Your Ultimate Guide to Researching General Surgery Residency for US Citizen IMGs

Choosing where to apply for general surgery residency as a US citizen IMG is not just about filling out a long ERAS list—it’s a strategic project. Your program research strategy will directly affect your odds of a successful surgery residency match, your training experience, and your long‑term career.

Below is a detailed, step‑by‑step guide to how to research residency programs in general surgery, tailored specifically for a US citizen IMG / American studying abroad.

---

Understanding Your Starting Point as a US Citizen IMG in General Surgery

Before you dive into spreadsheets and program websites, you need a realistic view of where you stand. General surgery is competitive, and as a US citizen IMG, you are in a middle ground: you don’t face visa issues, but you still carry the “IMG” label in a US‑MD‑dominated specialty.

Key realities for US citizen IMGs in general surgery

1. Competitiveness of the specialty

   • General surgery is moderately to highly competitive.
   • Programs often prioritize:
     • Strong USMLE scores
     • US clinical experience (esp. surgery sub‑I/externships)
     • Strong letters of recommendation (LORs) from US surgeons
     • Evidence of resilience, teamwork, and work ethic

2. Advantages of being a US citizen IMG

   • No visa sponsorship needed: This is a major plus. Programs that avoid J‑1/H‑1B complexities may be more open to you.
   • Cultural and communication familiarity: If you did college or grew up in the US, you often integrate quickly into the system.
   • Easier credentialing/licensure: Some state licensing barriers are tighter for non‑US citizens; you may have slightly fewer obstacles.

3. Typical concerns programs may have about IMGs

   • Variability in:
     • Clinical training environment abroad
     • Grading systems and transcripts
     • Language and documentation style
   • Limited knowledge of your home school’s reputation
   • Fewer “trusted” faculty who are known to US program directors

When you design your program research strategy, your goal is to:

• Identify programs historically open to IMGs/US citizens studying abroad.
• Prioritize programs aligned with your credentials, goals, and personal needs.
• Avoid wasting applications on programs extremely unlikely to consider IMGs.

---

Step 1: Define Your Personal and Academic Profile

You cannot evaluate residency programs until you’ve honestly evaluated yourself. That’s the core of how to research residency programs in a focused way.

A. Quantitative profile

Create a one‑page summary of your key metrics:

• USMLE/COMLEX
  • Step 1: score / pass‑fail status and number of attempts
  • Step 2 CK: score and attempts
• Class rank / GPA
  • Quartile/decile if available
  • Honors or distinctions
• Research
  • Number of publications, posters, abstracts (especially surgical)
• Clinical experience
  • US clinical rotations in surgery or related fields (dates, locations)
  • Sub‑internships (“sub‑Is”) or acting internships in general surgery
• Red flags
  • Gaps in training
  • Exam failures
  • Repeated semesters

This snapshot will guide which programs are realistically within reach.

B. Qualitative and personal priorities

List your top 5–7 personal priorities:

• Geographic preferences (coasts vs Midwest vs South, urban vs suburban vs rural)
• Family/partner constraints (dual‑career, childcare, support system)
• Willingness to work in community vs academic vs hybrid settings
• Interest in:
  • Fellowship training (e.g., surgical oncology, trauma, vascular)
  • Research‑heavy vs clinically intensive programs
  • Global surgery, quality improvement, or health policy

Being explicit about both your academic profile and life priorities will make the next steps—filtering and ranking programs—more rational and less emotional.

---

Step 2: Build an Initial Long List Using Public Databases

Now that you know your profile, it’s time to identify programs that are even worth looking at. Start broad.

A. Use FREIDA and other centralized tools

1. AMA FREIDA (Fellowship and Residency Electronic Interactive Database)

   • Filter by:
     • Specialty: General Surgery
     • Program type: Categorical (and prelim if you plan that path)
     • State or region
   • Note:
     • Program size
     • Program type (university, community, university‑affiliated)
     • Required USMLE scores (if listed)
     • Contact and website links

2. NRMP “Charting Outcomes” and Program Director Survey

   • Use the most recent reports for:
     • General Surgery
     • US IMGs specifically (if data available)
   • Look for:
     • Median Step 2 CK of matched US IMGs
     • Average number of programs ranked by successful applicants
     • Program director priorities (USMLE, LORs, communication skills, etc.)

