The Ultimate IMG Residency Guide: Common Interview Questions for Prelim IM

Understanding the Preliminary Medicine Interview for IMGs

For an international medical graduate (IMG), the interview is often the most decisive step in obtaining a preliminary medicine (prelim IM) position. Your application got you into the room; your performance in answering common residency interview questions will determine whether you match.

Preliminary internal medicine programs are unique: they are one-year positions, often used by IMGs going into specialties such as neurology, anesthesiology, radiology, PM&R, or dermatology. Program directors know you may not stay in internal medicine long-term, so they focus heavily on:

• Whether you can function safely and efficiently as an intern
• How well you will fit into their team and culture
• Your professionalism, communication, and reliability
• Your long-term goals and how this year fits into them

This IMG residency guide will walk you through the most common interview questions for preliminary medicine, model structures for strong answers, and specific tips for IMGs.

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Core “Story” Questions: Who You Are and Why You’re Here

These are usually the first residency interview questions you’ll face. They set the tone and often drive the interviewer’s impression of you.

1. “Tell me about yourself.”

This is always asked in some form. It is not your life story; it is a concise professional narrative.

Goal of the question:
To assess your communication skills, clarity of goals, and how you organize information. For IMGs, it also helps the interviewer quickly understand your training path and any transitions between countries or systems.

Structure (2–3 minutes):

1. Present – Who you are now

   • Current status: “I am an IMG from [country], currently doing [observership/research/job].”
   • Clinical or academic focus related to internal medicine or prelim training.

2. Past – Key experiences that shaped you

   • Medical school, key rotations, leadership roles, research, or work that supports your interest in internal medicine or your advanced specialty.

3. Future – What you want and why this program/track

   • Long-term goal (e.g., neurology, anesthesiology)
   • Why a rigorous prelim IM year is important for you
   • Brief link to program strengths (teaching, patient population, ICU exposure, etc.)

Example “Tell me about yourself” answer (IMG, prelim IM–neurology bound):
“I’m an international medical graduate from the University of São Paulo in Brazil, where I developed a strong interest in internal medicine and neurology. During my clinical years, I enjoyed complex diagnostic cases, especially managing stroke and seizure patients on our neurology service.

After graduation, I completed a year working as a junior physician in a high-volume public hospital, which strengthened my clinical judgment, teamwork, and comfort managing acutely ill patients with limited resources. Over the past year in the U.S., I’ve completed observerships in internal medicine and neurology at [Hospital], and currently I’m involved in a quality improvement project focused on reducing readmissions in heart failure patients.

I’m now seeking a preliminary medicine year that will challenge me clinically, provide strong training in managing common inpatient conditions, and prepare me to be an effective neurology resident. I’m particularly drawn to your program because of your structured teaching rounds, exposure to stroke and critical care, and your experience training many IMGs who have gone on to successful specialty training.”

Common IMG pitfalls to avoid:

• Starting with childhood or high school
• Talking too long (>4 minutes)
• Reciting the CV line by line
• Overemphasizing personal hardship without connecting it to professional growth

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2. “Why internal medicine?” (for a prelim-only track)

Many prelim IM applicants ultimately pursue another specialty. Programs know this—but they still want to confirm you respect internal medicine and are motivated to work hard.

For a preliminary medicine year, you should:

• Acknowledge your advanced specialty goal honestly
• Emphasize that good internal medicine training is the foundation for your future specialty
• Show genuine appreciation for the breadth and intellectual challenge of IM
• Avoid sounding like IM is a “consolation prize”

Answer framework:

1. Foundation: Why IM is essential for your future specialty
2. Attraction: Which aspects of IM you enjoy (diagnostic reasoning, complex patients, longitudinal care even if just for a year)
3. Application: How you’ll use IM skills in your long-term career

Example (IMG, going into anesthesiology):
“While my long-term goal is anesthesiology, I see a strong internal medicine foundation as essential to becoming a safe and effective anesthesiologist. I enjoy internal medicine because it requires careful clinical reasoning—integrating history, physical exam, and data to manage complex, multisystem disease.

Managing conditions like heart failure, COPD, diabetes, and sepsis during a preliminary medicine year will directly strengthen my ability to assess perioperative risk, optimize patients before surgery, and recognize instability early in the OR and ICU. I’m excited about the opportunity to develop these skills in a rigorous internal medicine environment, and I take seriously the responsibility of caring for the general medicine patients entrusted to me during this year.”

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3. “Why this program?”

Programs want to hear more than “great teaching and diverse patients.” This question evaluates your preparation, sincerity, and fit.

