Essential Questions Caribbean IMGs Should Ask for Addiction Medicine Residency

Preparing thoughtful, strategic questions to ask programs is one of the most underused advantages you have as a Caribbean IMG pursuing Addiction Medicine. The right questions do far more than “show interest”—they help you assess fit, understand training quality, and signal that you are a serious candidate who understands the realities of addiction care in North America.

This guide is designed specifically for Caribbean medical school graduates (SGU, AUA, Ross, AUC, etc.) targeting Addiction Medicine fellowships or psychiatry/family/internal medicine residencies with strong substance use training. You’ll find question lists, how to adapt them, and what the answers really mean—plus how to avoid questions that quietly hurt your candidacy.

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Why Your Questions Matter Even More as a Caribbean IMG

As a Caribbean IMG, you’re often entering interviews with:

• Extra scrutiny on your clinical training background
• Concerns (spoken or unspoken) about US healthcare familiarity
• Assumptions about support needs during onboarding and transitions
• Questions about visa sponsorship, especially for fellowship

Smart, well‑targeted questions can:

• Show that you understand addiction medicine as a complex, multidisciplinary field, not just “detox and rehab”
• Demonstrate awareness of systems of care (inpatient, outpatient, community, MAT clinics, dual diagnosis)
• Reassure programs that you grasp the longitudinal nature of substance use care
• Help you compare programs on training depth, supervision, and career outcomes
• Clarify whether a program is realistic for you in terms of visa, location, and support

Think of your questions not as “what to ask to sound smart,” but as data collection tools for making a high‑stakes career decision.

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Core Strategy: How to Plan Your Questions

Before we get into specific examples, you should build a question strategy that you can adapt in any interview.

1. Divide Questions by Audience

You should have different question sets for:

• Program Director (PD) / Associate Program Director (APD)
• Faculty with Addiction Medicine focus
• Current Fellows/Residents
• Program Coordinator / GME Office
• Clinical Directors (e.g., Medical Director of Addiction Services)

For example, “what to ask program director” should focus on curriculum design, evaluation, and program vision, while “interview questions for them” (residents/fellows) should focus on day‑to‑day experience and culture.

2. Group Questions by Priority Domains

For Addiction Medicine and substance abuse training, consider:

1. Clinical exposure & curriculum
2. Supervision & teaching
3. Career development & fellowship pathways
4. Support for IMGs & wellness
5. Research/QI and scholarly work
6. Program culture, patient population, and safety
7. Logistics: call, visas, moonlighting, location

Aim to ask 2–3 strong questions in each major conversation, not every question from this article. Pick those that matter most to you and fit the flow of the interview day.

3. Avoid “Google‑able” Questions

Never ask questions easily answered on the website, such as:

• “How long is the fellowship?”
• “Do you use Epic?”

Instead, build on what you’ve learned:

• “I saw on your website that fellows rotate at both the VA and the community hospital. Could you describe how the addiction medicine experience differs between those sites?”

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High‑Yield Questions for Program Directors and Addiction Faculty

These are the questions that show you understand Addiction Medicine and help you evaluate the strength of the program’s substance abuse training.

A. Clinical Exposure & Curriculum

1. “How is addiction medicine integrated into the core curriculum, and what proportion of my time would be directly devoted to patients with substance use disorders?”
   Why this matters: You want to know whether addiction is central or just a brief rotation.

2. “Can you walk me through a typical month of addiction‑related rotations for your residents/fellows?”
   Look for:

   • Inpatient detox/consult services
   • Outpatient MAT clinic (buprenorphine, methadone, naltrexone)
   • Dual diagnosis psychiatry
   • Community or public health settings (needle exchange, mobile outreach)

3. “What opportunities are there to manage patients longitudinally with substance use disorders, rather than only seeing them in acute settings?”
   Good programs emphasize continuity of care: seeing the same patients in outpatient clinics and following them after detox or hospitalization.

4. “How are residents/fellows trained in treating common co‑occurring conditions, like depression, PTSD, or chronic pain in the context of addiction?”
   Addiction rarely exists in isolation; you want broad, real‑world preparation.

