IMG Residency Guide: Mastering Pre-Match Communication in Neurology

Understanding Pre-Match Communication in Neurology for IMGs

For an international medical graduate (IMG) pursuing neurology residency in the United States, the period between interviews and Match Day can feel like a black box. Programs may go silent, or you might receive warm, encouraging messages. You might hear rumors of “pre-match offers,” “early commitment,” or “neuro match shortcuts.” Navigating this landscape correctly is essential—not just for success, but also to remain fully compliant with NRMP rules and ethical expectations.

This IMG residency guide will walk you through what pre-match communication is (and isn’t), how it interacts with pre-match offers and early commitment, what’s appropriate to say, how to respond to programs, and how to manage your own communication strategy in neurology residency.

This article is written for neurology-focused IMGs but much of the advice applies across specialties.

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1. Key Concepts: Match Rules, Pre-Match, and Early Commitment

Before sending or responding to any message, you must understand the rules that govern program communication before match.

1.1 The NRMP framework (US Match system)

If you are applying to ACGME-accredited neurology residency programs that participate in the NRMP, you are bound by the NRMP Match Participation Agreement. This governs:

• What programs may say to you
• What you may say to programs
• What constitutes an improper pre-match offer or early commitment

While there are some non-NRMP pathways (e.g., certain military, “early decision,” or non-participating community programs in some states), most U.S. neurology residency positions are NRMP-participating. Always confirm each program’s status on their website or the NRMP directory.

1.2 What is “pre-match communication”?

In this context, pre-match communication refers to any interaction between you and a residency program after you submit your ERAS application and especially after your interview, but before the Rank Order List (ROL) deadline and Match results. Examples:

• Thank-you emails after interviews
• Program-initiated follow-up emails (“We enjoyed meeting you”)
• Update letters (new step scores, publications)
• “Letters of intent” or signals of interest from applicants
• Occasional phone calls from program directors (PDs) or coordinators

These communications are allowed—but content and tone matter.

1.3 What is a “pre-match offer” or “early commitment”?

A pre-match offer or early commitment usually means:

• A program tells you explicitly that they will rank you in a position that guarantees matching if you also rank them first; or
• A program offers you a contract outside the Match (in NRMP-participating programs, this is normally prohibited unless they’ve formally withdrawn positions from the Match); or
• You and the program agree (either verbally or in writing) to match each other in a way that bypasses the algorithm.

In NRMP-participating neurology programs, this kind of early commitment is typically not allowed and can be a violation for both parties. However, in some countries or some non-NRMP U.S. positions, “pre-match” contracts are still used. As an IMG, you must:

• Confirm if the program is actually in NRMP for that track.
• Understand that different rules apply if they are not.

1.4 Why neurology is special for IMGs

Neurology has historically been relatively IMG-friendly compared with some other specialties, but it is becoming more competitive. Programs increasingly value:

• Strong USMLE scores
• U.S. clinical experience in neurology
• Research or demonstrated interest in neuroscience

This environment can increase the anxiety around pre-match communication. You may feel pressure to “say the right thing” or to extract certainty where none exists. Your goal is to stay professional, ethical, and clear—without overpromising or misrepresenting your intentions.

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2. What You Can and Cannot Say: Rules and Ethics

2.1 NRMP rules: high-yield summary for IMGs

While you should review the NRMP’s official documents, these are the most relevant points for pre-match communication:

Programs may not:

• Ask you how you will rank them or other programs.
• Ask you to state they are your “number one” or to commit to ranking them first.
• Offer guarantees like “If you rank us #1, you will match here.”
• Ask you to sign any contract for a NRMP-participating position before Match.

You may not:

• Accept or sign a contract for a NRMP-participating position before Match Day.
• Misrepresent your ranking intentions if explicitly asked (e.g., lying about ranking order). Note: They are not allowed to ask, but if you choose to disclose, you should not lie.
• Attempt to pressure a program into making statements about ranking or positions that are against NRMP rules.

Both sides may:

• Share general interest (e.g., “We are very interested in you” / “I’m very enthusiastic about your program”).
• Ask or answer questions about program features, visa policies, research, call structure, etc.
• Provide and request honest feedback (within reasonable boundaries).

2.2 “Am I allowed to tell a program they are my #1?”

Yes. It is allowed to voluntarily tell a neurology residency that you plan to rank them #1, as long as:

• The program did not coerce or pressure you into saying this.
• You genuinely intend to rank them #1.
• You do not tell multiple programs that they are your #1.

