Essential Guide for IMGs: Pre-Match Communication in Radiology Residency

International medical graduates (IMGs) entering the diagnostic radiology match face two parallel challenges: mastering a complex specialty and navigating an unfamiliar residency selection system. One of the least understood—yet most influential—aspects of this process is pre-match communication: all the emails, calls, messages, and unofficial signals exchanged between applicants and programs before rank lists are finalized.

Handled well, pre-match communication can help you build genuine professional relationships, clarify fit, and avoid misunderstandings about things like pre-match offers, early commitment, and program communication before match. Handled poorly, it can damage your candidacy or violate Match rules.

This IMG residency guide focuses specifically on pre-match communication for international medical graduates applying to diagnostic radiology. It will help you understand what’s appropriate, what’s risky, and how to communicate effectively and professionally with programs from application submission through Match Week.

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Understanding Pre-Match Communication in Diagnostic Radiology

Pre-match communication refers to any interaction between you and residency programs from the time you submit ERAS until the start of the Match’s rank order list lock. This includes:

• ERAS application–related emails (acknowledgements, invitations, rejections)
• Interview invitations and scheduling messages
• Thank-you emails and post-interview updates
• Informal “interest” emails or calls from you or the program
• Any talk of pre-match offers or early commitment (where applicable, e.g., outside NRMP or in some states/institutions historically)

Why this matters more for IMGs in radiology

Diagnostic radiology is:

• Highly competitive, especially at academic centers
• USMLE-dependent: scores and credentials are heavily weighed
• Relationship-driven: PDs and faculty often remember applicants who communicate clearly and professionally

As an international medical graduate, you face added challenges:

• Less access to in-person away rotations in the U.S.
• Possible gaps in training due to visas or prior experience
• Less familiarity with U.S. Match culture and NRMP rules
• Communication across time zones and sometimes cultural expectations

Thoughtful pre-match communication can help:

• Show genuine interest and professionalism
• Compensate (to an extent) for limited face time
• Clarify visa issues or gaps in your CV
• Distinguish you from other qualified applicants

Key NRMP and Match rules you must know

The NRMP Match Participation Agreement sets strict rules for both programs and applicants. Some crucial points:

• No commitments before rank list certification

  • Programs cannot require you to reveal your rank list.
  • You cannot ask programs how they will rank you.
  • Neither side can ask for “promises” of ranking order.

• Voluntary expressions of interest are allowed

  • You may tell a program it is your top choice or that you intend to rank it highly.
  • Programs may say that they are interested in you.
  • These statements are not binding for either side.

• No coercion or pressure

  • Programs cannot pressure you to reveal other interviews or offers.
  • You cannot threaten programs or exert pressure (e.g., “Rank me highly or I will report you”).

• Honesty is expected

  • You should not lie. Saying “You are my number one choice” to multiple programs is unethical.

For IMGs, misunderstandings often occur around the concept of pre-match offers. In the traditional NRMP Match, pre-match contracts are generally not allowed. Some non-NRMP positions (for example in certain states or military systems) may still use genuine pre-match contracts, but you must be crystal clear about whether a position participates in the Match and what obligations you would have.

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Types of Pre-Match Communication: What’s Normal and What’s Risky?

1. Application acknowledgment and administrative emails

What it is: Automated or brief emails acknowledging receipt of your ERAS application, providing information about the program and interview logistics.

Your role:

• No need to respond unless explicitly asked.
• If there is a link to a supplemental questionnaire, complete it promptly and accurately.

Risk level: Very low. Just be prompt and professional.

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2. Interview invitations and scheduling messages

Common scenarios:

• Standard email with several date options
• Interview via a scheduling platform (Thalamus, Interview Broker, etc.)
• Alternate list or “waitlist” messages

How to respond as an IMG applicant in radiology:

• Respond within 12–24 hours if possible—competitive spots fill fast.
• Use clear and concise language, confirm time zones carefully.
• If you need to reschedule, apologize briefly and offer several alternative dates.

Example reply:

Dear [Coordinator/Dr. X],

Thank you very much for the invitation to interview for the Diagnostic Radiology residency position at [Institution Name]. I am delighted to have this opportunity.

