Navigating Pre-Match Communication for Caribbean IMGs in EM-IM Residency

Understanding Pre-Match Communication as a Caribbean IMG in EM-IM

Pre-match communication is one of the most confusing and anxiety‑provoking parts of residency applications—especially for Caribbean IMGs aiming for the highly competitive Emergency Medicine-Internal Medicine (EM-IM combined) programs. You’ve heard stories: “My friend got an email hinting they’d be ranked highly,” or “Someone in my SGU residency match group got a phone call and then an early commitment.” It can be hard to know what’s normal, what’s ethical, and what actually helps.

This article focuses specifically on how Caribbean medical school residency applicants targeting Emergency Medicine-Internal Medicine can navigate pre-match offers, early commitment conversations, and program communication before match day. While examples often reference the SGU residency match experience, the guidance applies broadly to Caribbean IMGs.

We’ll cover:

• What pre-match communication is (and isn’t) in the NRMP era
• Typical communication patterns in EM-IM combined programs
• How to respond to “we will rank you highly” and similar messages
• How to ethically express interest and send post-interview updates
• Red flags and how to protect yourself as a Caribbean IMG
• Sample email templates and practical scripts

---

The Ground Rules: NRMP Policies and What They Mean for You

Before you decide what to say in pre-match communication, you need to understand what programs are allowed to say—and what you are allowed to say. Everything in this section assumes you are participating in the NRMP Match, which includes nearly all EM-IM combined programs.

Pre-Match vs. Pre-Match Offers

There are two different concepts that often get blurred:

1. Pre-match communication

   • Normal, ongoing contact between applicants and programs after interviews (emails, thank-you notes, updates, interest letters).
   • Allowed and common—within boundaries.

2. Pre-match offers / early commitment

   • Offers of guaranteed positions outside the NRMP Match.
   • In NRMP-participating programs, this is not allowed.
   • Some states and specialties (e.g., certain Texas programs not in NRMP historically) may use true pre-match offers, but EM-IM combined programs within the NRMP do not.

For EM IM combined training in the U.S., expect pre-match communication, not binding pre-match offers. Any program that seems to promise you a position before rank lists are certified should set off alarm bells.

Key NRMP Principles That Affect Your Communication

The NRMP (National Resident Matching Program) has the Match Participation Agreement, which regulates behavior for both applicants and programs. For your purposes, some key principles are:

• No solicitations of ranking information

  • Programs cannot ask: “Where will you rank us?”
  • You cannot be required to reveal your rank list to any program.

• No commitments before the Match

  • Programs can’t make or require binding commitments outside the Match.
  • You can express strong interest or intent, but nothing is legally binding until the Match results.

• Verbal promises are not enforceable

  • “We will rank you to match” or “We will rank you very highly” is not guaranteed.
  • You should treat such statements as encouraging but not definitive.

• You may express your preferences voluntarily

  • You can say “You are my top choice” if it’s true and you choose to.
  • You cannot be forced to reveal that information.

For a Caribbean IMG, understanding this protects you from over-interpreting vague language—and from feeling manipulated by programs or rumors in your school’s match groups.

---

How EM-IM Combined Programs Typically Communicate Before the Match

The Emergency Medicine-Internal Medicine combined pathway is relatively small, academically oriented, and closely watched by program leadership. Communication styles can differ from program to program, but some patterns are common.

Types of Communication You May See

After you interview, you might encounter:

1. Standardized “thank you for interviewing” emails

   • Sent to all or most applicants.
   • Often include generic language like “We enjoyed meeting you” or “We appreciate your interest in our EM-IM combined program.”
   • These do not indicate rank status.

2. Personalized follow-up emails from faculty or PDs

   • Refer to specific things you discussed in the interview.
   • May say “You are a strong candidate” or “We hope you will consider us highly on your rank list.”
   • Positive, but still non-committal.

3. “We will rank you highly” or similar messages

   • This is where anxiety spikes.
   • Wording may range from:
     • “We will rank you to match”
     • “We anticipate ranking you very highly”
     • “You are ranked in our top group of candidates”
   • You cannot assume this equals a guaranteed match outcome.