3. Residency Explorer

   • If accessible, enter:
     • Specialty: General Surgery
     • Your Step 1/Step 2 CK (or approximations)
     • Research/US experiences
   • Get a comparison against the distribution of matched applicants.
   • Use this to categorize programs into rough tiers for you:
     • “Ambitious”
     • “Realistic”
     • “Safety”

B. Create a master spreadsheet

A spreadsheet is the backbone of your program research strategy. Columns might include:

• Program name
• State/city
• Program type (university, community, hybrid)
• Number of categorical positions
• IMG‑friendliness indicators
• Minimum USMLE requirements
• US clinical experience required? (Y/N)
• Visa sponsorship info (even if you don’t need it, it signals past IMG acceptance)
• Research emphasis (high/medium/low)
• Laparoscopic/robotic surgery exposure
• Trauma level (if important to you)
• Board pass rate (ABMS / ABS)
• Duty hours / resident wellbeing emphasis
• Notes (call schedule, didactics, reputation, red/green flags)
• “Fit” score or category (1–5 or A/B/C)

Aim for an initial list of 150–200+ programs for review; you’ll later narrow this.

---

Step 3: Identify IMG-Friendly General Surgery Programs

As an American studying abroad, one of the most powerful filters is determining which programs actually consider IMGs—especially US citizen IMGs.

A. How to detect IMG-friendliness

Use a combination of methods:

1. Program websites (current residents page)

   • Look at:
     • Where residents attended medical school
     • Presence of Caribbean, European, Asian, or other international schools
     • Patterns across multiple years (one IMG in 2016 is less meaningful than several in recent classes)
   • If you see more than 1–2 IMGs in recent classes, note the program as IMG‑friendly.

2. Program social media (Instagram, X/Twitter, LinkedIn)

   • Many programs highlight resident “spotlights” or match day posts.
   • Look for:
     • International med school names
     • Posts celebrating diverse educational backgrounds

3. ERAS and program FAQs

   • Some programs explicitly state:
     • “We accept IMGs”
     • “We require at least X months of US clinical experience”
     • “We do not sponsor visas” (less relevant for you as a US citizen, but suggests historic IMG involvement)

4. Third‑party lists and forums

   • Use cautiously:
     • Old lists of “IMG‑friendly programs”
     • Reddit/SDN threads
   • Cross‑check with official data; don’t rely solely on informal lists.

B. Distinguish between “IMG-friendly” and “IMG-reliant”

Not all IMG‑friendly programs are the same:

• IMG‑friendly academic programs

  • Mix of US MD, DO, and a few IMGs
  • Strong structure, research, and fellowships
  • Often competitive but realistic for strong US citizen IMGs

• IMG‑reliant community programs

  • Large proportion of IMGs
  • May have fewer research opportunities
  • Can vary widely in teaching quality and resources

Neither category is inherently good or bad; the key is alignment with your goals and profile.

C. Track IMG data in your spreadsheet

Add columns for:

• “IMG residents in last 5 years?” (Y/N)
• “US citizens studying abroad among current residents?” (if you can identify)
• “Visa sponsorship” (J‑1/H‑1B/N/A)
• Approximate percentage of IMG residents

This will help you prioritize programs where your profile is clearly within their usual pattern.

---

Step 4: Deep-Dive into Each Program’s Website and Curriculum

Now you move from surface‑level filters to real evaluating residency programs detail. The program website is your primary source.

A. Core elements to examine

1. Program mission and values

   • Look for keywords:
     • “Diversity and inclusion”
     • “Service to underserved populations”
     • “Resident education first”
   • Ask yourself:
     • Do these values match what you want from training and your life?

2. Curriculum and rotations

   • Check:
     • Rotations by year (PGY‑1 to PGY‑5)
     • Balance of:
       • General surgery
       • Subspecialty services
       • ICU, trauma, transplant exposure
     • Presence of community vs VA vs main hospital sites

3. Case volume and autonomy

   • Look for:
     • ABS case logs or sample numbers
     • Statements about “graduated autonomy”
     • Opportunities for chief‑level operative experience

4. Research opportunities

   • Formal research tracks or dedicated research years
   • Affiliated basic science or clinical labs
   • Number of resident publications or conference presentations per year

5. Board pass rates and fellowship matches

   • ABS board pass rates (written and oral)
   • Recent graduates’ fellowship placements (if listed)
   • Where graduates practice (academic vs community vs rural)

6. Didactics and education

   • Protected weekly didactics
   • Simulation labs, cadaver labs
   • Morbidity & Mortality (M&M) structure

7. Resident support and wellbeing

   • Wellness initiatives
   • Mentorship programs
   • Moonlighting policies
   • Policies on parental leave, sick leave

B. Red flags and green flags for US citizen IMGs

Green flags:

• Multiple IMGs in recent resident classes
• Clear curriculum, transparent expectations, organized website
• Emphasis on teaching, not just service
• Reasonable ABS board pass rates
• Public praise from residents or students on rotations

Red flags:

• No information about residents or rotations
• High attrition rate (frequent resident departures)
• Minimal educational content (no didactics mentioned)
• Historically poor board pass rates
• Consistent complaints online about malignant culture

Document your impressions (1–2 lines) in your spreadsheet after reviewing each site.

