Essential Interview Questions for Non-US Citizen IMGs in General Surgery Residency

Preparing for a general surgery residency interview as a non-US citizen IMG (international medical graduate) is uniquely challenging. You must show not only that you can handle the intense demands of a surgical training program, but also that you can adapt to a new culture, health system, and team dynamic.

Program directors know that many foreign national medical graduates are clinically strong. The real question they are trying to answer during your interview is:

“Will this person be safe, teachable, resilient, and a good fit for our surgery residency?”

This article breaks down common interview questions for non-US citizen IMGs in general surgery, explains what programs are really testing, and provides sample answers, structures, and practical tips so you can prepare with confidence.

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Understanding What General Surgery Programs Are Looking For

Before reviewing individual residency interview questions, it helps to understand the core competencies program directors are assessing, especially for a non-US citizen IMG:

1. Clinical readiness for surgery

   • Knowledge base appropriate for your level
   • Understanding of basic surgical principles, pre-op/post-op care
   • Ability to recognize and escalate emergencies

2. Work ethic and stamina

   • Willingness to work long, physically demanding hours
   • Emotional resilience in a high-stress environment

3. Teamwork and communication

   • Ability to work in multidisciplinary US teams
   • Comfort communicating with nurses, colleagues, and patients
   • Language clarity and listening skills

4. Professionalism and adaptability

   • Maturity, humility, accountability
   • Willingness to learn US norms of communication and patient care
   • Ability to adjust from your home country’s system to the US system

5. Cultural and visa-related stability

   • For a foreign national medical graduate on a visa (J-1 or H-1B), they want to know:
     • Will you finish the program?
     • Do you understand visa constraints and timelines?
     • Are you realistically prepared for the non-clinical challenges of training in the US?

When you structure your answers, keep in mind: every question is an opportunity to demonstrate one or more of these qualities.

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Foundational Questions: Telling Your Story with Clarity and Purpose

These are often the first questions you’ll be asked and set the tone for the rest of your interview.

1. “Tell me about yourself.”

This is one of the most common residency interview questions, and it is not asking for your full life story. Programs are looking for:

• A clear, organized, 1–2 minute summary
• A logical path from:
  • Who you are now → your medical/surgical experiences → why you’re here interviewing for general surgery
• Evidence that you can present your story confidently and succinctly

Simple Structure (3-part):

1. Present: Who you are now (education, current role, recent experiences)
2. Past: Key experiences that shaped you (surgery exposure, research, leadership)
3. Future: Why general surgery in the US, and what you hope to accomplish

Example (Non-US Citizen IMG):
“I’m a non-US citizen IMG from India, currently completing a surgical research fellowship in colorectal surgery at [US Institution]. I graduated from [Medical School] in 2020, where I developed a strong interest in general surgery through early exposure to emergency laparotomies and trauma cases.

After graduation, I completed a rotating internship, then spent two years as a junior resident in general surgery in my home country. During that time, I became particularly interested in complex abdominal surgery and perioperative care, and I also recognized some gaps in our system—especially in standardized protocols and post-op monitoring.

To expand my knowledge and gain exposure to evidence-based surgical practice, I came to the US for research. Over the past year, I’ve worked on outcomes projects in colorectal surgery, presented at [Conference], and gained observership experience in the OR and surgical wards. These experiences have confirmed that I want to pursue general surgery residency in the US, where I can train in a structured, team-based environment and eventually contribute to improving surgical care for underserved populations, both here and in my home country.”

Tips for Non-US Citizen IMGs:

• Briefly acknowledge your transition to the US system (research, observerships, USCE).
• Emphasize continuity of interest in surgery; avoid sounding like you “switched last minute.”
• Keep your “tell me about yourself” answer professional, not personal biography-heavy.

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2. “Why general surgery?”

Programs want to see a deep, realistic understanding of what general surgery involves—not just “I like working with my hands.”

They’re testing:

• Insight into the demands of surgery
• Authentic long-term commitment
• Reflective thinking about your experiences

Structure:

1. Hook: A specific experience that drew you to surgery
2. Core reasoning: 2–3 reasons that fit your personality and strengths
3. Reality check: Evidence you understand the lifestyle and demands
4. Future: How you see your career in general surgery

Example: “My interest in general surgery began during my third-year clerkship when I scrubbed into an emergency laparotomy for a perforated duodenal ulcer. What struck me was how quickly decisive intervention could change the patient’s trajectory. I was drawn to the blend of problem-solving, technical skill, and immediate impact on a patient’s life.

Over time, that early fascination matured. I enjoy working with my hands, but I also appreciate the continuity of care—from preoperative evaluation and shared decision-making to postoperative management and follow-up. I’ve consistently gravitated toward acute care and complex abdominal pathology, where multidisciplinary collaboration is essential.

