otolaryngology (25 signals), all of which are highly competitive.

• For fields with just a few signals, or that are not as competitive, your strategy would of course be different

When to use a non-targeted strategy: few signals and a less competitive specialty

If you’re applying to Family Practice, you have five signals. As Family Practice is one of the least competitive fields, many strong applicants would be seriously considered by many family practice programs. Setting your geographic preference to “none” indicates that you are open to going anywhere in the country, and that provides you with more options.

Having said that, some applicants will have a harder time matching into family practice, perhaps because of Step failures or other red flags with their application. These applicants may wish to change their strategy.

● For such applicants, we usually recommend the “targeting strategy” described previously.

● In this case, you would seek out programs that are specifically known to accept residents who are not as strong in certain areas of their application.

● For IMGs, you would target IMG-friendly programs in IMG-friendly states.

● In order to further target these programs, you could make a compelling case for why you were interested in a specific geographic region and practice setting, in order to double up on indicators of fit.

Remember: your signal may not mean much at competitive programs

The data indicates that some programs receive far more signals than others.

• In 2023, the range of signals received by Internal Medicine programs ranged from 5 to 1222.⁴

• In specialties that provide a small number of signals (let’s say 5 signals total), an average of 24% of the signals were sent to just 10% of programs. 

• In specialties with large numbers of signals, an average of 18% of signals were sent to 10% of programs.

• In specialties with gold signals, 22% of the signals were sent to 10% of the programs.⁵

What does this mean for you? Overall, these findings indicate that your signal may be overlooked at “popular” programs with strong reputations or in desirable locations. In other words, for programs that receive too many signals, your signal may not impact their interview decisions.⁶

Your signal is unlikely to help you if you are not already competitive for this program (in most cases)

In general we advise students to not “waste” their signals on programs where they know they don’t meet the qualifications. That’s because for most PDs, a signal does not take precedence over meeting a program's requirements. Having said that, some PDs have invited applicants that they might not have otherwise invited, due to a signal. One PD stated that they “interviewed a few below our cut score that otherwise wouldn't have been offered an interview because they signaled us...”³

Although you might think that doing a home or away rotation is a strong indicator of interest by itself, some programs may not interview you unless you send a signal

At your home program, and at your away rotations, you’ll need to determine if they want you to send them a signal. These programs represent your best chances for matching, so you need to get it right.

In a survey, PDs were asked what guidance they would give to applicants with regards to signaling and away rotations. Here we find some pretty divergent views.

• 66% advised applicants to "signal our program if you are interested" regardless of whether it was a home program or if you completed an away rotation there. 

• However, 17% stated explicitly to not signal their program if you completed an away rotation there, because completing the rotation was essentially your signal of interest.

This is such a challenging area, because signaling is such a new process. That means that we haven’t had enough time yet to establish norms or standard operating procedures. Each PD is looking at the signaling process in their own individual way, and we have no way of knowing how an individual program will regard the use of signals.

We recommend that you (in an appropriate fashion) ask your home program and your away rotations about how they would like you to use your signals.

“I know that some programs don’t want applicants to use signals as an expression of interest if they’ve already done an away rotation there. I am very interested in your program, and just wanted to check with you. Do you advise students who have done an away rotation here to signal their interest? Or do you ask that they not?”

Avoid these 3 major mistakes when signaling programs

It’s easy to get caught up in the strategy and overlook some important cautions. Here are three major mistakes to avoid:

• Ego Signaling: You should not signal a program just for the program's prestige. A mistake many applicants make is signaling highly competitive programs that don't align with their background, goals, and application.

• Signaling to Match: While your main goal is to match, applicants should avoid signaling programs for the sole purpose of matching. You should only signal programs where you would be happy completing a residency.

• Not Utilizing Signals: The worst mistake you can make is not utilizing program signaling at all. This is a huge opportunity to stand out to programs that receive thousands of applicants each year. It's a tool to help you stand out to programs and, hopefully, get you an interview.

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Navigating Geographic Preferences

Learn the basics of ERAS geographic Signals and setting signals

● Program signaling is used to “signal” an applicant’s interest in a program. 

●Similarly, geographic signaling is used to indicate an applicant’s interest in a particular geographic region. 

