Essential SOAP Preparation Guide for IMGs in Pediatrics Residency

Understanding SOAP for Pediatrics: What Every IMG Needs to Know

The Supplemental Offer and Acceptance Program (SOAP) can feel intimidating, especially as an international medical graduate (IMG) aiming for pediatrics residency. But with the right SOAP preparation strategy, it can become a powerful second chance to secure a position in the peds match.

This IMG residency guide will walk you step-by-step through what SOAP is, how it works specifically for pediatrics, and exactly how to prepare before and during Match Week so you can respond quickly, strategically, and professionally.

What Is SOAP?

SOAP is a structured process run by the NRMP during Match Week that allows eligible unmatched or partially matched applicants to apply to and accept unfilled residency positions.

Key points for IMGs:

• SOAP is not a free-for-all scramble; it’s an organized, time-limited process with strict rules.
• You can apply to a maximum of 45 programs across all specialties.
• Communication rules are strict: you may not contact programs directly unless they contact you first through ERAS-permitted channels.
• There are multiple “offer rounds” over several days where you may receive and respond to offers.
• SOAP involves mainly categorical PGY-1 or preliminary PGY-1 positions that did not fill in the main match.

Why SOAP Matters for Pediatrics IMGs

Pediatrics is often considered a relatively IMG-friendly specialty compared with some others, but it remains highly competitive at desirable locations and university programs. Each year:

• Some pediatrics programs do not fully fill in the main match.
• Many of those unfilled positions appear in SOAP.
• A number of IMGs successfully enter pediatrics residency through SOAP, particularly in community-based or smaller university-affiliated programs.

If you are an IMG and:

• Have solid US clinical experience, especially in pediatrics
• Have decent but not standout USMLE scores, or have some application limitations
• Or faced visa or timing issues

…then SOAP may be one of your best opportunities to secure a pediatrics spot.

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Pre–Match Week SOAP Preparation Strategy (Start 2–3 Months Early)

Your SOAP success is largely determined before Match Week ever starts. Treat SOAP preparation with the same seriousness as your main application.

1. Know Your Eligibility and Risks

Before Match Week, make sure you understand:

• Are you SOAP-eligible?
  Typically, you must:

  • Be registered for the Match with NRMP
  • Be unmatched or partially matched (e.g., advanced position without a PGY-1)
  • Have no violations of NRMP policies
  • Have your USMLE/COMLEX and ECFMG certification status clarified

• Understand partial match scenarios
  If you have matched to an advanced (PGY-2) position but not a preliminary year, you can use SOAP to obtain a PGY-1 preliminary or transitional position.

• Clarify your visa situation
  Programs vary greatly:

  • Some pediatrics programs sponsor J-1 only
  • Some sponsor both J-1 and H-1B
  • Others do not sponsor visas at all
    This will heavily shape your SOAP strategy.

2. Build a “SOAP-Ready” Application Profile

Your ERAS application during SOAP must be complete, updated, and tailored to pediatrics. Before Rank Order List (ROL) certification, do the following:

a. Update Your Personal Statement for Pediatrics and for SOAP

Create two versions of your personal statement (PS):

1. Standard Pediatrics PS – already in place for the main match.
2. SOAP-focused Pediatrics PS – that:
   • Briefly acknowledges your situation without sounding defeated
   • Emphasizes resilience, quick learning, and commitment to pediatrics
   • Shows awareness of underserved populations, continuity of care, and child advocacy

Example SOAP-oriented sentence:

“While the match process has been challenging, it has reinforced my determination to train in pediatrics and contribute meaningfully to the care of children, particularly those from underserved and immigrant communities.”