Research before the interview:

• Program size and structure (number of prelim vs categorical residents)
• Unique features: night float, ICU exposure, simulation lab
• Educational culture: noon conferences, mentorship, research electives
• IMG support: visas, prior IMGs in the program, US clinical experiences
• Location-specific aspects: patient population, community needs, cost of living

Answer components:

1. Evidence of research: Reference specific program features
2. Personal connection: Link features to your goals and needs
3. Contribution: How you will add value to the program

Example answer snippet:
“I’m particularly interested in your program because of the strong critical care exposure during the prelim year and the emphasis on bedside teaching. Your schedule with an early ICU month and structured simulation training is ideal preparation for my future in neurology, where managing acute strokes and neurologic emergencies is critical.

I also appreciate your history of supporting IMGs and providing visa sponsorship, as well as your mentorship program pairing each intern with a faculty advisor. Having completed observerships in similar safety-net hospitals, I’m excited to contribute my experience working with underserved populations and to be an active member of your quality improvement initiatives.”

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Behavioral Interview Questions in Medicine: How You Work With Others

Many of the most important residency interview questions are behavioral, often introduced with: “Tell me about a time when…” These assess professionalism, teamwork, resilience, and integrity—critical for any intern.

Use the STAR method for behavioral interview medical questions:

• Situation – Brief context
• Task – What your role/responsibility was
• Action – What you did (focus here)
• Result – Outcome + what you learned

4. “Tell me about a time you made a mistake.”

They are not looking for perfection; they are assessing honesty, insight, and growth.

Guidelines:

• Choose a real but moderate mistake, not something catastrophic
• Avoid mistakes that raise red flags about patient safety or ethics
• Emphasize your accountability, correction of the error, and system-level insight

Example (IMG, ward miscommunication):
“During my internship year in my home country, I was responsible for updating the medication list for a patient being discharged after treatment for pneumonia. In the rush of a busy evening with multiple discharges, I neglected to restart the patient’s chronic antihypertensive medication, which had been held temporarily due to borderline low blood pressure.

The next morning, during rounds, my attending noticed the omission and discussed it with me. I immediately took responsibility, contacted the patient by phone, and coordinated with our outpatient clinic to ensure they received a corrected medication list and an earlier follow-up appointment.

This experience taught me the importance of using systematic checks during discharge, especially when medications are held in the hospital. Since then, I’ve made a point of reviewing each discharge medication list against the admission list and hospital course, and in a quality improvement project I helped implement a discharge checklist in our unit to minimize such errors for all providers.”

What this shows:

• Ownership of the error
• Patient-centered correction
• Growth mindset and system awareness

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5. “Tell me about a conflict with a colleague and how you handled it.”

Residency is team-based and high-stress; conflict is inevitable.

Good answer qualities:

• Demonstrates respect and emotional control
• Shows you seek to understand before judging
• Includes specific communication strategies (e.g., private conversation, using “I” statements)
• Ends with positive resolution or learning, even if the relationship remained difficult

Example (working with a difficult senior):
“During my clinical internship in [country], I worked on a busy internal medicine service with a senior resident who often dismissed my concerns when I presented patient updates. In one case, I felt worried about a patient’s increasing shortness of breath and requested that we reassess them, but he told me to wait until rounds. I felt frustrated and concerned about patient safety.

Instead of reacting in the moment, I asked to speak with him privately later that day. I explained, using ‘I’ statements, that I respected his experience but felt uncomfortable when my concerns weren’t fully heard, especially when I was worried about patients. I also asked for feedback on how I could present my assessments more clearly to make it easier for him to trust my judgment.

He shared that he was under pressure managing many patients and sometimes responded too quickly. We agreed on a system where I would highlight my top concern for each patient and clearly state when I felt something was urgent. After that, our communication improved significantly, and our team functioned more smoothly. The experience reinforced for me that addressing conflict early and respectfully can improve both patient care and team dynamics.”

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6. “Tell me about a challenging patient or family interaction.”

For IMGs, this often intertwines with language, culture, or health literacy barriers.

What interviewers look for:

• Empathy
• Communication skills
• Cultural sensitivity
• Ability to maintain professionalism under stress

Example (end-of-life conversation challenge):
“During my internal medicine rotation, I cared for an elderly patient with advanced heart failure and multiple comorbidities. The cardiology and palliative care teams agreed that the focus should shift to comfort measures, but the family strongly insisted on continuing aggressive interventions. They were very emotional and sometimes angry with the staff.

