Changes to the 2023-2024 ERAS Application:
Program Signaling, Geographic Preferences, and Experiences Section for ANESTHESIOLOGY Residency Applications

Guidance provided by the Association of Anesthesiology Core Program Directors Council

Purpose: Changes to the ERAS application in the 2024 season include modifications to the experiences section, geographic preferencing, and program signaling. These alterations are meant to showcase applicant characteristics and to give the applicant a reliable and equitable approach to demonstrate true preferences in location as well as sincere interest in specific programs. Residency programs may choose to consider geographic preferences and signals as they select applicants to interview.

Background: Over the past decade the average number of applications to Anesthesiology residency programs has climbed to over 65 applications per applicant. This has not improved match rates and resulted in application congestion. This increase in application numbers may result in programs filtering applications using metrics (such as USMLE Step Scores, clerkship grades, and reputation of medical schools) that may not identify the best residents for their program. Many applicants, faculty, and deans directly contact program directors to emphasize applicant’s interest. This creates inequity in the process because applicants with personal advocates or mutual contacts may have an unfair advantage over an applicant reaching out independently, who may go unnoticed. A more transparent, equitable and reliable system for communicating applicant preferences to residency programs is critical.

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PROGRAM SIGNALING FOR ANESTHESIOLOGY IN 2023-2024:

The decision to participate in program signaling within ERAS is voluntary. Both applicants and programs must opt in to participate in signaling.

  • Applicants who participate in the signaling for Anesthesiology will assign up to:
    • five (5) gold signals indicating HIGHEST interest in a program
    • ten (10) silver signals indicating VERY HIGH interest in a program

Programs will be able to view signaling (if present) on each applicant’s ERAS profile. Signals are not further presented in any particular order. In other words, there is not a “gold number 1, gold number 2, etc.).

Applicant Information/Guidelines

  1. Data from the 2022-2023 season:
  2. The signaling process is voluntary. While many believe that signaling is beneficial to both applicants and programs, applicant and program participation is entirely voluntary. Applicants indicate participation in the signaling process at the time of submitting their ERAS application. There are no anticipated downsides to participating in signaling as programs will not know if an applicant did not signal them or just opted out of signaling. There are, however, likely negative consequences to not participating as programs are likely to give significant preference for interviews to applicants who signal their program. The AACPD Council strongly recommends applicants participate in signaling and use all signals available to them in the 2023-24 application season.

  3. Applicants should signal all programs that they have both a strong interest in and where they have a reasonable ability to receive an interview INCLUDING their home programs if they are interested in them. Applicants are strongly encouraged to consider their personal values and goals, consult faculty advisors, as well as utilize resources to explore residency programs such as individual program websites, AMA FREIDA, AAMC Residency Explorer, and any other resources they would typically use. The applicant’s goal should be to find the programs that best align with their goals and where they are most likely to be competitive. It is highly discouraged to send signals to programs at which the applicant is unlikely to be competitive as this may result in the waste of a signal that would have been better used at another program.

  4. Given the increased number of signals available for anesthesiology applicants in the 2023-2024 season, applicants SHOULD signal home programs and programs where they completed a sub-internship if those programs are among their preferred programs. Applicants should plan to use all their signals. There is no known advantage to not using all their available signals.

  5. Programs will be able to see in ERAS if an applicant signals them. Programs will not know which other programs an applicant may have signaled.

Program Guidelines

  1. Data from the Anesthesiology 2022-2023 season:
    • Mean number of signals received per program = 104.55 ranging from 14 to 278
    • Average % of signals received relative to applications = 7% (range 2-19%)

      Signals were not distributed evenly across programs. In Anesthesiology, 10% of programs received 21% of the available signals.

  2. Changes in signaling were done with the following information in mind:
    • Total number of signals increased to 15 to give students the ability to identify more programs they are genuinely interested in and to minimize the amount of post application communication/emails directed at programs regarding interest.
      • 15 signals represent 23% of the average # of programs applied to per student in Anesthesiology. Programs should be aware that there will be students who do not signal a program but who are still interested in the program.
    • “Gold” and “silver” signaling were added to allow tiers of interest. Programs received a wide range of signals, and they were not distributed evenly between programs.  Addition of tiered signals allows for programs to receive more signals but also to utilize the tiers to distinguish level of interest.

  3. Signals are not intended to be used as a screening tool but as a “plus factor” to indicate genuine interest. Programs should perform a holistic review of the entire application and make decisions based upon the merit of the application. The signal is one of many data points to be utilized when deciding to whom interviews will be offered.

