Mastering SOAP Preparation: A Guide for MD Graduates in Global Health

Understanding SOAP in the Context of Global Health

The Supplemental Offer and Acceptance Program (SOAP) is a structured, time‑limited process that allows unmatched or partially matched applicants to obtain unfilled residency positions after the NRMP Main Match. For an MD graduate interested in global health, SOAP is not just a backup plan; it may be a strategic second pathway to reach a global health residency track or an international medicine–focused career.

What Is SOAP?

SOAP (Supplemental Offer and Acceptance Program) is:

• A formal NRMP process that begins on Match Week Monday
• A way for eligible unmatched or partially matched applicants to apply to unfilled residency positions
• A sequence of application, interview, and offer rounds that happen over four intense days
• A programmatically controlled system—programs initiate contact, applicants do not cold-call or email programs

SOAP is different from “scramble” (the older, chaotic system). It’s structured, time‑stamped, and rule‑driven.

Why SOAP Matters for MD Graduates Interested in Global Health

If you are an MD graduate from an allopathic medical school focused on global health, SOAP can:

• Provide a second chance to secure a categorical or preliminary position that can still lead to a global health career
• Open doors to programs that value international medicine, underserved care, immigrant health, refugee health, or health systems work
• Allow you to pivot strategically from a narrowly targeted global health residency track to a broader foundational specialty (e.g., Internal Medicine, Family Medicine, Pediatrics) with global health opportunities integrated later

Think of SOAP as a contingency plan that should be built into your overall allopathic medical school match strategy—not as an afterthought.

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Pre-Match SOAP Preparation: Start Months Before Match Week

Effective SOAP preparation begins before you submit your ERAS application, and continues throughout interview season. This is especially true if you are an MD graduate targeting global health, where programs can be more competitive or geographically clustered.

1. Clarify Your Global Health Career Narrative

Residency programs want a coherent, realistic story about your global health interests that fits into their training environment.

Reflect on:

• Your long-term goal
  • Example: “I want to practice as a general internist splitting my time between a safety‑net hospital in the U.S. and short‑term capacity‑building projects in East Africa.”
• Your practical skill set
  • Tropical medicine exposure, public health training (MPH), language skills, research in global health, refugee/immigrant health clinic experience, health policy, or health systems work
• Your flexibility
  • Are you open to Internal Medicine, Family Medicine, Pediatrics, or Emergency Medicine with a global health residency track?
  • Are you willing to use a more general program as a stepping-stone, then add global health through fellowships, certificates, or electives?

Write a 2–3 sentence global health pitch you can adapt quickly:

“I am an MD graduate from [School] with focused experience in international medicine, especially in refugee health and capacity building in low-resource settings. I am seeking a residency where I can build strong clinical foundations in [Specialty] and integrate global health work through electives, research, and care of underserved populations.”

This narrative will reappear in your personal statement, SOAP communications, and interviews.

2. Build a Tiered Specialty Strategy

If you are set on a global health residency track—for example in Internal Medicine or Family Medicine—you still need a tiered plan in case the main allopathic medical school match does not go as planned.

Create specialty tiers:

1. Tier 1: Primary target specialty with global health track
   • Example: Categorical Internal Medicine with established global health residency track or international medicine curriculum.
2. Tier 2: Broad specialty still aligned with global health
   • Family Medicine, Pediatrics, Emergency Medicine, Internal Medicine without formal global health track but strong underserved or safety‑net focus.
3. Tier 3: Transitional or Preliminary year positions
   • Consider medicine prelim or transitional year if it keeps doors open while you build more experience and reapply or pursue global health fellowships later.

In SOAP, your odds improve if you are open to multiple related specialties. Before Match Week, decide your flexibility in writing, so you can move quickly under pressure.

3. Identify Programs with Global Health or Underserved Focus

You may not access the SOAP List of Unfilled Programs until Match Week Monday, but you can pre‑research likely targets:

• Use FREIDA, program websites, and institutional GME pages to find:
  • Global health residency track or global health pathway
  • Longitudinal underserved or rural health tracks
  • International rotations or partnerships
  • Strong immigrant/refugee health clinics
• Create a spreadsheet with:
  • Program name, specialty, location
  • Type of global health/underserved work
  • Notes on visa policies (if relevant), research opportunities, MPH/MPH‑like training
  • Your priority level (A/B/C)

During SOAP, even if your dream global health program is not open, you can still target programs that approximate your interests: safety‑net hospitals, community-based residencies, or institutions with global health centers.

