Essential Questions for IMGs in General Surgery Residency Interviews

Why Your Questions Matter as an IMG in General Surgery

As an international medical graduate interested in general surgery residency, the questions you ask programs are not just a formality—they are a powerful tool. They help you:

• Evaluate whether a program truly supports IMGs
• Demonstrate maturity, insight, and genuine interest
• Clarify expectations around visas, support, operative experience, and fellowship prospects
• Protect yourself from landing in an unsupportive or exploitative environment

This IMG residency guide focuses on the most strategic questions to ask residency programs—including what to ask program directors, residents, coordinators, and even during pre-interview socials. It is tailored specifically to IMGs targeting the surgery residency match in general surgery.

Think of your question list as a diagnostic test: each answer reveals whether a program will help you grow into the surgeon you aim to be.

---

Strategy First: How to Ask Smart Questions

Before diving into specific question lists, you need a strategy.

Principles for Asking Questions

1. Be Specific, Not Generic
   Avoid: “Do you support research?”
   Better: “What types of research projects are residents typically involved in here, and how are they supported to present or publish?”

2. Show You’ve Done Your Homework

   • Reference their website, case numbers, or a specific rotation.
   • Example: “I noticed your program offers a dedicated acute care surgery rotation in PGY-2; how does that rotation prepare residents for independent decision-making?”

3. Tailor Questions as an IMG
   You must clarify:

   • Visa support and past IMG experience
   • Evaluation style and expectations for someone trained in another system
   • Support with transitions: EMR, documentation, communication, and cultural adaptation

4. Ask Different People Different Things

   • Program Director (PD): Vision, expectations, advancement, remediation, major policies.
   • Residents: “Real life” culture, workload, operative experience, burnout, support.
   • Coordinator/Admin: Logistics, visas, onboarding, licensure, housing, pay/benefits.

5. Avoid Red-Flag Questions Early Don’t open with money, vacation, or moonlighting before you’ve established your interest in surgery, education, and patient care. These are valid topics—but sequence them later in the conversation.

6. Have a Core List and a Flexible List Prepare:

   • 5–7 core questions you definitely want answered for every program
   • 3–5 optional questions to use depending on how the conversation flows

---

Core Questions Every IMG Should Ask General Surgery Programs

These core questions are foundational for any IMG residency guide in surgery. Use them (or adapt them) for nearly every interview day.

1. Questions to Ask the Program Director

These questions show you understand the structure and demands of a general surgery residency and that you are thinking long term.

A. Fit, Expectations, and Support

• “How have IMGs historically performed in your program, and what qualities do successful IMG residents here tend to share?”
  This tells you whether they have a track record with IMGs and what they value.

• “How do you support residents who may need additional help adjusting to the U.S. clinical system, documentation, or communication style?”
  Critical for IMGs transitioning to a very different healthcare environment.

• “What is your approach when a resident is struggling—either academically, clinically, or personally?”
  Look for structured remediation, mentorship, and a supportive tone rather than purely punitive language.

B. Education and Operative Experience

• “How do you ensure residents progressively gain autonomy in the operating room?”
  In a surgery residency match, case numbers are not everything—autonomy and decision-making matter.

• “By graduation, what types of cases do most residents feel comfortable performing independently?”
  Compare their answer with ACGME case minimums and your own goals.

• “Can you describe how simulation is used to support technical skill development, especially in the early years?”
  Helpful for IMGs who want structured, low-risk ways to adapt to new equipment and systems.

C. Career Progression, Fellowships, and Job Placement

• “What have your graduates done in the past five years—fellowships, academic vs. community positions, or international careers?”
  This reveals program reputation and networking strength.

• “Are there particular fellowships that your graduates commonly match into from here?”
  For example, surgical oncology, MIS, trauma/acute care surgery, vascular, colorectal, etc.

• “How does the program support residents with fellowship applications—letters, research, or dedicated time?”