  4. Signals should ONLY be utilized when deciding whom to invite to interview and NOT as a part of the ranking process. Applicant interests can change after they submit signals in September due to many factors, including applicants’ experiences on interview day.

  5. The signaling program (process) is a voluntary process. While many believe that widespread participation in this process is beneficial for both applicants and programs, programs must OPT IN to signaling by indicating their participation at the time of ERAS enrollment. Applicants will then see that program appear on the list of programs they may signal.

  6. Programs MUST NOT:
    • Require a signal to review and offer interviews to applicants.
    • Disclose the names, AAMC registration number or any identifiable information of applicants who have signaled their program to any individual outside their residency selection committee.
    • Ask interviewees to disclose the names or number of programs they signaled. This would be a violation of the NRMP match agreement which prohibits programs from asking applicants where they have applied for residency.
    • Disclose the number of signals they received.

Mentoring and Career Advising Guidelines

  1. Applicants MUST OPT IN to participate in the signaling process. This is a voluntary choice made by the applicant.

  2. Advice to applicants regarding whom to signal should be based upon individual review of the applicant’s overall application package, including alignment with the program’s requirements and values. Resources such as individual program websites, AMA FREIDA, and AAMC Residency Explorer are some tools that exist to advise students on their alignment with programs.

  3. Applicants SHOULD only signal programs where they desire to interview and where they believe they have a reasonable chance of receiving an interview offer.

  4. Applicants SHOULD signal home programs and programs where they have participated in a sub-internship if they are interested in interviewing at those programs.

  5. Mentors should provide honest advice based upon a holistic review of the applicant’s entire application package. Advising a student to signal programs where they are unlikely to get an interview may harm the student’s chances of matching in the specialty.

  6. Applicants ultimately must make the final decision on which programs to signal.

EXPERIENCES SECTION IN ERAS 2023-2024:

Analysis of the ERAS application including program/applicant surveys and data points from years past pointed to the need to abbreviate the application and shorten the time spent preparing it while decreasing the pressure on applicants to list as many experiences as possible. The new application in 2023-2024 will incorporate several elements of the Supplemental Application piloted during the two previous years. The Supplemental Application will cease to exist.

The 2023-2024 ERAS application will streamline the “Experiences” section by limiting the number of experiences each applicant can submit to 10. All 10 experiences will allow for more detailed and organized descriptions including experience type, primary focus area, and key characteristics. Each entry will allow for a 750-character limit description of context, roles, and responsibilities. Applicants will be able to select their top 3 meaningful experiences and describe them in free text with a 300-character limit. The intent of this section is to allow programs to identify those applicants whose experiences align with the program’s mission.

The ability to describe an impactful experience (as was present in the supplemental application in previous years) will be available but will not necessarily apply to all applicants (description in the worksheet). It is meant to allow those applicants who want to share information regarding their background, hardships overcome, or life experiences not otherwise available to programs in the application materials.

A reference to what the applicant worksheet looks like can be found here: https://students-residents.aamc.org/media/14031/download?attachment.

Categories to help define an applicant’s experience include:

Experience Type:

  • Work
  • Research
  • Volunteer/service/advocacy
  • Education/training
  • Military service
  • Other extracurricular activity
  • Professional Organization
  • Teaching/mentoring

Primary Focus Area:

  • Basic science
  • Clinical/translational science
  • Community involvement/outreach
  • Customer service
  • Healthcare administration
  • Improving access to healthcare
  • Medical education
  • Music/athletics/art
  • Promoting wellness

Key Characteristics:

  • Communication
  • Critical thinking and problem solving
  • Cultural humility and awareness
  • Empathy and compassion
  • Ingenuity and innovation
  • Reliability and dependability
  • Resilience and adaptability
  • Self-reflection and improvement
  • Teamwork and leadership

GEOGRAPHIC PREFERENCES IN ERAS 2023-2024:

In the 2023-2024 application cycle, there will be standardized fields for all location information across the application (country, state, city, postal code, and setting [rural or urban only]), including hometown and addresses for experiences and education. Geographic preferences for training will become a part of the main ERAS application, but entries will remain optional for applicants. The division preferences section offers an applicant the ability to communicate your preference or lack of preference for a particular region.

