As the largest primary care specialty in the U.S., Family Medicine faces workforce challenges to meet the growing needs of the American population.
Associate Professor Lauren Oshman, MD, MPH, FAAFP, of the Department of Family Medicine at the University of Michigan, collaborated with researchers from Rush University Medical Center, University of Chicago, Northwestern University Feinberg School of Medicine, and the Medical College of Wisconsin to examine the perspectives of residency program directors on signals and preferences in the residency application process in screening applicants for Family Medicine residencies.
The team also identified opportunities for applicants, advisors, programs, and policymakers to optimize the use of signals and preferences.
The paper is titled, “Signals and Preferences: Experiences of Midwest Family Medicine Residencies” and was published in the journal Family Medicine.
The Association of American Medical Colleges implemented the signaling and preferences system in 2022-2023 in response to significant increases in application volume and burden on residency program coordinators. Family Medicine residency programs began using them in 2023-2024.
Signals and preferences are now built into the application process and allow applicants to “signal” the residency programs where they most hope to receive an interview. Geographic preferences allow them to specify which geographic areas they prefer for their residency.
Oshman and her co-authors conducted a qualitative study, interviewing 21 faculty members from Midwest universities. They found that half of the respondents agreed that program signals (48%) and geographic and setting preferences (52%) added value to the application process.
On average, respondents allocated 26% of interview spots to candidates who sent a preference signal, with a range from 5% to 60%. About half of respondents somewhat or strongly agreed that program signals (10, 48%) and geographic and setting preferences (11, 52%) add value to the current system. However, few strongly or somewhat agreed that program signals (3, 14%) and geographic and setting preferences (1, 5%) will have a positive impact on equity, diversity, and inclusion.
Four main themes emerged from the study:
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Strategic Adoption: Faculty members strategically integrated signals and preferences into their existing application review processes to complement them.
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Reduction in Application Volume: Signals were perceived as effective in reducing the volume of applications and the associated burden on program administrators.
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Impact on Diversity and Equity: While signals did not significantly impact diversity and equity, geographic preferences were seen as potentially beneficial for community health.
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Recommendations for Optimization: The team recommended modifications to the use of signals and preferences to enhance their effectiveness in family medicine. For example, respondents requested a free-text box for applicants to explain why they were signaling a program and for consideration of interventions to determine who among applicants was interested in practicing Family Medicine.
Results suggest that signals and preferences are promising interventions to help residency coordinators select suitable residency candidates. However, more needs to be understood about their implementation and impact, considering that interviewees noted that signals and preferences did not enable them to discern whether applicants truly preferred Family Medicine.
“To strengthen the primary care physician workforce, our results support further investigation into the impact of multispecialty signaling and model possible changes such as a total cap on signals regardless of specialty or limiting signals to a single specialty,” the authors wrote. They also suggested the use of AI tools and interview management technology, which may help residency directors find applicants that best match their program mission.
The research team is part of the Family Medicine Midwest Scholarly Activity Collaborative, a network of family medicine residency faculty from residency program across the Midwest United States (https://www.fmmidwest.org/collaboratives). The mission of the collaborative is to create a network to improve residency scholarship through multi-site collaboration that improves health outcomes and health equity.
Article Citation: Harriett, L., Anderson, L., Wheat, S. J. G., Prunuske, J., & Oshman, L. (2025). Signals and preferences: Experiences of midwest family medicine residencies. Family Medicine, 57(2), 123–131. https://doi.org/10.22454/fammed.2025.447031
