Essential Pre-Match Communication Guide for Caribbean IMGs in Emergency Medicine

Pre-match communication is one of the most misunderstood parts of the ERAS and NRMP process—especially for a Caribbean IMG aiming for an emergency medicine (EM) residency. Done well, it can increase your visibility, clarify your fit for programs, and sometimes open doors for interviews and strong ranking. Done poorly, it can hurt your candidacy or even risk NRMP violations.

This guide breaks down exactly how to approach pre-match communication as a Caribbean IMG in EM, including what to say, when to say it, and where the boundaries are.

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Understanding Pre-Match Communication vs. Pre-Match Offers

Before you type a single email, you need to understand the vocabulary and rules.

What is “pre-match communication”?

“Pre-match communication” refers to any contact between you and residency programs between:

• Application submission (ERAS opens)
  and
• Rank order list certification / Match Day

This includes:

• Thank-you emails after interviews
• Updates on new scores, publications, or rotations
• “Letters of interest” or “letters of intent”
• Informal messages when you see faculty at conferences
• Clarifying questions about the program

For a Caribbean IMG in emergency medicine, this communication is often your best opportunity to:

• Reinforce interest in a program
• Highlight your EM-specific strengths
• Stay on a program’s radar in a crowded applicant pool

What are “pre-match offers” and early commitment?

“Pre-match offers” or “early commitment” typically describe situations where:

• A program communicates that you are “guaranteed a spot” before the Match, or
• You are asked to make a binding commitment outside the NRMP Match.

In NRMP-participating programs (which includes the vast majority of ACGME-accredited EM programs):

• True pre-match offers are prohibited.
• Programs cannot ask you to commit to ranking them first.
• You cannot sign a contract with them before Match Day for a categorical EM spot.

When people casually say “pre-match offers” in EM, they often mean:

• Strong expressions of interest from a program (e.g., “We intend to rank you highly”)
• Informal signals that you are very competitive for their program
• Sometimes, for non-NRMP positions (e.g., certain prelim/TY or non-standard positions), actual early offers

As a Caribbean IMG, especially from schools like SGU (Saint George’s University), you may hear upperclassmen talk about SGU residency match strategies and “pre-match” in older or international contexts. For U.S. emergency medicine residency positions participating in the NRMP, assume:

There is one official binding event: Match Day.

Everything before that is communication, signaling, and relationship-building—not contracts.

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The Rules and Ethics: What’s Allowed, What’s Risky

NRMP rules you must know

NRMP has clear policies that govern program communication before match as well as what applicants can or cannot be asked to do:

Programs cannot:

• Ask you to reveal how you will rank programs
• Ask you to commit to rank them first
• Make offers or contracts for NRMP-participating positions outside the Match
• Pressure or harass you for ranking information

You can:

• Voluntarily express interest
• Voluntarily tell a program you plan to rank them highly (including #1)
• Ask about program features, schedule, training, etc.
• Communicate updates or new accomplishments

You should not:

• Ask programs how they plan to rank you
• Ask them for guarantees or assurances
• Try to negotiate an “early commitment” for NRMP training slots

If a program explicitly offers a “pre-match” position or seems to violate NRMP rules, document what happened and consider contacting your Dean’s office or the NRMP for guidance.

Caribbean medical school residency context

Caribbean graduates, especially from large schools like SGU, Ross, and AUA, often feel extra pressure to “do more” in terms of networking and communication to overcome bias. This can lead to:

• Over-emailing programs
• Inadvertently sounding desperate or transactional
• Crossing professional lines in follow-up messages

The key is to communicate strategically and professionally, not endlessly. You want to be remembered for maturity, clarity, and fit—not for inbox spam.

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Strategic Communication Before and After Interviews

Think of communication in phases: pre-interview, post-interview, post-interview season. Each phase has a purpose and a different approach.