●Setting preference is another optional section of ERAS. There are 6 options: rural, rural/suburban, suburban, suburban/urban, urban, and no preference.  

With geographic signaling, applicants can choose from 9 different regions in the US, based on US Census regions, and can select up to 3 of these regions. As with program signaling, this is optional.  Note that some of these regions are pretty limited. For example, the East South Central region has only four states: Mississippi, Alabama, Kentucky, and Tennessee.  See below for a map of the 9 regions, or you can see the map here. 

Geographic Preference - US Census Divisions from AAMC.org

For each of your geographic preferences, you will have the opportunity to describe the reason for your interest in training there. You may have family or friends in a particular city in that region, but if you choose to write about your specific interest in that city or state for that reason, you may turn off programs in other states. For example, an applicant who selected the South Atlantic as a preferred geographic division because she has family in Washington, D.C. may not be viewed as attractive to programs in Florida, another state in the South Atlantic region.

How Preference is Shared with Programs

	Geographic Preference	Setting Preference
Preference identified	Only shared with programs that you apply to in that geographic region	Shared with all programs you apply to
Lack of preference identified	Shared with all programs you apply to	Shared with all programs you apply to
No response	No information will be shared with programs you apply to	No information will be shared with programs you apply to

Geographic Preference

If you identify a geographic division, only the programs you apply to in that geographic region will be notified of your preference. If you choose that you do not have a geographic preference, all programs you apply to will be able to see this.

The “setting” section is a different section

This section allows you to share your preferences for rural, rural/suburban, suburban, suburban/urban, or urban. “No preference” is the final choice. 

You can only choose one of these options. This section is optional-you may choose not to indicate any preference here. Your setting preference will be shared with all the programs you apply to. If you do not respond to this section, or skip setting preferences, no information will be shared with the programs you apply to.

Learn how PDs use geographic signaling

How do PDs use geographic preferences in their decision-making? In a survey of PDs:

• 53% reported using these as part of the holistic process to help decide whom to interview

• 30% reported using these as part of an initial screen, alongside other data, before conducting a holistic review  

• 40% of PDs agreed or strongly agreed that this preference helped identify applicants who otherwise would’ve been overlooked.⁷

For the strongest benefits, align your program signals with your geographic preference

As you might predict, combining program signals with geographic preferences yields the best results. 

In Internal Medicine (with 7 program signals):

●  72.6% of applicants submitted at least one geographic preference and 43.7% submitted three preferences. 

● Applicants who signaled a program AND signaled that program’s geographic area were significantly more likely to receive an interview (OR 3.2; p <0.01) 

● They were also significantly more likely to match (OR 6.4; p <0.01) as compared to applications with neither a preference signal nor a geographic signal.⁸

In Anesthesiology and Pediatrics, the highest likelihood of interview invitations occurred when an applicant signaled a program AND their geographic preference aligned with the program’s location.⁹ 

for competitive specialties we usually recommend specifying geographic preferences

If you're planning to apply broadly, all programs will be able to see that you do not have a geographic preference. PDs are likely to interpret this as you're geographically open to all programs.

From a strategic standpoint, though, if you’re applying to a competitive specialty, we recommend targeting a smaller subset of programs. This recommendation is counterintuitive, so please pay close attention. On the face of it, wouldn’t it be better to let program directors know that you’re willing to go anywhere in the country? For highly competitive specialties, the answer is no.

• In Dermatology, the latest data indicate that students had a minimal chance of matching at a program that they did not signal. 

• In other words, your greatest chances are at the 28 programs which you’ve signaled. 

• Given the data, we recommend that you try to keep these 28 programs within 3 geographic regions, so that you can use both your preference signal and your geographic preference. 

• The same strategy would apply for highly competitive specialties with a large number of signals, such as Orthopedic Surgery and Otolaryngology.

For fields that are less competitive, such as Family Medicine and Emergency Medicine (5 signals each), your strategy may change. If you’re a competitive applicant, you’ll be competitive at much more than these 5 programs. Therefore, if you don’t feel the need to live in a particular region, it’s fine to opt out of geographic preferences. 