4. Prepare SOAP‑Specific Application Materials in Advance

You will not have time during SOAP to write from scratch. Prepare and save variation-ready documents:

Updated CV

• Highlight:
  • Global health rotations, international electives, or service
  • Public health coursework, MPH, or global health certificates
  • Language proficiency (especially in high‑need languages)
  • Work with underserved communities, free clinics, or mobile clinics
  • Research or publications in international medicine or health disparities

Multiple Personal Statement Variants

Create short, adaptable personal statements (around 650–850 words) tailored to:

1. Global health–oriented Internal Medicine
2. Family Medicine or Pediatrics with underserved/global themes
3. Transitional/Preliminary year with emphasis on building strong core clinical skills first

Each version should:

• Emphasize your fit for that specific specialty
• Anchor your global health interests in practical clinical goals, not just travel narrative
• Show humility, teachability, and commitment to long-term, ethical global work

Letters of Recommendation Strategy

You cannot add new letters during SOAP, but you can:

• Pre‑select a set of letters that support both broad and global health–specific applications:
  • One or two letters emphasizing your clinical excellence
  • One letter highlighting your work in global health, international medicine, or underserved care
• Ensure your Letter of Evaluation from your global health mentor or public health supervisor is uploaded and assigned to a wide range of programs in advance.

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Logistics and Systems: Setting Yourself Up for SOAP Week

SOAP residency success for an MD graduate often hinges on tight logistics and calm execution. Treat SOAP preparation as a project with deadlines and tools, not as an improvisation.

1. Know the Timeline and Rules

Review the NRMP and ERAS official guidance on:

• SOAP eligibility (e.g., registered for NRMP, certified rank order list, unmatched/partially matched status)
• Key times (all in Eastern Time typically)
  • Monday: You learn you are unmatched or partially matched; List of Unfilled Programs released (to eligible applicants)
  • Monday–Thursday: Application period, interviews, offer rounds
• Communication rules
  • Programs initiate contact during SOAP
  • You may not solicit positions outside ERAS during SOAP
  • All offers and acceptances occur through the NRMP system

Re-read the “what is SOAP” section of the NRMP website so you clearly understand constraints and do not accidentally violate rules.

2. Set Up a Physical and Digital Command Center

Match Week is stressful. Plan for it like an on-call shift.

Physical setup:

• Quiet room with reliable internet, power, and backup device
• Headset or earbuds for video/phone interviews
• Calendar visible with SOAP rounds marked
• Printed copies of:
  • Your CV and personal statements
  • List of pre-researched programs
  • Talking points on global health and your career narrative

Digital setup:

• Clean, clearly named files:
  • CV_LastName_2025.pdf
  • PS_IM_GlobalHealth_Short.pdf
  • PS_FM_underserved.pdf
• Browser bookmarks:
  • ERAS, NRMP, email, Zoom/Teams
  • Folder with program websites and your spreadsheet
• A real-time tracker (spreadsheet or project board) for:
  • Programs applied to via SOAP
  • Responses received
  • Interviews scheduled/completed
  • Offer status and ranking

3. Build Your Support Team Before Match Week

Even as an MD graduate capable of independent work, SOAP is easier with support:

• Faculty mentor (ideally with global health experience)
• Dean’s office or advising team
• Recent graduates who successfully navigated SOAP residency
• A trusted friend or partner for emotional support and to help with logistics (e.g., scheduling, note‑taking during interview days)

Ask in advance:

• Who will be available during SOAP week?
• How quickly can they review a revised personal statement?
• Can they help you rehearse 1–2 mock “rapid‑fire” interviews?

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Executing SOAP: Strategy for Applications, Interviews, and Offers

Once you learn you did not match (or only partially matched), your SOAP preparation must become decisive action.

1. Interpreting Your Unmatched Status

Before you start firing off applications, take 60–90 minutes to analyze:

• What might have limited your Main Match success?
  • Late ERAS submission?
  • Narrow geographic preferences?
  • Highly competitive programs with limited global health residency track spots?
  • Red flags (exam scores, leaves, professionalism issues)?
• Which of these are fixable short‑term vs long‑term?
  • In SOAP, you can adjust specialty breadth, geographic flexibility, and program type more than exam scores or academic history.

This clarity helps you choose the right category of SOAP positions, not just any open seat.

