Ultimate IMG Residency Guide: Key Questions for EM-IM Programs

Why Your Questions Matter More Than You Think

As an international medical graduate (IMG) applying to Emergency Medicine–Internal Medicine (EM-IM) combined programs, the questions you ask during interviews can be just as important as the answers you give.

Well-chosen questions:

• Show you understand the unique demands of EM-IM combined training
• Signal maturity, insight, and readiness for US residency
• Help you evaluate fit—especially crucial when you may not know the US system intimately
• Clarify areas that directly affect IMGs: visa, support, clinical autonomy, and fellowship outcomes

This IMG residency guide focuses on questions to ask residency programs—and especially what to ask the program director, faculty, and residents—so you leave each interview with a clear, realistic picture of your potential training home.

You do not need to ask every question here. Instead, think of this as a menu of high-yield interview questions for them, tailored to the EM-IM combined pathway and the specific needs of international medical graduates.

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Core Strategy: How IMGs Should Approach Asking Questions

Before diving into specific questions, you should understand how to ask questions strategically.

1. Prioritize Depth Over Quantity

Asking three or four thoughtful, specific questions is more impressive than rapid-firing ten generic ones. Aim for:

• 2–3 questions for the program director
• 2–4 questions for residents during the social or Q&A
• 1–2 questions for faculty during interviews or breakout sessions

2. Show You Understand EM-IM Combined Training

EM-IM combined programs are intense: dual accreditation, broader responsibilities, complex scheduling. Signal that you understand this by:

• Asking about integration between Emergency Medicine and Internal Medicine
• Exploring how residents are supported through this demanding track
• Inquiring how graduates are positioned for both EM and IM careers

3. Tailor Questions as an IMG

As an international medical graduate, you have additional needs and concerns:

• Visa sponsorship and long-term support
• Orientation to the US healthcare system and documentation
• Cultural integration and communication support
• Fellowship and job placement for IMGs

Your questions should address these areas directly—but professionally.

4. Avoid Questions You Could Easily Answer Online

Do not ask:
“How many residents are in your program?” or “Do you have a night float?” if that’s clearly on the website. Instead, build on what you’ve already read:

“I saw on your website that you have a night float system in PGY-2 and PGY-3. How does that work specifically for EM-IM combined residents?”

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High-Impact Questions to Ask the Program Director (PD)

The program director often shapes the program’s culture and vision. This is your best chance to understand:

• How the program views EM-IM residents
• How they support IMGs
• How they plan to develop the program over the next 3–5 years

Here are targeted questions to ask the program director, with notes on why they matter.

1. Questions About Program Vision and Structure

Q1.
“From your perspective, what makes the EM-IM combined program here different from other EM or IM categorical residencies?”

• Shows: You understand EM-IM is not just two programs stapled together.
• Reveals: How intentional the integration is and whether EM-IM gets equal attention.

Q2.
“How do EM-IM residents fit into the broader department culture of both Emergency Medicine and Internal Medicine?”

• Shows: You care about belonging and identity.
• Reveals: Whether EM-IM residents are valued or feel like ‘extras’ on either side.

Q3.
“What changes or improvements are you hoping to make to the EM-IM program over the next few years?”

• Shows: Long-term thinking and interest in program growth.
• Reveals: How reflective and proactive leadership is.

2. Questions About Training, Autonomy, and Supervision

Q4.
“How is clinical autonomy for EM-IM residents developed over the five years, particularly regarding high-acuity decisions in the ED and ICU?”

• Shows: Awareness of progressive responsibility.
• Reveals: How early you’ll be making independent decisions, and support systems.

Q5.
“For EM-IM residents, are there specific rotations or responsibilities that differ meaningfully from categorical EM or IM residents?”

• Shows: You’re thinking about the uniqueness of dual training.
• Reveals: Whether you are truly ‘dual-trained’ or function mainly as one then the other.

Q6.
“How do you support residents when they struggle, whether clinically, academically, or personally?”

• Shows: Maturity and insight that residency is challenging.
• Reveals: Wellness resources, remediation style, and program culture.

3. Questions About IMG Support and Visa Issues

These are especially important in an IMG residency guide. Phrase them professionally and factually.

Q7.
“As an international medical graduate, I’m interested in understanding how your program has supported IMGs in the past—both in terms of clinical transition to the US system and navigating visas. Could you share how that typically looks here?”

• Shows: You are direct, but professional.
• Reveals: Track record with IMGs and level of institutional support.

Q8.
“What types of visas do you sponsor for residents, and has this changed in recent years?”

• Shows: You’ve done your homework and know visa types exist (J-1, H-1B, etc.).
• Reveals: Stability and predictability for your legal status.

Q9.
“For EM-IM residents who are IMGs, how have they typically performed, and what have been some common challenges they face in their first year?”

• Shows: Self-awareness and openness to feedback.
• Reveals: How honest the PD is about challenges; may foreshadow how much support you’ll receive.

