Mastering SOAP Preparation for Preliminary Medicine Residency Success

Understanding SOAP and Its Role in a Preliminary Medicine Year

The Supplemental Offer and Acceptance Program (SOAP) can dramatically change the trajectory of your residency path—especially if you’re targeting a preliminary medicine year (prelim IM) as a bridge to advanced training (e.g., neurology, anesthesiology, radiology, PM&R, dermatology).

Many applicants only start learning “what is SOAP” after they discover they are unmatched or partially matched on Monday of Match Week. That’s too late to prepare well.

This guide walks you through SOAP preparation specifically for Preliminary Medicine, with practical steps you can start long before Match Week. You’ll learn how to:

• Assess your SOAP risk and build a backup strategy
• Target prelim IM positions intelligently
• Prepare SOAP documents and communication scripts
• Navigate the four SOAP rounds strategically
• Protect your long-term specialty and fellowship goals

Throughout, you’ll find tips tailored to applicants seeking preliminary medicine for one year, not categorical IM.

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1. SOAP Fundamentals for Preliminary Medicine Applicants

1.1 What is SOAP?

SOAP is an organized, time-limited process run by the NRMP during Match Week to help unmatched or partially matched applicants fill unfilled residency positions.

Key points:

• It occurs Monday–Thursday of Match Week.
• Participation is by invitation only (NRMP notifies eligible applicants Monday).
• All communication with programs must occur within ERAS or via NRMP-permitted methods—no cold-calling or emailing program directors outside approved channels.
• Positions filled through SOAP are binding once you accept an offer.

For prelim medicine applicants, SOAP is often a second chance to secure a PGY-1 year needed before entering an advanced PGY-2 specialty.

1.2 Why SOAP Is Especially Important in Preliminary Medicine

A preliminary medicine year is often:

• A required clinical year before advanced specialties (e.g., neurology, radiology, anesthesiology, derm, ophthalmology).
• A path for applicants who want more US clinical experience and time to reapply.
• A bridge for IMGs or reapplicants to strengthen their profile.

However, prelim IM positions can be:

• Competitive at top academic centers
• Vulnerable to last-minute shifts (e.g., spots converting from categorical to prelim or vice versa)
• Concentrated in certain regions (often urban centers and large hospitals)

SOAP is a critical safety net if:

• You match into an advanced position but not into a prelim year.
• You don’t match at all and need any clinical PGY-1 to stay on track.
• Your original prelim applications were too narrow.

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2. Assessing Your SOAP Risk and Building a Back-Up Plan

Preparation starts months before Match Week. Good SOAP preparation means decreasing your likelihood of needing SOAP—and being ready if you do.

2.1 Risk Factors for Needing SOAP in Prelim IM

You’re at higher risk of entering SOAP if one or more of these apply:

• You applied to few prelim medicine programs (e.g., <20–25, depending on competitiveness).
• You targeted only top-tier academic or big-name urban centers.
• Your USMLE/COMLEX scores are below national averages for prelim IM.
• You are an IMG or non-US IMG with limited US clinical experience.
• You ranked only advanced programs but very few PGY-1 prelim options.
• You had late exam scores, visa issues, or large gaps in training.

Your SOAP preparation should be inversely proportional to your odds of matching directly—the more risk, the more detailed your SOAP plan.

2.2 Pre–Match Week Back-Up Strategy

Starting in the fall and winter before Match:

1. Broaden Your Program List

   • Include a range of community and university-affiliated community prelim IM programs.
   • Consider geographically flexible locations where competition may be less intense.
   • Avoid applying only to ultra-competitive metro areas.

2. Clarify Your Priorities for a Prelim Year
   Decide what matters most if you’re SOAPing:

   • Location vs. guaranteed position
   • Teaching/academic exposure vs. service-heavy roles
   • Workload (ICU, night float, ED rotations)
   • Support for research or specialty application prep

3. Discuss Scenarios with Mentors
   Schedule a conversation with:

   • Your home program director or clerkship director
   • Specialty advisors in your target advanced field
   • Mentors who understand the SOAP landscape

   Ask them:

   • “If I enter SOAP, should I prioritize any prelim IM or consider other prelims (surgery, transitional year)?”
   • “Which types of prelim programs align best with my long-term goals?”
   • “Would a community prelim be acceptable to my preferred PGY-2 specialty?”

4. Understand Your Advanced Specialty’s Flexibility

   • Some specialties (e.g., neurology, anesthesiology) may accept prelim IM or transitional year.
   • Others are more strict about medicine-heavy training.
   • Confirm in advance what your field expects from a preliminary medicine year.

