Essential SOAP Preparation Guide for US Citizen IMGs in Preliminary Medicine

Understanding SOAP for the US Citizen IMG in Preliminary Medicine

As a US citizen IMG (American studying abroad), the Supplemental Offer and Acceptance Program (SOAP) can be both a lifeline and a source of intense stress—especially if you are targeting a preliminary medicine year (prelim IM) as your bridge into a categorical residency.

Before you can truly master SOAP preparation, you need to understand:

• What is SOAP?
  SOAP is the NRMP-managed, structured process that allows eligible unmatched or partially matched applicants to apply to and receive offers from unfilled residency positions during Match Week.

• Who is it for?

  • Applicants who are eligible for the Match, registered with NRMP, did not match to any position, or
  • Applicants who partially matched (e.g., matched to an advanced spot like Neurology or Anesthesiology but need a preliminary medicine year), and
  • Are SOAP-eligible per NRMP criteria.

• Why it matters for preliminary medicine:
  Prelim IM spots are often heavily represented in the SOAP. For US citizen IMGs, these positions can be:

  • A one-year bridge to your advanced specialty
  • A way to get US clinical experience and strong letters to reapply for categorical IM or another specialty
  • A foot in the door at institutions that may later rank you for PGY-2 or categorical positions

Key mindset:
SOAP is not the time to figure things out from scratch. It’s the time to execute a plan you’ve built in advance. The rest of this article will walk you through building that plan.

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Pre-SOAP Preparation: What to Do Before Match Week

Most of the work that determines your SOAP outcome happens months before Match Week. As a US citizen IMG in preliminary medicine, you are competing with both US MD/DO seniors and non-US IMGs, so your preparation needs to be meticulous.

1. Confirm SOAP Eligibility and Logistics Early

By late January to early February, you should:

• Verify NRMP registration and fee payments

  • Ensure you are fully registered for the Main Residency Match.
  • Confirm your NRMP ID and keep it easily accessible.

• Check SOAP eligibility criteria

  • You must be:
    • Registered for the Match
    • Unmatched or partially matched at the time of the Confidential Applicant Report release on Monday of Match Week
    • Not withdrawn or ineligible due to violations
  • Confirm with your medical school dean’s office or ECFMG (if IMG) that:
    • Your credentials are verified
    • Your USMLE Step results are all in and reported
    • You will be listed as SOAP-eligible if unmatched

• Plan your week off

  • Do not schedule:
    • Clinical duties
    • Flights
    • Exams
  • SOAP is a full-time, high-pressure week, and programs expect you to be reachable and responsive.

2. Optimize Your ERAS Application for SOAP

You do not use a new application for SOAP. You use your existing ERAS application, so it must be written with SOAP as a backup scenario in mind.

Focus on:

• Personal Statement Strategy

  • Primary personal statement: Aligned with your main target specialty (e.g., categorical IM, anesthesia, neurology).
  • SOAP-specific personal statement for preliminary medicine:
    • Upload in advance as an extra personal statement.
    • Emphasize:
      • Interest in internal medicine fundamentals
      • Desire for broad clinical exposure
      • Readiness for high-volume admitting services, night float, cross-cover
      • Flexibility and team-based work
    • Address your plan:

      “I intend to complete a preliminary year in internal medicine to build a strong clinical foundation while I pursue advanced training in [your specialty].”

• Update CV and experiences

  • Make sure all:
    • Recent US clinical experiences (USCE)
    • Observerships
    • Volunteer work
    • Research are up to date.
  • Highlight:
    • Hospital-based roles
    • Teamwork in inpatient care
    • Experiences with acutely ill adults

• US citizen IMG angle

  • As an American studying abroad, explicitly mention:
    • Familiarity with US culture and healthcare expectations
    • Strong English communication skills
    • Long-term intention to practice in the US
  • Some programs favor US citizens due to visa simplicity; indicate clearly that you do not require visa sponsorship if that’s true.

3. Build a Target List for Preliminary Medicine Beforehand

You won’t know exactly which programs will have unfilled spots until Monday of Match Week, but you can:

• Create a preliminary IM “watch list” of programs that:

  • Historically have SOAP or unfilled prelim IM positions
  • Are IMG-friendly
  • Accept US citizen IMG backgrounds
  • Have advanced specialties you’re targeting (if relevant)

• Use data sources like:

  • NRMP’s Charting Outcomes and Program Director Survey
  • FREIDA and program websites
  • Past unfilled list patterns (from alumni, mentors, forums—use cautiously)

For each program on your watch list, document:

• State, city, and hospital type (academic vs community)
• US citizen IMG friendliness (from alumni or Reddit/SDN patterns)
• Visa policies (even if you don’t need one—helps understand IMG openness)
• Workload and reputation (intense but supportive vs malignant rumors)

This gives you an instant framework to prioritize when the unfilled list drops.

