Essential Questions for IMGs in Anesthesiology Residency Interviews

Why Your Questions Matter as an IMG in Anesthesiology

As an international medical graduate (IMG), you face unique challenges in the anesthesia match: visa issues, unfamiliar health systems, potential bias, and navigating a specialty with high responsibility and a steep learning curve. Asking strong, targeted questions to anesthesiology programs is not just polite—it is strategic.

Thoughtful questions:

• Show you understand anesthesiology training and its demands
• Demonstrate that you have done your homework on the program
• Help you assess whether the program will genuinely support IMGs
• Clarify expectations so you can perform well if you match there

This IMG residency guide will help you know exactly what to ask programs, faculty, residents, and program leadership—so you can walk into interviews with confidence and leave with the information you truly need.

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How to Approach Asking Questions as an IMG

Before we list specific questions, you need a strategy. Many IMGs feel pressure to “impress” and end up asking generic or overly soft questions. You need questions that are:

• Specific (to anesthesiology and to that program)
• Relevant to your situation as an IMG
• Open-ended enough to invite a real, honest answer
• Professional, never confrontational

General Principles for Asking Strong Questions

1. Do your homework first

   • Review the program’s website, social media, and FREIDA listing.
   • Avoid asking about information that is clearly listed (number of residents, basic curriculum, call schedule headlines).
   • Use your questions to go deeper, not to confirm what’s already online.

2. Prioritize what matters most to you as an IMG
   For most IMGs in anesthesiology, priorities include:

   • Visa sponsorship and long-term support
   • Emphasis on education vs service
   • Hands-on case exposure and OR autonomy
   • Step scores/US clinical experience expectations for future fellowship
   • Culture: how IMGs are treated, communication style, support during challenges

3. Direct questions to the right person

   • Program Director (PD): curriculum, expectations, evaluation, institutional support
   • Associate/Assistant PD or Chair: vision for training, future of the department, quality improvement, departmental culture
   • Current Residents (especially IMGs): day-to-day reality, culture, how the program handles stress, actual case volume
   • Program Coordinator: logistics, visa/welfare issues, onboarding, paperwork

4. Use the “3–3–3” method Before each interview day, plan:

   • 3 questions for leadership (PD/APD/Chair)
   • 3 questions for residents
   • 3 questions specific to that program (from your website research)

5. Phrase questions to invite detail Instead of: “Do IMGs do well here?”
   Try: “Can you share examples of how the program has supported IMGs in adapting to the system here and advancing to fellowship or practice?”

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Core Questions to Ask Program Directors and Leadership

This is where “what to ask program director” becomes critical. PDs want to see that you care about education, professionalism, and your future career. You want to see how the program will invest in you.

Below are high-yield interview questions for them, tailored to IMGs and anesthesiology.

A. Questions About Education, Supervision, and Autonomy

1. “How do you balance supervision and resident autonomy in the OR, especially for first-year anesthesia residents?”
   Why this matters: As an IMG, you may be unfamiliar with U.S. OR culture and medico-legal expectations. You need safe but progressive responsibility.

   What to listen for:

   • Clear structure in early months (shadowing, orientation, simulation lab)
   • Gradual independence with backup readily available
   • An explicit culture of asking for help without stigma

2. “Can you describe how your curriculum prepares residents for managing critical events and high-acuity cases?”
   Why this matters: Anesthesiology is high-risk. Look for:

   • Regular simulation (codes, airway, massive hemorrhage, anaphylaxis)
   • Problem-based teaching, mock code drills, crisis resource management
   • Protected education time that is truly honored

3. “How is resident performance evaluated, and how do you provide feedback, especially to residents who may need extra support during the transition?”
   IMGs often need initial adaptation to communication styles, EMR, and protocols.

   Look for:

   • Structured evaluations (milestones, 360° feedback)
   • Scheduled feedback meetings (e.g., semiannual PD/mentor meetings)
   • Remediation that is supportive, not punitive

4. “How do you ensure residents meet case requirements across subspecialties (cardiac, peds, OB, regional, ICU)?”
   For anesthesia match success and board eligibility, case numbers matter.
   They should know their numbers and have a system to fill gaps.

B. Questions About IMG Support and Visa Issues

5. “What has been the experience of IMGs in your program over the past five years—in terms of performance, board pass rate, and post-residency placement?”
   Why this matters: Programs that truly value IMGs can quote outcomes, not vague reassurances.

6. “What type of visas do you sponsor, and how experienced is your institution with visa and immigration issues for residents?”
   Key points:

   • Whether they sponsor J-1, H-1B, or both
   • Whether they have had any recent changes or restrictions
   • Whether they have in-house legal or GME visa support

7. “Are there any institutional limitations that might affect an IMG’s ability to moonlight, apply for certain fellowships, or pursue academic jobs in the future?”
   Some visas limit moonlighting or delay certain opportunities. Good programs will be transparent.