Avoid:

• Blaming others (schools, mentors, “the system”)
• Sounding desperate or apologetic
• Over-explaining why you didn’t match

b. Optimize Your CV and Experiences

Revisit your ERAS experiences with a pediatrics lens:

• Move pediatrics-related experiences to the top:
  • Pediatric clerkships and sub-internships
  • NICU/PICU rotations
  • Pediatric outpatient or community clinics
  • Child-focused volunteer work (camps, schools, shelters)
• Highlight:
  • Longitudinal relationships with patients/families
  • Communication with children/parents
  • Multicultural and multilingual outreach
  • Advocacy or quality improvement related to child health

For IMGs, especially:

• Emphasize US clinical experience (USCE) and observerships in pediatrics.
• Clarify your role: observer vs. hands-on (within allowed limits).
• Quantify: “Saw ~10–15 patients per day in pediatric continuity clinic; documented notes under supervision.”

c. Letters of Recommendation (LoRs) for SOAP

You cannot reliably obtain new letters during SOAP week, so prepare ahead:

• Aim for at least 3 pediatrics-focused letters:
  • From US pediatric attendings if possible
  • One from inpatient pediatrics
  • One from outpatient or ambulatory pediatrics, if available
• Choose letter writers who:
  • Know you well
  • Can comment on your clinical skills, teamwork, communication with children and families, and reliability
• Upload them to ERAS well before Match Week.
• Keep an extra general letter (e.g., from an internal medicine or family medicine rotation) in case you decide to also apply to non-peds preliminary positions during SOAP.

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3. Research Likely SOAP-Friendly Pediatrics Programs

During SOAP, you will only have a few hours to review the list of unfilled programs and submit applications. Preparation means:

• Make a list of pediatrics programs that:
  • Historically have unfilled spots
  • Demonstrate IMG-friendliness (past residents, website statements, Doximity/NRMP data)
  • Sponsor your visa type
• Organize this list in a spreadsheet with:
  • Program name and ACGME code
  • Location and setting (community vs. university)
  • Visa policy
  • Past NRMP fill rates and IMG percentages
  • Your level of competitiveness (reach vs. realistic vs. safety)

When the SOAP residency list is released, this spreadsheet will help you prioritize within minutes instead of starting from scratch.

4. Plan Your SOAP Communication Strategy

Even though you cannot initiate direct contact with programs during SOAP, some may:

• Send you ERAS messages or invite you for brief virtual interviews (often via Zoom or phone).
• Expect you to be reachable with short notice.

Prepare:

• A professional voicemail greeting with your name.
• A dedicated email you check frequently.
• A quiet space and stable internet connection for quick video calls.

Create 3–5 core talking points for pediatrics, such as:

• Your motivation for pediatrics as an IMG
• How your background (cultural, linguistic) helps you connect with children and families
• Specific examples of resilience and adaptability
• Why you can start quickly and integrate smoothly into a team

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Match Week: Navigating SOAP Step-by-Step as an IMG

On the Monday of Match Week, you learn your match status. If you are unmatched or partially matched and SOAP-eligible, you will be notified and gain access to the List of Unfilled Programs.

1. Day 1 (Monday): Rapid Assessment and Prioritization

Once SOAP starts:

1. Review the list quickly but strategically

   • Filter for pediatrics (categorical) first.
   • Then consider transitional year or preliminary medicine/surgery only if:
     • You have an advanced peds-related position (less common), or
     • You are open to alternative pathways.

2. Match your spreadsheet with the actual SOAP list

   • Highlight pediatrics programs on your pre-researched list that appear in SOAP.
   • Add any new pediatrics unfilled programs and quickly assess via:
     • Program website
     • FREIDA
     • NRMP/other data if available

3. Rank your interest Consider:

   • Visa sponsorship (non-negotiable)
   • IMG-friendliness (critical for IMGs)
   • Location preferences (flexible during SOAP if possible)
   • Track type: categorical pediatrics is ideal; verify not just prelim.

Build tiers:

• Tier 1: Highly IMG-friendly peds programs that sponsor your visa type.
• Tier 2: Reasonable options where you meet most criteria.
• Tier 3: Less ideal location or fit, but still pediatrics and visa-compatible.

2. Submitting Applications (Up to 45 Programs)

Once you’ve triaged the list:

• Apply first to all Tier 1 and Tier 2 pediatrics programs.
• If you still have room under the 45-program cap:
  • Consider some preliminary internal medicine or transitional year positions if you:
    • Are willing to reapply to pediatrics next year
    • Need a PGY-1 to maintain visa status or stay clinically active

For all pediatrics SOAP applications:

• Attach:
  • Your pediatrics-specific SOAP PS
  • Pediatrics-focused LoRs
• Ensure your ERAS profile is consistent with your intent to pursue pediatrics as your primary specialty.

