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This was a big question when I was applying to residencies so I will put it out on the forum to let some of the APDs/PDs respond. The idea was that if an applicant let a program know they were ranking them #1, it may sway the program to rank them to match (if they were close but on the fence) so as to guarantee that program had a good "yield" (how far a program had to go down its rank list to fill its class). But, this was all hearsay so perhaps we can have more clarity on this. Alternatively, this could also just let a program know you believed strongly you would be a good fit there and wanted to be there, which programs presumably would want from their incoming matched residents.