Essential SOAP Preparation Guide for IMGs in Psychiatry Residency

Understanding SOAP and Its Role in the Psychiatry Match for IMGs

The Supplemental Offer and Acceptance Program (SOAP) is often misunderstood, especially by international medical graduates (IMGs). For psychiatry residency applicants, SOAP can be a second chance to enter training in a specialty that is increasingly competitive and evolving.

What is SOAP?
SOAP is a structured, time‑limited process run by the NRMP during Match Week that allows eligible unmatched or partially matched applicants to apply to unfilled residency positions. It replaces the old “Scramble” with a more organized and transparent system.

Why SOAP matters specifically for psychiatry and IMGs:

• Psychiatry is popular and getting more competitive, but unfilled positions still appear every year, often in:
  • Community programs
  • Newer programs
  • Less geographically popular locations
• Many psychiatry programs are IMG-friendly, but they may use SOAP to fill remaining positions quickly with motivated, prepared applicants.
• For an international medical graduate, a strong SOAP preparation plan can turn a disappointing Match result into a successful entry into psychiatry or a related stepping‑stone specialty.

Key SOAP Concepts You Must Know

• Eligibility:
  You may participate in SOAP if:

  • You are registered for the Main Residency Match (NRMP), and
  • You are eligible to start training on July 1 (e.g., ECFMG certified or expected to be before start date), and
  • You are fully unmatched or partially matched (i.e., matched to a preliminary or advanced position but not a complete PGY‑1+ program).

• When SOAP happens:

  • Starts Match Week Monday at 11:00 AM ET when you learn your match status.
  • Ends Thursday of Match Week after multiple offer rounds.
  • It is extremely fast-paced. The time to act is measured in minutes and hours, not days—which is why SOAP preparation must happen before Match Week.

• Psychiatry in SOAP:

  • Not all unfilled psychiatry positions will appear in SOAP; some remain unfilled for visa or institutional reasons.
  • Many psych positions that do appear may:
    • Require US clinical experience (USCE)
    • Prefer or require ECFMG certification at the time of SOAP
    • Be in less desirable locations or smaller programs
  • Some IMGs consider applying in SOAP to prelim medicine, transitional year, or family medicine as a strategic stepping‑stone if psych positions are very limited.

Understanding this framework is the first step in a serious IMG residency guide for psychiatry SOAP preparation.

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Pre‑SOAP Preparation: What Every IMG in Psychiatry Must Do Before Match Week

For the SOAP process, 99% of the real work should be done before Match Week starts. If you wait until Monday of Match Week, it is already too late to build a strong SOAP application.

1. Confirm Eligibility and Documentation Early

As an international medical graduate, paperwork can make or break your SOAP chances.

Action steps:

• ECFMG certification:

  • Ideally, be fully ECFMG certified before Match Week.
  • If you are not yet certified, ensure all exams and documents are submitted and that ECFMG has no pending requirements.
  • Monitor OASIS/ECFMG and email regularly in the months before Match.

• USMLE status:

  • Step 1 and Step 2 CK should be passed and reported.
  • If you have a recent fail, prepare a brief, honest explanation for your SOAP personal statement or interviews (if asked).

• Visa considerations:

  • Clarify your visa eligibility (J‑1, H‑1B, or no visa sponsorship needed).
  • Understand that some programs will exclude applicants who need H‑1B sponsorship during SOAP to move faster.
  • Have a ready sentence in your PS and during interviews:
    • Example: “I am eligible for J‑1 visa sponsorship through ECFMG and have already reviewed the process.”

Why this matters: Programs have very little time during SOAP. They often favor applicants with clear, low‑risk paperwork who can start on time.

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2. Optimize Your ERAS for SOAP Before Match Week

You do not upload a new full ERAS for SOAP; you modify your existing ERAS. This means your pre‑Match ERAS must be SOAP‑ready.

Update and Tailor Your Key Components

1. CV / Experiences:

   • Ensure all USCE, observerships, externships, and research are:
     • Properly dated
     • Clearly described
     • Explicitly linked to psychiatry where possible
       • Example: “Inpatient psychiatry clerkship – exposure to mood disorders, psychosis, interdisciplinary care.”
   • Emphasize work with:
     • Vulnerable populations
     • Mental health settings
     • Addiction services
     • Primary care with behavioral health components

2. Letters of Recommendation (LoRs):

   • Aim for at least one letter from a psychiatrist, ideally from US experience.
   • Additional letters can be:
     • Internal medicine or family medicine (especially if you might apply to those through SOAP)
     • Research mentors in psychiatry/behavioral science
   • Upload all letters well before Match Week; you will not have time later.

