Essential SOAP Preparation Guide for IMGs in Transitional Year Residency

Understanding SOAP for the Transitional Year–Bound IMG

As an international medical graduate (IMG) aiming for a Transitional Year (TY) residency, Match Week and the Supplemental Offer and Acceptance Program (SOAP) can feel intense and confusing. Yet, for many IMGs, SOAP is a powerful second chance to secure a TY program that keeps you on track for your ultimate specialty.

This IMG residency guide will walk you through SOAP preparation step by step, with a specific focus on Transitional Year programs. You’ll learn what SOAP is, how it works, how to prepare in advance, and how to strategically target TY programs during the process.

What Is SOAP and Why It Matters for IMGs

In simple terms, SOAP (Supplemental Offer and Acceptance Program) is an organized, time-limited process during Match Week that helps unmatched or partially matched applicants apply to and accept positions in unfilled residency programs.

For an IMG targeting TY:

• SOAP is often the key backup plan if a categorical internal medicine, surgery, or another primary specialty spot does not materialize.
• Transitional Year programs frequently appear in SOAP, especially those in community hospitals or less competitive regions.
• SOAP can bridge your training gap, allowing you to start residency, build U.S. clinical experience, and re-apply to your preferred specialty later.

Understanding what is SOAP in operational terms:

• You apply via ERAS to a limited number of unfilled programs.
• Programs review applications and conduct rapid interviews (often virtual).
• There are four offer rounds (sometimes fewer, depending on the year) where you either accept or reject time-limited offers.
• Once you accept, you are bound to that program for that Match cycle.

For IMGs, preparation before Match Week is critical. Without it, the speed and rigidity of SOAP can be overwhelming.

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Pre-SOAP Self-Assessment: Are You Likely to Enter SOAP?

Your SOAP preparation should begin well before Match Week—ideally at the time you submit ERAS, and certainly by January or February.

1. Evaluate Your Match Risk as an IMG

Consider these red flags that raise your likelihood of entering SOAP:

• Low number of interviews (e.g., fewer than 8–10 total, depending on specialty competitiveness).
• No TY interviews despite applying to categorical programs.
• Significant red flags: exam failures, long gaps, older graduation date, visa complexity.
• Applying only to highly competitive specialties (e.g., dermatology, radiology, anesthesia) without enough safety programs.

If any of these apply, you should proceed with full SOAP readiness planning, even if you hope to match.

2. Clarify Your Transitional Year Strategy

Ask yourself:

• Do you see TY as a true backup (to re-apply to your desired specialty later)?
• Or as an integral component of your long-term plan (e.g., for advanced specialties requiring a PGY‑1, such as anesthesia, radiology, PM&R)?

This shapes how aggressively you will target a transitional year residency through SOAP versus preliminary or categorical positions in other specialties.

Key point: Many IMGs mistakenly ignore TY and prelim programs, then scramble during SOAP. Planning a deliberate TY backup pathway ahead of Match Week will significantly reduce stress.

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Building Your SOAP Toolkit Before Match Week

To succeed in SOAP residency opportunities, you must have core documents and structures ready to deploy within hours, not days. During SOAP, time is your scarcest resource.

1. Prepare Multiple Targeted Personal Statements

For a Transitional Year–focused IMG, prepare at least:

1. Transitional Year–Specific Personal Statement

   • Emphasize broad-based training, adaptability, and interest in multiple disciplines.
   • Highlight how TY’s structure fits your plan (e.g., “I plan to pursue Diagnostic Radiology, and a strong Transitional Year will develop my clinical acumen…”).
   • Show that you value rotational variety, teamwork, and foundational clinical skills.

2. Internal Medicine or Surgery–Oriented Statement (Optional)

   • Useful if you plan to apply to preliminary Internal Medicine or Surgery positions alongside TY programs in SOAP.

3. General SOAP Emergency Personal Statement

   • A flexible, less specialty-specific statement that can be quickly adjusted for unexpected program types.

Actionable tip:
Write and proofread all statements by early February. Store Word and PDF versions in an organized folder (e.g., SOAP_2026/Personal_Statements/).