D. IMG- and Visa-Specific Questions

If you are an IMG on or requiring a visa, you must address this clearly and professionally.

• “Does your institution currently sponsor [J-1 / H-1B] visas for categorical general surgery residents?”
  Ask only after confirming general interest; don’t make it the first question.

• “How many of your current residents are IMGs, and are any of them on visas?”
  Programs familiar with IMGs on visas are more likely to navigate issues smoothly.

• “Have there been any recent changes or anticipated changes in your visa policies?”
  Avoid surprises after rank lists are submitted.

2. Questions to Ask Residents (Categorical and Preliminary)

Residents are your best source for unfiltered insight into daily life.

A. Culture, Support, and IMG Experience

• “How would you describe the culture here among residents and attendings—collaborative, hierarchical, supportive, or otherwise?”

• “Are there current IMGs in the program, and how has their experience been?”
  If possible, speak directly with another IMG; ask:

  • “Was the transition hard?”
  • “Did you feel supported early on?”
  • “Any specific challenges as an IMG here?”

• “When a resident is having a bad week or is overwhelmed, what actually happens—who notices, and how does the team respond?”
  Look for peer support, faculty attention, and wellness resources.

B. Workload and Operative Exposure

• “On a typical service month (e.g., trauma, vascular, colorectal), what does a weekday look like—from pre-rounding to sign-out?”

• “Do you feel the program meets or exceeds ACGME case minimums? In which areas do you get the most and the least operative exposure?”

• “Are juniors trusted to operate, or do fellows take most of the cases?”
  Programs with many fellows can still provide strong operative experience, but the balance matters.

C. Education, Feedback, and Mentorship

• “How consistent and useful is feedback after cases or rotations?”

• “Are there particular faculty who are known for mentoring residents, especially IMGs or those interested in specific fellowships?”

• “Are didactics and M&M conferences protected time, or are you frequently pulled away for pages and floor issues?”

D. Life Outside the Hospital

• “Do you have time for family, hobbies, or anything outside of residency, realistically?”

• “How is the call schedule—home call vs. in-house, weekend burden, and post-call days?”

• “What do you wish you had known about this program before you started?”
  This open-ended question often reveals hidden pros and cons.

---

Targeted Questions by Topic: Building Your Personalized List

Beyond the core set, you’ll want to tailor questions to your specific concerns: operative skill, research, visas, family, and long-term goals. Use these as a menu to choose from.

A. Operative Experience and Training Structure

For an international medical graduate entering general surgery, verifying that you will actually operate is crucial.

Ask the PD or senior residents:

• “How early are interns and PGY-2s able to get into the operating room as primary surgeon or first assist?”

• “What systems do you use to track and review resident case logs and ensure no one falls behind in particular categories?”

• “Can you describe how chief residents’ operative autonomy compares to junior years?”

• “Do residents ever feel they need to ‘compete’ with fellows for cases? If so, how is that managed?”

• “Are there particular rotations known as ‘high-yield’ for building core skills, like laparoscopic cholecystectomy, hernia repairs, appendectomy, and basic open cases?”

These interview questions for them communicate that you care deeply about becoming a safe, skilled surgeon—not just matching a residency.

B. Research, Academics, and Fellowships

If you aim for competitive fellowships or academic surgery, probe this thoroughly.

Ask the PD, APDs, or research faculty:

• “What research opportunities are available to residents—clinical, outcomes, basic science, or quality improvement?”

• “Do residents have protected research time, or are projects done mostly on personal time?”

• “How many residents typically present at national meetings each year, and is there financial support for travel and conference fees?”

• “Are there formal links to specific fellowships (e.g., MIS, surg onc, vascular) within your institution, and do they recruit heavily from your residents?”

Ask current residents:

• “Have you found it easy to get involved in research if you’re motivated? How did you get started?”

• “Is authorship fairly assigned, and do junior residents have chances to be first author?”

For IMGs, strong research and presentations during residency can significantly enhance fellowship applications and future mobility, especially if you might consider practicing in different countries.