C. Questions About Call, Workload, and Wellness

8. “How is call structured at each level of training, and how do you monitor for duty hours and fatigue?”
   For anesthesia, ask specifically:

   • OR call vs ICU call
   • In-house vs home call
   • Backup systems for sick calls

9. “What formal wellness resources and informal support systems do residents use most often here?”
   As an IMG away from family and social support, you need:

   • Mental health resources
   • A culture where residents check on each other
   • Access to mentors, including IMG faculty or senior residents

10. “Can you describe how the program handled a resident who was struggling—academically, clinically, or personally—while protecting their dignity and career?”
    You don’t need names; you want to hear:

• That this has happened
• That support was structured
• That the final outcome was thoughtful and fair

D. Questions About Career Development and Fellowships

11. “How does the program support residents interested in competitive fellowships (e.g., cardiac, critical care, regional, pain)?”
    Look for:

• Faculty advocacy and letters
• Research or QI opportunities
• Mentorship from subspecialty experts

12. “Where have your graduates gone in the last 3–5 years, and how do you help them decide between fellowship and going straight into practice?”
    For an IMG residency guide, this is key: you want doors open for both options.

13. “If I’m interested in an academic or leadership career, what opportunities exist for teaching, QI projects, or committees as a resident?”
    Programs that encourage resident involvement in:

• Department committees
• Curriculum development
• National anesthesiology organizations (e.g., ASA, SPA, SCA)

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Questions to Ask Current Residents (Especially IMGs)

Residents will give you the clearest picture of daily life. Focus your questions to uncover the unspoken parts of a program.

A. Daily Workload, OR Experience, and Learning

1. “What does a typical day look like here for a CA-1? For a CA-2/CA-3?”
   Ask about:

   • Start/end times
   • Pre-op clinic responsibilities
   • Turnover pressure and OR efficiency

2. “Do you feel you get enough hands-on airway experience, regional blocks, and critical cases?”
   Anesthesia is procedural. You need:

   • Frequent airway management
   • Central/arterial lines
   • Regional blocks with ultrasound
   • Exposure to sick patients (ASA 3–4)

3. “How well are attendings at this program at teaching in the OR? Are they approachable for questions?”
   Look for honest, concrete examples of:

   • Attendings explaining decision-making
   • Encouraging questions, not just “move faster”
   • Managing emergencies with teaching, not shouting

4. “Do you feel prepared and confident when you progress to more complex rotations like cardiac, neuro, or ICU?”
   This tells you whether early training is strong and structured.

B. Culture, Communication, and IMG Integration

5. “As an IMG (if you’re one), what helped you the most when you first started here? What was hardest?”
   Their answers will give you:

   • Practical adaptation tips
   • A sense of how supportive the environment is

6. “How does the program help new residents adjust to the EMR, U.S. hospital culture, and communication with surgeons and nurses?”
   Ask for specific examples:

   • Orientation content
   • Shadowing or gradual integration into OR
   • Simulation of typical OR conflicts (e.g., case delays, disagreements)

7. “Do residents spend time together outside of work? What does the social dynamic feel like?”
   IMG or not, you need a supportive peer group.

8. “Have you ever felt uncomfortable raising concerns—about safety, fairness, or mistreatment? How was it handled?”
   Psychological safety is essential in anesthesiology where speaking up can save lives.

C. Reality vs Marketing

9. “What is one thing you wish you had known about this program before you matched here?”
   This often brings out:

   • Hidden strengths
   • Real challenges (e.g., heavy workload, limited subspecialty exposure)

10. “If you had to choose this program again, would you? Why or why not?”
    Listen carefully to tone and specifics, not just the words.

11. “How responsive is leadership when residents bring up problems, like schedule issues or educational needs?”
    Ask for a story: “Can you share an example of a problem that residents raised and how it was resolved?”

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Program-Specific Questions: Tailoring Your Approach

Generic interview questions for them are less effective than customized ones. Use details you learn from:

• Program website and curriculum
• Case volume and subspecialty strengths
• Resident bios or research projects
• Location, patient population, or unique features

A. Curriculum and Rotation Structure

1. “I saw that you have a strong [cardiac / regional / critical care] rotation. How early in training do residents rotate there, and how is the progression of responsibility structured?”

2. “Your website mentions simulation training—how often do residents participate, and are scenarios tailored to anesthesiology emergencies?”

3. “I noticed you have a combined ICU exposure with other specialties. How is anesthesia represented in the ICU, and are anesthesia residents able to function in a leading role?”

B. Patient Population and Case Mix

4. “What are the most common types of cases here, and what unique patient populations do residents work with?”
   For example, in a safety-net hospital:

   • High-acuity, under-resourced patients
   • Complex comorbidities

5. “Are there opportunities for residents to rotate at different hospitals (VA, children’s hospital, community sites), and how do these sites complement each other?”

C. Research and Scholarly Work

6. “I noticed residents have presented at [ASA/SOCCA/etc.]. How do you help residents get involved in research or QI, especially those with less previous research experience like many IMGs?”

7. “Is there any protected time or mentoring structure for residents pursuing scholarly projects?”

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Questions to Ask About Logistics, Support, and Life Outside the OR

These often get overlooked but are crucial if you’re moving to a new country and city.

