Essential Guide for Caribbean IMGs: Researching Preliminary Surgery Residencies

Understanding Preliminary Surgery for Caribbean IMGs

For a Caribbean international medical graduate (IMG), the road to residency can feel especially complex, and preliminary surgery is one of the most misunderstood pathways. Before you can research programs effectively, you need to be very clear on what a preliminary surgery year is—and what it is not.

What is a Preliminary Surgery Residency?

A prelim surgery residency (or preliminary surgery year) is:

• A one-year (PGY-1) position in General Surgery
• Non-categorical: it does not promise continuation to PGY-2 and beyond in surgery at that institution
• Primarily focused on surgical rotations (wards, ICU, trauma, night float, etc.)
• Often used to:
  • Strengthen your application for a future categorical surgery spot
  • Fulfill a surgical internship requirement for other specialties (e.g., radiology, anesthesia, PM&R)
  • Provide clinical experience and US exposure if you are still deciding on your long-term path

Unlike categorical surgery, where you are matched into a full 5+ year program, a preliminary year is a limited “bridge” year.

Why Caribbean IMGs Commonly Consider Prelim Surgery

Caribbean medical school graduates often use prelim years to:

• Improve competitiveness for future categorical positions
• Gain more US clinical experience and letters of recommendation
• Re-enter the Match after a previous non-match or SOAP outcome
• Keep options open for surgery and non-surgical specialties

For Caribbean IMGs, especially from schools like SGU, AUC, Ross, and others, prelim surgery can be a strategically smart step—but only if you choose programs carefully.

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Step 1: Clarify Your Goals Before You Start Researching

Your program research strategy should start with your long-term objectives. Different goals require a different kind of prelim program.

Ask yourself:

1. Are you aiming for a categorical general surgery spot?

If yes, then you’ll want programs that:

• Have a history of advancing prelims into categorical spots (within their own program or elsewhere)
• Provide solid operative exposure and strong evaluation/letter-writing support
• Have faculty who are IMG-friendly and willing to advocate for strong prelims

You are not just looking for any prelim year—you’re looking for a launchpad to categorical surgery.

2. Are you planning to pursue another specialty later?

Example: You matched or will apply to Radiology, Anesthesiology, PM&R, or Neurology, and you’re using prelim surgery as your required clinical base year.

If yes, then your priorities include:

• A program with a reasonable workload so you can study for future boards or interviews
• Strong general clinical training (ICU, floors, EM)
• A supportive culture—not a malignant environment where you simply try to survive

3. Are you trying to strengthen an otherwise weak application?

For example:

• Lower USMLE/COMLEX scores
• Gaps in training
• Average or limited letters
• Prior non-match

Then you’ll need:

• Programs that will actually give you face time with attendings and PDs
• A system where they value hard work and improvement, not just pre-existing prestige
• A track record of helping prelims build strong letters and go on to better positions

Clarifying your main goal helps you prioritize what matters when evaluating residency programs and avoids wasting time on options that don’t align.

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Step 2: Build a Strong Program Research Strategy

To successfully research options as a Caribbean IMG in preliminary surgery, you must be organized and systematic. Randomly browsing websites is not enough.

Core Tools You’ll Need

1. Spreadsheet or tracker
   Include columns for:

   • Program name & ACGME ID
   • City/state
   • Type (academic, community, hybrid)
   • Number of prelim spots
   • % IMGs (especially Caribbean)
   • Historical advancement of prelims to categorical
   • USMLE cutoffs / score ranges
   • Visa sponsorship (J-1, H-1B, none)
   • Duty hours and call structure
   • Notable positives/negatives
   • Personal “fit” score (1–5)
   • Application status (applied, interviewed, ranked, etc.)

2. Official data sources

   • FREIDA (AMA): Filter for General Surgery and “Preliminary” track
   • NRMP data (Charting Outcomes, Program Director Survey)
   • Program websites and GME pages
   • Your Caribbean medical school’s residency match reports (e.g., SGU residency match lists by specialty)

3. Informal data sources

   • Residents and alumni from your Caribbean medical school
   • Online forums (Reddit, Student Doctor Network) – use cautiously
   • Social media (program Instagram, X, Facebook) – to see culture and activity

Using SGU and Other Caribbean Match Data

Even if you are not from SGU, the SGU residency match lists can be highly informative. Many programs that take SGU graduates are already somewhat IMG-friendly, and often overlap with those that take other Caribbean IMGs.