Through my junior residency at home and my US research and observership experiences, I’ve seen firsthand the demanding nature of a surgical career: long hours, frequent calls, and emotionally intense situations. Despite this, I’ve found that I thrive in high-intensity environments, and I value the strong team culture within surgery.

In the long term, I see myself as a general surgeon with a focus on [e.g., acute care surgery / global surgery / colorectal / surgical oncology], contributing to both clinical care and outcomes research, particularly in resource-limited settings.”

Avoid:

• Vague answers like “I like surgery because it’s interesting.”
• Overemphasizing prestige or income.
• Ignoring the challenges and lifestyle realities.

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Behavioral Questions: How You Think, React, and Work with Others

Behavioral interview questions in medicine are based on the idea that past behavior predicts future performance. These questions often start with:

• “Tell me about a time when…”
• “Describe a situation where…”
• “Give me an example of…”

For a behavioral interview medical format, use the STAR method:

• Situation – Brief context
• Task – Your responsibility
• Action – What you did (focus here)
• Result – Outcome and what you learned

3. “Tell me about a time you faced a significant challenge or conflict on a team.”

Programs are assessing:

• Conflict resolution skills
• Emotional maturity
• Respect for nurses, peers, and seniors
• Ability to work within hierarchy but still advocate appropriately

Example (Using STAR):
Situation: “During my internship in general surgery in [Country], we had a busy night in the emergency department with multiple trauma cases arriving simultaneously. The surgical resident and emergency physician disagreed on the triage priority for a hemodynamically borderline patient with abdominal pain.”

Task: “As the intern managing initial assessments, I was responsible for organizing the workup and communicating information to both teams.”

Action: “I noticed the disagreement was delaying care, so I calmly summarized the key clinical data: vital signs, hemoglobin, FAST exam results, and response to fluids. I respectfully clarified each consultant’s concerns and asked if we could agree on a short-term plan—obtaining a CT scan while closely monitoring vitals, with a clear threshold for proceeding to exploratory laparotomy. I ensured all orders were entered quickly, and I kept both teams updated.”

Result: “The patient’s condition worsened during the CT scan, consistent with ongoing intra-abdominal bleeding. Because we had already discussed contingency plans, the team moved quickly to the OR. The patient underwent a successful laparotomy and recovered well.

From this experience, I learned the importance of clear communication, objective data, and maintaining respect on a multidisciplinary team, even when there are disagreements. I’ve carried these skills into my US observership and research experiences, where effective communication is essential.”

Tips for Non-US Citizen IMGs:

• Choose examples that show you can work within US-style team dynamics, even if the case happened abroad.
• Avoid stories that portray you as fighting directly with seniors or disrespecting hierarchy.
• Show that you listen and collaborate, not just insist on your opinion.

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

This is a core behavioral interview medical question. They want to know:

• Are you honest and accountable?
• Can you learn from mistakes?
• Do you avoid repeating them?

Key Principles:

• Choose a real, but non-catastrophic mistake (e.g., communication, time management, minor clinical oversight).
• Focus on what you did and what you changed afterward.
• Avoid blaming others or making excuses.

Example: “During my early internship, I was covering the surgical ward during a particularly busy shift. A nurse notified me about a post-op patient with mild tachycardia and low-grade fever. I evaluated the patient, attributed it to post-op pain and atelectasis, and increased analgesia and encouraged incentive spirometry. I did not immediately discuss the case with my senior because the patient’s blood pressure and oxygenation were stable.

Over the next several hours, the patient’s tachycardia worsened, and his blood pressure dropped slightly. My senior resident was then involved, and a CT scan revealed an early anastomotic leak. The patient was taken back to the OR and ultimately recovered, but I realized I had underestimated the potential seriousness of his early signs.

I discussed this case with my attending afterward. I learned that, especially for high-risk post-op patients, early subtle changes can signal serious complications. Since then, I have adopted a much lower threshold to escalate concerns to seniors and have developed a more systematic approach to evaluating post-op patients, including trending vital signs and labs more carefully.

This experience taught me the importance of vigilance and seeking help early in surgery, and it has significantly changed how I approach post-operative monitoring.”

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5. “Describe a time you worked with someone from a different background or culture.”

Programs interviewing a non-US citizen IMG are particularly interested in cultural competence—both yours and the team’s.

Example: “In my home institution, I worked in a rural rotation where many patients spoke a local dialect that I was not fluent in. One elderly woman presented with abdominal pain, and there was significant miscommunication about her symptoms and consent for surgery.

