Essential SOAP Preparation Guide for US Citizen IMGs in Med-Peds Residency

Understanding SOAP for the US Citizen IMG in Med-Peds

As a US citizen IMG and an American studying abroad, the Supplemental Offer and Acceptance Program (SOAP) can be both an opportunity and a source of stress—especially when you’re aiming for a competitive combined specialty like Medicine-Pediatrics (Med-Peds). Knowing what SOAP is, how it actually works, and how to prepare months in advance can be the difference between scrambling blindly and executing a focused, strategic plan.

What is SOAP?

The Supplemental Offer and Acceptance Program (SOAP) is NRMP’s structured process that allows eligible unmatched or partially matched applicants to secure unfilled residency positions during Match Week. It replaced the old “Scramble” to make the process more fair and organized.

Key characteristics of SOAP:

• Runs Match Week, Monday–Thursday (US Eastern Time)
• You cannot directly contact programs during SOAP; programs must contact you
• All communication and offers are managed via ERAS and NRMP
• There are multiple offer rounds where programs send offers and applicants can accept or reject

For a US citizen IMG in particular:

• You are considered an Independent Applicant rather than a US MD/DO Senior
• You must meet specific eligibility criteria set by NRMP and ERAS (including USMLE scores, ECFMG status if required, etc.)
• Status as an American studying abroad (US citizen IMG) can be an advantage, especially at certain community or university-affiliated programs accustomed to IMGs

SOAP and Med-Peds: What’s Different?

Medicine-Pediatrics (Med-Peds) is a 4-year ACGME-accredited combined residency in both Internal Medicine and Pediatrics. SOAP for Med-Peds has some unique aspects:

• Fewer total positions compared with categorical Internal Medicine or Pediatrics
• Fewer unfilled spots historically, meaning opportunities may be quite limited in SOAP
• Some Med-Peds applicants may also consider SOAPing into categorical IM or Pediatrics as a parallel plan

If Med-Peds is your top choice, SOAP preparation must include:

• Primary strategy: Med-Peds positions if available
• Backup strategy: Categorical IM or Pediatrics (and, for some, prelim IM or Transitional Year), depending on your career goals

Understanding this broader landscape early will shape how you prepare your documents, letters, and mindset.

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Timeline: When and How to Start SOAP Preparation

Preparing for SOAP only after you see “You did not match” on Monday is too late. As a US citizen IMG, you should have a SOAP-ready plan months in advance.

6–9 Months Before Match Week

This is usually mid-to-late application season (September–December):

1. Understand your risk profile for going unmatched

   • USMLE/COMLEX scores (including any failures)
   • Number and strength of US clinical experiences (USCE), especially in IM and Pediatrics
   • Quality and specificity of your Med-Peds letters of recommendation
   • Any red flags (gaps, professionalism issues, visa complications)

2. Develop a Plan B and Plan C

   • Plan A: Match in Med-Peds via the main Match
   • Plan B: SOAP into Med-Peds, Internal Medicine, or Pediatrics
   • Plan C: Non-clinical gap year, research, preliminary year, or reapply with strengthened application

3. Identify SOAP-relevant documents

   • A Med-Peds–tailored personal statement
   • Separate Internal Medicine and Pediatrics personal statements, if you might apply to categorical programs
   • Updated CV with focused Med-Peds/IM/Peds experiences
   • Multiple LoRs that can function across Med-Peds/IM/Peds (e.g., from IM and Peds attendings, sub-I supervisors)

3–4 Months Before Match Week

Focus on formal SOAP preparation:

• Review NRMP and ERAS SOAP eligibility rules for the current year
• Ensure your ECFMG certification path is on track (if you need ECFMG; many US citizen IMGs do)
• Begin drafting a SOAP-specific personal statement (shorter, more direct, adaptable)
• Prepare a SOAP contact sheet:
  • US phone number (reliable and quiet during business hours)
  • Professional email and backup email
  • Time zones if you are still abroad
• Make arrangements for reliable internet and a quiet space during Match Week (even if you’re abroad or traveling)

4–6 Weeks Before Match Week

By this stage, your main Match application is locked in. Now:

1. Finalize multiple personal statements

   • Med-Peds core statement
   • Categorical IM statement
   • Categorical Pediatrics statement
     These can share content but should highlight what’s unique to each field.