C. Evaluation, Promotion, and Remediation

As an IMG, you may be concerned about how your performance will be judged in an unfamiliar system.

Ask the PD, APD, or core faculty:

• “How are residents evaluated—what tools are used, and how often do they receive formal feedback?”

• “What does promotion from year to year depend on—clinical performance, exams, milestones, case numbers?”

• “How do you prepare residents for the ABSITE and ultimately the American Board of Surgery exams? Is there structured test-prep or remediation if someone scores below expectations?”

Ask residents:

• “Do you feel evaluations are fair and consistent? Are there any perceived biases—for IMGs, for example?”

• “Have you seen colleagues struggle and still succeed here? What made the difference?”

You are listening for a transparent, structured, and supportive system—not one that is opaque, arbitrary, or punitive.

D. Visas, Contracts, and Institutional Stability

These questions are essential for any international medical graduate. They can be asked politely and professionally, often to the program coordinator, GME office, or PD if needed.

• “Can you confirm which types of visas your institution currently supports for incoming residents in general surgery?”

• “Have there been any recent changes in hospital or university policy that might affect visa sponsorship during residency?”

• “If a resident’s visa processing is delayed, how does the program handle start dates, onboarding, and pay?”

• “Are there any additional contractual obligations after residency linked to visa sponsorship (e.g., service commitments)?”

• “How has the financial health of the institution and department been over the last few years—any significant budget cuts affecting residents?”

Red flags include:

• Vague or hesitant answers about visa sponsorship
• “We’ve never had that issue, but I’m sure it will be fine” with no specifics
• Rumors of hospital closures, mergers, or major instability

---

Questions to Ask in Different Settings: PDs, Residents, Socials, and Virtual Days

The context of your question matters as much as the content. Here’s how to adapt.

1. What to Ask Program Directors (PDs) and Leadership

Your “what to ask program director” list should emphasize big-picture issues: philosophy, training outcomes, and IMG support.

Examples of strong PD questions:

• “How do you see this program evolving over the next 5–10 years, and what role do residents play in that vision?”
• “Are there any recent program changes—curriculum, call structure, rotations—that you’re particularly proud of?”
• “What do you consider the greatest strengths and areas for growth in this residency right now?”

Avoid:

• Highly negative questions (“Why is your board pass rate so low?”)
  Instead: “I noticed your board pass rates have fluctuated recently. What changes are you putting in place to support residents’ exam preparation?”

2. What to Ask Current Residents

Residents are your main source for unfiltered reality. Ask:

• “Among your co-residents, what keeps people happiest here, and what causes the most frustration?”
• “How approachable are attendings in the OR when you don’t know something?”
• “If you had to decide again, would you choose this program, and why?”

During pre-interview dinners or virtual socials, you can ask more casually about:

• Housing cost and neighborhoods
• Partner/family friendliness
• Daycare or school options
• Social life in the city

3. Virtual and In-Person Interview Adaptations

In a virtual setting, adjust your questions to address what you cannot see in person:

• “How well did the program adapt during COVID or recent disruptions—did residents still get adequate operative experience?”
• “How does the program foster camaraderie and mentorship when people are spread out or on different services?”

Also ask about technology:

• “What EMR do you use, and how are new residents oriented to your documentation systems?”

4. Questions to Avoid or Rephrase

Some topics are important but require tact:

• Salary and benefits
  Instead of: “How much do I get paid?”
  Ask: “Where can I find detailed information about resident salary and benefits for this institution?”

• Vacation and leave
  Instead of sounding focused only on time off:
  “Can you describe how vacation and personal leave are scheduled to balance rest with continuity of patient care?”

• Negative gossip about other programs
  Never ask: “Why is your program better than [competitor]?”
  Focus on their strengths: “What types of residents tend to thrive particularly well in this environment?”

---

Putting It All Together: Building Your Personal Question Sheet

To make this practical, here’s how to create your own structured question list for each interview.