Look for:

• General surgery programs where SGU (or your school) has matched prelim or categorical residents multiple years
• Patterns of certain community hospitals or mid-tier academic centers repeatedly matching Caribbean grads
• Whether these programs accept J-1 or H-1B visas frequently

This helps you identify a core list of IMG-friendly prelim surgery programs to evaluate more deeply.

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Step 3: How to Research Residency Programs in Detail

Once you’ve assembled a broad list, the next step is deep research to evaluate which programs deserve your application, time, and energy.

1. Understand Program Type and Setting

Different program types offer distinct advantages and challenges for prelims.

Academic medical centers

• Pros:
  • High case volume, complex pathology
  • Strong name recognition
  • Potential exposure to fellowship-bound faculty
• Cons:
  • Prelims may be lower priority than categorical residents
  • Higher competition for OR time and attention
• Ask:
  • How many prelims vs categorical residents?
  • Are prelims allowed meaningful operative experience?

Community hospitals

• Pros:
  • Often more hands-on, more autonomy
  • Prelims may get more OR cases and attending face time
• Cons:
  • Less research, less “brand name” prestige (in some cases)
• Ask:
  • Do past prelims match into categorical spots at other strong programs?

Hybrid (community + academic affiliate)

• Often a good balance: strong training environment with academic connections.

As a Caribbean IMG, you should avoid chasing “big names” blindly. Focus on programs that will train you, support you, and write strong letters.

2. Analyze Prelim-Specific Details

When evaluating residency programs for a preliminary surgery year, ask questions that directly affect prelim experience:

• Number of prelim spots vs categorical spots
  A program with 10 prelims and 2 categoricals may overload them with scutwork; one with 2–3 prelims and 4–6 categoricals may integrate prelims more fully.

• Track record of advancing prelims

  • Do they routinely convert one prelim to categorical each year?
  • Do they help strong prelims secure positions at other institutions?

• Operative experience for prelims

  • Are prelims primary surgeons on cases or mostly observers?
  • Do they get ICU, trauma, and ED exposure?

• Prelim integration

  • Are prelims included in didactics, M&M, simulations, and education days?
  • Are they invited to retreats, wellness events, and mentoring programs?

Good programs will highlight their prelims’ successes. If a website says nothing about prelim outcomes, that’s a red flag to investigate.

3. Check IMG and Caribbean-Friendliness

Because this article focuses on Caribbean IMGs, IMG-friendliness is critical.

Look for:

• Current and past residents who are IMGs, especially Caribbean graduates
• Your school’s name (SGU, AUC, Ross, Saba, etc.) in their past match lists
• Program statements such as:
  • “We welcome applications from international medical graduates”
  • “We sponsor J-1 visas” or “We sponsor H-1B, subject to USMLE Step 3”

Use your school’s alumni and SGU residency match lists as a proxy map:
If SGU has matched multiple prelim or categorical residents into a program, it is likely more open to Caribbean IMGs.

4. Assess Visa Sponsorship Policies

For non-US citizens:

• Confirm whether the program sponsors:
  • J-1 visas (most common)
  • H-1B visas (fewer programs; requires Step 3)
• Check:
  • The GME office website
  • Program FAQ pages
  • FREIDA listing under “Accepts J-1” / “Accepts H-1B”

If visa sponsorship is mandatory for you, filter out programs that do not clearly support IMGs with visas early in your program research strategy.

5. Evaluate Culture and Work Environment

A prelim year can be intense, and some surgery programs have a reputation for being malignant—overly hierarchical, unsupportive, or demeaning.

To assess culture:

• Read the resident bios and see if they stay for fellowships or categorical positions—people rarely stay where they are mistreated.
• Look for program statements about:
  • Wellness initiatives
  • Mentorship programs
  • Feedback systems
• Check for:
  • Accreditation or duty hour citations on ACGME or third-party summaries
  • Online reviews—but interpret cautiously and look for consistent patterns

For Caribbean IMGs, a supportive culture is especially important, because you may need strong letters and advocacy from faculty to secure your next step.