4. Secure Letters of Recommendation Ready for SOAP

For preliminary medicine positions, strong internal medicine-oriented letters can differentiate you.

• Aim for:

  • 1–2 letters from inpatient IM attendings or subspecialists who saw you on wards
  • A letter that emphasizes:
    • Work ethic
    • Reliability on call and nights
    • Professionalism
    • Clinical reasoning and documentation skills

• Ask letter writers in advance:

  • Explain that you might be in SOAP and that your letter could be crucial.
  • Ensure they submit letters to ERAS well before Match Week.

5. Draft SOAP Communication Templates Early

During SOAP, programs may contact you by phone, email, or virtual meeting. You will have very little time to respond thoughtfully.

Prepare in advance:

• 30-second elevator pitch
  For a prelim IM program director (PD) or chief resident:

  “I’m a US citizen IMG who trained at [school], with strong inpatient experience and a long-term goal of [your specialty]. I’m seeking a preliminary medicine year where I can work hard, learn from high-volume patient care, and contribute as a reliable team member. My US clinical experience at [hospital] and my IM letters highlight my work ethic, communication skills, and adaptability in busy wards.”

• SOAP email template

  • Short, focused, customizable:

    Subject: SOAP Applicant – Preliminary Internal Medicine Position

    Dear Dr. [Name],

    My name is [Name], NRMP ID [ID], a US citizen IMG applying through SOAP to your preliminary internal medicine program. I completed my MD at [school] and have strong inpatient medicine experience at [US sites].

    I am eager to secure a rigorous preliminary year that will prepare me for [advanced specialty or long-term IM]. I would be honored to contribute to your team’s clinical work, especially in [night float, cross-cover, etc.], and I am prepared for a demanding schedule.

    I have applied to your program via ERAS and would greatly appreciate your consideration. I am available this week for an interview or call at [phone] and [time zone].

    Sincerely,
    [Name]
    [AAMC ID / NRMP ID]
    [Phone]

Have these ready to copy, paste, and personalize within minutes during SOAP.

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Strategic Approach to Preliminary Medicine in SOAP

SOAP is not just about clicking “apply” to as many programs as possible. Especially for preliminary medicine year positions, strategy matters.

1. Clarify Your Goal: Bridge Year vs Long-Term IM Path

As a US citizen IMG, you may be in one of two main scenarios:

• Scenario A: You have an advanced position (e.g., Neurology, Anesthesiology, Radiology) and need a prelim IM year

  • Your primary goal: Secure any solid prelim IM spot that:
    • Is ACGME-accredited
    • Has reasonable training and supervision
  • You can be broader geographically and somewhat flexible in program type, as long as the training is safe and accredited.

• Scenario B: You did not match at all and are seeking a prelim IM year as a stepping stone

  • Your goal is twofold:
    • Obtain a PGY-1 spot that keeps you clinically active in the US
    • Position yourself strongly to reapply to categorical IM or another field
  • In this scenario, you might:
    • Prioritize programs where prelim interns sometimes transition to categorical if they perform well.
    • Seek programs with supportive leadership and strong teaching so you can build robust letters and improve your application.

Your SOAP preparation must reflect which scenario you’re in—this will affect your personal statement, your pitch, and the programs you prioritize.

2. Understand the Competitive Landscape for Prelim IM in SOAP

Key realities:

• Preliminary medicine positions are common in SOAP, but:

  • Some are in high-intensity community hospitals with heavy call and limited academic support.
  • Some are at large academic centers that use prelims heavily for service.
  • Some have reputation concerns (high attrition, poor support).

• As a US citizen IMG, you may be relatively attractive to:

  • Programs that are IMG-friendly but prefer no-visa or easy-visa applicants.
  • Community hospitals that need hardworking interns who are likely to stay in the US system.

• However, competition during SOAP can include:

  • US MD/DO seniors who went unmatched
  • Non-US IMGs with solid scores and USCE

Your strategy should be:

• Breadth + realism + safety
  Don’t over-concentrate on only top academic prelim IM programs. Mix:
  • Academic programs
  • Mid-tier community hospitals
  • Safety programs in less popular locations

3. Ranking Priorities When Choosing Prelim IM Programs in SOAP

When evaluating unfilled prelim IM programs during SOAP, consider:

1. Accreditation and Program Stability

   • Current ACGME accreditation
   • No major citations or probation (check program websites, FREIDA)

2. Workload and Support

   • Typical census for interns
   • Presence of senior residents and fellows
   • 24/7 in-house attending or senior coverage

3. Educational Environment

   • Morning report, noon conference, case conferences
   • Mentorship or faculty accessibility

4. History with IMGs and US citizen IMGs

   • Do they commonly accept IMGs?
   • Any noted restrictions on IMGs?