Recognizing their distress, I asked my attending if I could spend extra time with the family. I sat down with them, listened to their concerns, and learned that in their culture, agreeing to comfort care felt like giving up on their loved one. I worked with our attending and an interpreter to explain the patient’s condition in simple terms, what further interventions would realistically achieve, and how comfort-focused care was an active way of caring, not abandonment.

Although the family still wished to continue some treatments, they agreed to a do-not-resuscitate order and accepted additional support from our palliative care team. The experience taught me that understanding the family’s cultural and emotional perspective is as important as explaining the medical facts, and that these conversations often require multiple discussions and patience.”

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Clinical and Knowledge-Based Questions: Can You Think Like an Intern?

While preliminary medicine programs do not expect you to know everything, they do want to see that you can think logically, apply basic clinical knowledge, and recognize when to ask for help.

7. “Describe a complex case you managed. What was your role?”

Choose a case that:

• Involves internal medicine (CHF, pneumonia, sepsis, DKA, etc.)
• Shows your clinical reasoning and teamwork
• Highlights your independence level appropriately for your training

Answer outline:

1. Brief patient summary (age, key comorbidities, presenting problem)
2. Differential diagnosis and initial workup
3. Your actions and reasoning
4. Team collaboration and outcome
5. What you learned

Example (sepsis case):
“I cared for a 62-year-old man with diabetes and chronic kidney disease who presented with fever, confusion, and hypotension. He had a history of a chronic foot ulcer. On exam, he was tachycardic, hypotensive, and had a warm, erythematous right foot with purulent drainage.

My differential included sepsis from a diabetic foot infection, possible osteomyelitis, or another source such as urinary tract infection or pneumonia. I promptly initiated the sepsis protocol under my attending’s supervision—obtained blood cultures, started broad-spectrum IV antibiotics, administered fluid resuscitation, and requested urgent labs, including lactate, CBC, creatinine, and inflammatory markers.

Recognizing his high risk of deterioration, I also alerted the ICU team early. Imaging confirmed osteomyelitis, and he eventually required surgical debridement. Fortunately, with timely therapy, he stabilized and improved.

This case reinforced for me the importance of early recognition and aggressive management of sepsis, especially in patients with chronic wounds and comorbidities. It also taught me the value of early multidisciplinary collaboration with surgery, infectious disease, and critical care.”

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8. “How would you manage a patient with chest pain on the wards?”

Some interviews include brief clinical scenarios. They’re testing your approach, not just final answers.

Approach they want to hear:

• ABCs and vital signs first
• Focused history and exam
• Consider life-threatening causes (ACS, PE, aortic dissection, tension pneumothorax, esophageal rupture)
• Immediate investigations (ECG, troponin, chest X-ray, basic labs, etc.)
• Early communication with senior/attending

Sample structure:
“In a patient with new chest pain on the wards, my first step is to quickly assess airway, breathing, and circulation and check vital signs. If the patient is unstable or in severe distress, I would call for help immediately, activate the rapid response team if available, and ensure IV access, oxygen if indicated, and continuous monitoring.

I would obtain a focused history to characterize the pain (onset, location, radiation, quality, duration, associated symptoms like dyspnea, diaphoresis, nausea, or syncope, and risk factors such as known CAD, hypertension, diabetes, or prior DVT/PE). On exam, I would assess heart sounds, lung sounds, peripheral pulses, signs of heart failure, and check for chest wall tenderness.

I would order an urgent ECG and troponin, along with basic labs and a chest X-ray. If I am concerned about acute coronary syndrome based on symptoms and ECG, I would start appropriate therapy under guidance of my senior and attending, including aspirin and other medications per protocol, and involve cardiology early. If I suspect pulmonary embolism, aortic dissection, or other emergencies, I would escalate care and arrange for appropriate imaging. Throughout, I would keep my senior resident and attending informed and ensure close monitoring of the patient.”

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9. “How do you stay up to date with medical knowledge?”

Programs want residents who are self-directed learners.

Strong answer elements:

• Specific resources: UpToDate, guidelines, NEJM, JAMA, ACP resources
• Strategies: case-based learning, note-taking, review schedules
• Examples: how you applied new evidence in practice or research

Example answer:
“I rely on a combination of case-based learning and structured reading. When I encounter a clinical question, I start with evidence-based resources such as UpToDate and major society guidelines—like ACC/AHA for cardiology and IDSA for infectious diseases. I also follow key journals such as NEJM and JAMA and subscribe to email updates and podcasts that summarize new trials.

