The Effect of Signaling on Changes in Applicant and Program Behavior in the Diagnostic Radiology Application Process.

Abstract

To evaluate the association between preference signaling and residency application behaviors in diagnostic radiology across presignal and postsignal eras and to compare outcomes between 6-signal and 12-signal cycles. We analyzed self-reported data from matched diagnostic radiology residency applicants in the Texas Seeking Transparency in Application to Residency (STAR) database from the 2019 to 2025 application cycles. Primary outcomes included the number of applications submitted, interview offers received, and interviews attended. Comparisons were made between the presignal (2019-2022) and postsignal (2023-2025) eras, as well as between the 6-signal (2023) and 12-signal (2024-2025) cycles. Two-sample t tests were used for group comparisons. A total of 1,371 matched diagnostic radiology applicants met inclusion criteria. Applicants in the postsignal era submitted significantly more applications than those in the presignal era (56.0 versus 45.6, P < .001). They also received fewer interview offers (13.7 versus 17.3, P < .001) and attended slightly fewer interviews (14.1 versus 15.1, P = .0014). When comparing signaling structures, applications submitted did not differ significantly between the 6-signal and 12-signal cycles (57.3 versus 55.1, P = .462), nor did interview offers (13.2 versus 14.0, P = .127) or interviews attended (13.7 versus 14.3, P = .194). Outcomes were stable between the two 12-signal years (2024 and 2025), with no statistically significant year-to-year differences. Preference signaling was associated with significant differences between the presignal and postsignal eras, but increasing the number of signals from 6 to 12 did not meaningfully change outcomes. Application and interview patterns remained stable across two consecutive 12-signal cycles. Further work is needed to understand how signals influence application review processes and to guide ongoing implementation.