This framework will inform your priorities if you find yourself SOAPing on Monday of Match Week.

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3. Concrete SOAP Preparation Steps Before Match Week

You cannot predict exactly which prelim medicine programs will be in SOAP, but you can set up tools and documents so you’re not starting from zero.

3.1 Build a Personal SOAP Playbook

Create a dedicated SOAP Playbook (digital folder + written notes). Include:

• A SOAP timeline (with key NRMP and ERAS deadlines).
• Your personal contact info template (for fast communication).
• Draft email and message templates for program communication (more on this below).
• An updated CV in PDF form.
• A simple table for quickly tracking:
  • Programs applied to
  • Interview invitations
  • Ranking priority

This playbook lets you respond quickly when time is compressed during SOAP.

3.2 Prepare Your ERAS Materials for SOAP

During SOAP, you’ll reuse your ERAS application, but targeted adjustments can strengthen your prelim IM appeal.

1. Personal Statement Strategy
   For prelim medicine SOAP applications, you may want:

   • A primary personal statement focused on your long-term specialty goals and how a rigorous prelim medicine year prepares you for them.
   • A shorter prelim IM–oriented statement emphasizing:
     • Commitment to hard work as an intern
     • Ability to handle acute and chronic medical illness
     • Teamwork and communication skills
     • Adaptability and resilience

   Save this as a separate document so it’s ready to upload and assign to SOAP programs.

2. Letters of Recommendation (LoRs)

   • Ensure you already have 2–3 strong internal medicine letters (ideally from inpatient rotations or sub-internships).
   • If you applied primarily to a different specialty (e.g., radiology, anesthesia), make sure you still have at least:
     • 1 letter from your target specialty
     • 1–2 from IM or inpatient services
   • Confirm in advance that letters are universal, not addressed to one program.

3. CV and Experience Updates

   • Add any late publications, QI projects, case reports, or leadership roles.
   • Highlight:
     • Inpatient responsibilities
     • Night float or call experiences
     • EHR skills, procedures (paracentesis, thoracentesis if any exposure), and common medicine competencies

   This extra detail reassures programs that you’re ready for floor and ICU work.

3.3 Construct a Flexible Program Target List

You won’t know the exact unfilled progams before SOAP begins, but you can:

• Identify prelim IM programs nationwide from FREIDA/ERAS early in the season.
• Flag:
  • Programs more likely to have fluctuating positions (large community hospitals, new or expanding programs).
  • Regions you’re willing to move to on short notice.
• Group them into categories:
  • “High priority”: Acceptable location + good training
  • “Moderate priority”: Less ideal location, but strong training
  • “Safety”: Places you would still accept if they were the only option

The purpose is not to guess the SOAP list but to pre-decide your flexibility so you don’t deliberate under time pressure.

3.4 Prepare Communication Templates

During SOAP, you must comply with NRMP rules, but program-initiated communication does occur.

Draft in advance:

1. Short Interest Message (200–250 words)
   Use this if programs can see messages or notes (depending on year’s ERAS functionality):

   • Introduce yourself concisely (name, school, year, visa status if relevant).
   • State clearly that you are genuinely interested in a Preliminary Medicine year.
   • Tie 1–2 program features (size, teaching focus, patient population) to your goals.
   • Emphasize work ethic and readiness to contribute from day one.

2. Phone Script for Program-Initiated Calls
   Sometimes PDs or coordinators call during SOAP:

   • 2–3 sentence overview of who you are.
   • 1–2 sentence explanation of why you want a prelim IM year there.
   • 1 sentence clarifying your advanced specialty goals and how you’ll be a strong intern.
   • A prepared question or two demonstrating genuine interest (not about salary or time off).

Rehearse these briefly out loud so you sound calm and concise if contacted unexpectedly.

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4. Strategy During Match Week: Executing Your SOAP Plan

Once Monday of Match Week arrives, SOAP moves on a strict schedule. Good preparation allows you to move surgically, not reactively.

4.1 Monday Morning: Confirming Status and Stabilizing

If you receive notice from NRMP that you are eligible for SOAP:

1. Accept the Reality Quickly

   • Allow yourself a short emotional response, then shift into action mode.
   • Reach out immediately to:
     • Your dean’s office
     • A trusted mentor or advisor
     • If you matched into an advanced position but not prelim IM, also notify that program.

2. Clarify Your Exact Situation

   • Are you:
     • Completely unmatched?
     • Matched into an advanced program but no prelim?
     • Partially matched (e.g., prelim match but no advanced)?