2. Targeting SOAP Positions with Global Health Awareness

When the List of Unfilled Programs becomes available:

1. Filter first by specialty:
   • Internal Medicine, Family Medicine, Pediatrics, Emergency Medicine, Transitional Year, and some Medicine‑Preliminary or combined programs are most flexible for global health–oriented careers.
2. Then filter by institution type and mission:
   • Safety‑net hospitals, county systems
   • Academic medical centers with global health or international medicine centers
   • Programs with “underserved,” “rural,” “community health,” “primary care,” or “health equity” in their descriptions
3. Finally consider geographic and personal factors:
   • Are you willing to train in a region with high immigrant/refugee populations or rural health needs?
   • Are there nearby global health NGOs or public health institutions?

Assign each program a priority:

• Priority A: Strong alignment with global health or underserved mission; realistic fit based on your record
• Priority B: Moderate alignment; may not advertise global health but environment could support it (e.g., diverse patient population)
• Priority C: Less aligned but still acceptable if needed; could be a stepping‑stone year

3. Crafting Fast, Targeted SOAP Applications

You can apply to up to a NRMP‑defined maximum number of programs during SOAP (check the current year’s rules). For high-priority programs:

• Adjust your personal statement choice:
  • Use the global health–tailored statement for programs with explicit global health/underserved focus.
  • Use a general specialty‑strong statement where global health is not clearly emphasized, but add 1–2 sentences about your interest in serving diverse or underserved populations.
• Highlight in ERAS experiences:
  • Global health electives and international rotations
  • Volunteer work with immigrant, refugee, or under‑resourced communities
  • Research in health disparities or international medicine
• Ensure your Global Health or Public Health referee letter is assigned to those programs, if appropriate.

For lower-priority programs where you have little time:

• Use a concise, general statement focused on work ethic, clinical readiness, and ability to work with diverse populations.
• Accept that you may not customize every detail; prioritize getting complete, professional applications submitted quickly.

4. Interviewing Effectively Under Time Pressure

SOAP interviews are often short, direct, and focused on fit and readiness. You may have phone or video calls with multiple programs in a single day.

Expect questions like:

• “You applied in [X] specialty originally; why are you interested in our [Y] program now?”
• “How does global health fit into your career plan if our program does not have a formal global health residency track?”
• “What did you learn from not matching, and how will that make you a better resident?”
• “Are you willing to commit to training here for the full duration of the program?”

Prepare crisp responses such as:

• On flexibility of global health pathway
  “For me, global health is about applying strong generalist skills to underserved populations, whether abroad or in the U.S. Your program’s diverse patient population and emphasis on community health would allow me to build the same core competencies I’d use in international medicine. I see this as a realistic and valuable pathway to my long‑term goal.”

• On not matching
  “In retrospect, I targeted a relatively narrow set of highly competitive programs with specific global health tracks. While my global health background is strong, I underestimated the value of broader flexibility. SOAP has pushed me to re-center on gaining excellent clinical training and serving underserved communities, which your program clearly prioritizes.”

Focus on:

• Humility without apologizing excessively
• Concrete ways you will add value to the team (language skills, teaching, research, leadership)
• Clear, calm communication and reliability (show up early, test technology, take notes)

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Evaluating and Accepting SOAP Offers with a Global Health Lens

SOAP residency offers come in rounds. You must think clearly under time constraints.

1. Understanding SOAP Offer Rounds

Each round:

• Programs submit lists of candidates they are willing to offer
• NRMP system sends official offers simultaneously
• You have a short window (often 2 hours) to:
  • Accept the offer (binding)
  • Let it expire (you cannot “hold” while you wait for others)
• If you accept, you are committed to that position and are removed from further SOAP consideration

Plan your decision-making framework in advance.

2. Decide What Is Non‑Negotiable vs Flexible

For a global health‑oriented MD graduate, consider:

Non‑negotiable:

• ACGME‑accredited program in your chosen pathway
• Reasonable track record of board pass rates
• Environment where you can safely learn and be supported (avoid programs with a history of major instability or resident exodus)

Flexible:

• Formal “global health” label vs informal opportunities
• Geographic location, provided you can access diverse or underserved patient populations
• Size of program (small community vs large academic) if you can still gain strong clinical exposure

Ask mentors beforehand:

• “What are absolute red flags that should make me decline a SOAP offer?”
• “At what point is it more strategic to take a solid but not perfect position vs risk going unmatched?”

3. Assessing Programs for Hidden Global Health Potential

Even if a program does not advertise a global health residency track, you can:

• Look for patient population profile:
  • Large immigrant/refugee communities
  • Rural or frontier health needs
  • Safety‑net hospital or FQHC affiliations
• Investigate institutional connections:
  • Global health centers or schools of public health
  • Faculty with international work or health disparities research
• Ask focused questions (if time allows):
  • “Do residents have any flexibility for international or underserved electives?”
  • “Is there faculty engaged in global health, health equity, or international medicine research?”