To retain information, I keep a digital notebook where I jot down key learning points from interesting cases, including diagnostic pearls and guideline changes. I review these notes regularly and discuss them with colleagues and mentors. During my observership at [Hospital], for example, I updated my understanding of anticoagulation in atrial fibrillation based on new guideline recommendations and applied that knowledge when presenting patients on rounds.”

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IMG-Specific Questions: Gaps, Transitions, and Cultural Adaptation

As an international medical graduate, you will almost certainly face questions about your background, training differences, and any gaps.

10. “Why did you choose to come to the United States for training?”

Goals of your answer:

• Show thoughtful career planning
• Explain that you understand the U.S. system
• Highlight what you will contribute in return

Example:
“I chose the United States for residency because of the strong emphasis on evidence-based medicine, standardized training, and multidisciplinary teamwork. I’m particularly drawn to the structured educational environment—daily teaching rounds, conferences, and mentorship—that I observed during my U.S. clinical experiences.

Training in the U.S. will prepare me to deliver high-quality care to diverse patient populations and to participate in quality improvement and research. At the same time, I bring experience working in resource-limited settings, adaptability to different healthcare systems, and strong appreciation for cultural and socioeconomic factors in patient care. I believe this combination will allow me to contribute meaningfully to your team while benefiting from the rigorous training here.”

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11. “Explain your gap in clinical training” (if applicable)

If you have a gap (research, exam preparation, family responsibilities, immigration processes), you must address it clearly and positively.

Key principles:

• Be honest but concise
• Emphasize productivity and growth during the gap
• Show that your clinical skills are up to date (observerships, CME, volunteering)

Example (exam preparation + research):
“After graduating in 2020, I dedicated a year to preparing for the USMLE exams and relocating to the U.S. During this period, I also worked as a research assistant in a cardiology outcomes project at [Institution], where I learned about data analysis and quality metrics in heart failure care.

I recognize the importance of maintaining clinical exposure, so over the past year I completed observerships in internal medicine and ICU at [Hospitals], where I participated in rounds, case discussions, and simulation sessions. These experiences have kept me clinically engaged and helped me adapt to the U.S. healthcare environment in preparation for residency.”

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12. “What challenges do you anticipate as an IMG in U.S. residency, and how will you address them?”

Interviewers want to see self-awareness and resilience.

Points to consider:

• Electronic medical record systems
• Communication style with patients and staff
• Cultural differences in hierarchy and teamwork
• Workload and time-pressure

Sample answer:
“As an IMG, I anticipate several challenges. First, while I have some experience with electronic medical records from my observerships, I expect a learning curve in documenting efficiently while managing a high patient load. To address this, I plan to actively seek feedback from seniors, use templates appropriately, and review examples of high-quality notes.

Second, communication styles in the U.S.—especially with nurses and multidisciplinary teams—can be different from what I experienced at home. I’ve already seen how effective it is when everyone feels comfortable speaking up. I intend to be open, respectful, and proactive in asking clarifying questions and confirming plans.

Finally, adapting to the intensity of intern year will require strong organization and self-care. I’ve started using task management tools and checklists during my observerships, and I will continue to develop these skills while also paying attention to my own well-being, such as maintaining sleep and exercise when possible. I believe my prior experience working long hours in a busy hospital has prepared me to handle the workload here.”

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Professionalism, Ethics, and Career Goals

These questions help the program understand your judgment, reliability, and long-term direction.

13. “Where do you see yourself in 5–10 years?”

Even as a prelim resident, you should have a coherent vision.

Strong answer elements:

• Clear planned specialty (if known)
• Integration of clinical care, teaching, QI, or research
• Openness to evolving within your field

Example:
“In five to ten years, I see myself as a board-certified neurologist working in an academic or large community hospital setting, with a particular focus on stroke and inpatient neurology. I hope to be actively involved in teaching residents and medical students, and to participate in quality improvement initiatives aimed at optimizing acute stroke pathways and post-stroke care.

A strong preliminary medicine year will be the foundation for this path—by improving my skills in managing complex comorbidities, recognizing systemic complications, and working effectively within interdisciplinary teams.”

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14. “Do you plan to stay in the U.S. long term?”

Programs often ask this, especially for IMGs requiring visas.

Guidance:

• Be honest but avoid sounding uncertain or non-committal
• Express commitment to completing training and contributing meaningfully
• Acknowledge visa realities briefly but focus on professional goals

Example answer:
“My goal is to complete my residency and subsequent specialty training in the United States and to practice here for the foreseeable future. I value the structure, resources, and team-based care in the U.S. system, and I believe I can contribute significantly, particularly in caring for diverse and underserved populations. I understand the challenges related to visas and long-term planning, but I am committed to navigating these responsibly and building a stable, long-term career here.”