   Your SOAP approach will differ:

   • Scenario A: Matched to advanced, missing prelim
     • SOAP priority: prelim IM (or acceptable alternative PGY-1) in time to start your PGY-2.
   • Scenario B: Completely unmatched
     • Broader scope: prelim IM, categorical IM, transitional year, or other prelims depending on your long-term goals.

3. Pull Up the List of Unfilled Programs
   At the designated time, NRMP releases the List of Unfilled Programs to SOAP-eligible applicants.

   Now you must align:

   • The national list
   • Your pre-built priority framework
   • Your personal constraints (geography, visas, finances, family)

4.2 Selecting Programs to Apply to During SOAP

Within SOAP you are typically limited to 45 total applications across all rounds (confirm for your specific year).

For a prelim medicine focus:

1. Prioritize Prelim IM First (If You Already Have an Advanced Match)

   • Check for prelim internal medicine positions at any institution.
   • Don’t hesitate to include:
     • Community hospitals
     • Less familiar regions
   • Your main criteria:
     • ACGME-accredited
     • Reasonable reputation or neutral (avoid known severe red flags if possible)

2. Balance Quantity and Quality (If You’re Completely Unmatched)

   • Apply broadly to:
     • Prelim IM
     • Categorical IM
     • Transitional year
     • Possibly other prelims (surgery, etc.) if acceptable to your long-term specialty
   • Keep preliminary medicine year positions high on your list if your goal is an IM-based training path.

3. Avoid Overly Narrow Choices

   • Many applicants fail in SOAP by:
     • Applying only to major academic centers
     • Rejecting community or peripheral programs that could’ve offered solid training

   A less-famous but stable prelim IM program is far better than no PGY-1. Your future fellowship or attending career will rarely hinge on the name of your preliminary institution.

4.3 Interviews and Communication During SOAP

Programs may conduct phone or virtual interviews in compressed time frames.

• Be reachable at all times
  • Keep your phone charged and ringer on.
  • Check email frequently.
• Maintain a professional environment for calls/video
  • Quiet background, business-casual attire if on video.
  • Keep a brief program notes sheet near you for reference.

During the conversation:

• Emphasize:

  • Your strong work ethic and reliability
  • Comfort in busy inpatient environments
  • Willingness to take on night float, ICU rotations, cross-coverage
  • Team-player mentality and communication skills

• Clarify your situation if needed (e.g., “I am already matched into an advanced radiology position and need a strong prelim medicine year.”)

Avoid:

• Asking for guarantees (“Will you rank me first?”)
• Complaining about the Match process or past interviews
• Oversharing negative experiences

4.4 Ranking Offers and Rounds of SOAP

SOAP typically has multiple offer rounds on Wednesday and Thursday.

Key principles:

1. Any Accepted Offer is Binding

   • Once you accept a SOAP offer, you are removed from further SOAP participation.
   • Do not accept an offer unless you are prepared to attend that program.

2. Create a Provisional Priority List
   Before offers are extended, rank your top possible outcomes:

   • Tier 1: Ideal or very strong prelim IM programs
   • Tier 2: Acceptable prelim IM or categorical IM
   • Tier 3: Less optimal location or program, but still better than going unmatched
   • Tier 4: Would not accept (don’t apply)

3. Use Each Round Strategically

   • Early rounds: Aim for your higher-priority programs.
   • Later rounds: Consider widening your acceptance range if no offers have come in.

Remember: a demanding but legitimate preliminary medicine year is often a launchpad to a successful PGY-2 and beyond.

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5. Life After SOAP: Making the Most of a Prelim Medicine Year

Once you secure a prelim IM position—via SOAP or otherwise—your focus shifts to maximizing its value.

5.1 Reframing a SOAP Prelim Year Positively

Even if SOAP was not your original plan, a preliminary medicine year can offer:

• Intense exposure to core clinical medicine
• Robust inpatient experience valued by many specialties
• Networking with subspecialists who can support your later applications
• Opportunities for QI, teaching, and research despite the heavy workload

Approach it as:

• A 12-month professional boot camp in patient care
• A way to prove you can function as a strong resident in any system
• A period to refine your clinical judgment and efficiency

5.2 Protecting Your Long-Term Goals

If you still aim to enter a specific advanced specialty (e.g., derm, radiology, anesthesia):

• Seek out elective time (if any) in your target field, or at least in related areas.
• Maintain close contact with mentors from:
  • Your medical school
  • Your advanced specialty
  • Your prelim IM program
• Plan for future application cycles:
  • Identify projects that are feasible given intern hours (case reports, short QI projects).
  • Keep a log of notable clinical experiences that can later inform personal statements and interviews.