1. Pre-interview: Limited but targeted outreach

Before interview invitations go out, your main communication should be:

• Application itself (ERAS, personal statement, letters, MSPE)
• Occasionally, a very targeted email if you have a legitimate, program-specific reason

Appropriate pre-interview outreach for a Caribbean IMG in EM might include:

• You rotated there as an EM visiting student, and the PD invited you to stay in touch
• You worked closely with a faculty member who encourages you to introduce yourself to the PD
• You have a tightly aligned geographic or personal reason (e.g., spouse’s job, military commitments, undergrad alumni connection) and a mentor suggests an introduction

Example of appropriate pre-interview email:

• Brief introduction (name, school, grad year, EM focus)
• Clear connection to the program (e.g., sub-I, research, geographic connection)
• One or two sentences on why the program is a strong fit (e.g., trauma volume, community vs. academic mix, ultrasound focus)
• Thank them for reviewing your application—no demands or pressure

Avoid:

• Mass-emailing 50+ programs with generic “I’m very interested” messages
• Attaching long CVs or reiterating everything already in ERAS
• Asking directly for an interview (“Can you please offer me an interview?”)

2. Post-interview: Thank-you and “continued interest” emails

After your emergency medicine residency interviews, this is where Caribbean IMGs can stand out—not by volume, but by quality.

General timing:

• Send thank-you email within 24–72 hours of your interview
• Send one follow-up/interest email 3–4 weeks later if appropriate

Thank-you email tips:

• Personalized: Mention something specific from the conversation or the day
• Concise: 1–2 short paragraphs
• Professional: Correct names, titles, and spelling

Example structure:

1. Sincere thanks for their time and insights
2. One unique aspect of the program that aligns with your goals (e.g., robust ultrasound curriculum, county-style patient population, global health track)
3. Brief mention of your fit (EM rotations, SGU residency match track record, EM SLOEs, commitment to underserved care)
4. Closing line expressing that you look forward to staying in touch

“Continued interest” email:

This is especially valuable if:

• You have new information (Step 2 score, new publication, another EM rotation
  evaluation, improved SLOE)
• You had a strong connection to the program’s mission or region
• You genuinely could see yourself training there

Structure:

• State your ongoing strong interest
• One or two specific reasons (program features that match your goals)
• Update them on any new accomplishments
• Reaffirm your excitement about the possibility of joining their team

3. Late-season communication and letters of intent

After most interviews have finished (often January–February):

• Programs start building their rank lists
• Applicants finalize their ranking strategies

At this point, applicants may consider:

• A “letter of intent” to their true #1 program
• Selective “letters of strong interest” to a small number of other programs

Letter of intent: How, when, and what to say

A true letter of intent is a statement to one program:

“If I match at your program, I will be thrilled, and I plan to rank you #1.”

Ethically, you must:

• Send this letter to only one program
• Be honest—do not tell multiple programs they’re your #1

Timing:

• Typically late January or early February, before rank lists are submitted.

Content:

• Thank them for the interview and what you learned
• State clearly: “I intend to rank [Program Name] as my first choice.”
• Provide specific reasons: curriculum, EM training style, patient population, mentorship, or location
• Reinforce your strengths and fit as an EM-bound Caribbean IMG (e.g., diverse clinical exposure, resilience, strong EM SLOEs, SGU emergency medicine track experiences)
• Close professionally, without asking them how they will rank you

“Letters of strong interest”

For a few other programs you really like (but not #1):

• Express that you are very interested and will rank them highly
• Avoid explicit statements that sound like a letter of intent
• Keep it honest and respectful

Example:

“I remain very enthusiastic about the prospect of training at [Program Name] and anticipate ranking your program highly.”

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Practical Email Templates You Can Adapt

Below are sample templates tailored to a Caribbean IMG applying to emergency medicine. Customize them heavily; generic emails are easy to spot.