---

Step 5: Time-Efficient Program Research Strategy for Busy US Citizen IMGs

You’re likely balancing clinical rotations, Step 2 CK, and ERAS preparations. You need a program research strategy that is thorough but efficient.

A. Use a tiered research approach

1. Stage 1: Rapid triage (2–3 minutes per program)

   • Check:
     • Location and program type
     • Minimum score requirement vs your scores
     • Evidence of IMGs in current residents
   • Assign:
     • “Yes” (worth deeper look)
     • “Maybe”
     • “No” (objective exclusion criteria)

2. Stage 2: Intermediate review (10–15 minutes per “Yes”)

   • Read:
     • Curriculum page
     • Resident listing
     • Program director’s welcome
   • Decide:
     • Keep on list
     • Move to “Maybe”
     • Drop

3. Stage 3: Deep dive (30+ minutes per top‑tier program)

   • Detailed website review
   • Check social media
   • Look at recent research/publications
   • If possible, talk to current or recent residents

B. Leverage your network strategically

As an American studying abroad, your network may feel limited compared to US MD peers, but you still have options:

• Alumni from your medical school

  • Ask your dean’s office or alumni affairs for graduates in US residencies (esp. surgery).
  • Contact them respectfully via email or LinkedIn.

• US rotations or electives

  • Attendings and residents from your US surgery rotations may know programs’ reputations.
  • Ask targeted questions:
    • “Do you know if X program considers US citizen IMGs?”
    • “How is the operative autonomy and culture at Y?”

• Professional organizations

  • American College of Surgeons (ACS) student/trainee memberships
  • Association of Women Surgeons (if applicable)
  • Specialty interest groups

C. Be honest about your competitiveness

Align your application strategy with realistic tiers:

• For a strong US citizen IMG (high 230s–250+ Step 2 CK, strong US letters, some research):

  • Apply broadly, including:
    • A mix of university and community programs
    • IMG‑friendly academic centers
    • Some “reach” programs where IMGs are rare but not impossible

• For an average US citizen IMG (Step 2 CK near national average, good US rotations, limited research):

  • Prioritize:
    • Programs with a track record of US citizen IMGs
    • Strong, well‑structured community programs
    • University‑affiliated community hospitals
  • Include some prelim surgery applications as backup.

• For a weaker profile (low scores, exam attempts, limited USCE):

  • Heavily favor:
    • IMG‑friendly community programs
    • Programs that explicitly accept IMGs
  • Consider:
    • Prelim surgery year strategy
    • Transitional or prelim medicine if absolutely needed as a bridge

---

Step 6: Comparing and Ranking Programs for Your ERAS List

After detailed research, you’ll have more information than you can easily hold in your head. You need a systematic way to evaluate residency programs and refine your list.

A. Create a scoring system

For each program, rate 1–5 (or 1–10) on:

• IMG‑friendliness
• Academic strength and operative volume
• Location fit (personal and family)
• Lifestyle and support (call schedule, culture, wellness)
• Alignment with career goals (fellowships, research, community practice, etc.)
• Overall “gut feeling”

You can weight certain domains higher. For example, if your top priority is operative exposure and fellowship placement, you might double‑weight those.

B. Categorize into tiers

Split your programs into:

• Tier 1 (Top Choice / Best Fit)
  • High interest + realistic chance
  • You’d be very happy to match here.
• Tier 2 (Solid Options)
  • Reasonable interest + good fit
• Tier 3 (Safety / Backup)
  • Programs where you’re highly likely to be competitive and would accept a categorical spot.
• Prelim programs (if applying)
  • Organized separately.

Aim for:

• 60–100+ total programs for many US citizen IMGs in general surgery (depending on competitiveness and budget).
• A good distribution across tiers.
• At least a handful of true “safety” options.

C. Track communication and updates

Add columns to your spreadsheet for:

• Application submitted (Y/N)
• Token-specific notes (if a program has supplemental questions)
• Interview invite received (date)
• Post‑interview impressions (1–2 lines)
• Thank‑you note sent (if appropriate)
• Rank list position (later in the season)

This not only keeps you organized but also informs your decision‑making for future cycles if needed.

---

Step 7: Using Electives, Sub‑Is, and Observerships to Refine Your List

Your real‑life experiences in US hospitals are one of the most powerful tools in how to research residency programs for general surgery.

A. During US clinical electives

• Observe:
  • Resident happiness and burnout
  • How attendings teach
  • Operative autonomy
  • How IMGs are treated early in the team hierarchy
• Ask residents discreetly:
  • “What do you like least about this program?”
  • “If you had to choose again, would you come here?”
  • “How is the program with IMGs or Americans studying abroad?”