2. Tailor and Update Your CV and ERAS Application

While you can’t overhaul ERAS during SOAP, you can:

• Ensure all experiences are up to date before ERAS locks for SOAP.
• Add any recent U.S. clinical experience, publications, presentations, or courses as early as possible.
• Confirm accurate visa status, contact information, and exam dates.

Prepare a one-page CV summary outside of ERAS for quick emailing if a program requests it during informal pre-SOAP contact (where permitted).

3. Secure Flexible Letters of Recommendation (LoRs)

For a Transitional Year applicant, strong general medicine or multi-disciplinary letters are especially valuable.

Aim for:

• At least 3 letters that are:
  • From U.S. attendings whenever possible.
  • Focused on clinical performance, reliability, and communication skills.
• At least 1 letter that explicitly supports you for a broad-based PGY‑1 year (e.g., “I highly recommend Dr. X for a Transitional Year or preliminary position in Internal Medicine or Surgery”).

Before February:

• Ask letter writers if they can support you for a TY or preliminary year.
• Confirm all letters are uploaded to ERAS and assigned to all relevant program types, including possible SOAP targets.

4. Set Up Logistics and Technology

SOAP happens fast. You may have only minutes to respond to a program email or schedule a phone interview.

Ensure you have:

• Stable internet and backup (hotspot, second location if needed).
• Quiet, professional space ready for last-minute video calls.
• Working webcam, microphone, and headphones.
• A professional SOAP interview outfit (conservative suit or equivalent) ready and cleaned.

Create a dedicated SOAP folder on your computer with:

• PDF copies of USMLE/COMLEX transcripts, ECFMG certificate, CV.
• Personal statement versions.
• Reference list (if asked).

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Strategic Targeting: How IMGs Should Approach TY Programs in SOAP

When unfilled positions are released on Monday of Match Week, you’ll see a list that may include:

• Transitional Year (TY) programs
• Preliminary Internal Medicine/Surgery
• Categorical Internal Medicine, Family Medicine, Psychiatry, Pediatrics, etc.
• Occasionally advanced positions (less common for SOAP use)

Your goal as an IMG is to decide where to spend your limited applications wisely.

1. Understand Transitional Year vs Preliminary vs Categorical

• Transitional Year Residency (TY Program)

  • Broad-based PGY‑1 with rotations across IM, surgery, ER, electives.
  • Ideal if your long-term goal is an advanced specialty or you want a strong clinical base before reapplying.
  • Often perceived as more flexible and less stressful than prelim surgery but more competitive than some prelim IM.

• Preliminary Internal Medicine or Surgery

  • PGY‑1 only, typically more focused (medicine wards or surgical services).
  • Common if you only need one year before advanced positions.
  • Some prelim surgery slots can be intense; prelim IM often more manageable.

• Categorical Programs

  • Offer full training (e.g., full 3 years in IM, 4 years in Psychiatry).
  • At SOAP, these may be in less competitive specialties or locations.
  • Good if you are open to practicing in that field long term.

For many IMGs:
If your ultimate goal is an advanced specialty (like radiology, anesthesia, PM&R, neurology), TY or prelim IM is often more aligned during SOAP than categorical IM (unless you are truly willing to switch specialties).

2. Prioritize Programs Based on Fit and Feasibility

Within the unfilled list, prioritize:

1. Programs that accept IMGs and/or sponsor visas

   • Quickly scan:
     • Past program lists or website.
     • FREIDA and residency review websites.
     • Any known data on IMG match history.

2. TY programs in less competitive regions

   • Community hospitals.
   • Non-coastal states.
   • Newly accredited TY programs.

3. Programs aligning with your profile

   • Similar prior IMG match patterns.
   • Willingness to consider your graduation year and USMLE scores.
   • Rotations that complement your long-term specialty aims (e.g., a TY heavy in medicine for future cardiology).

3. Plan Your 45-Program SOAP Application Strategy

ERAS limits how many applications you can send in SOAP rounds. Policies can evolve, but typically:

• You have a maximum number of applications across all SOAP-eligible programs (e.g., 45).