1. Post-interview thank-you email (to PD or faculty)

Subject: Thank you – [Your Name], EM Interview on [Date]

Dear Dr. [Last Name],

Thank you for taking the time to speak with me during my visit on [date]. I appreciated learning more about how [Program Name] serves a diverse, high-acuity patient population and trains residents to manage critical emergencies with confidence.

As a Caribbean IMG who has trained in resource-limited settings and busy U.S. emergency departments, I am especially drawn to your program’s emphasis on [e.g., trauma exposure, ultrasound training, community engagement]. Our conversation about [specific topic discussed] reinforced how aligned your program is with my goals of becoming a well-rounded emergency physician committed to caring for underserved communities.

I am very grateful for the opportunity to interview and to learn more about your residency. Thank you again for your time and consideration.

Sincerely,
[Full Name], MS4
[Caribbean School – e.g., Saint George’s University]
AAMC ID: [Number]

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2. Follow-up / continued interest email (with update)

Subject: Continued Interest in [Program Name] – [Your Name]

Dear Dr. [Last Name],

I hope you are well. I wanted to thank you again for the opportunity to interview at [Program Name] on [date]. The experience confirmed my strong interest in your emergency medicine residency, particularly your [e.g., county-style training environment, volume of critical care cases, ultrasound curriculum, or global health opportunities].

Since we last spoke, I have [completed another EM rotation at ___ with a strong evaluation / received my Step 2 CK score of ___ / had a manuscript accepted for publication in ___]. These experiences have further strengthened my commitment to a career in emergency medicine and my confidence in handling high-acuity patients.

I remain very enthusiastic about the possibility of joining [Program Name] and would be honored to train with your team.

Thank you again for your time and consideration.

Best regards,
[Full Name]
[Caribbean School]
AAMC ID: [Number]

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3. Letter of intent to your #1 EM program

Subject: Letter of Intent – [Your Name], Emergency Medicine Applicant

Dear Dr. [Last Name],

I hope this message finds you well. After completing my interviews and carefully considering my goals and experiences, I am writing to share that I intend to rank [Program Name] as my first choice in the Match.

During my interview on [date], I was especially impressed by [specific experiences—e.g., the residents’ camaraderie, your program’s leadership in community-based emergency care, the strong critical care and ultrasound training, or your commitment to mentorship]. Your approach to training aligns closely with my values and aspirations as a future emergency medicine physician.

As a Caribbean IMG, I have had the privilege of caring for diverse patients in both international and U.S. settings, which has taught me adaptability, resilience, and teamwork in high-pressure environments. I believe that [Program Name] offers the ideal environment for me to continue growing in these areas while contributing positively to your residency community.

Thank you again for the opportunity to interview and for your consideration. I would be thrilled to match at [Program Name] and contribute to the mission of your department.

Sincerely,
[Full Name]
[Caribbean School]
AAMC ID: [Number]

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Common Pitfalls for Caribbean IMGs in EM Pre-Match Communication

1. Over-communicating or sending mass messages

Residency leadership and coordinators are extremely busy—especially in emergency medicine programs. Too many emails can create the opposite of what you want: email fatigue and annoyance.

Avoid:

• Sending weekly updates with no real new information
• Forwarding every minor accomplishment
• Mass-copying multiple programs in one message

Aim for:

• 1 thank-you email after the interview
• 1 thoughtful follow-up/interest email with meaningful updates
• 1 letter of intent (to your #1) and, at most, a few “strong interest” emails to others

2. Sounding transactional or desperate

Phrases like:

• “I will do anything to match at your program”
• “You are my only hope”
• “Can you guarantee I will match there?”

can raise concern about your judgment and professionalism.

Instead:

• Emphasize your fit with the program’s mission and training environment
• Be confident but humble about your strengths
• Keep your tone professional, calm, and respectful

3. Misrepresenting your intentions

Telling multiple programs they are your “#1” or making promises you don’t intend to keep is unethical and can damage your reputation and your school’s relationship with programs.

Remember:

• The EM community is smaller than it looks; PDs talk.
• Your long-term identity as a physician matters more than any one match year.