I would be happy to interview on [Date A] or [Date B]. Please let me know which works best with your schedule. I am currently based in [Country/State], so I will adjust to your time zone.

Sincerely,
[Your Name], MD
AAMC ID: [XXXXXX]

Risk level: Low, as long as you are reliable, polite, and accurate.

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3. Thank-you emails after interviews

Most diagnostic radiology programs and faculty are accustomed to thank-you emails, though they do not change rank lists dramatically. For IMGs especially, these can:

• Reinforce specific connections you made
• Clarify your interest in academic versus community training
• Highlight alignment with the program’s strengths (e.g., cardiac imaging, AI, IR synergy)

Best practices:

• Send within 24–72 hours of your interview.
• Write short, personalized notes (3–7 sentences).
• Reference something specific you discussed or appreciated.
• No need to restate your entire CV.

Example:

Dear Dr. [Last Name],

Thank you for taking the time to speak with me during my interview for the Diagnostic Radiology residency at [Program Name]. I especially enjoyed our discussion about your work in body MRI and how residents are involved in protocol optimization.

As an international medical graduate with prior imaging research experience, I am excited by the opportunity to contribute to and learn from an academically focused program like yours. I appreciate your insights into the culture of the department and the close collaboration with referring clinicians.

With gratitude,
[Your Name], MD

Risk level: Very low, as long as the message is sincere and not overly long or repetitive.

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4. Updates, LOIs, and post-interview “interest” messages

After interviews, IMGs often wonder how much they should stay in touch. Common forms of communication:

• Update emails: New publications, Step 3 scores, awards.
• Letter of interest (LOI): Indicating strong interest in the program.
• Letter of intent: Explicitly stating the program is your “first choice” or “plan to rank #1”.

When should you send an update?

Appropriate when:

• You gain a meaningful, new achievement: publication accepted, Step 3 passed, new U.S. clinical experience completed, or significant research milestone.
• You’ve had an important change in immigration/visa status that improves your eligibility.

Guidelines:

• 1–2 update emails total per program is usually sufficient.
• Keep it concise; attach updated CV if warranted.
• Briefly link your update to how it strengthens your candidacy for that program.

Should you send a letter of intent?

You may send a sincere letter of intent to one program only, if you truly know it is your first choice. It should:

• Be honest and specific.
• Avoid pressuring the program.
• Acknowledge that the Match remains non-binding in practice but that you plan to rank them first.

Example structure:

• 1st paragraph: Thank them, reaffirm appreciation after interview.
• 2nd paragraph: Specific reasons the program is your top choice (faculty, case mix, IMG support, research).
• 3rd paragraph: Statement of intent (e.g., “I intend to rank [Program] as my first choice in the Match.”).

Risk level: Moderate if misused.

• Do not send “you are my #1” messages to multiple programs.
• Do not imply that the program owes you anything in return.

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5. Conversations about ranking and “pre-match offers”

This is the area with the greatest confusion for IMGs.

In NRMP-participating radiology programs

For the vast majority of diagnostic radiology residency programs in the U.S., there are no legal pre-match offers—all positions are filled via the Match. What you might encounter:

• Program: “We are very interested in you.”
• Applicant: “I plan to rank your program highly.”
• Program: “We hope you will rank us highly.”

These are allowed but non-binding statements. They are not contracts.

You should avoid:

• Asking: “Where will you rank me?” or “Can you guarantee I will match if I rank you first?”
• Accepting any suggestion that you must promise not to rank other programs.

In non-NRMP or special positions (rare but relevant)

Some positions—especially in certain states or systems, or in transitional years—might historically have used true pre-match contracts (binding offers before the Match). These are now uncommon for diagnostic radiology but still possible in some settings outside the NRMP.

If you are ever approached with an apparent early commitment or contract, ask clearly:

1. “Does this position participate in the NRMP Match?”
2. “Is this offer contingent on withdrawing from the Match?”
3. “Is this a binding contract?”
4. “By accepting, will I be ineligible to participate in the NRMP main residency match?”

