Sophomore Signaling: The Second Year of the ERAS Supplemental Application for Dermatology Residency

J Clin Aesthet Dermatol. 2023;16(4):26–27.

by Redina Bardhi, MD; Arif Musa, MD, MS; Steven Daveluy, MD; and Geoffrey Potts, MD

Drs. Bardhi and Musa are with a Transitional Year Residency Program at ProMedica Monroe Regional Hospital in Monroe, Michigan. Drs. Daveluy and Potts are with the Department of Dermatology at Wayne State University in Dearborn, Michigan.

FUNDING: No funding was provided for this article

DISCLOSURES: The authors report no conflicts on interest relevant to the content of this article.

ABSTRACT: The sophomore year of the supplemental application remains largely unchanged for applicants to dermatology residency. Both program preferences and geographic preferences, although optional, may strongly benefit applicants based on the evidence following the first application cycle. They may greatly improve the residency application process with continued refinements.

First implemented in the 2020–2021 cycle by the Otolaryngology specialty solely for applicants to otolaryngology residency programs, preference signaling was incorporated with hopes to empower applicants to “stand out from the crowd” and make their sincere interests known to up to five residency programs prior to submitting their application.1,2 Following a trend of increasing numbers of applications received by each residency program, applicants expressed frustration at being unable to make their preferences known to their most desired programs while residency programs across the country were being overwhelmed with the sheer volume of applicants. In 2021, applicants to otolaryngology residency programs received significantly more interviews from programs they signaled (58%) compared to those they did not (14%), an impact that was noted to be consistent among both highly competitive and less competitive applicants.1 After the conclusion of the application cycle, 91 percent of program directors and 77 percent of applicants expressed strong support for preference signaling.1 

Concurrently, the Association of American Medical Colleges (AAMC) piloted an optional supplemental application in conjunction with the standard Electronic Residency Application Service (ERAS) application in hopes of improving transparency, promoting holistic review, and empowering applicants. Three specialties—dermatology, general surgery, and internal medicine—participated in the supplemental application during the 2021–2022 application cycle.3 It included a past experiences section that allowed applicants to highlight five meaningful experiences, a geographic section that allowed applicants to select three geographic preferences, and a preference signaling section where applicants could indicate three preference signals. The past experiences section also included an additional “Other Impactful Life Experiences” question, providing applicants the opportunity to discuss a challenging life event. Applicants face difficulties in conveying their genuine interest, which may include spending considerable time and money to write letters, send email correspondence, seek mentorship and research opportunities, and participate in sub-internships.4 Conversely, dermatology residency programs often faced considerable difficulty in evaluating large numbers of competitive applications and parsing out genuine interest from applicants. 

The 2022–2023 application cycle marks the second academic year in which the majority of accredited dermatology residency training programs will participate in the supplemental application. In 2021, dermatology applicants had limited information on how the supplemental application would impact them. Preference signaling had yet only been implemented successfully by one specialty. Unlike the five signals available to otolaryngology applicants, dermatology applicants were offered three preference signals. Dermatology applicants were not recommended to signal “home” programs or programs at which they had completed rotations,3 suggesting that an away rotation holds value equal to or greater than a signal. 

From March to May 2021, a survey of 66 dermatology program directors and 194 applicants found that 81.8 percent and 75.3 percent, respectively, were in favor of preference signaling.5 Following the conclusion of the 2021–2022 application cycle, an AAMC survey was submitted to program directors and applicants to dermatology, general surgery, and internal medicine residencies, to which 93 percent of dermatology applicants (950/1,019) and 44 percent of dermatology program directors (52/117) responded.6 Key findings are summarized below:

  • 70 percent of dermatology program directors indicated that the “Other Impactful Life Experiences” section was useful in contextualizing applicants
  • 90 percent of dermatology program directors used geographic preferences within their holistic review and/or as a tiebreaker when deciding to extend an interview offer
  • 64 percent of dermatology program directors indicated that geographic preferences were useful to identify applicants who would otherwise be overlooked
  • One-quarter of dermatology programs received approximately half of all signals
  • About 1/3 of dermatology mentors or advisors felt comfortable when advising applicants about preference signaling and geographic preferences
  • 80 percent of all program directors used the “Past Experiences” section when deciding to extend an interview offer
  • 75 percent of all program directors indicated that preference signals were useful to identify applicants who would otherwise be overlooked
  • All program directors strongly incorporated preference signaling to extend interview offers (95–96%) and as a tiebreaker between competing applicants for extending an interview (84–94%)