3. Personal Statement (PS) Strategy for SOAP:

   • Create at least two versions:
     • Primary: Psychiatry-focused SOAP PS
     • Secondary: Non-psych or broad clinical PS (for internal medicine, family medicine, transitional year, prelim medicine)
   • Psych SOAP PS should:
     • Be shorter and more direct than your original main Match PS (1 page maximum).
     • Focus on:
       • Your clinical readiness on Day 1
       • Your maturity, reliability, and communication
       • Your understanding of bread-and-butter psychiatry (depression, anxiety, psychosis, substance use, suicide risk, emergency stabilization)
       • Evidence you can manage high-volume, diverse clinical workload
   • Example angle:
     • “During my psychiatry observership at [hospital], I worked closely with residents managing acute psychosis, substance withdrawal, and suicidal patients. Under supervision, I practiced risk assessment frameworks and collaborated with social work and nursing teams, which solidified my commitment to a career in psychiatry and prepared me for residency demands.”

4. Photo, demographics, and other sections:

   • Professional, neutral, and consistent.
   • Remove any unprofessional or unnecessary details.

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3. Build a Strategic SOAP List in Advance

You will not know exactly which programs will be unfilled, but you can forecast likely options and prepare.

Research now:

• Use:
  • NRMP’s “Results and Data” reports from prior years
  • FREIDA
  • Program websites, especially those labeled “IMG-friendly”
• Identify:
  • Psychiatry programs that:
    • Previously had unfilled positions
    • Frequently interview or rank IMGs
    • Provide J‑1 sponsorship
    • Are in less competitive states/regions

Create a spreadsheet with:

• Program name and ACGME ID
• Location and type (university, community, hybrid)
• Visa policy (J‑1 / H‑1B / no sponsorship)
• IMG percentage historically
• Required USMLE minimums (if published)
• Any specific requirements (ECFMG by rank list deadline, etc.)
• Contact email and program coordinator

This becomes your personal IMG residency guide for potential SOAP targets.

Plan different “tiers” of specialties:

• Tier 1 – Psychiatry (preferred):

  • All potentially IMG-friendly programs
  • Extra attention to less popular locations

• Tier 2 – Transitional Year / Preliminary Internal Medicine:

  • These can be strong stepping stones if psychiatry is closed.
  • One year in a good clinical environment will improve your candidacy for a later psych match.

• Tier 3 – Family Medicine or Internal Medicine categorical (if aligned with your long-term goals):

  • For some applicants, this is a true backup rather than a stepping stone.

During SOAP, you can apply to a maximum of 45 programs total across all specialties, so your preparation should focus on prioritization, not just volume.

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The SOAP Week Timeline and What to Do Each Day

SOAP is highly structured. Knowing exactly what happens each day reduces panic and improves your performance.

Monday: Status Notification and Emotional Control

11:00 AM ET – You learn your match status.
Options include: fully matched, partially matched, or unmatched.

If you are fully unmatched or partially matched and eligible for SOAP, your SOAP preparation begins immediately.

Action steps:

• Allow yourself a short, structured emotional break (30–60 minutes). Disappointment is normal.
• Then switch into problem-solving mode:
  • Confirm SOAP eligibility on NRMP.
  • Log into ERAS and review your application one last time.
  • Finalize personal statements you will use for psychiatry and any backup specialties.

Tuesday Morning: List of Unfilled Programs Released

11:00 AM ET Tuesday – The List appears in ERAS/NRMP.

You will see all unfilled programs, including psychiatry. This is the moment your pre‑SOAP research pays off.

Action steps:

1. Filter for psychiatry first:

   • Check:
     • PGY‑1 categorical vs. PGY‑2/advanced
     • Visa requirements
     • Location preferences (but be flexible)

2. Apply pre-defined tiers:

   • Tier 1: All acceptable psychiatry programs that sponsor your visa and match your minimal criteria.
   • Tier 2: Other specialties you identified as backup (TY/prelim, FM, IM).
   • Remember: Total maximum = 45 programs.

3. Submit applications early on Tuesday:

   • The earlier you apply, the earlier programs can review you, but quality of choices matters more than minutes.
   • Use your psychiatry PS for all psychiatry programs; use your backup PS for non‑psych programs.

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Program Review and Interviews (Tuesday–Thursday)

After you submit, programs start reviewing applications, scheduling interviews, and forming rank lists.

Be reachable at all times:

• Keep:
  • Phone charged and with you.
  • Email notifications ON.
  • Zoom/Teams/Skype account tested and ready.
• Respond quickly but professionally.