B. Using sub‑Is for “auditions”

If you can do a sub‑I at a program where you’re a strong fit:

• Treat it as a month‑long interview.
• Learn:
  • Call structure
  • Operative experiences
  • Team culture
• Adjust your ranking of similar programs based on that experience.

C. Indirect information from faculty

Your US‑based attendings may help you indirectly:

• “What’s your impression of X program?”
• “Do you think Y program is realistic for someone with my profile as a US citizen IMG?”

Use this information to refine your tier system, not as the sole decision maker.

---

Step 8: Common Pitfalls US Citizen IMGs Should Avoid When Researching Programs

Being methodical helps you avoid mistakes that can derail your surgery residency match strategy.

A. Overemphasizing “big names”

• It’s tempting to overload your list with brand‑name academic centers.
• Problem:
  • Many such programs rarely take IMGs.
• Solution:
  • Apply to some ambitious programs, but anchor your list in realistic and IMG‑friendly institutions.

B. Ignoring community and hybrid programs

• Many robust community or university‑affiliated programs:
  • Offer strong operative experience.
  • Place graduates into competitive fellowships.
  • Are more open to US citizen IMGs.
• Don’t underestimate:
  • Smaller training environments
  • Regionally strong reputations

C. Underestimating the importance of culture

• Malignant culture can make even a “prestigious” program miserable.
• Look for:
  • High attrition
  • Residents warning future applicants online
  • Extremely negative reputation among clinicians you speak with

D. Applying too narrowly by geography

• As a US citizen IMG, geographic flexibility can be your superpower.
• If you only apply to a few large coastal cities, you may drastically reduce your match chances.
• Include regions:
  • Midwest
  • South
  • Smaller cities where IMGs are more common

---

Putting It All Together: A Practical Example

Imagine you are a US citizen IMG from a Caribbean school with:

• Step 1: Pass (first attempt)
• Step 2 CK: 241
• 2 months of US general surgery electives
• 1 US surgery LOR from an academic center
• 1–2 small research abstracts

Your strategy could look like:

1. Initial list from FREIDA: ~200 general surgery programs.
2. Filter out:
   • Programs with strict minimum Step 2 CK > 250.
   • Programs explicitly stating “no IMGs.”
   • Programs with no IMGs visible in any resident class.
3. After first triage: ~130 programs.
4. Intermediate review:
   • Prioritize programs with clear evidence of IMGs and structured curriculum.
   • Use social media and websites to differentiate stronger vs weaker options.
   • Narrow to ~90–100 programs.
5. Tier them:
   • Tier 1: 20–25 IMG‑friendly academic or hybrid programs where your scores and profile fit well.
   • Tier 2: 40–50 community/university‑affiliated programs with strong training and multiple IMGs.
   • Tier 3: 20–25 highly IMG‑friendly community programs and a handful of prelims.
6. Execute applications:
   • Apply to all tiers.
   • Update spreadsheet with invites and experiences.
   • Continually re‑evaluate based on information gathered during interview season.

This is how a deliberate, data‑driven approach to evaluating residency programs can be implemented in real life.

---

FAQs: Researching General Surgery Programs as a US Citizen IMG

1. As a US citizen IMG, should I limit myself only to “IMG-friendly” programs?

No. You should prioritize IMG‑friendly programs but not limit yourself exclusively to them. Include:

• A solid core of programs with a proven track record of taking IMGs.
• A smaller set of more competitive programs where your metrics and experiences are strong enough to warrant a shot.

Just avoid spending too many applications on programs that historically almost never consider IMGs.

2. How many general surgery programs should a US citizen IMG apply to?

Numbers vary by profile and budget, but many US citizen IMGs aiming for categorical general surgery apply to 60–100+ programs. Less competitive profiles may need even more. The key is a broad but targeted list:

• Enough IMG‑friendly and safety programs.
• Reasonable number of ambitious choices.

3. What’s the single most important factor programs look at for US citizen IMGs?

For general surgery, the biggest early filter is often USMLE Step 2 CK performance, followed closely by:

• US clinical experience in surgery or related fields.
• Strong, specific LORs from US surgeons. These help programs compare you directly with US grads and build trust in your capabilities.

4. Can a strong research background offset lower scores as a US citizen IMG?

Research helps, especially for academically oriented programs, but it rarely fully compensates for significantly low scores or exam failures in general surgery. It can, however:

• Make you more attractive to research‑heavy or academic programs.
• Differentiate you among candidates with similar scores. For lower scores, emphasize:
• Strong performance in US rotations.
• Consistent upward trend in academics.
• Programs with slightly more flexible score cutoffs.

---

By approaching program research like a structured project—honestly assessing your profile, systematically collecting data, and thoughtfully evaluating programs—you can dramatically improve your chances of a successful surgery residency match as a US citizen IMG.