To optimize for a Transitional Year focus:

• Allocate:
  • A substantial portion (e.g., 15–25 apps) to TY programs.
  • The rest to preliminary IM/Surgery and potentially categorical safety specialties (FM, Psych, etc.) depending on your flexibility.

Example allocation for an IMG aiming for radiology with moderate risk profile:

• 20 Transitional Year programs (community, mid-tier academic).
• 15 Preliminary Internal Medicine programs.
• 10 categorical Family Medicine or Psychiatry programs as “ultimate backup.”

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Executing During SOAP Week: Timeline and Tactics for IMGs

Once Match Week starts, organization and speed are everything. Here’s how to navigate from Monday to Thursday effectively.

1. Monday Morning: SOAP Eligibility and Mindset

On Monday, NRMP informs you whether you are:

• Fully matched
• Partially matched (e.g., advanced match but no PGY‑1)
• Unmatched

Only eligible unmatched or partially matched applicants participate in SOAP.

If you are partially matched into an advanced position requiring a PGY‑1, your focus should be laser-targeted on Transitional Year residency and prelim programs that satisfy your advanced specialty’s prerequisites.

Mental reset:

• Acknowledge the disappointment; take 1–2 hours to process.
• Shift quickly into problem-solving mode.
• Remind yourself: many successful attendings found their pathway through SOAP.

2. Monday Afternoon: Reviewing the Unfilled List

Once the NRMP releases the list of unfilled programs:

1. Export or copy the list into a spreadsheet.
2. Filter by:
   • Transitional Year
   • Preliminary Internal Medicine
   • Preliminary Surgery
   • Categorical backup specialties
3. Mark each program with:
   • IMG-friendly? (Yes/Maybe/No/Unknown)
   • Visa support? (Yes/Maybe/No/Unknown)
   • Location preference (Green / Yellow / Red)
   • Deadline or any unique instructions from program websites.

Then, rank your targets:

• High priority: TY programs that are known IMG friendly or neutral, with visa support if needed.
• Medium: prelim IM; some categorical FM/Psych.
• Low: prelim surgery in high-intensity environments unless that is your clear choice.

3. Monday–Tuesday: Submitting Applications and Outreach

Once ERAS opens for SOAP applications:

• Submit all your applications as early as available. Timing matters.
• Attach the most relevant personal statement:
  • TY-specific PS for Transitional Year programs.
  • IM or Surgery-focused PS for prelim programs.
  • General PS if you must, but avoid mismatched content (e.g., “I want to be a surgeon” to a TY that barely includes surgery).

Programs may reach out by:

• ERAS messages
• Email
• Phone calls
• Video interview invites

Respond immediately and professionally:

• Use a standard professional email signature with phone number and ECFMG ID.
• Keep your phone on loud; ensure voicemail is professional and not full.

Important:
Direct unsolicited calls/emails to programs during SOAP may be restricted by NRMP rules. Carefully follow the current year’s SOAP communication regulations—typically, you may respond if they contact you first, and cold-contact is limited or prohibited.

4. Interviewing During SOAP

SOAP interviews are often:

• Short (10–20 minutes).
• Highly focused on:
  • Can you work hard?
  • Are you dependable?
  • Do you understand what this program offers?
  • Why Transitional Year, and why here?

Prepare concise answers to:

• “Why are you interested in a Transitional Year residency?”
• “What are your long-term goals?”
• “Tell me about a challenging clinical situation and how you handled it.”
• “Why did you go unmatched this cycle, and what have you learned?”

As an IMG, also be ready for:

• Visa status questions.
• Questions about adapting to U.S. clinical systems.
• Clarification of any gaps or exam failures.

Keep notes during each call:

• Program name, interviewer, key points they emphasized.
• Your impression: Strong / Neutral / Weak.

These notes will help you decide which offers to accept or decline during the offer rounds.

5. Offer Rounds: Making Smart, Rapid Decisions

SOAP typically runs four offer rounds (e.g., Wednesday–Thursday), each with specific time windows to accept or reject offers.

Key rules:

• You can receive multiple offers in a round but can accept only one.
• When you accept an offer, you are immediately removed from further SOAP consideration.
• If you reject or let an offer expire, that slot is lost to you for the rest of SOAP.