The following 3 options will be available:

  1. The applicant will be able to select up to 3 of the 9 US Census Bureau Regions as geographic regions where they would prefer to train.
    • Each entry will allow for a brief description of the applicant’s preference or lack of preference.
    • Only programs within each selected region will see the listed preference (and the descriptive essay) and will not see any other geographic selections.
    • If the program is not in one of the selected regions, their application screen will display no geographic preference information just like if no divisions were selected.
  2. An applicant can choose the drop down “I do not have a division preference”
    • All programs will be able to see this response in ERAS along with the descriptive essay, if included.
  3. An applicant can choose to not respond to the geographic preference prompt (leave field blank)
    • If an applicant skips this section then no information is provided to any program

In the 2022-2023 application cycle, most applicants’ selection of the Geographic Preference reflected their true preference at the time of the application submission https://www.aamc.org/media/64611/download. Those who chose “no preference” did so either because geography was unimportant to them, or because they believed their application would be overlooked if no division preference was visible to the program. 

General FAQs

1. What is the benefit to an applicant to signal a residency program?
Signaling allows an applicant to demonstrate a genuine interest in a residency program. High numbers of applications mean many applicants do not undergo holistic review. A signal is an equitable approach to indicate interest in a program and increase an applicant’s visibility to a program, encouraging holistic review of their application. The signals allow applicants to stand out to programs.

2. Has signaling been useful in other fields?
Signaling has been utilized in multiple other specialties. Otolaryngology conducted a pilot study of signaling in the 2020 Match cycle. They demonstrated that applicants who signaled a program were more likely to get an interview at that program.

3. Is it mandatory to use all my signals? Can I signal a program more than once?
It is not mandatory for an applicant to use all their signals. However, we recommend applicants use all their signals as there are no recognized disadvantages in doing so. Applicants SHOULD NOT signal a program more than once as the program only sees one signal regardless of the number of signals selected. Also, applicants should not be submitting a gold and a silver signal to the same program as there is no advantage in doing so.

4. Is signaling in conflict with the NRMP Match Agreement?
No. As long as all NRMP Match rules are followed, there is no violation of the Match agreement. In fact, section 6.2 of the Match Participation Agreement for Applicants and Programs allows applicants and programs to express interest in each other. They may NOT solicit verbal or written statements indicating commitment. Programs cannot ask applicants to reveal the names, specialties, or other identifying information about programs to which they have applied or interviewed. The signaling process expressly forbids programs from asking or receiving any information about applicants’ signals. The signaling process, however, provides an equitable way to indicate interest in a program. Currently, many back channels, such as emails, phone calls, and other personal communications are completed by faculty, deans, and applicants to indicate interest in programs. While this is not a Match violation, many applicants do not have access to these extra channels. The signaling process provides the same opportunity for all applicants who voluntarily choose to participate.

5. If a program doesn’t receive a signal, does that mean an applicant won’t get an interview?
Each program can choose which applicants to interview and some may not rely much on preference signaling to determine interview offers. It is clear from the Otolaryngology signaling pilot and data from the 2023 application cycle that applicants who signaled a program were more likely to receive an interview offer. The application itself indicates interest in a residency program, and programs may offer interviews to applicants who have not signaled them. Signaling offers a transparent and reliable method of communicating very high program interest, but programs will use other factors in addition to signals to inform decisions around interview offers.

Applicant FAQs

1. Do I have to participate in the signaling process?
No. The signaling process is a voluntary program. Signaling is meant to provide an equitable opportunity for applicants to indicate high interest to a program, and for programs to identify and holistically review applicants. This is an OPT IN program. Programs will not know if an applicant has not signaled them or has opted to not participate in signaling. 95% of applicants applying to Anesthesiology in the 2023 cycle participated in program signaling.

2. Will there be additional costs to participate in program signaling?
No. There are no additional costs to participate.

3. How many signals will I receive?
Each participating applicant will receive five (5) gold signals and ten (10) silver signals. The gold signals are a means of indicating the highest level of interest in the program and the silver signals indicate a very high level of interest.

4. Can I only apply to programs that I have signaled?
No. Applicants can apply to as many programs as they desire. It is recommended to consult with an advisor in Anesthesiology to determine the right number of programs to which to apply based upon your individual application package.

5. How do I decide which programs to signal?
Similar to deciding to which programs to apply, each applicant will need to reflect on their application and their alignment with programs. It is recommended that you consult with an Anesthesiology advisor in reviewing your ENTIRE application, your goals in training, and other factors that may influence where you want to train (community vs. university based, geography, etc.). Several tools such as program websites, AMA FREIDA, and AAMC Residency Explorer can aid both applicants and advisors in choosing which programs are best choices for application and signaling.