If the answer suggests withdrawing from the Match, consult:

• Your medical school’s dean’s office or IMG advisor
• The NRMP (you can email them for clarification)
• Trusted faculty mentors who understand the system

Risk level: High if you misunderstand a pre-match contract and jeopardize your eligibility. Clarify in writing and do not rush.

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Strategic Communication Timeline for IMGs in Radiology

Below is a practical structure you can use—adapt it to your needs.

Phase 1: ERAS submission to interview invitations (September–October)

Goals:

• Ensure your application speaks for itself.
• Limit unsolicited emails to programs.

Communication you might initiate:

• In very selective cases, an introductory email:
  • When you have a specific, strong connection (e.g., published with their faculty, completed an away rotation there, or have a mentor who directly recommended you).
  • When your unique situation needs a brief explanation (e.g., visa status recently changed, or you’re a reapplicant with new qualifications).

Example short inquiry (only when justified):

Dear Dr. [Program Director],

My name is [Name], an international medical graduate from [Medical School, Country], and I have applied to the Diagnostic Radiology residency at [Institution Name] through ERAS (AAMC ID: XXXXXX). I wanted to briefly highlight that I recently completed a dedicated radiology rotation at [U.S. Institution] with strong support from [Dr. X], who recommended that I consider your program given my interest in [subspecialty/research area].

I understand that you receive many excellent applications and I appreciate your time and consideration. I look forward to the possibility of learning more about your program.

Respectfully,
[Your Name], MD

Avoid mass emailing—programs can recognize generic messages immediately.

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Phase 2: Interview season (October–January)

Your focus:

• Clear logistics communication.
• Professional, reliable behavior.
• Thoughtful, specific thank-you notes.

Don’t:

• Over-email programs for updates if you have not been invited; one email may be reasonable late in the season if you have a strong, specific reason (new Step 3 score, updated visa eligibility, or a very strong program preference).

For programs where you interviewed:

• Send thank-you notes within 1–3 days.
• Keep a spreadsheet: faculty names, main discussion points, your personal impression, and any research or visa aspects you discussed. This will help when writing later update or interest letters.

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Phase 3: Post-interview to rank list certification (January–February)

This is when program communication before match is often most active and stressful.

Your main tasks:

1. Decide your true preferences.
2. Possibly send:
   • Updates (scores, publications).
   • One letter of intent (to your genuine first choice).
   • A small number of “letters of strong interest” to other programs you especially like.

How to phrase interest without violating norms:

• For your first choice:

  • “I intend to rank [Program Name] as my first choice in the Match.”

• For other highly ranked programs:

  • “I will be ranking [Program Name] very highly.”
  • “Your program remains among my top choices.”

Avoid:

• Asking “Will you rank me to match?”
• Repeating the same message every week.
• Sending emotionally charged or desperate-sounding emails.

If a program contacts you:

• If they express strong interest: thank them and reiterate your appreciation.
• If they ask indirectly about your rank list (“How do we compare?”), you may answer broadly without lying:
  • “I can honestly say that your program is one of my top choices and an excellent fit for my goals.”

Remember: rank programs in the order that reflects your true preference. You cannot “game” the algorithm by forcing mutual promises.

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Common Pitfalls and How IMGs Can Avoid Them

1. Over-communication and appearing desperate

Programs often talk to each other; patterns like weekly emails or long multi-paragraph essays can be red flags.

Solution:

• Limit contact to meaningful updates and one or two interest messages.
• Keep emails short (under 250–300 words).

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2. Cultural communication differences

Some IMGs from more hierarchical cultures may:

• Avoid expressing interest clearly, fearing it’s “too forward.”
• Or, alternatively, use very deferential or flowery language that comes across as excessive.

Solution:

• Aim for clear, respectful, neutral-professional language.
• Avoid overly emotional expressions (“I beg you to consider me,” “You are my only hope”).
• Ask a U.S.-trained mentor to review key messages when possible.

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3. Misunderstanding “pre-match offers” or early commitments

Especially if you have trained or applied in systems where early contracts are the norm (e.g., some non-U.S. systems), you may misinterpret informal enthusiasm as a binding offer.

Solution:

• If you hear anything like “We will rank you very highly,” treat it as good news but non-binding.
• If you receive a written offer outside the Match, immediately clarify participation in NRMP and seek advice before signing anything.