These findings demonstrate possible benefits to applicants to indicate both program preferences and geographic preferences, given that the majority of dermatology program directors used these responses when deciding whom to interview or as a “tiebreaker” for interview offers. According to program directors, signaling preferences helped with the identification of applicants who would have otherwise gone unnoticed.2 The “Meaningful Activities” section allows applicants to highlight their most meaningful experiences, especially during a time where applications are growing longer and longer. Although program directors found this section helpful, there were concerns regarding redundancy.6 The relative value of preference signaling and supplemental application responses compared to rotations, research participation, and other means of expressing interest to dermatology residencies still remains unknown. The data showing conversion of signals to interviews has not been made publicly available. 

 The supplemental application is the first step in improving the residency application process. However, there are still areas that require improvement. Currently, there is no outcome data related to likelihood of matching based on program signals. Also, certain programs may interpret the lack of signal as a lack of applicant interest (and the same for geographic preference). A small subset of dermatology residencies received the majority of preferences, although we do not know the number of positions in each program, so it may be that larger programs are receiving more signals.2 In addition, applicants may have submitted applications to certain “top-tier” programs rather than those that would be “best fit,” or other individual factors.2,4,6 The survey conducted by the AAMC to gather feedback from applicants and program directors regarding supplemental application outlined specific areas they will focus efforts for improvement, which include minimizing redundancy, providing additional guidance to applicants seeking to fill out the “Other Impactful Life Experiences” essay, and omitting the “do not wish to indicate” response option for the geographic preference section.3,6 In addition, they also mentioned potentially recommending applicants to signal programs where an away rotation was completed.3,6 One alternative to preference signaling that may invite further exploration is application caps for dermatology applicants.7 

The sophomore year of the supplemental application remains largely unchanged for applicants to dermatology residency. However, the percentage of dermatology programs participating has increased from 87 percent (117/135) to 91 percent (123/135) and dermatologist mentors have one year’s worth of experiences to draw upon when advising future applicants.6,8 Most found the resources made available by the AAMC to be useful in this regard.6 Applicants who participated in the (optional) supplemental application and submitted a signal to a program had a higher probability of receiving an interview.3 With continued refinements, preference signaling and the supplemental application could help bring more meaning to the application process and reduce the burdens to both applicants and program faculty. 


  1. Pletcher SD, Chang CWD, Thorne MC, et al. The otolaryngology residency program preference signaling experience. Acad Med. 2022;97(5):664–668. 
  2. Dirr MA, Brownstone N, Rigel D. Preference signaling in dermatology residency match. SKIN The Journal of Cutaneous Medicine. 2022; 6(4): 343–344.
  3. Association of American Medical College. Supplemental ERAS® Application Guide. Published July 2022. Accessed August 2022.
  4. Gangal A, Blalock TW. A perfect match: pros and cons of preference signaling in dermatology. J Am Acad Dermatolog. 2021;84(5):1504–1505.
  5. Brumfiel CM, Jefferson IS, Rinderknecht F-A, et al. Current perspectives of and potential reforms to the dermatology residency application process: a nationwide survey of program directors and applicants. Clin Dermatol. 2022;40(5):595–601.
  6. Association of American Medical Colleges. AAMC Supplemental ERAS® Application: Key Findings From the 2022 Application Cycle. Published February 2022. Accessed May 2022.
  7. Secrest AM, Coman GC, Swink JM, et al. Limiting Residency Applications to Dermatology Benefits Nearly Everyone. J Clin Aesthet Dermatol. 2021;14(7):30–32.
  8. Association of American Medical Colleges. Programs participating in the supplemental ERAS® application. Published July 2022. Accessed August 2022.