For programs with 15 signals, such as General Surgery or Internal Medicine, a lot of this depends on how competitive you are. If you’re not considered a highly competitive applicant for these fields, it may be a better strategy to target particular programs in a particular geographic region. 

Don’t overlook these important factors when planning out your geographic and setting preferences

We have a strong focus on helping you match successfully, so we’ve talked a lot about factors related to increasing your chances of a match. However, don’t overlook these important factors.

• Assess Lifestyle Factors: Consider factors such as cost of living, cultural amenities, and proximity to family and support networks.

• Explore Programs for Fit: Research the regions in your desired specialty that have residency programs that you are a good fit for. Consider factors such as professional interests (research, underserved populations, etc.), professional culture, board passing rates, and other factors. See this post for a more in-depth discussion of fit. 

• Balance Personal and Professional Priorities: You’ll need to strike a balance between your personal preferences and your career aspirations. Since residency is a minimum of 3 years, you'll need to live in this area for an extended amount of time. From weather to politics to cultural amenities to ease of commuting, there’s a lot to consider. 

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Conclusion

Mastering the Program Signaling and Geographic Preferences section of the ERAS application is critical for maximizing your chances of securing interviews at your preferred residency programs. By strategically signaling your preferences and selecting geographic locations aligned with your goals, you can increase your chances of a successful match. 

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Alyssa Harlow is Director of Marketing at MD2B Connect.

Dr. Rajani Katta is the creator of The Residency Interview 101, the online course that helps applicants quickly and confidently prepare for their residency interviews. She is also the co-author of The Successful Match: Rules to Succeed in the Residency Match and served as Professor of Dermatology at the Baylor College of Medicine for over 17 years.

Dr. Samir Desai is the author of The Successful Match: Rules to Succeed in the Residency Match and is co-founder of MD2B Connect, the most trusted and highest-rated provider of hands-on clinical experiences for IMGs in the U.S.

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References

1.Bardhi R, Musa A, Daveluy S, Potts G. Sophomore Signaling: The Second Year of the ERAS Supplemental Application for Dermatology Residency. J Clin Aesthetic Dermatol. 2023;16(4):26-27.

2. Association of Professors of Dermatology. Accessed September 17, 2024. https://www.dermatologyprofessors.org/programdirectors_resources.php

3. NRMP® Explores Impact of Program Signaling on Program Director Residency Selection Behaviors. NRMP. September 25, 2024. Accessed October 28, 2024. https://www.nrmp.org/about/news/2024/09/nrmp-explores-impact-of-program-signaling-on-program-director-residency-selection-behaviors/

4. Supplemental ERAS Application Data and Reports. AAMC. Accessed November 2, 2024. https://www.aamc.org/data-reports/students-residents/report/supplemental-eras-application-data-and-reports

5. Preliminary Program Signaling Data and Their Impact on Residency Selection. AAMC. Accessed October 28, 2024. https://www.aamc.org/services/eras-institutions/program-signaling-data

6. Catalanotti JS, Swails JL. Preference Signals in Residency Applications: a Potential Tool to Combat Application Inflation. J Gen Intern Med. 2024;39(3):357-358. doi:10.1007/s11606-023-08451-6

7. ERAS® Statistics. AAMC. Accessed September 17, 2024. https://www.aamc.org/data-reports/data/eras-statistics-data

8.  Benjamin WJ, Lenze NR, Bohm LA, et al. Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes. J Gen Intern Med. 2024;39(3):359-365. doi:10.1007/s11606-023-08342-w

9. 4 tips for residency applicants to wisely use program signals. American Medical Association. May 22, 2023. Accessed October 28, 2024. https://www.ama-assn.org/medical-students/preparing-residency/4-tips-residency-applicants-wisely-use-program-signals

Links & Additional Resources:

AAMC Program Signaling for the 2025 MyERAS® Application Season - https://students-residents.aamc.org/applying-residencies-eras/program-signaling-2025-myeras-application-season#programs

AAMC Biographical Information - https://students-residents.aamc.org/applying-residencies-eras/publication-chapters/biographical-information

Supplemental ERAS® 2022-2023Application Cycle: Results of the Program Director Reaction Survey - https://www.aamc.org/media/64996/download