B. Supervision, Teaching, and Autonomy

5. “Who typically supervises addiction‑focused rotations—board‑certified Addiction Medicine or Addiction Psychiatry attendings, or general psychiatrists/internists?”
   Board‑certified addiction faculty usually indicates more specialized teaching.

6. “How does supervision evolve over the course of training, especially in addiction clinics—do trainees gain more prescribing autonomy with buprenorphine, methadone, and other MATs?”
   You’re signaling you understand MAT and want to practice it competently and safely.

7. “How do you provide feedback on addiction‑related clinical skills—for example, motivational interviewing, managing craving, or handling relapse?”
   This shows you value behavioral and communication skills, not just pharmacology.

C. Program Direction and Vision

8. “Where do you see the addiction component of your program in the next 3–5 years? Are there plans to expand services or fellowships in Addiction Medicine?”
   Programs that are growing in addiction services will offer richer experiences and often have more resources.

9. “What differentiates your program’s approach to addiction medicine from other institutions in this region?”
   You’ll get insight into what they value most: research, community engagement, integrated care, etc.

D. Questions Specific to Caribbean IMGs

10. “As a Caribbean IMG, I’m particularly interested in how you support trainees who are adapting to U.S. systems of care. What specific supports are in place during the first 6–12 months, especially on high‑acuity services like addiction consults?”
    This is direct but professional; you acknowledge your background and ask about structure, not special treatment.

11. “Do you have current or recent Caribbean IMGs in your program, particularly those who have pursued an Addiction Medicine fellowship? How have they performed, and what helped them succeed here?”
    Listen for genuine examples, not vague reassurances.

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Questions for Current Residents and Fellows: What They Can Tell You That PDs Can’t

Residents and fellows will be your most honest source about day‑to‑day life, culture, and how strong the addiction training really is.

A. Day‑to‑Day Reality of Addiction Training

1. “On addiction‑related rotations, what does a typical day actually look like for you?”
   Ask:

   • Start/end times
   • Typical patient load
   • Balance of inpatient vs. outpatient
   • Time for reading or teaching

2. “Do you feel you graduate truly comfortable managing common substance use disorders, including alcohol, opioids, stimulants, and benzodiazepines?”
   You want to hear specific examples of confidence: managing withdrawal, MAT titration, dealing with complicated cases.

3. “How often do you get to practice skills like motivational interviewing or leading group sessions, and how much supervision or feedback do you receive?”
   If they say “we rarely get feedback,” that’s a red flag for training quality.

4. “How well integrated are addiction services with other specialties—do you feel like part of a multidisciplinary team?”
   Addiction care is best when integrated with social work, psychology, primary care, and psychiatry.

B. Culture, Support, and IMG‑Friendliness

5. “As a Caribbean IMG, I’m curious—how welcoming is the program to IMGs, and do you feel there is any difference in expectations or opportunities compared to U.S. grads?”
   Listen for:

   • Equal access to leadership roles
   • Fair rotation assignments
   • Respectful attitudes from staff and faculty

6. “Did you feel adequately supported in your first year—especially learning documentation, EMR systems, and U.S. clinical workflows?”
   This matters heavily if your clinical rotations were largely outside the U.S.

7. “Have any residents/fellows struggled here? If so, how did the program respond?”
   A good program addresses struggles early and constructively, not punitively.

8. “How does the program handle difficult, disruptive, or threatening patient behavior, which can be more common in addiction settings? Do you feel physically and emotionally safe?”
   Safety is important, especially in emergency or detox environments.

C. Workload, Burnout, and Wellness

9. “When you’re on addiction‑heavy services, how manageable is the workload?”
   Watch for chronic understaffing or unsafe volumes.

10. “How does the program support wellness, especially given the emotional toll of working with patients who relapse or have complex social situations?”
    Addiction medicine can be emotionally demanding; resilience support is crucial.

11. “What is something you wish you had known about the addiction training here before you matched?”
    This often surfaces hidden pros or cons.

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Addiction‑Specific Questions to Evaluate Depth of Training

These questions go deeper into substance abuse training and the quality of the addiction curriculum—critical if you plan to pursue an Addiction Medicine fellowship later.