4. Phone calls from PDs or chairpersons

   • Less common, but can happen, especially for combined programs with smaller applicant pools.
   • Often meant to convey strong interest and answer your questions.
   • Still cannot be used as binding pre-match offers.

5. Communication initiated by you (thank-you notes, updates, intent letters)

   • This is one area where Caribbean IMGs can strategically differentiate themselves—by being polished, professional, and intentional.

Why EM-IM Programs May Reach Out to You Specifically

As a Caribbean IMG, you might be surprised to get positive outreach, especially if you’re from a school like SGU, AUC, Ross, or Saba. There are several reasons you may be targeted:

• Strong overall application + good interview performance
• Demonstrated interest in combined training (research, electives, dual interests in EM and IM)
• Unique background that fits program priorities (global health, underserved care, leadership)
• Prior experience with strong Caribbean IMGs (e.g., from SGU residency match success data)

When a program makes the effort to reach out, it usually means you genuinely impressed them—but it still doesn’t remove the uncertainty of the Match algorithm.

---

How to Respond to Pre-Match Interest, “Rank You Highly,” and Early Commitment Language

You cannot control what programs say, but you can absolutely control how you respond. This section focuses on practical, scripted approaches for Caribbean IMGs in EM-IM.

General Principles for Your Responses

1. Be appreciative, not overeager

   • You want to show you’re genuinely grateful and interested, without sounding desperate.

2. Stay honest and non-committal unless you’re truly sure

   • Do not say “I will rank you #1” unless you are sure and intend to follow through.

3. Align your words with NRMP rules

   • Avoid language suggesting a binding agreement.
   • Emphasize interest, fit, and alignment, not promises.

4. Keep all written communication professional and mistake-free

   • Spelling, grammar, and tone matter; you’re being evaluated on professionalism.

Example: Program Says “We Will Rank You to Match”

Program email:

“We were very impressed with your interview and intend to rank you to match. We hope you will consider us highly when you create your rank list.”

Suggested Reply:

Dear Dr. [Last Name],

Thank you very much for your email and for the opportunity to interview with the [Program Name] Emergency Medicine-Internal Medicine residency. I truly enjoyed meeting the faculty and residents, and I especially appreciated learning about your program’s approach to [specific feature—e.g., ultrasound education, global health, critical care exposure].

I remain very interested in your EM-IM combined program and see it as an excellent fit with my long-term goals in both emergency medicine and internal medicine, particularly in [briefly restate your interests].

I appreciate your consideration and the time you and your team have dedicated to my application.

Sincerely,
[Your Full Name], M.D.
[Caribbean School Name]
AAMC ID: [########]

This response:

• Shows appreciation and interest
• Reiterates fit and professionalism
• Avoids implying any binding promise

Example: Program Director Calls Expressing Strong Interest

If a PD calls you and says something like, “We were very impressed; you’re in the top part of our list, and I hope you’ll rank us highly,” you can respond:

• “Thank you so much, Dr. [Last Name]. I really enjoyed my interview day, and your EM-IM program aligns very well with my goals in both emergency medicine and internal medicine. I will definitely be considering [Program Name] very highly when I create my rank list.”

This is truthful and non-binding. You do not need to reveal exact rank order.

If You Truly Decide a Program Is Your #1

If you’re certain a specific EM-IM program is your top choice, a “letter of intent” can help clarify your interest.

Important: Only send one true #1 letter. Caribbean IMGs rely heavily on reputation; sending multiple conflicting “you are my #1” letters is unethical and can severely damage your credibility if discovered.

Sample Letter of Intent:

Subject: Continued Strong Interest in [Program Name] EM-IM

Dear Dr. [Last Name],

I wanted to thank you again for the opportunity to interview for the Emergency Medicine-Internal Medicine residency at [Program Name]. After completing my interviews and reflecting on my career goals, I have concluded that [Program Name] is my top choice for residency training.

The combination of your strong emergency medicine and internal medicine training, the supportive culture I experienced on interview day, and opportunities in [research/critical care/ultrasound/global health, etc.] make your program the ideal environment for me to grow as a physician.

I plan to rank [Program Name] as my first choice on my NRMP rank list.