Be honest, even if that means you say:

• “I anticipate ranking your program highly” rather than “#1”

4. Ignoring your unique strengths as a Caribbean IMG

Many Caribbean students focus only on “explaining” their path, instead of highlighting what it offers:

• Exposure to diverse health systems
• Adaptability in different clinical environments
• Resilience and persistence
• Often substantial hands-on experience with acute and emergency conditions

In your communication, frame your Caribbean background as:

• A strength that prepared you for emergency medicine
• Evidence of your ability to thrive in high-pressure and resource-limited settings

When you hear about SGU residency match or other Caribbean match stories, notice how the most successful EM applicants own their story and make it an asset, not an apology.

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How Pre-Match Communication Fits Into Your Overall EM Match Strategy

Pre-match communication is just one lever. It will not compensate for fundamental weaknesses (e.g., no EM SLOEs, very low board scores without explanation), but it can:

• Push you from “on the list” to “on the radar”
• Remind busy programs why you are a good fit
• Allow you to articulate priorities and clarify alignment

For a Caribbean IMG aiming for an EM match:

1. Strong foundation first

   • Two or more solid EM SLOEs
   • Step 1 / Step 2 CK commensurate with your target programs
   • Clear, EM-focused personal statement
   • Evidence of teamwork, resilience, and communication skills

2. Targeted program list

   • Mix of community and academic EM programs
   • Attention to historic Caribbean and IMG-friendliness
   • Geographic flexibility where possible

3. Thoughtful communication plan

   • Work with your Dean’s office or EM advisor to identify programs where communication might be most impactful
   • Decide early which programs are your likely top tier so your intent message later is authentic
   • Keep a simple spreadsheet tracking interviews, thank-you emails, follow-ups, and any notable faculty interactions

Over time, this approach helps establish you as:

• Professional
• Organized
• Genuinely committed to emergency medicine

That reputation can be just as important as any single email you send.

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FAQs: Pre-Match Communication for Caribbean IMGs in EM

1. Can pre-match communication actually help me match into EM as a Caribbean IMG?

Yes—when done well. Pre-match communication can:

• Keep you on a program’s radar during rank list discussions
• Highlight key updates (e.g., improved Step 2 score, strong EM rotation, new publication)
• Clarify your genuine interest, especially for programs where Caribbean IMGs have matched before

It won’t turn a non-viable application into a guaranteed match, but it can tip the scales between similar candidates.

2. Should I tell a program they are my #1 choice?

If it’s true, you may send a letter of intent to your genuine #1 program and say you plan to rank them first. Be sure:

• You only send such a letter to one program
• Your language is clear and honest
• You do not ask how they will rank you

If you’re unsure, use softer language like: “I anticipate ranking your program highly.”

3. Is it okay to ask a program for feedback or my position on their rank list?

No. NRMP rules prohibit soliciting or disclosing specific ranking information. You should not ask:

• “Where am I on your rank list?”
• “Will I match at your program?”

You can ask clarifying questions about the curriculum, schedule, research, wellness, or logistics, but avoid anything that pressures the program to reveal Match-related information.

4. How does pre-match communication differ if I have not received an interview yet?

If you have not been invited for an interview:

• A single, polite, targeted email might be appropriate if you have a compelling connection (e.g., you did a rotation there, have a spouse in the city, or an attending advocate).
• Avoid repeatedly asking for an interview.
• Focus on strengthening the overall application (e.g., EM rotations, Step 2 CK, additional SLOEs) rather than relying on emails alone.

If you’re still uncertain, discuss your situation with your EM advisor or your Caribbean school’s match office; they often have insights into how specific programs respond to pre-interview communication.

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Used thoughtfully and ethically, pre-match communication allows you to bring your full story as a Caribbean IMG into view—showing emergency medicine programs not only your scores and SLOEs, but also your judgment, professionalism, and genuine interest in their specific residency.