Inaugural year of preference signaling in im subspecialty fellowships
Multi-institutional survey about program director perceptions, benefits, and challenges
Bibliographic Data
| ID | 21650338 |
|---|---|
| Authors | Radhika Narla (0000-0001-6184-7975, Division of Endocrinology, Metabolism, and Nutrition, Veterans Affairs Puget Sound Health Care System, corresponding author), Robin Stiller (Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health and Science University), Laura A Huppert (0000-0002-8512-5608, University of California System) |
| Year | 2026 |
| Volume | 31 |
| Issue | 1 |
| Pages | 2688662-2688662 |
| Publication date | 2026-12-31 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Medical Education Online (JOURNAL) |
| Journal identifiers | ISSN: 1087-2981 • E-ISSN: 1087-2981 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/10872981.2026.2688662 |
| PMID | 42294568 |
| OpenAlex | W7164849429 |
| Language | EN |
| References cited | 12 |
BACKGROUND: Preference signalling was introduced into internal medicine subspecialty fellowship recruitment in the 2025-2026 cycle, adding a new consideration for applicants, mentors, and fellowship programs. We sought to characterize program director (PD) perceptions of signalling during this inaugural cycle and identify implications for advising. METHODS: We conducted a cross-sectional anonymous survey of PDs in five internal medicine subspecialties at three West Coast academic institutions (University of Washington, Oregon Health & Science University, and University of California, San Francisco) from December 2025 to January 2026. Quantitative responses were summarized descriptively, and free-text responses were analyzed using inductive content analysis. RESULTS: Eleven of 15 PDs responded (73%). Ten of 11 respondents (91%) agreed that signalling helped identify applicants with genuine interest, and 10 of 11 (91%) agreed that it streamlined interview selection. However, signalling was not perceived to reduce overall review burden. Common challenges included interpreting a 'no signal' (7/11, 64%), uncertainty about how much weight to assign signals (5/11, 45%), ambiguity regarding whether home-institution applicants should signal, and inconsistent interpretation of tiered signals across programs. PDs emphasized the importance of transparency and consistency in signalling practices. CONCLUSIONS: In this early multi-institutional experience, preference signalling was valued as a practical screen-in tool, but its interpretation remained variable across programs. For educators, the main challenge is not deciding whether signalling matters but helping applicants navigate how it is used in different subspecialty contexts. More consistent communication about non-signals, home-institution expectations, and tiered signals may improve advising, transparency, and trust in the fellowship recruitment process
Ambiguity · Internal consistency · Preference · Program director · Signalling · Subspecialty · Diversity and Career in Medicine · Hospital Admissions and Outcomes · Medical Education and Admissions
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The Otolaryngology Residency Program Preference Signaling Experience
Impact of Applicants’ Characteristics and Geographic Connections to Residency Programs on Preference Signaling Outcomes in the Match
Internal Medicine Residency Program Directors’ Screening Practices and Perceptions About Recruitment Challenges
Three Approaches to Qualitative Content Analysis
| Highly cited | No |
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