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Step 4: Evaluating Residency Programs with a Caribbean IMG Lens

Now that you know how to gather information, it’s time to prioritize. Evaluating residency programs effectively is about balancing training quality, opportunity, and realistic fit.

Key Criteria to Score Each Program

Create a simple 1–5 scoring scale for each of the criteria below (1 = poor, 5 = excellent). This can be your program research strategy core.

1. IMG-Friendliness (Especially Caribbean-Friendly)

Consider:

• Evidence of Caribbean IMGs in recent classes
• SGU residency match and similar data showing placements
• PD or faculty history of supporting IMGs

Programs where Caribbean grads have consistently matched into prelim or categorical positions deserve higher scores.

2. Advancement Opportunities

Ask:

• Do prelims at this institution:
  • Get converted to categorical spots in surgery?
  • Match into categorical surgery elsewhere?
  • Match into other competitive specialties (radiology, anesthesia, etc.)?

Even if you can’t find exact numbers, you can note:

• Website examples of prelim career paths
• Statements from PDs on webinars or open houses
• Alumni feedback from your Caribbean medical school

3. Educational Quality and Exposure

Focus on:

• Volume and variety of surgical cases
• Exposure to:
  • General surgery
  • Trauma/acute care surgery
  • Surgical ICU
  • Night float and cross-coverage
• Protected didactic time, M&M, journal club, simulation labs

A good prelim surgery year should make you a stronger physician, not just an overworked note writer.

4. Support and Mentorship

Look for:

• Formal mentorship matching (each prelim assigned a faculty mentor)
• Regular evaluations with actionable feedback
• PD availability (open-door policy? scheduled meetings?)
• Faculty known for advocating for residents

Caribbean IMGs particularly benefit from faculty who understand non-traditional paths and can help explain your journey to future programs.

5. Location and Lifestyle

Location matters more than many applicants admit:

• Are you okay with:
  • Cold winters?
  • Rural or small-town settings?
  • High cost of living in major cities?
• Do you have:
  • Social support or family nearby?
  • Access to cultural or religious communities important to you?

A less “prestigious” program in a city where you can thrive may be better than a name-brand program where you struggle with isolation or burnout.

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Step 5: Practical Tactics to Deepen Your Research

Beyond websites and spreadsheets, there are ways to gain inside information on how programs truly function—information especially valuable for Caribbean IMGs.

1. Leverage Your Caribbean School’s Network

If you’re from a larger Caribbean medical school (e.g., SGU, AUC, Ross, Saba):

• Use the alumni office and mentorship programs
• Request a list of alumni who:
  • Completed prelim surgery years
  • Matched categorical surgery after prelim
  • Matched in your target geographic area

Contact alumni with specific, respectful questions, such as:

• “How were prelims treated compared with categoricals?”
• “Did the program help you find a categorical position?”
• “Would you recommend this program for a Caribbean IMG doing a prelim year?”

This targeted feedback is often more honest than anything on an official website.

2. Attend Virtual Open Houses and Webinars

Many surgery programs now host:

• Virtual open houses
• Q&A sessions for applicants
• Special “IMG-friendly” or diversity-focused sessions

Prepare questions that show you’ve done your homework:

• “Can you describe how preliminary residents are integrated into the team?”
• “How many prelims have transitioned to categorical positions here or elsewhere in the last 3–5 years?”
• “How do you support IMGs adapting to the US system?”

These events give you a feel for:

• The PD’s communication style
• Resident morale
• How transparent they are about prelim outcomes

3. Contact Programs Strategically (When Appropriate)

For preliminary surgery specifically, it may be appropriate to reach out if:

• You have a strong specific interest in their program
• You are a Caribbean IMG with a clear reason for their region (family, previous rotations, etc.)

When emailing:

• Keep it concise and professional
• Mention:
  • Your medical school and graduation timing
  • That you’re applying in preliminary general surgery
  • One or two specific, reasonable questions not answered on the website

Do not ask for special favors, guaranteed interviews, or “What are my chances?” That will hurt you more than help.

4. Use Interviews as Data Collection

If you are invited to interview, treat it as two-way evaluation, not just “please pick me.”

Ask residents privately (when appropriate):

• “How do prelims fare after their year here?”
• “What’s the culture like between faculty and residents?”
• “Do prelims feel like valued team members?”