I recognized the barrier, so I requested help from a nurse who was from the same village and spoke the dialect fluently. I took extra time to explain the condition and procedure using simple terms and non-technical language, and I asked the nurse to translate and check for understanding. We also involved her son in the discussion to ensure she felt supported.

The patient underwent surgery for a perforated appendix and did well. This experience reinforced for me that communication is more than just speaking the same language—it requires cultural sensitivity, checking for understanding, and adapting our approach based on the patient’s background. This has helped me in my US experiences as well, where I’ve worked with patients and colleagues from many different cultures.”

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Questions Specific to Non-US Citizen IMGs and Foreign Nationals

For a foreign national medical graduate, interviewers may ask targeted questions about your adaptation to the US, visa status, and future plans. They are not doing this to discriminate; they are assessing stability and fit.

6. “Why do you want to train in the United States?”

They’re checking:

• Have you thought seriously about why the US system?
• Are you familiar with US-style training and expectations?
• Is this a long-term, realistic plan?

Example: “I want to train in the United States because of the structured nature of residency, the emphasis on evidence-based practice, and the strong culture of multidisciplinary teamwork. In my home country, I gained valuable hands-on experience, but I also recognized limitations in standardized protocols, postoperative monitoring, and access to advanced technology.

Through my research fellowship and observerships, I’ve seen how US general surgery programs integrate clinical care with academic inquiry and quality improvement. The consistent supervision, structured curriculum, morbidity and mortality conferences, and surgical simulation training create an environment where residents can grow in a safe but challenging way.

I believe that training in such a system will not only make me a better surgeon but will also equip me with tools to contribute to improving surgical systems in whichever setting I ultimately practice, whether in the US, my home country, or in collaboration between both.”

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7. “How do you plan to handle visa issues and long-term career planning?”

This question is common for a non-US citizen IMG and foreign national medical graduate. Interviewers want reassurance that you understand the process and won’t have unexpected disruptions.

Key Points:

• Know whether you’re aiming for J-1 or H-1B (if available).
• Show that you have done basic research, but don’t turn the answer into an immigration lecture.
• Emphasize commitment to completing residency and being flexible.

Example: “I understand that as a non-US citizen IMG, visa sponsorship is a critical part of my training. I am open to training on a J-1 visa, which is the most common pathway for IMGs, and I have reviewed the requirements and the need for a return-home period or waiver afterward. My primary goal is to complete a high-quality general surgery residency and become an excellent, safe surgeon.

I also recognize that long-term career options may depend on factors like waiver jobs or further fellowship training. I am prepared to be flexible about geographic location and practice setting if it allows me to continue practicing surgery and contributing meaningfully.

From the program’s perspective, I want to reassure you that I am fully committed to completing residency and have carefully considered the challenges and responsibilities that come with training in the US as a foreign national.”

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8. “You have been out of clinical practice for some time—how have you stayed current?”

Many non-US citizen IMGs have research gaps or time away from active clinical practice.

They want to know:

• Are your clinical skills and knowledge still sharp?
• Have you used the gap productively?

Example: “After graduating in 2019, I completed my internship and one year of junior residency in general surgery. For the past two years, I have been in a full-time research fellowship in colorectal surgery in the US.

Although I’ve not been in a traditional clinical role, I’ve stayed connected to patient care by observing in the OR and clinics, attending academic conferences, participating in weekly M&M and tumor board meetings, and reviewing cases for our outcomes research. I’ve kept up with core clinical knowledge through regular reading of surgical texts and journals, participating in resident teaching conferences, and using question banks such as [resource] to maintain my clinical reasoning.

This period has strengthened my understanding of surgical outcomes, evidence-based practice, and research methods, and I feel mentally well-prepared to return to full-time clinical work in residency.”

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Clinical and Scenario-Based Questions for General Surgery

For a general surgery residency match, expect some clinical or judgment-based questions, especially during faculty interviews.

9. “Tell me about a challenging clinical case you managed.”

They’re testing:

• Your clinical reasoning
• Your understanding of surgical principles
• Your ability to communicate a case succinctly

Structure:

1. Brief patient summary (age, key problem)
2. Your role
3. Key decision points
4. Outcome
5. What you learned

Example: “I once managed a 45-year-old man with generalized peritonitis secondary to a perforated sigmoid diverticulum. As a junior resident, I was responsible for initial stabilization and work-up, under the supervision of my senior.

We resuscitated him aggressively, started broad-spectrum antibiotics, and obtained an urgent CT scan, which confirmed free air and fluid. I accompanied him to the OR, where the attending performed a Hartmann procedure. Postoperatively, I monitored him closely for signs of sepsis and organ dysfunction. On day two, his urine output decreased, and his lactate increased. I recognized that he was developing early septic shock and promptly escalated to my senior. We transferred him to the ICU, adjusted antibiotics after culture results, and provided vasopressor support.