A. Medication‑Assisted Treatment (MAT)

1. “What kind of hands‑on experience will I have with MAT—buprenorphine, methadone, naltrexone—and at what point in training do I start prescribing under supervision?”
   Strong answers describe:

   • Early exposure
   • Structured supervision
   • Clear graduation to independent practice

2. “Are residents/fellows supported in obtaining the necessary training for buprenorphine prescribing, and is this incorporated into the curriculum?”
   Even though the X‑waiver requirement has changed, programs that prioritize MAT education indicate seriousness about addiction care.

3. “How comfortable are graduates with managing complex opioid use disorder cases—such as high‑dose methadone conversions or concurrent benzodiazepine use?”
   Comfort with complexity signals rigorous training.

B. Behavioral Therapies and Psychosocial Interventions

4. “How much formal training do trainees receive in evidence‑based psychotherapies for addiction, such as CBT, contingency management, or relapse prevention?”
   Many programs focus on meds only; you want a balanced approach.

5. “Are there opportunities to observe or co‑lead group therapy or family sessions in addiction programs?”
   This builds vital skills for motivational work and family dynamics.

C. Systems of Care and Special Populations

6. “What exposure do trainees have to different care settings—detox units, residential programs, intensive outpatient programs, harm reduction services, or criminal justice settings?”
   This helps you understand how broad your experience will be.

7. “Do trainees work with specific populations, such as pregnant patients with opioid use disorder, adolescents, or individuals experiencing homelessness?”
   Subspecialty exposure is valuable if you’re considering an Addiction Medicine fellowship.

8. “How does the program approach harm reduction, including naloxone distribution, syringe services, and overdose prevention education?”
   Shows whether the program is current with modern addiction medicine principles.

D. Research and Quality Improvement in Addiction Medicine

9. “What opportunities exist for residents/fellows to participate in addiction‑related research or quality improvement projects?”
   For a future addiction medicine fellowship, scholarly activity is very valuable.

10. “Do you have ongoing projects related to overdose prevention, MAT access, or integrated care models that trainees can join?”
    Programs with robust addiction research often have strong mentorship and connections.

11. “Have previous Caribbean IMGs in your program published or presented addiction‑related work at conferences, and how were they supported to do so?”
    Shows if IMGs are truly included in academic opportunities.

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Practical Questions About Career Pathways and Post‑Training Opportunities

You should also think beyond residency/fellowship and how this program will position you for your next step.

A. Addiction Medicine Fellowship Pathways

If you’re applying to a residency (Psychiatry, IM, FM) and planning an Addiction Medicine fellowship later:

1. “Among recent graduates, how many have pursued an Addiction Medicine fellowship, and where have they matched?”
   This is similar to asking about the SGU residency match concept—does this program place its trainees in competitive fellowships?

2. “Are there faculty here with formal Addiction Medicine fellowship training who can mentor residents through the application process?”
   Mentorship is key for a strong addiction medicine fellowship application.

3. “Are there structured tracks or electives that help prepare residents specifically for Addiction Medicine fellowship?”
   Some programs have addiction tracks, extra clinic time, or scholarly pathways.

If you’re applying directly to an Addiction Medicine fellowship:

4. “How do fellows typically split their time between clinical work, teaching, and scholarship?”
   A good fellowship protects time for learning and projects, not just service.

5. “What types of positions do graduates of your Addiction Medicine fellowship obtain—academic centers, community addiction programs, VA, leadership in MAT clinics?”
   Helps you see if the program matches your long‑term goals.

B. Job Market and Visa Considerations

6. “Do you provide career counseling or job search support for IMGs, particularly regarding visas and job opportunities in addiction medicine after graduation?”
   This is critical if you’re on J‑1 or H‑1B.

7. “Have previous Caribbean IMGs secured positions in addiction medicine or psychiatry in the U.S. after training here, and what challenges did they face?”
   You want a realistic picture, not just optimism.

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Logistics, Red Flags, and How to Ask Tough Questions Professionally

Some of the most important questions to ask programs are about workload, safety, and fairness. Here’s how to ask them without sounding negative.

A. Workload, Call, and Safety

1. “On addiction‑related services, what is the typical census per trainee, and how is acuity balanced?”
   If the census seems very high with limited support, that’s a warning sign.

2. “How are overdoses, intoxicated patients, or aggressive behavior handled in your ED and inpatient settings? What protocols and security measures are in place?”
   You’re emphasizing safety and professionalism.

