Mixed Signals: Navigating the Obstetrics and Gynecology Signaling Initiative

Abstract

Objective: There are few published accounts of the obstetrics and gynecology (OBGYN) specialty-specific experience with a formal signaling program. Prior studies examining other medical specialties’ experiences with signaling are quantitative, having not examined the complexity of the residency applicant experience by directly engaging applicants; therefore, this study aimed to describe the lived experiences of OBGYN residency applicants who employed a formal signaling program during the 2022-2023 residency application cycle to assist and guide future residency applicants. Design: A phenomenological approach was chosen to explore and describe a common meaning for OBGYN residency applicants' experiences. Purposive sampling was employed to ensure racial, ethnic, and institutional geographic diversity in participant representation. Semi-structured interviews were conducted virtually between April and May 2023. Thematic analysis occurred iteratively with the use of inductive reasoning, ultimately defining themes that reflected the lived experiences of participants. The process of thematic analysis involved iterative examination of the data using inductive reasoning to identify themes and subthemes that accurately reflected the lived experiences of the participants. Results: Twenty-five OBGYN residency applicants participated. Fourteen identified as under-represented in medicine. Four themes emerged: non-uniform decision-making processes, inconsistent guidance, evolution of applicant emotions, and signaling reflections. Some themes had associated subthemes. Critical aspects of the applicants’ journey were revealed, including decision-making dynamics and reliance on trusted advisors. Applicants described tensions and complexities when navigating signaling strategy in relation to abortion education opportunities in a post-Dobbs era. They also conveyed concerns about inconsistencies in signaling guidance, the emotional toll on well-being, and persistent inequities in the application process. They ultimately made recommendations for future directions, including suggestions for more robust advising and improved signaling execution. Conclusions: This study offers a comprehensive exploration of the experiences of OBGYN residency applicants with formal program signaling. To ensure equity and transparency in the residency application process, it is crucial to not only provide OBGYN residency applicants with clear guidance on signaling but also encourage a standardized approach for its utilization by residency programs.