He improved gradually and was eventually discharged. This case reinforced the importance of early recognition of deterioration, multidisciplinary care, and clear communication between the OR, ICU, and ward teams. It also taught me the value of protocols, such as sepsis bundles, which I’ve seen implemented even more systematically in US hospitals.”

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10. “How would you handle a situation where you think your attending is making the wrong decision?”

They’re assessing:

• Professionalism
• Courage and tact
• Patient safety awareness

Example: “If I believed there was a potential error or oversight, my first step would be to clarify my understanding. I would say something like, ‘I may be missing something, but I’m concerned about X because of Y. Could you help me understand the rationale for this plan?’ This allows me to voice my concern respectfully while recognizing the attending’s experience and authority.

If I still felt that patient safety was at risk and time allowed, I might discreetly discuss the situation with a senior resident or another attending, following the institution’s chain-of-command and policies. Ultimately, patient safety must come first, but in surgery, it’s crucial to maintain professionalism and respect while raising concerns.

Coming from a different training culture, I’ve learned that in the US, there is a strong emphasis on speaking up for safety, and I am committed to doing so in a way that is respectful, evidence-based, and consistent with the team’s values.”

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Practical Strategies to Prepare as a Non-US Citizen IMG

1. Create a Personal “Question Bank”

• List common surgery residency match questions:
  • Tell me about yourself
  • Why general surgery?
  • Why this program?
  • Strengths and weaknesses
  • Most significant clinical challenge
  • Time you failed or made a mistake
  • Working with a difficult colleague
  • Ethical dilemma
  • Plans after residency
• Write bullet-point answers, not scripts.
• Practice answering out loud, focusing on clarity and timing (1–2 minutes each).

2. Practice Behavioral Answers Using STAR

For each key theme (teamwork, conflict, leadership, mistake, resilience), prepare 2–3 stories from different settings:

• Medical school
• Internship/junior residency
• Research or US observerships
• Non-clinical roles (teaching, volunteering)

3. Address IMG-Specific Concerns Proactively

As a non-US citizen IMG, interviewers may silently worry about:

• Communication/language barriers
• Adapting to US healthcare culture
• Visa and long-term commitment

Address these implicitly by:

• Demonstrating clear, fluent communication
• Sharing examples of successful US-based experiences (research, observerships)
• Mentioning your understanding of visa pathways and long-term flexibility

4. Prepare Questions for the Interviewers

Programs expect you to ask thoughtful questions. Examples:

• “How do you support interns transitioning from different training systems, including IMGs?”
• “What opportunities are there for research or quality improvement in general surgery?”
• “How is feedback typically given, and how often?”
• “What characteristics do your most successful residents share?”

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Frequently Asked Questions (FAQ)

1. Do non-US citizen IMGs get asked different residency interview questions than US graduates?

The core questions (tell me about yourself, why general surgery, strengths/weaknesses, behavioral scenarios) are the same. However, as a non-US citizen IMG, you may be asked more about:

• Your adaptation to the US system
• Visa status and long-term plans
• Gaps in training or time spent in research
• Reasons for choosing to leave your home country’s training system
  These are not necessarily negative; they’re opportunities to show maturity, planning, and commitment.

2. How can I improve my answers to behavioral interview medical questions?

• Use the STAR structure for clarity.
• Focus on your actions and what you learned, not just the story.
• Choose examples that show growth, especially in communication, teamwork, and resilience.
• Practice with a friend, mentor, or through mock interviews (ideally with someone familiar with US residency culture).

3. I struggle with “tell me about yourself.” How long should my answer be?

Aim for 60–120 seconds. Longer than that can lose the interviewer’s attention. Focus on:

• Your current status
• 2–3 key experiences that led you to general surgery
• A brief mention of why you’re seeking general surgery residency in the US
  Avoid detailed personal history, childhood stories, or repetition of your entire CV.

4. How honest should I be about my weaknesses or mistakes?

You should be truthful but strategic:

• Choose weaknesses that are real but improvable (e.g., overcommitting, initial shyness in speaking up), not core safety issues.
• When discussing mistakes, emphasize:
  • What you learned
  • How you changed your behavior
  • Evidence that you do not repeat the same error
    Programs value self-awareness and growth more than perceived perfection.

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By preparing thoughtfully for these common interview questions—and tailoring your answers to highlight your strengths as a non-US citizen IMG applying to general surgery—you can turn your unique path into a compelling story that resonates with program directors and interviewers.