4. Questions About Career Outcomes and Fellowship

EM-IM opens multiple paths: critical care, EM leadership, hospital medicine, academic medicine, etc.

Q10.
“Where have your recent EM-IM graduates gone after residency—both in terms of jobs and fellowships?”

• Shows: You’re planning ahead and thinking long-term.
• Reveals: Real-world outcomes for people like you.

Q11.
“Do you feel that having combined EM-IM training gives graduates a significant advantage for certain fellowships or leadership roles? Could you share some examples?”

• Shows: Strategic career thinking.
• Reveals: How the program leverages the combined skill set.

Q12.
“For IMGs graduating from EM-IM here, have there been any unique challenges in securing fellowships or positions in the US, and how does the program help with that?”

• Shows: Realistic expectations.
• Reveals: Whether there’s structural or informal bias and how it is addressed.

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Key Questions to Ask Residents: The Real Story of Daily Life

Residents will often give you the most honest version of what it’s like to train there. Use resident sessions to probe:

• Culture and workload
• True level of support for IMGs
• How EM-IM is seen by peers and attendings
• Practical lifestyle realities

1. Questions About Culture and Mentorship

Q13.
“As an EM-IM resident, do you feel equally part of both departments, or more aligned with one side?”

• Reveals: Identity and whether EM-IM is genuinely integrated or “in-between.”

Q14.
“How approachable are attendings on both the EM and IM sides when you’re unsure about a management plan, especially in high-acuity situations?”

• Reveals: Safety culture and how mistakes are handled.

Q15.
“Do EM-IM residents have dedicated faculty mentors from both Emergency Medicine and Internal Medicine, and has that been helpful in career planning?”

• Reveals: Structured mentorship and how seriously EM-IM is taken.

2. Questions About Workload, Scheduling, and Burnout

EM-IM is longer and often more intense than a categorical residency. Ask residents very concretely about schedules.

Q16.
“How does the schedule feel across the five years? Are there particular phases when it feels especially intense or more manageable?”

Q17.
“How easy is it to switch between EM and IM mindsets, especially when the schedule alternates frequently between the ED and inpatient wards?”

Q18.
“How does the program handle scheduling requests for important events—visa appointments, exams, or family emergencies, especially for IMGs?”

These questions reveal whether the program treats residents as humans with lives outside work.

3. Questions About Support for IMGs

You want to know how IMGs actually experience this program.

Q19.
“As an IMG (or having worked with IMGs), what kinds of challenges have you or your colleagues faced early in training, and how has the program helped you navigate them?”

Q20.
“Did you feel you had enough orientation to the US healthcare system, documentation, and communication expectations when you started?”

Q21.
“Do IMGs here feel comfortable speaking up—whether it’s for patient advocacy, safety concerns, or asking for help?”

These questions help you gauge whether the environment is psychologically safe and inclusive.

4. Questions About Life Outside the Hospital

Residency is a five-year commitment for EM-IM; you must consider life beyond work.

Q22.
“What is it realistically like to live here on a resident salary—housing, transportation, safety, and community?”

Q23.
“How much time do you actually have for hobbies, family, or rest, especially during the busier rotations?”

Q24.
“Do residents—especially those who moved from abroad—feel they’ve been able to build a support system or friend group here?”

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Specialty-Specific Questions for EM-IM Combined Programs

To stand out in Emergency Medicine–Internal Medicine interviews, you must show that you understand what makes EM IM combined training unique.

1. Integration Between Emergency Medicine and Internal Medicine

Q25.
“How do you coordinate rotations so that EM-IM residents maintain their skills in both areas without long gaps away from the ED or inpatient medicine?”

• Reveals: Thoughtfulness in schedule design and skill retention.

Q26.
“Are there any unique rotations or experiences that are specifically designed for EM-IM residents, such as observation units, ED-based critical care, or hospitalist-ED liaison roles?”

• Shows: You’re interested in hybrid or bridge roles where both skill sets are used.

Q27.
“How are EM-IM residents involved in transitions of care from the ED to the inpatient setting or ICU? Do you get to follow patients across settings?”

• Reveals: Whether the program uses your dual training as an asset for continuity and systems-based practice.

2. Education, Conferences, and Evaluation

Q28.
“How do EM-IM residents balance educational conferences from both departments? Are there conflicts, and how are they resolved?”

Q29.
“Do EM-IM residents have separate evaluation processes or milestones, or are we evaluated separately by EM and IM with someone synthesizing the feedback?”

Q30.
“Are there specific scholarly activity expectations for EM-IM residents—for example, quality improvement in ED-to-ward transitions or research that spans both specialties?”

These questions demonstrate an academic mindset and interest in systems improvement.

3. Long-Term Career Roles for EM-IM Graduates

One of the strengths of EM-IM combined training is flexibility.

Q31.
“What career paths have EM-IM graduates from this program pursued—such as ED-based critical care, academic IM with ED roles, or administrative/leadership positions?”

Q32.
“Does the hospital or health system employ any EM-IM trained physicians currently, and what roles do they fill?”