Thank you again for your time and consideration.

Sincerely,
[Your Full Name], M.D.
[Caribbean School Name]
AAMC ID: [########]

This is clear, honest, and voluntary—exactly within NRMP rules.

---

Strategically Initiating Communication: Thank-You Notes, Updates, and Interest Letters

You don’t have to wait passively for programs to contact you. Strong, well-timed communication can help reinforce your interest, particularly important for a Caribbean IMG seeking to stand out among mostly US graduates.

Post-Interview Thank-You Emails

Thank-you emails are standard, and in EM-IM they are usually well received.

When to Send:

• Within 24–72 hours of your interview day.

Who to Email:

• Program Director (always)
• Associate Program Director(s) you met with
• Key faculty or chiefs (optional, if you had a meaningful interaction)
• Coordinators (brief, appreciative message)

What to Include:

• Personal detail from the conversation
• Specific aspects of EM-IM training that stood out
• A brief reaffirmation of your interest

Mini-template:

Dear Dr. [Last Name],

Thank you for taking the time to speak with me during my interview for the Emergency Medicine-Internal Medicine residency at [Program Name]. I particularly appreciated our discussion about [specific topic, e.g., combined ED-ICU exposure or continuity clinic structure].

Our conversation reinforced my strong interest in training at [Program Name], and I can clearly see myself thriving in your EM-IM program’s [specific strengths].

Thank you again for the opportunity to interview.

Sincerely,
[Your Name]

Post-Interview Updates (New Achievements)

If you have meaningful updates after interviews (pubmed-indexed publications, conference presentations, new leadership roles, step score improvements, graduation honors), you can send a brief update email—especially to programs that you are strongly considering.

When appropriate:

• New publication accepted
• Abstract/poster/presentation at a national EM or IM society
• Significant new responsibility (chief extern, major QI project completion)
• Match-relevant certifications (e.g., ATLS, POCUS course with certificate)

Short update example:

Subject: Application Update – [Your Name], EM-IM Applicant

Dear Dr. [Last Name],

I hope you are well. I wanted to share a brief update since our interview for the EM-IM residency at [Program Name].

My manuscript, “[Title],” has been accepted for publication in [Journal Name]. This project focused on [brief relevance to EM/IM].

I remain very interested in your EM-IM combined program and appreciate your continued consideration of my application.

Sincerely,
[Your Name], M.D.

Letters of Strong Interest (But Not #1)

For programs you like but may not be your #1, a letter of strong interest is appropriate. This is especially important if you are a Caribbean IMG and want to demonstrate that your interest is genuine, not just “I applied everywhere.”

Suggested structure:

1. Short reminder of who you are and when you interviewed
2. Clear statement of continued strong interest
3. Specific reasons that program fits your EM-IM goals
4. Reaffirmation of appreciation

This can be sent once, typically late January to mid-February, before rank list certification.

---

Red Flags, Common Pitfalls, and How Caribbean IMGs Can Protect Themselves

Pre-match communication is not just about what to do; it’s also about what to avoid. This section is especially important if you’re under pressure—financially, geographically, or from family expectations.

Red Flag #1: Programs Hinting at Binding Early Commitment

If a program (especially if it’s not EM-IM, or if it’s outside the NRMP) suggests:

• “If you promise to rank us first, we’ll definitely rank you to match.”
• “We expect you to commit to us before you submit your rank list.”
• “We can offer you a spot if you agree not to go through the Match.”

You must:

• Recognize this is incompatible with NRMP policies for participating programs.
• Avoid making any binding verbal commitment.
• Consider whether such behavior reflects poorly on program professionalism.

Red Flag #2: Pressure to Reveal Rank List

You might be asked directly:

“Are we your number one?”
“Where do we stand on your list?”

You are not obligated to answer. Acceptable responses include:

• “I’m still finalizing my rank list, but I can say that your EM-IM program will be ranked very highly.”
• “I am strongly considering your program and believe it’s an excellent fit for my goals.”

If you decide to voluntarily share that they are #1, that’s your choice—but you must be prepared to follow through.