2. Refine your CV

   • Emphasize experiences that show:
     • Continuity of care
     • Comfort with both acute and chronic disease
     • Work with diverse age ranges
     • Interest in primary care, underserved populations, or transitional care (all valued in Med-Peds)

3. Prepare a short “SOAP pitch”

   • 30–60 second verbal summary of:
     • Who you are (US citizen IMG, where you studied)
     • Why Med-Peds / IM / Peds
     • What makes you ready to start on July 1
   • Have two to three key “stories” ready (example: a patient case that shows your maturity, compassion, and adaptability)

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Step-by-Step SOAP Process: What Happens During Match Week

1. Monday: Learning You Are SOAP-Eligible

On Match Week Monday, NRMP notifies you if:

• You are fully matched
• You are partially matched (matched to an advanced position but not a preliminary, or vice versa)
• You are unmatched
• You are SOAP-eligible or not

To be SOAP-eligible, you must meet NRMP rules, such as:

• Registered for the Match and paid all fees
• Not fully matched to a position
• Have valid exam results and, if required, ECFMG certification by NRMP deadlines
• Not withdrawn from the Match prior to SOAP

If you are a US citizen IMG who is SOAP-eligible, ERAS will unlock your application so you can apply to a limited number of unfilled programs.

2. Monday: Reviewing the List of Unfilled Programs

NRMP releases the List of Unfilled Programs to SOAP-eligible applicants and their schools.

For Med-Peds aspirants, you should:

• Filter for Medicine-Pediatrics (combined) programs first
• Also identify:
  • Categorical Internal Medicine programs
  • Categorical Pediatrics programs
  • Preliminary IM or Transitional Year positions (if part of your backup plan)
• Note program type:
  • University, community, or university-affiliated
  • IMG-friendly history (from websites, past years, or your advisor’s knowledge)
  • Visa info (often less crucial for US citizen IMGs, but some processes are still more US-IMG friendly)

3. Monday–Tuesday: Submitting SOAP Applications

During the application phase, you can usually apply to up to a set number of programs (e.g., up to 45) via ERAS, but always confirm the current year’s rules.

Strategy for a US citizen IMG targeting Med-Peds:

1. Tier 1: Med-Peds unfilled positions

   • Apply to every reasonable Med-Peds spot (unless your advisors strongly counsel otherwise)
   • Customize PS and program signals for Med-Peds

2. Tier 2: Categorical Internal Medicine and Pediatrics

   • Especially programs with known IMG-friendliness, community programs, and those in regions more open to US citizen IMG applicants
   • Use specialty-specific personal statements

3. Tier 3: Other backup options (if aligned with your goals)

   • Preliminary IM or Transitional Year
   • Only if you truly would attend if offered

Application customization during SOAP:

• You often lack time for deeply personalized, program-specific PS edits, but you should still:
  • Reference combined training in Med-Peds when appropriate
  • Emphasize your flexibility and readiness to start clinically July 1
  • Highlight any US-based rotations, sub-Is, or observerships in IM or Peds

4. Tuesday–Thursday: Program Contact and Interview Process

Programs may review applications and then:

• Invite you to virtual interviews (often brief, 15–30 minutes)
• Ask for additional information through ERAS or secure email (within NRMP rules)
• Prioritize candidates for offers in upcoming SOAP rounds

Important: NRMP rules strictly limit direct contact. You must not call or email programs to solicit positions during SOAP. They contact you.