6. Don’t signals only benefit programs?
While preference signals will help programs know which applicants are highly interested in their programs, data from the application cycles in 2022 and 2023 shows that signals improve the chances of applicants who have a true interest in a program to be seen by that program regardless of their perceived “competitiveness” or personal connections. Currently, the average number of applications per program is >1400 without an ability to determine genuine applicant interest. Because of this, applicants who do have a genuine interest may be overlooked in the myriad of applications. Signals will likely allow those applicants with a genuine interest to be considered by those programs.

7. Should I place all my gold signals on “reach” programs?
While it is the applicant’s choice to place signals as they choose, signals should be placed on the programs that you are most interested in receiving an interview from AND where you have a reasonable chance of getting an interview.

8. Should I use my signals on my home program or programs where I have completed a sub-internship?
Yes, if those are programs where you are interested in interviewing.

9. How will I know that a program received my signal?
The programs will be receiving your signals at the time they review your applications since the signals are submitted with your application.

10. Am I guaranteed an interview at programs I have signaled?
No. The signal is a tool for you to indicate interest in the program and your desire to interview. Programs will utilize their application review process and decide upon whom they wish to interview.

11. Can I still receive an interview offer at programs I have not signaled?
Yes, as signals are only one factor in the application review process. Each program can choose which applicants to interview and may not rely on preference signaling to determine interview offers. It is clear from the Otolaryngology signaling pilot and Anesthesiology 2022-2023 ERAS supplemental application signaling data that applicants who signaled a program were more likely to receive an interview offer. The application itself indicates interest in a residency program, and programs may offer interviews to applicants who have not signaled them. Signaling offers a transparent and reliable method of communicating very high program interest, but programs will use other factors to inform decisions around interview offers.

12. Is sending a program signal equivalent to a geographic preference?
No. The preliminary data from the Anesthesiology 2022-2023 ERAS supplemental application signaling process shows that the strongest predictor of receiving an interview was in the cohort of applicants who sent a program signal that aligned with geographic preferences. Those who sent a program signal that did not have geographic preferences or did not align their geographic preferences still had a higher chance of receiving an interview than applicants who did not send a program signal. Amongst applicants who did not send a program signal, those whose geographic preferences aligned were more likely to receive an interview over those who had no geographic preference or who did not have aligned preferences.

13. Will my signals be made public? Will other programs know where I signaled?
No. Applicant signals are confidential. Programs will see a signal only in the ERAS database of applications sent to them. Programs have no way of knowing which other programs you have signaled. 

14. How will I know which programs are participating in signaling?
The signaling process is a voluntary process and programs must OPT IN to participate. Applicants will see a list of the programs participating in signaling at the time of submission of their ERAS application.

Residency Program FAQs

1. Do I have to participate in the ANESTHESIOLOGY signaling process?
No. While preference signaling may help programs identify interested applicants in order to direct resources for holistic application review towards those most interested in their program, this is an OPT IN process. Programs have to indicate their desire for participation at the time of confirmation of ERAS participation. There are no anticipated downsides to receiving this information in a more transparent, reliable, and equitable way that minimizes the effort of reading and interpreting emails and calls from applicants and their advisors reaching out to convey interest.

2. Will programs be charged an additional fee to participate in program signaling?
No. While this is an OPT IN process both for programs and applicants, there are no additional fees associated with participation.

3. How/When will programs receive signals?
Programs will be able to view signals directed at them individually as a part of the ERAS application system when it opens to programs.

4. How should programs use the signal data?
Programs will receive both gold and silver signals. Gold indicates an applicant expressing highest interest, and silver indicates very high interest. Programs will need to individually decide how signals are ultimately used. While programs should consider all applications received regardless of an associated signal, signals may be used to assess genuine interest and may identify candidates that programs may not have recognized as a potential recruit. Applicants are limited to a total of 15 signals, so programs should recognize that many highly qualified and potentially interested applicants will be in the non-signaling group.

5. Does a program have to offer interviews to all applicants who have signaled them?
No. Signals are one of many tools for programs to use to assess alignment with their program when conducting their application review and consideration for interview offers.

6. What if a program does not get enough signals from applicants to fill its interview spots?
Programs can interview any applicants for their program regardless of whether they have shown additional interest using a signal. The application itself communicates interest in the residency program. As applicants are limited in total number of signals, programs should review and expect to offer interviews to applicants who have not signaled their programs. They should consider conducting their application reviews as they have always done in previous years and use the signals as an additional indicator for higher interest from an applicant.