However, you must understand:

• This statement is not binding for either side.
• Even if you both rank each other #1, the Match algorithm determines the final outcome, and nothing is guaranteed.
• Overstating your commitment or telling multiple programs they are your top choice is unethical and can damage your reputation if discovered.

2.3 “Can programs tell me I’m ranked to match?”

Programs may sometimes say things like:

• “We will rank you highly.”
• “You are a very competitive candidate for us.”
• “We would be happy to have you here.”

In some cases, they may say more direct things such as:

• “You will be ranked in a position where we think you will match.”
• “We plan to rank you to match.”

These communications are allowed, but they are not guarantees and should always be treated cautiously. Program rank lists can change; leadership can change; additional candidates may impress them late in the season.

As an IMG, interpret these messages as positive signals but not promises. Do not anchor your entire strategy on one such message.

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3. How to Communicate Professionally: Before, During, and After Interviews

3.1 Before interviews: initial contact and clarification

You might need to contact neurology programs before interviews for:

• Clarifying visa sponsorship (J-1 vs. H-1B)
• Asking about minimum USMLE score requirements
• Updating step results or ECFMG certification status
• Inquiring about U.S. clinical experience expectations

Best practices:

• Use a professional email address (e.g., firstname.lastname@gmail.com).
• Keep subject lines clear:
  • “Application Update – ERAS AAMC ID XXXXXXXX – Neurology”
  • “Visa Eligibility Question – Neurology Applicant (IMG)”
• Be concise: 2–3 short paragraphs maximum.
• Attach PDFs only if specifically relevant (e.g., updated transcript, new score report).

Example (pre-interview visa clarification):

Subject: Visa Sponsorship Question – Neurology Applicant (ERAS ID XXXXXXXX)

Dear Dr. Smith and Neurology Residency Team,

I hope this message finds you well. I am an international medical graduate who has applied to your neurology residency program this cycle (ERAS ID XXXXXXXX). I am writing to confirm whether your program sponsors J-1 and/or H-1B visas for incoming residents.

This information will help me plan my application strategy appropriately. I appreciate your time and consideration.

Sincerely,
[Your Full Name], MD
[Medical School], Class of [Year]

This is neutral, compliant, and professional.

3.2 During interview season: thank-you notes

Thank-you emails are not mandatory, but they are low-risk opportunities to reinforce your interest.

General guidelines:

• Send within 24–72 hours after your interview.
• Write to each interviewer or to the PD/chair and chief residents if individual emails are not available.
• Mention one or two specific details from your conversation or the program.
• Do not talk about ranking or “number one” at this stage.

Example (post-interview thank-you):

Dear Dr. Lee,

Thank you again for the opportunity to interview with the [Program Name] Neurology Residency on [Date]. I particularly appreciated our discussion about the stroke service and your approach to involving residents in clinical research.

As an IMG with a strong interest in vascular neurology, I was impressed by your program’s comprehensive stroke center and the emphasis on multidisciplinary care. I left the interview even more enthusiastic about the possibility of training with your team.

Thank you again for your time and consideration.

Sincerely,
[Your Name], MD

This expresses enthusiasm without discussing ranking or promises.

3.3 After interviews: update letters and letters of interest

After interviews, programs may go quiet. This is normal. It does not necessarily reflect disinterest.

You might choose to send:

• An update letter (1–2 times maximum) when you have:

  • New publications
  • New USMLE Step or OET/TOEFL results
  • ECFMG certification
  • New U.S. neurology or IM rotations

• A letter of interest if:

  • You strongly like the program and want them to know you are highly interested.
  • But you are not yet ready to tell them they are your #1.

• A letter of intent (#1 letter) if:

  • After completing all interviews, you decide this program is your genuine first choice in the neuro match.
  • You are comfortable putting this in writing honestly.

Key point: You do not have to send a #1 letter to match successfully. Many applicants match without any such letters.

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4. Crafting Effective Pre-Match Messages: Examples and Templates

4.1 Update letter template for neurology IMGs

Subject: Application Update – [Your Name], Neurology Applicant (ERAS ID XXXXXXXX)

Dear Dr. [Program Director Last Name] and the Neurology Residency Selection Committee,

I hope you are doing well. I had the pleasure of interviewing with your neurology residency program on [Interview Date], and I remain very interested in the opportunity to train at [Program Name].