5.3 Managing Burnout and Well-Being

Prelim IM years are often known to be service-heavy. To survive and thrive:

• Learn to triage tasks efficiently (prioritize sickest patients, time-sensitive orders).
• Build peer support with co-interns and senior residents.
• Use downtime realistically (rest, brief exercise, meal prep if possible).
• Seek help early if you feel burnt out or unsafe; residency is hard, but you’re not supposed to do it alone.

A strong performance in a demanding prelim medicine year—especially one obtained through SOAP—demonstrates resilience and professionalism that future programs respect.

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6. Common Pitfalls and How to Avoid Them

6.1 Over-Focusing on Program Prestige

In SOAP, prestige matters far less than:

• Accreditation status
• Work environment and training quality
• Compatibility with your long-term specialty goals

Don’t reject a solid community prelim IM spot in hopes that a big-name institution might appear in a later round.

6.2 Poor Communication with Advanced Programs

If you are matched to an advanced program but SOAPing for prelim IM, maintain transparent communication:

• Inform them as soon as you know you’re SOAP-eligible.
• Ask whether they have:
  • Affiliated prelim IM or transitional year programs
  • Recommendations on acceptable PGY-1 pathways
• Occasionally, advanced programs can advocate on your behalf with affiliated prelims.

6.3 Violating SOAP Communication Rules

NRMP strictly limits:

• When and how programs and applicants can communicate
• What coordinators can say outside ERAS or official channels

Do not:

• Cold-email or call a program director before or outside allowed windows.
• Ask faculty to directly lobby programs in ways that violate NRMP rules.

Follow your dean’s office guidance and the NRMP SOAP guidelines for your application year.

6.4 Not Preparing Emotionally

SOAP week is intense. Prepare by:

• Setting expectations that SOAP is not failure, but a standard contingency path.
• Planning a small support system (friends, family, mentors) who understand the timeline and can be available.
• Reminding yourself: one difficult week does not define your entire career trajectory.

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FAQs About SOAP Preparation in Preliminary Medicine

1. If I already matched into an advanced position but not a prelim, do I have to SOAP only into Preliminary Medicine?

Not always, but often yes or strongly preferred. Many advanced specialties accept:

• Prelim Internal Medicine
• Transitional Year (TY)
• Sometimes Prelim Surgery or other prelims (depends on specialty and program)

You should check with your advanced program:

• Some require a medicine-heavy PGY-1, making prelim IM or TY the best choice.
• Others are flexible but still prefer IM-based training.

During SOAP, prioritize preliminary medicine year positions and transitional years that meet your advanced program’s requirements.

2. Can I SOAP into a categorical Internal Medicine position instead of a prelim IM year?

Yes. If categorical IM programs are available and you’re open to internal medicine long term, a categorical IM spot may be a stronger long-term option than a one-year prelim:

• You gain a full three-year pathway to board certification.
• You keep doors open for IM fellowships (cards, GI, etc.).
• You can still later try to transition into your desired advanced specialty, though it may be more complicated.

If you already matched into an advanced PGY-2, a categorical IM spot may not align with that commitment, so coordinate with all relevant programs before deciding.

3. How many SOAP programs should I apply to for prelim IM?

Within the overall application cap (often 45 total programs for all specialties during SOAP), many applicants seeking prelim medicine:

• Apply to as many prelim IM programs as possible that are acceptable in terms of:
  • Visa support (if needed)
  • Location (broad but realistic)
  • Accreditation status

If you are only missing a PGY-1 year (advanced position secured), it is reasonable to dedicate most of your SOAP applications to prelim IM and TY programs that meet your advanced specialty’s PGY-1 requirement.

4. What if I don’t get any offers in SOAP—do I still have options?

Yes, though options are more limited:

• Some unfilled positions may be available after SOAP for non-SOAP processes, depending on NRMP rules and program needs.
• You can:
  • Reapply in the next Match cycle.
  • Strengthen your application with research, US clinical experience, or additional exams.
  • Explore non-residency opportunities temporarily (research fellowships, MPH, etc.), guided by mentors.

Not matching—even after SOAP—is painful but not career-ending. Many physicians have non-linear paths and still build excellent careers.

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Bottom line: Effective SOAP preparation for a preliminary medicine year starts months before Match Week. Understand your risk, clarify your priorities, prepare your documents, and build flexible strategies in advance. If you enter SOAP, move quickly but thoughtfully, prioritize solid prelim IM positions that meet your long-term goals, and remember that how you use your prelim year matters far more than how you obtained it.