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15. “What are your strengths and weaknesses?”

This is classic—but still important.

Strengths:

• Choose 2–3 that are demonstrable with examples:
  • Strong work ethic
  • Adaptability
  • Communication skills
  • Cultural competence
  • Organization

Weaknesses:

• Pick a real but manageable weakness
• Explain how you are actively working on it
• Avoid critical red flags (unreliable, disorganized with no efforts at improvement)

Example (strength and weakness pair):
“One of my strengths is my adaptability. As an IMG, I’ve trained in different healthcare settings, from resource-limited public hospitals to more structured academic centers, and I’ve learned to adjust quickly to new systems and expectations. For example, during my observership at [Hospital], I rapidly learned their EMR workflow and ward routines, which allowed me to participate effectively in rounds and case discussions.

A weakness I’ve been working on is a tendency to take on too many responsibilities myself instead of asking for help early. In my home country, this sometimes led to unnecessary stress. Over the past year, I’ve become more intentional about prioritizing tasks, communicating my workload to colleagues, and delegating appropriately when part of a team. I’ve noticed that this not only improves my efficiency but also enhances patient care and team functioning.”

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Practical Preparation Tips for IMGs Interviewing in Prelim IM

To use this IMG residency guide effectively, practice is crucial. Here is how to prepare efficiently:

Build Your Personal “Answer Bank”

• Write out bullet-point answers for the 15 questions above
• For behavioral questions, list 6–8 versatile cases you can reuse:
  • A leadership example
  • A conflict with a colleague
  • A medical error or near miss
  • A difficult patient/family situation
  • A time you received critical feedback
  • A case that inspired you

Practice Out Loud

• Conduct mock interviews with:
  • Mentors or residents
  • Friends familiar with the U.S. system
  • Online IMG support groups or paid services (if available)
• Record yourself and review for:
  • Clarity and structure
  • Length (most answers 1–3 minutes)
  • Filler words (“uh,” “you know,” “like”)

Adapt to U.S. Communication Style

• Maintain eye contact (without staring)
• Use “I” to describe your role, but acknowledge the team
• Be confident yet humble
• Avoid overly formal or overly casual language

Prepare Questions for Interviewers

Programs expect you to ask questions. Examples tailored to prelim IM:

• “How is the preliminary medicine year integrated with categorical residents?”
• “What proportion of your prelim IM graduates move on to their desired specialties?”
• “How do you support IMGs in adapting to the U.S. system?”
• “What are typical responsibilities for prelim residents on ICU or night float?”

Having thoughtful questions reinforces your interest and preparation.

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FAQ: Common Questions From IMGs About Prelim Medicine Interviews

1. Are prelim IM interviews different from categorical internal medicine interviews?
The structure is similar, but emphasis differs. Prelim programs focus more on your short-term goals, reliability as an intern, and how the year fits into your path to another specialty. They understand you may not pursue internal medicine long term; however, they still want assurance that you will treat your medicine patients with full seriousness and professionalism.

2. How should I answer if they ask why I didn’t apply categorical internal medicine?
Be honest but respectful. For example:
“My long-term goal is to train in anesthesiology, so I applied primarily to preliminary medicine programs that would give me a strong foundation in managing medical comorbidities and acutely ill patients. I have great respect for internal medicine as a specialty and see this prelim year as essential preparation for my career, even though my ultimate goal is in another field.”
Avoid framing IM as a backup or inferior choice.

3. What if my U.S. clinical experience is limited? How do I still look competitive in the interview?
Emphasize the quality and depth of whatever U.S. experience you do have—observerships, electives, research—and connect your prior clinical work abroad to skills relevant to U.S. residency (resourcefulness, managing high volume, handling complex diseases). Show that you have taken concrete steps to understand the U.S. system and that you are eager to learn, adaptable, and coachable.

4. How should I handle tough or unexpected residency interview questions?
Pause briefly, organize your thoughts, and use a structure like STAR for behavioral questions. It is acceptable to say, “Let me think for a moment,” instead of rushing. If you don’t know a medical fact, say so honestly and pivot to how you would look it up or seek help. Programs value integrity and reasoning more than perfect recall.

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By thoroughly preparing for these common interview questions and tailoring your answers to highlight your experiences as an international medical graduate, you can demonstrate that you are ready to excel in a preliminary medicine year—and to be a reliable, collegial, and thoughtful member of any residency team.