Ask the PD or faculty:

• “How would you describe the ideal prelim resident for your program?”
• “How often do you convert prelims to categorical positions?”
• “What have your last few prelim cohorts gone on to do?”

Take notes immediately after each interview while the details are fresh.

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Step 6: Putting It All Together – Ranking and Realistic Strategy

Once you have researched thoroughly, you will need to prioritize programs based on your goals and competitiveness.

Building Your Application List

For a Caribbean IMG aiming for a preliminary surgery year, a balanced list might include:

• Higher-reach programs
  • Strong academic centers known to take a small number of IMGs
• Core realistic programs
  • Community or hybrid hospitals with clear IMG representation
  • Programs that appear on SGU residency match or your school’s list repeatedly
• Safety programs
  • Smaller community programs in less popular locations
  • Places that have taken multiple Caribbean IMGs in the past

Because prelim surgery spots are often more numerous than categorical spots, you can sometimes cast a slightly wider net. Still, you must remain realistic based on:

• Exam scores
• Clinical performance
• Visa status
• Gaps or red flags

Example: Two Different Applicant Strategies

Applicant A:

• SGU graduate
• Strong scores, no gaps
• Goal: Categorical general surgery after prelim

Strategy:

• Focus on programs with documented prelim-to-categorical movement
• Situate most applications in mid-tier academic and high-volume community programs
• Attend multiple open houses, build familiarity with PDs and residents
• Apply broadly but prioritize quality of training and advancement opportunities

Applicant B:

• Caribbean IMG with average scores and a previous non-match
• Goal: Strengthen application and remain open to multiple specialties

Strategy:

• Apply broadly to IMG-friendly, supportive community programs
• Prioritize programs with good teaching and strong letters, even if not prestigious
• Use the prelim year to:
  • Excel clinically
  • Obtain outstanding letters
  • Explore alternative specialties if categorical surgery doesn’t work out

Both strategies require careful, deliberate program research, rather than blind application to any open prelim positions.

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FAQs: Caribbean IMGs and Preliminary Surgery Program Research

1. As a Caribbean IMG, how many preliminary surgery programs should I apply to?

There is no single number, but many Caribbean IMGs aiming for a prelim surgery year apply to 25–60 programs, depending on:

• Competitiveness of their application
• Visa needs
• Flexibility in location

If your profile has notable weaknesses (low scores, gaps, previous non-match), you should lean toward the higher end of this range and focus on IMG-friendly community and hybrid programs.

2. How can I tell if a preliminary surgery program actually helps residents secure categorical spots?

Look for:

• Website mentions like “Many of our preliminary residents successfully match into categorical surgery and other specialties.”
• Open house or webinar comments from PDs with approximate numbers or examples.
• Alumni and current resident testimonials (especially Caribbean IMGs) from your school.

If a program avoids the topic completely or is vague, consider that a caution flag, especially if your main goal is future categorical surgery.

3. Are academic programs always better than community programs for a prelim surgery year?

Not necessarily. Academic centers may offer more prestige and research, but:

• Some treat prelims more like service-only residents
• OR time and mentorship may be limited compared with categoricals

Well-structured community or hybrid programs can provide:

• Excellent operative exposure
• Extensive attending interaction
• Strong letters and advocacy

For Caribbean IMGs, the best prelim surgery residency is the one that offers training, support, and advancement, not just a famous hospital name.

4. How important is it that a program has had SGU (or another Caribbean school) residents before?

Very important as a signal of openness, but not absolutely required. If a program appears repeatedly in the SGU residency match or your own school’s match lists for surgery (prelim or categorical), that strongly suggests:

• They understand the Caribbean school curriculum
• They value those graduates
• They are less likely to discriminate based solely on school location

If a program has never had Caribbean IMGs, you should look more carefully at:

• Their stated IMG policy
• Visa sponsorship history
• Openness in communication when you contact them or attend open houses

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By approaching your search with a clear program research strategy, grounded in your goals as a Caribbean IMG and the realities of a preliminary surgery year, you can move beyond guesswork and build a targeted, intelligent list of programs. Careful research, structured evaluation, and strategic networking will position you to use your prelim year as a powerful stepping stone toward the surgical or specialty career you ultimately want.