Since our interview, I would like to share a brief update to my application:

• I received my USMLE Step 2 CK score of [Score].
• My manuscript titled “[Title]” was accepted for publication in [Journal Name].
• I recently completed an observership in neurology at [Institution], where I gained additional exposure to [brief description, e.g., epilepsy monitoring, neuro-ICU].

These experiences have further strengthened my commitment to a career in neurology, particularly in [subspecialty interest if applicable]. I remain highly enthusiastic about your program’s strengths in [mention 1–2 features: research, mentorship, subspecialty, patient population].

Thank you again for your time and kind consideration of my application.

Sincerely,
[Your Full Name], MD
[ERAS AAMC ID]
[Contact Information]

4.2 Letter of interest (strong interest but not clear #1)

Subject: Continued Interest – [Your Name], Neurology Applicant (ERAS ID XXXXXXXX)

Dear Dr. [PD Last Name],

I wanted to express my continued interest in the [Program Name] Neurology Residency Program following my interview on [Date]. As I review my interview experiences, your program stands out for [2–3 specific reasons – e.g., your structured EMG curriculum, exposure to diverse pathology, and supportive culture].

As an international medical graduate passionate about neurology, I feel that [Program Name] offers the environment and mentorship that would allow me to grow into a well-rounded and compassionate neurologist. If I am fortunate enough to match into your program, I would be deeply committed to contributing to your clinical and academic community.

Thank you again for considering my application.

Sincerely,
[Your Name], MD

This signals genuine enthusiasm without any mention of “ranking first” or “top choice.” It is appropriate for most applicants.

4.3 Letter of intent (#1 program) – use cautiously

Send only one such letter, and only if you are genuinely sure.

Subject: Letter of Intent – [Your Name], Neurology Applicant (ERAS ID XXXXXXXX)

Dear Dr. [PD Last Name],

I am writing to express my sincere gratitude for the opportunity to interview with the [Program Name] Neurology Residency Program on [Date]. After careful consideration of all the programs where I interviewed, I have decided that [Program Name] is my first choice for residency training.

I plan to rank your program as my number one choice in the upcoming NRMP Match. My decision is based on [2–3 specific factors: e.g., the strong mentorship structure, the breadth of exposure to complex neurological diseases, and the welcoming atmosphere I experienced during my interview day].

As an international medical graduate, I was particularly impressed by your program’s history of supporting IMGs and fostering their development into successful neurologists. If I am fortunate enough to match at [Program Name], I will be fully committed to contributing to your clinical services, education, and research activities.

Thank you once again for considering my application.

Respectfully,
[Your Full Name], MD
[ERAS AAMC ID]
[Contact Information]

This is clear, honest, and fully allowed. You are not asking for a guarantee; you’re simply stating your genuine intent.

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5. Responding to Program-Initiated Pre-Match Communication

5.1 When you receive a warm but vague email

Example message from program:

“We enjoyed meeting you and think you would be an excellent fit for our neurology residency. We will certainly consider you very favorably as we prepare our rank list.”

How to interpret:

• Positive. You did well.
• Not a guarantee.
• Do not change your entire ranking based only on such general language.

Example response:

Dear Dr. [PD Last Name],

Thank you very much for your kind message. I truly enjoyed learning more about [Program Name] and meeting your residents and faculty. I remain very interested in your neurology residency program and appreciate your consideration of my application.

Sincerely,
[Your Name], MD

Keep it short, polite, and appreciative.

5.2 When a program hints at “rank-to-match”

Sometimes neurology PDs or associate PDs may say:

“We plan to rank you in a position where we believe you will match here.”

How to respond:

You may:

• Thank them for their confidence.
• Express your continued or strong interest.
• You are not obligated to say you will rank them first.

Example:

Dear Dr. [PD Last Name],

Thank you for your encouraging message and for your confidence in my candidacy. I truly appreciated the opportunity to interview at [Program Name], and I remain very interested in your neurology residency program.

I look forward to the outcome of the Match. Thank you again for your support and consideration.

Sincerely,
[Your Name], MD

You preserve flexibility without being misleading.

5.3 When a program appears to make a pre-match offer (NRMP-participating)

If a neurology program that is NRMP-participating sends something like:

“If you rank us #1, we can guarantee you a position here.”

This is problematic. It risks an NRMP violation. Do not agree in writing. You can:

• Respond with a neutral, non-committal message.
• Continue with your normal ranking strategy.
• Optionally seek advice from your dean’s office, an advisor, or NRMP (anonymously).