Q33.
“If an EM-IM graduate wanted to work part-time in EM and part-time in IM or ICU, how realistic is that in your practice environment?”

Such questions help you imagine your future in concrete terms.

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How to Adapt These Questions to Different Interviewers

You should not ask everyone the same questions. Tailor them to:

• Program directors
• Associate/assistant PDs
• Faculty interviewers
• Chief residents and junior/senior residents

With Program Directors

Focus on:

• Vision, structure, and culture
• Outcomes and fellowship opportunities
• IMG support and institutional policies

Example grouping for a PD session:

1. Vision and identity of EM-IM at this institution
2. Clinical autonomy and mentorship
3. IMG support and visa history
4. Career outcomes for EM-IM graduates

With Faculty Interviewers

Focus on:

• Day-to-day supervision and feedback
• Educational philosophy
• Opportunities for research or quality improvement

Sample questions:

• “How do you like to give feedback to residents during shifts or rotations?”
• “What kind of projects or scholarly activities have EM-IM residents worked on with you or your department?”
• “What qualities do you see in residents who really thrive in this EM-IM program?”

With Residents

Focus on:

• Reality vs website description
• Support, wellness, and culture
• How IMGs and EM-IM residents truly experience the program

Avoid putting residents in an awkward position where they feel they must criticize leadership. Instead, use open, neutral questions:

• “What has surprised you most about this program, in a good way and in a challenging way?”
• “If you had to choose again, would you still pick this EM-IM program, and why?”

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Practical Tips for IMGs: Using Questions Strategically

1. Prepare a Written Shortlist

Before each interview, prepare:

• 6–8 core questions you care about deeply
• Mark 2–3 as “priority” for the PD
• Mark 3–4 as “priority” for residents

Bring them in a small notebook or on a single page, and adjust depending on what has already been answered in the presentations.

2. Listen First, Then Adapt

Many standard questions will be answered during:

• Program overview
• Orientation slides
• Pre-interview emails

Cross out questions that are clearly covered; instead, ask a follow-up:

“You mentioned the strong critical care exposure for EM-IM residents. Could you share an example of how an EM-IM resident might be involved in managing a complex ICU case from ED arrival through inpatient care?”

3. Time Management During Q&A

You may only get 5–10 minutes for your questions. Use them wisely:

• Start with your most important question
• Avoid overly long lead-in stories or explanations
• Keep each question succinct but specific

4. Avoid Potentially Problematic Questions Early On

Some questions are better saved for later in interview season, once you’ve built rapport:

• Salary and moonlighting (unless critical for visa/financial reasons)
• Very aggressive questions about duty hours enforcement
• Asking directly about ranking practices

Instead, focus on learning about the environment and whether it supports your growth.

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FAQs: Questions to Ask Programs as an IMG in EM-IM

Q1. As an IMG, what are the most essential questions I should ask every EM-IM program?
At minimum, you should clarify:

• Visa sponsorship: “What types of visas do you sponsor, and has this been consistent over time?”
• IMG experience: “How many current or recent EM-IM residents have been IMGs, and what has their experience been like?”
• Transition support: “What support is available to help IMGs adapt to US clinical practice and documentation?”
• Outcomes: “What fellowships or jobs have your IMG EM-IM graduates obtained?”

These four areas directly impact your ability to train, thrive, and remain in the US system.

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Q2. How many questions should I ask the program director vs residents?
Aim for:

• Program Director: 2–4 high-yield, strategic questions (vision, support, outcomes).
• Faculty Interviewers: 1–2 questions focused on teaching, feedback, and EM-IM expectations.
• Residents: 3–5 questions about culture, workload, IMG experience, and life outside the hospital.

It’s better to ask fewer but more thoughtful questions that spark a real conversation than many quick questions that feel rushed.

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Q3. Is it okay to ask direct questions about visa issues and job prospects for IMGs?
Yes—but phrase them professionally and contextually. For example:

• “As an IMG, understanding visa stability is very important to me. How has your program approached visa sponsorship over the past few years?”
• “For your IMG graduates, have there been any unique challenges in finding positions or fellowships, and how does the program help navigate those?”

These are reasonable, responsible concerns; programs are used to hearing them from international medical graduates.

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Q4. Should I ask different questions for EM-IM combined programs compared to categorical EM or IM?
Absolutely. For an emergency medicine internal medicine combined program, include questions that specifically address:

• How scheduling integrates EM and IM time
• Whether you’re treated as fully part of both departments
• Unique hybrid experiences such as ED-ICU, observation medicine, or hospitalist-ED collaboration
• How combined training shapes fellowship and job opportunities

Using these specialty-focused interview questions for them demonstrates that you truly understand and value EM IM combined training rather than simply applying to every possible program.

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By selecting and adapting these questions to ask residency programs thoughtfully, you’ll not only present yourself as a prepared and insightful candidate, but also gain the detailed information you need to rank EM-IM programs wisely as an international medical graduate.