As a Transitional Year–focused IMG, plan your acceptance hierarchy in advance:

1. Top-tier TY programs (good educational structure, IMG friendly, acceptable location).
2. Solid TY or prelim IM in moderate-preference locations.
3. Any TY or prelim that fulfills your PGY‑1 requirement, even in less desirable settings.
4. Categorical backup only if you are genuinely willing to complete that specialty.

Do not over-idealize “prestige” at this stage. A well-structured community Transitional Year with supportive teaching can be more beneficial for your career than a big-name program where you are overworked and under-supported.

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After SOAP: Stabilizing Your Path and Planning Ahead

Whether you secure a Transitional Year position through SOAP or not, you need a clear post-SOAP plan.

1. If You Match Into a TY Program Through SOAP

Congratulations—you now have:

• A starting point in U.S. residency.
• An opportunity to build strong U.S. clinical letters.
• Time to strategically plan your post-TY specialty application (if you still need an advanced spot).

Next steps:

• Review the TY curriculum and identify rotations that align with your long-term goals (e.g., radiology electives, cardiology rotations, ICU).
• Discuss with your future program director:
  • Possibilities for mentorship in your desired specialty.
  • Opportunities for research, QI, or leadership.

During your TY:

• Excel clinically: be reliable, punctual, and proactive.
• Seek mentors who can write strong, specialty-aligned letters.
• Begin preparing for ERAS and the Match again if you still need an advanced or categorical position.

2. If You Do Not Match in SOAP

If SOAP ends without a position:

1. Decompress and reflect—take a brief period to process emotions.

2. Conduct a structured debrief:

   • Evaluate your application data: scores, attempts, YOG, visas.
   • Analyze where your interview numbers dropped.
   • Reflect on your SOAP strategy: program targeting, responsiveness, interview performance.

3. Develop a 12-month improvement plan:

   • Strengthen U.S. clinical experience (observerships, externships, research).
   • Address red flags: exam re-takes (if permissible), recent clinical work to cover gaps.
   • Improve communication and interviewing skills.

For many IMGs, the combination of better planning, more U.S. experience, and a stronger SOAP residency strategy the following year leads to success.

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FAQs: SOAP Preparation for IMGs Targeting Transitional Year

1. As an IMG, should I list Transitional Year programs on my main ERAS application, or rely on SOAP?

You should absolutely include Transitional Year programs in your main ERAS strategy if TY fits your long-term plan. Relying solely on SOAP is high-risk. Many strong TY programs fill during the main Match, and waiting for SOAP restricts your options. SOAP should be your backup, not your primary plan.

2. What is the difference between SOAP residency and the main Match for an IMG?

The main Match is a months-long application and interview process leading to a rank order list and a single Match result. SOAP residency is an emergency, time-limited process during Match Week where only unfilled positions are available, you have restricted applications, and must respond quickly to offers. For IMGs, SOAP is more compressed, more stressful, and generally offers fewer, less predictable options than the main Match.

3. How can I make my SOAP preparation stronger specifically for Transitional Year programs?

Focus on:

• A TY-focused personal statement explaining your interest in broad-based training and long-term goals.
• At least one letter of recommendation that explicitly supports you for a transitional or preliminary year.
• Targeting IMG-friendly TY programs early (researching program histories and policies).
• Practicing short, focused interviews where you clearly express why TY is an excellent fit for your career path.

4. If I accept a Transitional Year spot in SOAP, can I still apply for an advanced specialty later?

Yes. Many advanced specialties expect applicants to complete a TY or prelim year first. After or during your TY, you can:

• Re-enter the Match to secure an advanced position beginning after your TY.
• Use your TY experience and letters to present a stronger application.
• Coordinate timelines so that there is no gap between your TY and advanced specialty training.

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By preparing early, understanding what SOAP is in detail, and strategically targeting Transitional Year residency programs, you can turn a high-stress week into a real opportunity. For an international medical graduate, SOAP residency success often comes down to organization, flexibility, and clarity about your long-term goals—start now, so when Match Week arrives, you’re ready.