5. Location and Cost of Living

   • Can you realistically relocate there on short notice?
   • Is housing affordable on a resident salary?

6. Future Opportunities

   • Do prelims ever convert to categorical there?
   • Does the program have strong connections or alumni network that can help you reapply?

In SOAP, you will be tempted to take anything. While you must be flexible, avoid programs with significant red flags (unsafe conditions, severe abuse/mistreatment if documented by multiple credible sources).

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Executing During SOAP Week: Step-by-Step Timeline

SOAP is highly structured. Knowing the flow helps you plan your actions and manage stress.

1. Monday: The Moment You Learn You’re Unmatched or Partially Matched

• 11:00 AM ET (approx.) – NRMP notifies match status

  • If you are unmatched or partially matched, confirm SOAP eligibility in your NRMP portal.
  • This is usually when the emotional shock hits—have support ready (friends, family, mentor).

• Immediately after: Regain focus

  • Take 15–30 minutes for emotional processing.
  • Then shift to operational mode:
    • Log into ERAS
    • Make sure your documents are complete
    • Confirm your SOAP-specific personal statement for prelim IM is ready

2. Monday Noon-ish: Review Unfilled Program List

Once the List of Unfilled Programs is released:

• Filter for:

  • Preliminary Internal Medicine positions
  • Programs that accept IMGs
  • Geographic preferences (but stay flexible)

• Compare against your pre-made watch list:

  • Highlight programs you had already researched.
  • Add new ones that fit your criteria.

• Create tiers:

  • Tier 1: Programs you strongly want and are realistic
  • Tier 2: Programs that are acceptable and realistic
  • Tier 3: Programs you would accept if nothing else works

You are given a limited number of applications per SOAP round (usually 45 total across all rounds). Use them strategically.

3. Monday Afternoon: Submit Your SOAP Applications

• Apply quickly but not recklessly:

  • Attach the prelim medicine personal statement to prelim IM applications.
  • Ensure you choose the right LORs—prioritize IM letters.
  • Double-check program type (preliminary vs categorical IM).

• Use initial batch of applications across:

  • Tier 1 + Tier 2 programs
  • Reserve a few application slots in case better or newly posted positions appear in later rounds (rare but possible).

4. Tuesday–Thursday: Communication, Interviews, and Offers

During SOAP, direct unsolicited contact is restricted in some ways; you cannot cold-call programs excessively, but programs can reach out to you. Check NRMP/ERAS guidance for the current year’s specific communication rules.

General guidance:

• Be reachable at all times

  • Keep your phone on, email notifications active.
  • Avoid long drives or flights; stay in a quiet, stable location.

• Respond professionally and promptly

  • For phone calls:
    • Answer with: “Hello, this is [Name].”
    • Have your elevator pitch ready.
  • For interview invitations:
    • Confirm promptly.
    • Treat them as real interviews: dress professionally, stable internet, neutral background.

• Interview focus for prelim IM Programs often care about:

  • Work ethic and resilience
  • Ability to handle night float, cross-cover, and high-volume admissions
  • Compatibility with the team
  • Clear understanding that prelim year is 1 year only

Expect questions like:

• “Why are you interested in a preliminary medicine year?”
• “How will you handle a heavy workload?”
• “What are your long-term goals?”
• “If you don’t match into your advanced specialty, what is your plan?”

Answer honestly but positively:

“I’m committed to excelling in my preliminary year regardless of my long-term specialty outcome. My focus will be on being a reliable intern, learning to manage complex patients, and contributing fully to the team. I see this year as foundational to being a better physician in any field.”

5. Offer Rounds: Accepting and Finalizing

SOAP has multiple offer rounds over two days (timing can vary slightly year to year).

• When you receive an offer:

  • You have a limited time window to accept or decline (often 2 hours).
  • Offers are legally binding if accepted.
  • Think in advance:
    • What is the minimum standard you will accept?
    • Are you willing to gamble on waiting for another program?

• As a US citizen IMG in prelim IM, in most cases:

  • Any ACGME-accredited prelim IM position with reasonable conditions is worth strong consideration.
  • Choosing no offer over a workable prelim year is risky unless there is a significant safety or career concern.

