Strategic Application in the Era of ERAS Signals: Optimizing Interview Opportunities in Radiology Residency Programs

Rationale and Objectives: The radiology residency application process is highly competitive, requiring applicants to make strategic decisions to maximize interview opportunities. This study addresses the need for actionable, data-driven insights by providing the first analysis of actual interview rates stratified by signal type and geographic factors. Our objectives are to evaluate the effectiveness of optimized signaling strategies, to determine the influence of in-state residency status on interview likelihood, and importantly, to highlight the substantial variability in how residency programs interpret and utilize these signals, offering evidence-based guidance to improve applicant decision-making in a complex landscape. Materials and Methods: Data from the 2024 match cycle, sourced from the AAMC's Residency Explorer Tool, were analyzed. Descriptive statistics were calculated for program-specific interview rates, stratified by signal type and applicant characteristics. An iterative algorithm identified the optimal signaling strategy (maximizing interview rates) by allocating six Gold and six Silver signals. A simulation model (10,000 iterations) compared optimal signaling to random signal allocation. Geographic bias was evaluated by calculating the mean difference in interview probability between in-state and out-of-state applicants for each state. Results: Programs interviewed 54%, 40%, and 6% of students who sent Gold, Silver, or no signals, respectively. Optimal signaling yielded an average of 9.87 interviews from 12 signals, compared to 4.71 with random signaling. The average applicant applying to 66 programs can expect an additional 3.24 interviews from non-signaled programs, for a total of 13.11 and 7.95 interviews with optimal and random signaling, respectively. While an in-state advantage appears to exist in some states, the interpretation and utilization of preference signals varies significantly among programs. Conclusion: Strategic use of ERAS signals and consideration of the existing in-state advantage can significantly improve interview opportunities in diagnostic radiology residency applications. These findings provide applicants with evidence-based guidance for navigating the signaling landscape, enabling them to make informed decisions and maximize their chances of securing interviews.