Typical SOAP interviews:

• Often short and focused (10–20 minutes).
• May be:
  • Phone calls
  • Video interviews
  • Quick panel interviews

Common psychiatry SOAP interview questions for IMGs:

• “Why did you not match in the main cycle?”
• “Why psychiatry, and why now?”
• “Tell me about a challenging patient with depression/psychosis.”
• “How do you handle language and cultural differences with patients?”
• “How will you adjust to the US healthcare system?”

Prepare brief, structured answers:

• Use the STAR format (Situation, Task, Action, Result) for clinical examples.
• Be honest but solution-oriented when addressing not matching:
  • Example: “I had limited US clinical experience at the time of application; since then, I completed an observership at X, strengthened my understanding of US systems, and obtained a new letter. I am confident I can now transition smoothly into residency.”

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Offer Rounds (Wednesday–Thursday)

SOAP has multiple offer rounds (usually four) over two days.

• If a program ranks you and you rank them (informally through communication), offers may appear during these rounds.
• When you receive an offer, you usually have a very short window (around two hours) to accept or reject.

Important rules:

• If you accept an offer, your SOAP participation ends and you’re committed to that program.
• If you reject an offer, you cannot receive another offer from that same program, but you can still get offers from other programs in later rounds.

For an IMG focused on psychiatry:

• Think carefully but realistically:
  • A less ideal geography is usually worth accepting if it is a categorical psychiatry position.
  • If the offer is for a prelim/TY or a non-psych categorical, weigh it against:
    • Your long-term plan
    • Your exam scores and profile (how likely are you to re-match into psychiatry?)
    • Financial, visa, and personal constraints

In many cases, for IMGs with moderate profiles, accepting a reasonable SOAP offer is more strategic than hoping for an ideal match next year with no guarantee.

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Psychiatry‑Specific Strategy: Positioning Yourself as a Strong SOAP Candidate

Because psychiatry is a people‑centered specialty, how you present yourself matters as much as your exam scores during SOAP.

1. Emphasize Core Psychiatry Competencies

When talking to programs, highlight:

• Communication skills
  • Discuss examples of working with patients with:
    • Limited insight
    • Language barriers
    • Stigma-related concerns
• Empathy and non-judgmental attitude
• Teamwork:
  • Collaborating with social workers, therapists, nurses, and families.
• Risk assessment:
  • Suicidality
  • Homicidality
  • Self-harm
• Cultural competence:
  • As an IMG, your multicultural background can be an asset:
    • “My experience in [home country] helps me understand how culture shapes symptom expression, explanatory models of illness, and attitudes toward treatment.”

2. Address the “Why Psychiatry?” Question Powerfully

Programs are wary of applicants who seem to have chosen psychiatry by default. Prepare a clear narrative:

• Link to:
  • Meaningful patient stories
  • Specific experiences in mental health settings
  • Your own reflection on the mind–body connection
• Show that you understand modern psychiatry:
  • Not just talk therapy, but:
    • Psychopharmacology
    • Collaborative care models
    • Integration with primary care
    • Community mental health and public psychiatry

Example summary answer:

“I chose psychiatry because I am most engaged when I am understanding a patient’s story over time, using both biological and psychosocial frameworks. In my observership at [hospital], I saw how antipsychotics, therapy, social services, and family work together to stabilize a patient. I want a career where I can think longitudinally, build trust, and support vulnerable patients across their recovery journey.”

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3. As an IMG, Turn Potential Weaknesses into Strengths

Common concerns programs have about IMGs:

• Adjustment to US healthcare system
• Communication in high-stress situations
• Understanding of documentation and legal aspects (especially important in psychiatry)

Prepare to proactively reassure programs:

• Mention:
  • Any US clinical experience where you:
    • Used EMR systems
    • Participated in handoffs
    • Observed involuntary commitment processes
  • Your comfort with English, including:
    • Presenting cases
    • Writing notes
    • Communicating bad news compassionately

You can say:

“During my psychiatry observership at [institution], I practiced presenting cases using the U.S. format, wrote sample notes reviewed by attendings, and observed how residents managed documentation for involuntary admissions and capacity assessments. This experience reduced the learning curve I will face as an intern.”