Example neutral response:

Dear Dr. [PD Last Name],

Thank you for your message and for your confidence in me as an applicant. I greatly appreciated the opportunity to interview at [Program Name] and remain very interested in your neurology residency.

I understand that the NRMP Match will ultimately determine the outcome, and I will carefully consider all of my options when finalizing my rank list. Thank you again for your support and for considering my application.

Sincerely,
[Your Name], MD

You acknowledge the message without entering into any sort of binding or quasi-binding agreement.

5.4 When dealing with non-NRMP “pre-match” neurology positions

In some rare settings (e.g., a non-participating community neurology program or an international neurology residency), real pre-match offers and early commitment contracts are used. In that case:

• Confirm explicitly that the position is not in the NRMP.
• Review the contract carefully, including:
  • Start date
  • Salary and benefits
  • Visa sponsorship details
  • Obligations and penalties (if any)
• Consider how accepting this offer will affect your other applications and your long-term goals (e.g., fellowship opportunities, university vs. community training).

If in doubt, seek guidance from:

• A trusted mentor or attending in neurology
• Your medical school dean’s office
• An experienced IMG advisor
• An attorney with experience in physician contracts (if financially feasible)

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6. Strategic Considerations for IMGs in Neurology

6.1 Balancing honesty and strategy

As an international medical graduate, you may feel pressure to “say whatever they want to hear” to secure a neurology residency spot. However:

• Being truthful about your intentions is ethically important.
• The neurology community is smaller than you think; PDs and faculty know one another.
• Getting caught in a lie (e.g., telling multiple programs they are your #1) can seriously damage your professional reputation.

Your strategy should be:

• Be enthusiastic and specific with programs you like.
• Send a genuine #1 letter to only one program, if you choose to do so.
• Never promise something you don’t intend to do.

6.2 Managing anxiety and program silence

It is normal for programs to:

• Go completely silent after interview season.
• Not respond to every thank-you or update email.
• Avoid discussing ranking in any way.

Do not interpret silence as rejection. Many applicants match at programs that never sent them a single signal.

Focus on:

• Finalizing your rank list according to your true preferences (training quality, fit, location, visa support, family considerations).
• Avoid over-sending messages; too many emails may be counterproductive.

6.3 Rank list: trust the algorithm

For the neurology residency neuro match, NRMP’s algorithm is applicant-proposing, meaning:

• It tries to place you at your most preferred program where you can match.
• You should always rank programs in genuine order of preference, not based on who seemed “most interested” in you.

Signals from programs can be helpful to gauge interest, but they should never outweigh:

• Your own goals (e.g., desire for academic vs. community neurology, exposure to subspecialties like epilepsy or movement disorders).
• Objective program features: case volume, research, fellowship match, call schedule.

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FAQ: Pre-Match Communication for IMGs in Neurology

1. As an IMG, do I need to send a “letter of intent” to match into neurology?

No. Many international medical graduates match into neurology without ever sending a formal letter of intent. Such a letter can be useful if you have a clear #1 choice and want to signal strong commitment, but it is not required and does not guarantee a match.

2. How many programs can I tell are my “top choice” or “#1”?

Ethically, you should tell only one neurology residency that it is your true #1 in the neuro match. Telling multiple programs the same thing is dishonest and can damage your reputation if discovered, especially within a relatively close-knit specialty like neurology.

3. How often should I email programs after interviews?

In most cases:

• 1 thank-you email per program (or per interviewer if you choose)
• 0–2 update/interest emails total after interview season

More than that can appear excessive. If a program does not respond, do not keep emailing repeatedly. Silence does not equal rejection.

4. What should I do if a neurology program offers a pre-match contract outside NRMP?

First, confirm whether the position participates in NRMP. If it does, signing a pre-Match contract is likely a violation. If it does not, and it’s truly an outside pathway:

• Carefully review all terms (salary, visa, benefits, obligations).
• Consider how it fits with your long-term neurology career goals.
• Seek advice from mentors, your dean’s office, or a contract-savvy attorney if possible.
• Remember that once you sign a binding contract, you may have to withdraw from the Match or from other applications.

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Used thoughtfully, pre-match communication can support your neurology residency journey as an international medical graduate—but it cannot replace strong credentials, genuine fit, and a well-constructed rank list. Stay professional, stay honest, and let the Match algorithm work in your favor.