Remember: You cannot “tailor” each ERAS application individually during SOAP as much as during the main season, so your materials must be broadly strong for pediatrics.

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Interviewing During SOAP: Presenting Your Best Self in Pediatrics

Some pediatrics programs may conduct brief virtual interviews during SOAP. These are usually shorter and more focused than regular interview days.

1. Common Pediatrics SOAP Interview Questions for IMGs

Prepare concise, structured answers to questions such as:

• “Why pediatrics, and not internal medicine or family medicine?”
• “As an international medical graduate, what unique strengths do you bring to our pediatric program?”
• “What have you been doing since graduation?” (especially important for older graduates)
• “Why do you think you did not match in the main cycle?”
• “Why are you interested in our program specifically?”

For each:

• Answer honestly but strategically.
• Avoid speaking negatively about other programs, your school, or the match process.
• Emphasize growth, resilience, and readiness.

Example approach to the “Why didn’t you match?” question:

“In retrospect, I applied mostly to highly competitive university pediatrics programs with limited IMG acceptance and may have underestimated how much location and visa policies would affect my chances. I have reflected on this, sought feedback from mentors, and now I am casting a more balanced range of programs during SOAP. My commitment to pediatrics hasn’t changed—in fact, it has strengthened.”

2. Highlighting Your Strengths as a Pediatrics IMG

Emphasize qualities particularly valued in pediatrics:

• Communication with children and parents
  Example: Handling a scared child for blood draws, explaining conditions to anxious parents using simple language.

• Cultural and language skills
  As an IMG, you may:

  • Speak multiple languages
  • Understand immigrant family dynamics
  • Relate to health disparities in low-resource settings

Frame this as an asset for their patient population.

• Teamwork and humility
  Describe cases where you collaborated with nurses, social workers, and allied health professionals.

• Long-term commitment to child health
  Mention:

  • Longitudinal child health projects
  • Pediatric research or QI
  • Volunteering with children or adolescents

3. Professional Demeanor and Logistical Readiness

In SOAP, programs must trust that you can start quickly and function reliably.

Reassure them about:

• Start date readiness

  • Have your paperwork, ECFMG status, and visa documentation organized.
  • Be ready to promptly respond to onboarding requests.

• Location flexibility
  Within reason, emphasize your willingness to relocate and adapt quickly.

• Emotional maturity
  Convey that:

  • You handled not matching with composure.
  • You are focused on solutions and growth, not regret.

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Strategically Handling SOAP Offers and Planning for All Outcomes

SOAP has several offer rounds. Understanding how to respond is critical.

1. How SOAP Offers Work

• Programs rank the applicants they interviewed or reviewed.
• In each round, NRMP sends out offers to top-ranked candidates.
• You may:
  • Accept an offer (binding, then you are done with SOAP)
  • Reject an offer
  • Or let an offer expire (not advised unless strategic)

For pediatrics IMGs:

• If you receive an offer from a reputable, IMG-friendly pediatrics program that meets your visa needs, strongly consider accepting.
• Balance long-term goals with the reality that another offer may never come.

2. Decision-Making Framework for IMGs in Pediatrics

Ask yourself:

1. Is this a categorical pediatrics position?
   If yes and visa-compatible, it is usually preferable to any prelim-only spot if your dream is pediatrics.

2. Does the program sponsor my needed visa?
   Never assume you can “work it out later.” If they don’t sponsor your visa type, accepting could create complications.

3. Can I realistically succeed and thrive here?
   Consider size, workload, and support. Many community pediatrics programs are excellent training environments for IMGs.

4. Am I turning down a certain pediatrics opportunity for an uncertain future?
   Reapplying in another year is possible but costly and uncertain.

In most cases, for an IMG dedicated to pediatrics, any solid categorical pediatrics offer is worth accepting, especially if it provides strong training and allows board eligibility.

