Background The residency application period involves high levels of uncertainty, stress, and significant financial burden for trainees. Recent national workgroup recommendations have encouraged the development of professional standards for communication with applicants. Here, the authors explored the common but under-reported phenomenon of students submitting applications to residency programs but never receiving a response, termed “application ghosting.”

Methods A cross-sectional survey with multiple-choice and open-ended questions was shared with recent medical graduates across a national medical student listserv from March-May 2023. Ghosting was defined as the proportion of applications submitted by students that never received a response. Personal and academic factors, as well as preference signaling, were then examined for their potential contributions to ghosting. Thematic analysis was also conducted on open-ended responses to explore the emotional impact and other qualitative outcomes of application ghosting.

Results 6,006 applications to 21 specialties were submitted by 115 applicants. Applicants submitted an average of 52.2±34.8 applications. Amongst all applications, 2,900 (48.3%) were ghosted. Individuals who identified as men (p=0.004), from disadvantaged backgrounds (p=0.011), from lower class quartiles (p=0.015), or applying to the most competitive specialties (p<0.001) experienced higher ghosting rates. Preference signaling and geographical ties to the program’s region reduced ghosting. Open-ended responses highlighted feelings of uncertainty, false hope, professionalism double standards, and hidden expectations associated with application ghosting.

Conclusion Application ghosting has a negative impact on trainees and contributes to uncertainty within the residency selection process. To mitigate these undesired effects, residency programs should adopt standardized communication practices.