How to handle SOAP interviews as a US citizen IMG:

• Answer calls professionally:
  • “Hello, this is Dr. [Last Name].”
• Be prepared for short-notice video calls:
  • Have a neutral background, professional attire, and reliable audio/video
• Address “US citizen IMG / American studying abroad” directly:
  • Briefly explain your training system abroad and your strong adaptation to US clinical culture
  • Highlight any US rotations in Internal Medicine, Pediatrics, Med-Peds clinics, or continuity clinics
• Reinforce specific Med-Peds–relevant themes:
  • Interest in transitional care (e.g., adolescents with chronic conditions entering adulthood)
  • Comfort managing both complex adult and pediatric patients
  • Desire to serve underserved or rural populations across the lifespan

5. SOAP Offer Rounds

Over multiple rounds, NRMP coordinates program offers:

• Program ranks SOAP applicants they’re willing to train
• NRMP sends you offers at designated times
• You may receive:
  • No offer
  • One offer
  • Multiple offers (less common but possible)

When you receive an offer, you typically have a short time window to accept or reject (e.g., 2 hours). If you:

• Accept an offer → The process ends; you are matched to that program
• Reject or let it expire → That position goes to another applicant or appears in the next round

Crucial advice:
Do not reject an offer expecting a better one in the next round unless you and your advisors are very confident. As a US citizen IMG, any ACGME-accredited Med-Peds, IM, or Pediatrics position that you can succeed in may be better than no position.

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Positioning Yourself as a Strong US Citizen IMG for Med-Peds SOAP

Highlighting Your Unique Strengths

Being a US citizen IMG can actually be an asset if framed well:

• Cultural and language familiarity with US patients
• US citizenship often removes visa barriers, making you logistically easier for programs to onboard
• International training can reflect:
  • Resourcefulness
  • Adaptability
  • Exposure to diverse pathology and systems

In your SOAP materials and interviews, emphasize:

• Experiences where you coordinated care across different settings or age ranges
• Longitudinal relationships with patients (e.g., following patients across clinic and hospital)
• Systems-based practice: navigating different health systems abroad and understanding their strengths and limitations

Tailoring Your Personal Statement for SOAP

Your SOAP personal statement(s) should be:

• Shorter and more direct than your main Match PS
• Focused on why you are an excellent resident starting this July, not just your long-term dreams

For Med-Peds specifically:

• Emphasize:
  • Passion for lifespan care
  • Interest in caring for complex chronic disease in both adults and children
  • Any Med-Peds role models or mentors you have worked with
  • Commitment to underserved or complex populations (e.g., cystic fibrosis, sickle cell, congenital heart disease going into adulthood)

For Internal Medicine SOAP:

• Highlight:
  • Comfort with complex adult patients, chronic disease management, and inpatient medicine
  • Interest in hospitalist work, primary care, or subspecialty pathways (if appropriate)

For Pediatrics SOAP:

• Highlight:
  • Longstanding comfort with children and families
  • Any pediatric-related volunteer or teaching work
  • Interest in primary care pediatrics, hospital pediatrics, or subspecialties as aligned with your background

Letters of Recommendation and USCE

For SOAP, you typically cannot add new letters at the last minute (rules vary slightly by year), so your pre-SOAP planning matters.

As a US citizen IMG targeting Med-Peds:

• Aim for LoRs that are strong and flexible:
  • 1–2 from Internal Medicine attendings
  • 1–2 from Pediatric attendings
  • If available, a letter from a Med-Peds faculty member is ideal
• Ensure letters speak to:
  • Clinical reasoning and work ethic
  • Communication with patients and the healthcare team
  • Ability to care for different age groups

US clinical experience (USCE) is critical:

• Core IM and Peds clerkships or electives in the US
• Sub-internships (sub-Is) in IM, Peds, or Med-Peds
• Continuity clinic experiences in primary care

Programs in SOAP are particularly risk-averse; demonstrating that you can “hit the ground running” in a US system is key.