Step 1: Core Questions (Use for Almost Every Program)

1. How have IMGs historically performed here, and what supports are in place for their transition?
2. What is your approach to resident autonomy in the OR throughout training?
3. What have your graduates done in the last five years (fellowships vs. practice)?
4. How are residents evaluated and supported if they struggle academically or clinically?
5. How would current residents describe the culture and workload in this program?

Step 2: Program-Specific Questions (Customized)

Before the interview, review:

• Program website
• Case logs or ABSITE performance (if available)
• Unique rotations (e.g., rural, international, high-volume trauma center)

Then ask:

• “I noticed your program has a dedicated rural surgery rotation. How has that experience influenced residents’ preparedness for independent practice?”
• “Your website highlights minimally invasive and robotic surgery—how early are residents introduced to robotic platforms?”

Step 3: IMG- and Life-Specific Questions

Tailor based on your situation:

• If you have family:
  “Are there any resources for spouses/partners or family support in the area or through the hospital?”

• If you require a visa:
  “Can you share any recent experiences with onboarding residents on [J-1/H-1B] visas and how smoothly those processes have gone?”

• If you are research-focused:
  “Is there flexibility to take an additional research year, and how is that typically arranged?”

Step 4: Questions You Will Use to Build Your Rank List

As you finish interviews, certain questions become critical for ranking:

• “If you had to summarize in one or two sentences why someone should choose this program for general surgery, what would you say?”
• “What do you think is the biggest challenge a new intern will face here, and how do you help them overcome it?”
• “What distinguishes this program from others in terms of preparing residents for independent general surgery practice?”

Write down answers immediately after each interview. Over time, programs will blur together; your notes on their responses to your tailored questions will be your best tool for rank list decisions.

---

FAQ: Common Questions About What to Ask Programs as an IMG in General Surgery

1. How many questions should I ask during a residency interview?

Aim for 3–5 well-thought-out questions with each major person or group:

• 3–4 for the program director or leadership
• 3–5 for residents
• 1–2 for the coordinator or GME staff

Quality matters more than quantity. Make each question purposeful, and adapt based on what has already been discussed so you don’t repeat topics.

2. Is it okay to ask directly about visa sponsorship and IMG support?

Yes—this is essential for any international medical graduate. Just ask professionally and at the appropriate time, often later in the PD conversation or with the coordinator:

• “Could you please clarify your current policy regarding [J-1/H-1B] sponsorship for general surgery residents?”
• “How many current residents are IMGs, and have they had any challenges with visas that the program helped manage?”

Programs that routinely work with IMGs expect and respect these questions.

3. What if the program already answered most of my prepared questions in their presentation?

Acknowledge what you heard and build on it:

• “You mentioned during the presentation that residents have strong operative numbers, particularly in laparoscopic cases. Could you share how that experience is distributed across PGY levels and how you ensure juniors also get hands-on time?”

You can also pivot to more personalized questions:

• “Given my background as an IMG with prior surgical exposure abroad, how do you see me fitting into your training structure early on?”

4. Are there any “red flag” answers I should watch out for?

Be cautious if you hear:

• Dismissive comments about IMGs or “we prefer U.S. grads, but we consider IMGs sometimes.”
• Vague responses about operative experience: “You’ll get enough cases, don’t worry about it.”
• No clear structure for remediation or support if residents struggle.
• Uncertainty or discomfort about visa sponsorship: “We used to, but we’re not sure what the policy is now.”
• Residents who consistently look exhausted, speak negatively without balance, or say, “You survive, that’s all that matters.”

Use your questions not just to gather information, but to sense tone, transparency, and respect—especially toward IMGs.

---

By carefully planning questions to ask residency programs—and tailoring them to your goals as an international medical graduate in general surgery—you transform interviews from passive evaluations into active, two-way assessments. This approach not only helps you shine as a thoughtful, prepared candidate in the surgery residency match, but also protects your long-term training and career by guiding you toward programs where you can truly thrive.