You may discover that a solid community or academic program offers:

• Opportunities to work with high‑need populations domestically
• Possibility of creating or expanding a global health elective or project
• Access to mentors who will support you for future fellowships or global health leadership roles

4. When to Accept and When to Consider Reapplying

This is a personal decision, but for most MD graduates from allopathic medical schools:

• Accept a SOAP offer if:

  • It is in a specialty you can realistically see yourself practicing
  • The training quality appears solid, and the environment safe
  • You can frame a clear path from this program to your global health goals (even if indirect)

• Consider not accepting (rare, high‑risk) only if:

  • The program has significant red flags (e.g., ACGME citations, severe under‑staffing, chronic resident dissatisfaction)
  • The specialty is entirely misaligned with your skills and goals, making board certification or long‑term satisfaction unlikely
  • You have strong evidence you can significantly strengthen your application within a year (research, MPH, additional global health or domestic underserved experience) and are prepared emotionally, logistically, and financially to reapply

Discuss this choice with advisors who understand both residency match dynamics and global health career paths.

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Building Your Global Health Career After SOAP

Landing a SOAP residency position is not the end of your global health aspirations; it is the beginning of a new phase.

1. Maximize Global Health–Relevant Training Within Any Program

Wherever you match:

• Seek rotations with:
  • High immigrant/refugee populations
  • Travel or migrant clinics
  • Tuberculosis, HIV, or tropical disease management (if available)
• Pursue QI projects or research on:
  • Health disparities
  • Language access and cultural competence
  • Care coordination for underserved or international patients
• Build language proficiency further, especially for communities your program serves.

2. Connect with the Global Health Community Early

Even while in residency, you can:

• Join institutional global health interest groups or centers
• Attend relevant conferences (e.g., ASTMH, CUGH)
• Seek mentors who:
  • Have done work in global health or international medicine
  • Can help you plan fellowships (e.g., global health, infectious diseases, health equity)
• Explore opportunities for:
  • Short international electives (if allowed)
  • Domestic fieldwork that parallels global health (e.g., Indian Health Service, migrant worker clinics, border health)

3. Consider Additional Training Paths

If your residency has limited explicit global health content, you can later pursue:

• Global health fellowships after primary care or hospital-based residencies
• MPH or other graduate degrees during or after residency
• Certificates in:
  • Tropical medicine
  • Health policy and management
  • Humanitarian assistance

Your SOAP residency position is the clinical foundation; you can layer structured global health training on top of it over time.

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Frequently Asked Questions (FAQ)

1. I’m an MD graduate focused on global health and didn’t match. Should I see SOAP as a failure or another path?

SOAP is another path, not a failure. Many excellent residents and future global health leaders have entered training through SOAP residency positions. What matters most is how you use the opportunity—building strong clinical skills, serving underserved populations, seeking mentors, and constructing a sustainable global health pathway from wherever you train.

2. Can I still pursue global health if I match into a program without a formal global health residency track through SOAP?

Yes. Global health is more about your skills, values, and patient populations than a label. You can:

• Focus on underserved and diverse populations domestically
• Develop research or QI projects in health equity
• Arrange international or cross-cultural electives if allowed
• Later pursue global health fellowships, certificates, or an MPH

Many leaders in international medicine trained in programs without a named global health track.

3. What is SOAP preparation for an MD graduate in simple terms?

SOAP preparation means:

• Understanding what is SOAP and its rules
• Creating a flexible specialty and program strategy
• Preparing your CV, several tailored personal statements, and letters ahead of time
• Researching programs with potential global health or underserved strengths
• Setting up the logistics, technology, and support network to respond quickly during Match Week

It turns a stressful last‑minute process into a managed contingency plan.

4. If I accept a SOAP position, can I reapply later to a more global health–focused program?

This is very limited and often not advisable. Once you join a residency program, you are generally expected to commit to that training path. Transfers are uncommon, logistically complex, and require program director support from both sides. Instead of planning to switch, assume that your SOAP program is your long‑term training site and look for ways to build global health work from within—through clinical choices, research, electives, and post‑residency training.

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With deliberate SOAP preparation, an MD graduate interested in global health can navigate Match Week with clarity and purpose, using SOAP not merely as a fallback, but as a structured, strategic route toward a meaningful career in international medicine and health equity.