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US Citizen IMG–Specific Tips and Common Pitfalls

Being a US citizen IMG (American studying abroad) gives you a distinctive position in SOAP.

1. Leverage Your US Citizenship

Programs may prefer you because:

• You usually do not need visa sponsorship
• You are likely to stay in the US long-term
• You often bring a mix of international perspective with cultural familiarity

Communicate this clearly:

• On your ERAS:
  • “US Citizen” or “US Permanent Resident”
• In interviews:
  • “I am a US citizen and plan to build my career in the US healthcare system long-term.”

2. Address IMG-Related Concerns Proactively

Some PDs may worry about:

• Transition from overseas system to US healthcare
• Communication skills
• Clinical readiness

Counter these through:

• US clinical experience (USCE) emphasis
  • Highlight wards, subinternships, and electives with direct patient care.
• Case examples:
  • Briefly describe complex patients you managed in US hospitals.
• Strong letters that confirm:
  • “Functions at the level of a US senior medical student.”
  • “Communicates clearly with patients and team.”

3. Avoid These Common SOAP Errors

• Waiting too long to apply on Monday
  • Apply once you’ve prioritized; SOAP is not like the regular season where timing is loose.
• Using the wrong personal statement
  • Don’t send a highly specialized radiology or anesthesia PS to a prelim IM program. Use your prelim-focused statement.
• Overly narrow geographic focus
  • As a US citizen IMG, mobility is one of your advantages. Don’t limit yourself unnecessarily to major coastal cities.
• Underselling preliminary year interest
  • Even if your long-term goal is another specialty, programs want to hear that you are fully committed to intern year and won’t treat it as a throwaway.

4. Emotional and Practical Self-Care

SOAP week is brutal emotionally. Plan:

• Support system
  • Identify 1–2 people who understand the process and can support you.
• Structured breaks
  • Short walks, meals, hydration—burnout can impair judgment.
• Backup planning
  • In case SOAP does not result in a position:
    • Consider research, observerships, or a master’s program.
    • Plan how you’ll strengthen your application for the next cycle.

Knowing you have a backup roadmap reduces panic and helps you make clearer decisions during SOAP.

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FAQs: SOAP Preparation for US Citizen IMG in Preliminary Medicine

1. What is SOAP, and how is it different from the main Match?

SOAP (Supplemental Offer and Acceptance Program) is a structured, time-limited process run by NRMP during Match Week that matches unmatched or partially matched applicants to unfilled residency positions. Unlike the main Match:

• You do not submit a rank order list.
• You apply through ERAS during SOAP to unfilled programs.
• Programs review and may offer positions in several timed rounds.
• Once you accept an offer, it’s binding and you’re removed from further SOAP consideration.

2. How should I prioritize programs during SOAP as a US citizen IMG looking for a prelim IM year?

Prioritize based on:

1. Accreditation and safety – ACGME-accredited, stable program.
2. IMG-friendliness and culture – History of working with IMGs.
3. Quality of education – Supervision, conferences, mentorship.
4. Workload and support – Avoid unsafe environments.
5. Location feasibility – Can you relocate quickly and afford to live there?

As a US citizen IMG, you can often be more flexible with geography since you don’t have visa constraints.

3. How can I best prepare my ERAS for SOAP in preliminary medicine?

Key steps:

• Upload a preliminary medicine-focused personal statement well before Match Week.
• Ensure your LORs include at least 1–2 strong inpatient IM letters.
• Highlight US clinical experience in internal medicine.
• Make your US citizenship status clear.
• Update all experiences, publications, and volunteer roles.

This way, you can immediately assign appropriate documents to prelim IM programs when SOAP begins.

4. If I accept a preliminary medicine spot in SOAP, can it help me get a categorical IM position later?

Yes. A solid preliminary medicine year can be a powerful stepping stone:

• You gain US-based inpatient experience.
• You earn fresh, strong letters of recommendation from US faculty.
• You may be considered for:
  • Categorical positions at the same institution (if they have internal transfers).
  • Future positions elsewhere, leveraging your US PGY-1 training.

To maximize this, perform exceptionally during your prelim year, seek mentorship early, and communicate your long-term goals with your program leadership.

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Thoughtful SOAP preparation gives you structure in a chaotic week. As a US citizen IMG pursuing a preliminary medicine year, you bring real strengths to the table—US cultural familiarity, international training perspective, and flexibility. Combine those strengths with careful planning, strategic program selection, and professional communication, and you significantly increase your chances of turning SOAP into a meaningful start to your residency journey.