A. Questions for the Program Coordinator or GME Office

1. “What is the timeline and process for visa processing after match day? What should I be prepared for as an IMG?”

2. “What kind of support is available for finding housing, setting up banking, and understanding benefits when I first arrive?”

3. “Are there institutional orientation sessions tailored to IMGs or new international hires?”

B. Questions About Life in the City and Community

4. “How do residents typically commute and where do most live? Is the cost of living manageable on a resident salary?”

5. “Are there cultural or religious communities nearby that IMG residents have found helpful?”

6. “What do residents do outside of work for fun in this area?”

For an international medical graduate, feeling at home in the community significantly affects your overall wellness and performance.

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How to Phrase Questions Effectively and Professionally

The content of your questions matters, but so does the delivery.

A. Use Framing to Avoid Sounding Negative

Instead of:

• “Are you overworking your residents?”

Try:

• “How do you ensure residents maintain a healthy balance between service demands and education?”

Instead of:

• “Do you treat IMGs differently?”

Try:

• “How does the program support residents from diverse training and cultural backgrounds, including IMGs, in adapting and thriving here?”

B. Combine a Compliment with a Question

This shows you’ve done your homework:

• “I noticed you have a strong emphasis on regional anesthesia—what kind of graduated independence do residents get for performing blocks by CA-2 or CA-3?”
• “Your residents seem very successful in matching into fellowships. What structures are in place to help them achieve their specific career goals?”

C. Avoid These Common Pitfalls

• Over-focusing on salary, vacation, or moonlighting in your first few questions. Those matter, but lead with education and culture.
• Asking yes/no questions that end conversation.
• Asking questions you should clearly know from the website (e.g., “How many CA-1s do you take?”).

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Putting It All Together: Example Question Sets

To make this practical, here are example question sets you could use on an interview day.

Example Set for Program Director

1. “How do you structure the first six months for new anesthesia residents, especially those who may be new to the U.S. healthcare system?”
2. “What has been your experience with IMGs in the program, and how has the program evolved to better support them?”
3. “Can you share how residents here are prepared for both the written and oral anesthesia board exams?”
4. “Where have your recent graduates gone, and how do you see your program’s strengths reflected in their career paths?”

Example Set for Residents

1. “What surprised you the most about working here once you started as a CA-1?”
2. “How comfortable do you feel managing complex cases at night or during call? How is backup provided?”
3. “Do you feel the program listens to resident feedback? Can you give an example of a change made based on that feedback?”
4. “For those of you who are IMGs or trained abroad, what helped you adapt most quickly?”

Example Set for Coordinator / GME

1. “What are the biggest challenges IMGs typically face on arrival, and how does the program help address them?”
2. “Can you walk me through the steps and timeline for visa and onboarding after match day?”
3. “Are there any institutional workshops or support services that focus on communication skills or cultural adaptation for IMGs?”

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Final Tips for IMGs on Using Questions Strategically

• Prioritize: You will not have time to ask everything. Decide your top 5–7 must-ask questions per program.
• Take notes immediately after the interview day: Programs will blend together; your notes on answers will help with your rank list.
• Use questions to show who you are: Ask about aspects that matter to your personal goals—critical care, research, global health, teaching, or private practice.
• Be authentic: Programs are not only evaluating you; you are evaluating them. The right fit is critical for your success and well-being.

Thoughtful, targeted questions help you see beyond brochures and websites into the true nature of an anesthesiology residency. As an international medical graduate, this is one of your strongest tools to identify programs that will not just accept you, but truly invest in your development as a safe, confident, and successful anesthesiologist.

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FAQ: Questions to Ask Programs as an IMG in Anesthesiology

1. Is it okay to ask directly about visa sponsorship during interviews?
Yes. Visa status is a legitimate, critical concern for any international medical graduate. Phrase it professionally, for example:

• “Could you share what types of visas the institution currently sponsors for residents and whether there have been any recent policy changes?”
  You can ask PDs or coordinators; often coordinators know the detailed logistics best.

2. How many questions should I ask in each interview?
Aim for 2–4 thoughtful questions per formal interview and 3–5 during resident-only sessions. Depth matters more than quantity. It’s better to ask fewer, richer questions and listen carefully than to rush through a long list.

3. What if the program already answered some of my prepared questions in their presentation?
Acknowledge that and pivot:

• “You mentioned earlier that the program uses simulation extensively. Could you tell me specifically how simulation is integrated into preparing residents for rare anesthesia emergencies?”
  This shows you were listening and can think flexibly.

4. Can I ask about fellowship match outcomes as an IMG-specific concern?
Yes, and you should. Try:

• “How have IMGs from your program done in securing fellowships in areas like cardiac, critical care, or pain? Are there any additional challenges they face, and how does the program support them?”
  This gives you realistic expectations and shows you are thinking long-term about your anesthesiology career.

By preparing focused, strategic questions in advance, you transform the interview from a one-sided evaluation into a real conversation about whether this anesthesiology residency is the right place for you to grow as an IMG and future anesthesiologist.