3. “Does working with high‑risk or high‑acuity addiction cases significantly increase burnout, and how does the program mitigate that?”
   This invites them to share wellness strategies or gaps.

B. Evaluation, Feedback, and Difficult Situations

4. “How are trainees evaluated on addiction‑related competencies, and what happens if someone is struggling in that area?”
   You want programs that remediate thoughtfully, not punitively.

5. “Have there been trainees who had difficulty completing the program, and how was that managed?”
   You can also ask residents this—answers should feel honest, not evasive.

C. Visa and IMG‑Specific Logistics

6. “What visa types do you typically sponsor for IMGs, and have there been any recent changes in your institution’s policy?”
   Ask this to the PD or GME office, not during a casual chat with residents.

7. “Are there any restrictions that IMGs need to be aware of—for example, moonlighting, certain clinical sites, or leadership roles?”
   Some institutions limit IMG roles in subtle ways.

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How to Prioritize and Personalize Your Question List

You can’t ask everything, especially in a 15‑minute PD meeting or short group sessions. To make your questions count:

1. Identify your top 3 non‑negotiables
   For many Caribbean IMGs in Addiction Medicine, these might be:

   • Strong hands‑on substance abuse training
   • Demonstrated IMG support and visa sponsorship
   • Good fellowship or job outcomes

2. Prepare 10–12 questions total, divided by audience:

   • 4–5 for PD/faculty
   • 4–5 for residents/fellows
   • 1–2 for program coordinator or GME office

3. Adapt phrasing to each program
   Use their website, brochures, and pre‑interview materials. For example:

   • “I read that you have a busy buprenorphine clinic. Can you tell me how residents are integrated into that clinic and what level of responsibility they have?”

4. Have at least 1–2 questions that show you understand the field deeply, like:

   • “How do you prepare trainees to balance harm reduction approaches with institutional or regulatory constraints, especially in opioid prescribing?”

5. End with a reflective question

   • “What kind of trainee do you feel thrives most in your addiction‑related rotations or fellowship?”

   This helps you assess fit and shows self‑awareness.

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Frequently Asked Questions (FAQ)

1. As a Caribbean IMG, should I mention my background directly when asking questions?

Yes, but do it strategically and professionally. It’s appropriate to say things like:

• “As a Caribbean IMG, I’m especially interested in understanding how you support trainees who are adapting to U.S. systems and documentation.”
• “Are there faculty or residents from Caribbean medical schools who could share their perspective on training here?”

This shows insight into your own needs without sounding defensive or apologetic.

2. What are some questions to avoid asking during residency or fellowship interviews?

Avoid:

• Anything easily answered on the website (“How many residents per year?”).
• Questions that sound like you’re negotiating before you’ve matched (vacation trading, moonlighting pay).
• Overly personal or controversial questions (faculty conflicts, “Which hospitals are the worst?”).
• Questions suggesting minimal interest in addiction (e.g., “Can I avoid addiction rotations?” if you’re applying to an addiction‑heavy program).

Instead, focus on professional, informed questions about training, support, and your long‑term career in addiction medicine.

3. How many questions should I ask when they say, “Do you have any questions for us?”

Aim for 2–4 thoughtful questions in each conversation. Quality matters more than quantity. If time runs short, prioritize:

• One question about addiction training quality
• One about support and culture
• One about career/fellowship outcomes

If panel members have already addressed many of your planned questions, you can say:

• “You’ve answered many of my questions already. I do have one more that’s important to me…”

4. Can I reuse the same questions for different programs?

Yes—with customization. The same core themes (MAT training, supervision, IMG support, addiction medicine fellowship preparation) will apply to most interviews. Just:

• Adjust wording to reflect the program’s specific strengths or settings
• Remove anything already answered in their materials or during the session
• Avoid sounding scripted—be conversational and genuinely curious

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Thoughtful, targeted questions are one of your strongest tools as a Caribbean IMG interested in Addiction Medicine. They help you assess whether a program can truly prepare you for the realities of modern substance use care and signal to programs that you are serious, informed, and ready to contribute. Use this guide as a menu—then tailor it to your story, your goals, and the unique strengths you’ll bring to every program you meet.