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4. If You SOAP into a Non‑Psychiatry Spot

Sometimes, despite meticulous SOAP preparation, psychiatry positions are extremely limited or filled early. You may receive offers in:

• Transitional Year
• Preliminary Medicine
• Family Medicine
• Internal Medicine

If you accept such a position with the intention of pursuing psychiatry later:

• Excel clinically:
  • Residents with strong intern year evaluations are much more competitive for a later psych match.
• Seek psychiatry rotations or electives during your off months.
• Maintain contact with psychiatry faculty and ask for letters.
• Plan a clear timeline for reapplying:
  • Taking Step 3 (if appropriate)
  • Updating ERAS with robust US evaluations

Your SOAP preparation mindset should therefore include both direct psychiatry entry and strategic stepping‑stone planning.

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SOAP Preparation Checklist for IMGs Applying to Psychiatry

Use this as a rapid review in the weeks before Match:

1. Eligibility & Documents

   • NRMP registered and eligible for Match and SOAP
   • ECFMG certified or on track with no missing items
   • Visa strategy clarified (J‑1/H‑1B/none)

2. ERAS Application

   • CV updated with clear psychiatry-related experiences
   • All transcripts, MSPE, and LoRs uploaded and assigned
   • At least one strong psychiatry LoR, ideally US-based
   • Professional photo in place

3. Personal Statements

   • Psych SOAP PS (1 page) – focused, clinical, convincing
   • Backup PS for internal medicine/FM/TY/prelim if needed

4. Program Research (Pre‑SOAP)

   • Spreadsheet of IMG-friendly psychiatry programs
   • Notes on previous unfilled programs, visa policies
   • Tiered backup specialties identified

5. Technical & Logistical Prep

   • Stable internet, working headphones, quiet interview space
   • Zoom/Teams/Skype tested with professional background
   • Phone and email notifications turned on for Match Week

6. Interview Readiness

   • Practiced answers about:
     • Why psychiatry?
     • Why you did not match (if applicable)
     • Strengths and weaknesses
     • Challenging patient encounters
   • Short “elevator pitch” about yourself as a psychiatry candidate
   • Familiarity with basics of suicide risk assessment and common psych disorders

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FAQs: SOAP Preparation for International Medical Graduate (IMG) in Psychiatry

1. As an IMG, is it realistic to secure a psychiatry residency through SOAP?
Yes, it is possible but not guaranteed. Each year, a variable number of psychiatry programs go unfilled and enter SOAP, often in less competitive regions. IMGs do secure these spots, especially those with:

• Solid USMLE scores
• Some US clinical experience in psychiatry
• Clear commitment to the field
  However, because the number of psych SOAP positions is limited and competition is high, you should also prepare a backup SOAP strategy (e.g., TY/prelim/IM/FM) rather than relying only on psychiatry.

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2. Should I only apply to psychiatry in SOAP, or also to other specialties?
This depends on your risk tolerance and long-term goals:

• If you are strongly committed to psychiatry but have moderate or weaker credentials, it is usually safer to:
  • Apply broadly to psychiatry programs and
  • Include a set of backup programs in other specialties (TY, prelim, or FM/IM) you would realistically consider.
• If your profile is very strong and you can afford to wait a year if needed, you may choose to focus mainly on psychiatry.
  For most IMGs, a mixed, strategic application offers the best balance of opportunity and safety.

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3. What are the most important differences between SOAP and the regular psych match for an IMG?
Key differences:

• Timeline: SOAP is compressed into a few days; decisions are made quickly.
• Transparency: Programs see only candidates who applied through SOAP and are eligible; you cannot contact programs to solicit positions outside the system.
• Flexibility: There is less time to build relationships or “show interest.” Your ERAS file and a short interview carry more weight.
• Scope: The number of available psychiatry positions is smaller than in the main Match, and they tend to be in certain geographic areas.

Because of this, SOAP preparation emphasizes logistics, speed, and clarity of message, while the main Match allows more time for networking and lengthy interviews.

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4. How should I explain not matching if I am asked during SOAP psychiatry interviews?
Be honest, concise, and growth-oriented. For example:

• Identify one or two realistic factors:
  • Late exam scores
  • Limited US experience
  • Narrow geographic preferences
• Then focus on what you learned and what you changed:
  • “I broadened my geographic preferences.”
  • “I completed an additional observership and updated my letters.”
  • “I refined my understanding of the US system and improved my interview skills.”

Avoid blaming others or sounding bitter. Programs want to see that you can reflect, adapt, and persevere, which are essential attributes for a future psychiatrist.

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By approaching SOAP with a structured plan, realistic expectations, and a clear psychiatric identity, an international medical graduate can transform Match Week from a crisis into a genuine opportunity. With early SOAP preparation, strong documentation, a thoughtful program strategy, and confident interview skills, you significantly increase your chances of starting your journey in psychiatry—or positioning yourself for a successful psych match in the near future.