3. If You Do Not Match Through SOAP

Not matching in SOAP is difficult, but it is not the end of your pediatrics career. Begin immediately:

• Seek feedback from mentors:
  • Ask for honest assessment: scores, gaps, communication, specialty choice.
• Strengthen your portfolio in a targeted way:
  • USCE in pediatrics (observerships, externships where appropriate)
  • Pediatric research or QI projects
  • Additional USMLE attempts (if needed and appropriate)
  • Improved English communication skills (if this was a concern)
• Clarify your long-term plan:
  • Reapply in pediatrics with a stronger application
  • Consider a preliminary or transitional year, then reapply
  • Or, for some, adjust to a different specialty with better alignment

Having a deliberate post-SOAP plan reduces anxiety and keeps you moving forward.

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Practical Tips and Common Pitfalls for IMGs in Pediatrics SOAP

Key Practical Tips

• Start SOAP preparation months ahead. Your future self during Match Week will be grateful.
• Know exactly what SOAP is and the rules (no direct calls/emails to programs unless they contact you).
• Organize your documents:
  • Pediatrics SOAP PS
  • Updated CV
  • Pediatrics-focused LoRs
  • ECFMG and visa documentation
• Use time zones to your advantage. Be aware of when programs may call or schedule interviews.
• Practice concise answers to the most likely interview questions.

Common Mistakes to Avoid

• Waiting until Match Week to think about SOAP.
• Applying randomly to 45 programs without considering IMG-friendliness or visas.
• Using a generic personal statement that doesn’t clearly convey your commitment to pediatrics.
• Sounding desperate or defensive during SOAP interviews.
• Ignoring nonverbal communication in video calls: dress professionally, maintain eye contact, and ensure a clean background.
• Misunderstanding what is SOAP:
  • It is not a negotiation or bargaining process.
  • It is a structured application and offer system with specific rules.

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FAQs: SOAP Preparation for Pediatrics IMGs

1. What is SOAP, and how is it different from the main pediatrics match?

SOAP (Supplemental Offer and Acceptance Program) is a post–main match process that allows unmatched or partially matched applicants to apply for unfilled residency positions. Unlike the main pediatrics match, where you submit rank lists and results are determined in one step, SOAP:

• Happens during Match Week
• Has multiple rounds of offers
• Limits you to 45 program applications
• Prohibits you from initiating contact with programs directly

For an international medical graduate, SOAP is essentially a second structured chance to enter pediatrics residency after the main peds match.

2. As an IMG, should I apply only to pediatrics programs in SOAP or also to other specialties?

Your strategy depends on your long-term goals:

• If your primary and long-term goal is pediatrics, prioritize categorical pediatrics positions in SOAP.
• If you are open to doing a preliminary or transitional year and reapplying to pediatrics later, consider a limited number of prelim IM or transitional programs.
• Avoid diluting your focus too much; programs can detect a lack of clear direction. Most IMGs serious about pediatrics focus SOAP applications mainly on peds plus, at most, a small number of strategically chosen prelim positions.

3. How can I stand out as an IMG during a brief SOAP interview for pediatrics?

You stand out by being:

• Clear and concise about your motivation for pediatrics and what you bring to their program.
• Specific in describing your pediatric clinical experiences (USCE if possible).
• Professional and composed, demonstrating resilience about not matching.
• Culturally and linguistically valuable, showing how you can relate to diverse families and children.
• Ready to start, with your visa and documentation prepared.

Concrete examples and a calm, mature tone matter more than long speeches.

4. If I fail to match through SOAP, what should I do to improve my chances for next year’s peds match?

Key steps include:

• Seek honest feedback from mentors and, if possible, program directors.
• Increase pediatrics-specific US clinical exposure (observerships, externships) and obtain strong LoRs.
• Address academic concerns:
  • Consider retakes or additional exams only if strategic and allowed.
  • Improve English communication if flagged.
• Get involved in pediatric research or community work to demonstrate ongoing commitment.
• Apply more broadly next year, including IMG-friendly and community-based pediatrics programs, and prepare a robust SOAP strategy in advance.

By approaching SOAP preparation deliberately and understanding how the process works for pediatrics, you place yourself in the best possible position to convert this intense week into the beginning of your pediatric residency career.