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4. Being dishonest about your rank list

It may be tempting to tell multiple programs “You are my number one,” especially in a competitive specialty like diagnostic radiology.

Risks:

• Ethical breach.
• Word spreads if programs have close relationships.
• You may feel compelled to rank against your true preferences, which can affect your long-term happiness and training.

Solution:

• Use accurate language:
  • “You are among my top choices.”
  • “Your program stands out as an excellent fit.”

Reserve “first choice” for one program only—if you choose to say it at all.

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5. Neglecting visa discussion or clarifications

Diagnostic radiology programs vary widely in their willingness to sponsor J-1 or H-1B visas. Failing to clarify this can lead to misaligned expectations.

Best practices:

• Research each program’s visa policies via their website or FREIDA.
• If unclear and you are seriously interested, it’s appropriate to ask once, either during or shortly after the interview:
  • “May I ask whether your institution sponsors [J-1/H-1B] visas for Diagnostic Radiology residents?”

Being transparent about your visa status from the start prevents unpleasant surprises for both sides.

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Putting It All Together: A Sample Communication Strategy for an IMG in Radiology

Imagine you are an IMG with:

• USMLE Step 1: Pass; Step 2 CK: 246
• One year of U.S. research in neuroradiology
• J-1 visa requirement
• 8 radiology interviews (mix of university and community programs)

Your communication plan might be:

1. ERAS to interviews

   • No unsolicited emails except:
     • One short note to the institution where you did research, highlighting your existing relationship.

2. During interviews

   • Prompt, clear responses to scheduling.
   • Thank-you emails to PD and key interviewers within 48 hours.
   • One follow-up to clarify a missed question (e.g., about call responsibilities).

3. Post-interview

   • When Step 3 passes: one update email to all interviewed programs, including attached updated CV.
   • One letter of intent to your true first choice academic program, explaining how their neuroradiology strengths align with your background.
   • Two letters of strong interest to your next two favorites, emphasizing fit without claiming they are #1.

4. Final stretch before ROL certification

   • No additional emails unless:
     • A major new publication appears.
     • There is a significant change in visa or personal situation affecting start date.

This approach keeps you visible but not overwhelming, honest but not naïve, and aligned with NRMP expectations.

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Frequently Asked Questions (FAQ)

1. As an IMG, should I email programs that have not invited me to interview?

You may, but sparingly and strategically. It can be reasonable to send one brief, polite email late in the interview season if:

• You have a specific connection (research with their faculty, previous rotation).
• You have a new, significant update (e.g., Step 3 passed, new U.S. radiology experience).
• You are genuinely very interested in that program (e.g., proximity to family, unique radiology strengths).

Mass, generic emails typically do not help and can hurt your image.

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2. Can I tell more than one program that they are my “top choice”?

You can, but you should not. It is not illegal under NRMP rules, but it is considered unethical and unprofessional. If you choose to send a letter of intent, limit this to one program and be honest. For other programs, use accurate language such as “I will rank your program highly” without implying they are number one.

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3. Do thank-you emails really matter in the diagnostic radiology match?

Most program directors will say that thank-you emails rarely change rank positions significantly, but they can:

• Leave a positive final impression.
• Reinforce your professionalism and communication skills.
• Help faculty remember you favorably when discussing the rank list.

For IMGs, especially, thank-you notes are a chance to underline your fit and interest in U.S. radiology culture. Keep them concise, professional, and specific.

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4. How should I respond if a program says “We will rank you highly”?

Treat it as encouraging but non-binding information. You might reply:

“Thank you very much for your kind words. I truly appreciated the opportunity to interview at [Program Name], and I continue to be very interested in your Diagnostic Radiology residency program.”

Do not interpret this as a guarantee of matching. Continue to rank programs according to your true preferences and maintain a realistic perspective.

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Thoughtful, ethical pre-match communication is one of the few elements of the diagnostic radiology match process you can control. As an international medical graduate, using it wisely will help you demonstrate your professionalism, clarify your fit, and enter residency with confidence that you navigated the process with integrity and strategy.