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Practical SOAP Week Game Plan for Med-Peds Applicants

Before Monday 8:00 AM (ET)

Have the following ready:

• Updated CV in ERAS
• Multiple personal statements uploaded (Med-Peds, IM, Peds)
• A printed or digital SOAP checklist:
  • ERAS login working
  • NRMP login working
  • Internet backup plan (hotspot or alternative Wi-Fi)
• A quiet workspace reserved for the entire week

Monday Midday: When You See Your Status

If you are unmatched and SOAP-eligible:

1. Take 30–60 minutes to process emotionally.
2. Notify your school or dean’s office and ask for SOAP support.
3. Begin filtering the Unfilled List for:
   • Med-Peds programs
   • Then IM and Peds programs
4. List programs in priority tiers (Tiers 1–3 as above).

Monday Afternoon–Tuesday Morning: Submitting Applications

• Quickly assign appropriate personal statements:
  • Med-Peds PS to Med-Peds programs
  • IM PS to Internal Medicine
  • Peds PS to Pediatrics
• Ensure LoRs are appropriately assigned to each program.

Apply strategically:

• Do not waste applications on programs where you are clearly ineligible (e.g., they do not accept IMGs and explicitly say so; extreme score cutoffs, etc.).
• But also don’t overestimate how selective you can be in SOAP; breadth is important.

Tuesday–Thursday: Interviews and Offers

Daily routine:

• Be available and near your phone/computer during business hours ET.
• Check ERAS and email frequently.
• Keep a notepad of:
  • Programs that contacted you
  • Key people you spoke to
  • Impressions of each program

During virtual SOAP interviews:

• Use your SOAP pitch plus 1–2 patient stories relevant to each specialty.
• Prepare for common questions:
  • “Why did you go unmatched?”
  • “Why are you interested in our program specifically?”
  • “How will you handle the intensity of Med-Peds training?”

When offers come:

• Before SOAP week, rank your preference tiers with your advisors.
• Use this ranking to make rapid but thoughtful decisions within the offer window.
• Remember: If you accept, you’re committed. If you reject, you may not see another offer.

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FAQs: SOAP Preparation for US Citizen IMG in Medicine-Pediatrics

1. As a US citizen IMG, do I have an advantage in SOAP compared with non-US IMGs?
Often, yes. As an American studying abroad, you typically do not require visa sponsorship, which removes a logistical barrier for many programs. Some programs are more willing to consider a US citizen IMG than an applicant requiring complex visa arrangements, especially in SOAP when timelines are tight. However, exam scores, USCE, communication skills, and fit with the program still matter more than passport status alone.

2. How realistic is it to SOAP into a Med-Peds residency specifically?
Med-Peds is small and competitive, and historically there are few unfilled Med-Peds spots in SOAP. It is possible, but you should prepare for:

• Primary goal: Apply to any Med-Peds SOAP positions available
• Realistic backup: Have strong applications ready for categorical Internal Medicine and Pediatrics. Many successful Med-Peds-minded physicians begin in IM or Peds and later incorporate dual-care perspectives or pursue combined fellowships and practice patterns.

3. Should I focus my SOAP applications on Med-Peds only, or also on IM and Peds?
You almost always should apply to IM and Peds as well, unless the number of unfilled Med-Peds positions is unexpectedly large (which is rare). Your long-term career might still align closely with combined training goals by:

• Doing IM or Peds now and pursuing Med-Peds–style practice later
• Engaging in transitional care, complex chronic disease management, or dual-focus clinics within a single specialty

4. How can I explain going unmatched during SOAP interviews without sounding defensive?
Use a brief, honest, forward-looking explanation:

• Acknowledge the reality: e.g., “Med-Peds is highly competitive and I limited my applications geographically.”
• Avoid blaming others or sounding bitter.
• Immediately pivot to what you’ve learned and how you’ve grown: extra clinical work, improved step scores (if any), better clarity about your goals, and preparation to start residency strong on Day 1.

Emphasize that despite the disappointment, you are fully committed and ready for the opportunity at this program now, and that you’ve reflected deeply on fit, readiness, and the specialty.

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By understanding the mechanics of the SOAP residency process, planning months in advance, and presenting yourself as a well-prepared, flexible, and motivated US citizen IMG, you can turn Match Week—from an anxious scramble—into a measured, strategic effort to secure a high-quality position in Medicine-Pediatrics, Internal Medicine, or Pediatrics.