Red Flag #3: Over-Communicating or Sounding Desperate

As a Caribbean IMG, it can feel like you need to “make up ground” compared to US grads, leading to:

• Repeated emails when programs don’t respond
• Very long, emotional letters
• Contacting faculty through LinkedIn or social media randomly

This can backfire. Healthy communication looks like:

• Thank-you emails ✅
• 1–2 meaningful updates if relevant ✅
• 1 letter of intent and a small number of strong interest letters ✅
• No weekly check-ins ❌
• No complaints or guilt-tripping language ❌

Red Flag #4: Contradictory or Dishonest Statements

Programs communicate with one another more than you might expect. If you send:

• “You are my #1 choice” to multiple programs, or
• Conflicting signals that get back to a PD,

you risk:

• Losing credibility
• Being dropped in rank
• Damaging the reputation of your Caribbean school’s applicants

Honesty is both ethically required and strategically smart.

Matching Strategy: Rank Based on Preference, Not Hints

Despite all the noise of pre-match communication, the Match algorithm still works best if:

• You rank programs in true order of preference.
• You do not rearrange your list solely because one program said “rank you highly.”

For Caribbean IMGs in EM-IM:

• Do not push a less preferred program to the top just because they called you.
• Trust that if both sides rank each other highly enough, you will match there.
• Use communication to inform your preferences, not override them.

---

Putting It All Together: A Stepwise Plan for Caribbean IMGs in EM-IM

Here’s a practical roadmap to handle program communication before match in a calm, intentional way.

Before Interviews

• Review NRMP communication rules.
• Prepare a professional email signature with your full name, degree, Caribbean school, AAMC ID.
• Clarify your EM-IM narrative: why both specialties, and how your Caribbean training prepared you.

Immediately After Each Interview

• Send personalized thank-you emails within 24–72 hours.
• Take notes on:
  • Strengths of the program
  • Culture and “feel”
  • Any red flags you noticed
• Start informally ranking programs while impressions are fresh.

January: Mid-Season Communication

• Send updates if you have new, match-relevant accomplishments.
• Narrow down your top tier of EM-IM programs and note if any might be contenders for #1.
• Begin drafting potential letters of strong interest for top programs.

Late January–Mid February: Final Communication Push

• Decide on your true #1 program.
• Send one letter of intent to that program.
• Send a small number (2–4) of strong interest letters to other favorite programs.
• Respond professionally to any unsolicited PD emails or calls.

Final Week Before Rank List Deadline

• Build and finalize your rank list in true order of preference, not based solely on pre-match signals.
• Double-check that your letters/communications are consistent with your actual preferences.
• Stop sending additional, non-essential emails; last-minute excessive communication rarely helps.

---

FAQs: Pre-Match Communication for Caribbean IMGs in EM-IM

1. As a Caribbean IMG, do I need to communicate more aggressively to match EM-IM?
You don’t need to be aggressive; you need to be strategic and professional. Standard thank-you emails, 1–2 relevant updates, and a thoughtful letter of intent/interest are usually sufficient. Over-communication or emotional pressure can hurt rather than help, regardless of whether you’re an SGU, AUC, or Ross graduate.

---

2. If an EM-IM program tells me I’m in their “top group,” should I move them to #1 on my list?
Not automatically. That language is encouraging but not a guarantee. You should rank programs in true order of your preference. Let pre-match communication be one piece of information, not the sole driver of your ranking.

---

3. Can I tell more than one program they are my “top choice”?
You should not tell multiple programs they are your #1 if that’s not true. You can tell several programs that they are “among your top choices” or that you will rank them “highly.” Reserve “I will rank you #1” for the single program that truly is your first choice—and then follow through.

---

4. Do EM-IM programs care about thank-you emails and letters from Caribbean IMGs?
Most EM-IM PDs and faculty won’t base ranking decisions solely on thank-you notes, but they do notice professionalism, clarity, and genuine interest. For Caribbean IMGs, high-quality communication—well-written, punctual, and thoughtful—can reinforce that you will be a reliable, engaged resident and help counteract any bias about international training.

---

By understanding the rules, communicating ethically, and aligning your words with your true preferences, you can navigate pre-match communication confidently as a Caribbean IMG pursuing a career in Emergency Medicine-Internal Medicine.