Essential Questions for IMGs in Medicine-Psychiatry Residency Interviews

Why Your Questions Matter as an IMG Applying to Medicine-Psychiatry

As an international medical graduate (IMG) applying to a medicine psychiatry combined program, the questions you ask during interviews and open houses are just as important as the answers you give. This is not only your chance to show curiosity, insight, and professionalism; it is also your best opportunity to decide whether a program will truly support your growth as both a physician and psychiatrist.

A strong IMG residency guide for med psych residency should go far beyond generic “What’s your call schedule?” and help you ask nuanced, specialty-specific, and IMG-specific questions. This article will walk you through:

• Core domains you should ask about in medicine-psychiatry programs
• Tailored questions to ask program directors, faculty, and residents
• Special considerations for IMGs (visa, support, cultural adjustment)
• Red flags to watch for based on how programs respond
• A practical framework for organizing and using your questions effectively

Throughout, you’ll see phrases you can adapt directly into your interviews, so you never have to wonder what to ask program director or which interview questions for them will actually reveal the culture and quality of a program.

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Strategy First: How to Approach Questions as an IMG

Before diving into specific questions to ask residency programs, you should have a strategy. Asking strong questions in a med psych residency interview does three important things:

1. Demonstrates insight into the combined specialty
   Good questions show you understand the integrated nature of internal medicine and psychiatry, and that you’ve thought about how you want to develop your dual identity as a physician.

2. Shows you’re a self-directed learner
   Programs value residents who take ownership of their training. Thoughtful, specific questions convey exactly that.

3. Helps you determine actual fit
   The answers you get—plus how they are delivered—will tell you whether this is a training environment where you can thrive as an international medical graduate.

General Principles for Asking Questions

Use these principles to guide all of your questions:

• Be specific, not generic.
  Instead of “Tell me about your program,” ask “How are medicine and psychiatry integrated on a daily basis for residents in your program?”

• Ask about experiences, not just policies.
  “Can you describe a time when…” often yields richer information than “Do you have…”

• Tailor questions to the person.
  Use different questions for the program director, core faculty, chief residents, junior residents, and current IMGs.

• Limit the number per interaction.
  Aim for 2–4 meaningful questions in each conversation rather than a long checklist.

• Write things down.
  Keep a simple comparison table to track answers across programs; this will be invaluable when making your rank list.

Tip: Create three lists before interview day—questions for program leadership, questions for residents, and IMG-specific questions. Rotate through them across interview days so you don’t repeat yourself.

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Core Content Areas: What You Absolutely Must Ask About

Every strong IMG residency guide for medicine psychiatry combined training will emphasize that your questions should target several core domains. Below are key domains and sample questions to ask residency programs, with particular attention to the unique concerns of IMGs.

1. Structure and Philosophy of the Medicine-Psychiatry Program

You’re not just training in two separate fields—you’re training to think and practice in an integrated way. Use your questions to understand how deliberately the program supports that.

Key questions to ask program director or core faculty

1. Integration of Training

   • “How would you describe the overall philosophy of integration between internal medicine and psychiatry in your program?”
   • “Beyond separate blocks, what opportunities exist for residents to care for patients with both complex medical and psychiatric needs at the same time?”
   • “Are there longitudinal clinics or rotations where I would function explicitly as a med-psych physician in training?”

2. Curriculum Design

   • “How are the ACGME requirements for both internal medicine and psychiatry balanced across the five years?”
   • “What proportion of time is spent on medicine vs. psychiatry in each year, and how does that change over time?”
   • “Do residents have protected time for didactics that address combined topics such as delirium, somatic symptom disorders, and integrated care models?”

3. Faculty Expertise and Role Models

   • “How many faculty here are dually trained in medicine psychiatry combined or other integrated disciplines?”
   • “In what ways do dually trained faculty directly supervise or mentor residents?”
   • “Are there graduated med psych alumni practicing in integrated roles locally that residents can work with?”

What to listen for

• Clear, confident descriptions of integrated experiences (not just “you do medicine years and psychiatry years”).
• Specific examples of combined clinics, med-psych consult services, or collaborative care models.
• Visible enthusiasm from faculty about the med psych identity.

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2. Clinical Experience, Autonomy, and Supervision

Medicine-psychiatry residents must become competent in two specialties with the same depth as categorical residents. As an IMG, you’ll want to know not only what you’ll see, but also how supported you’ll be.

Questions to ask residency faculty and chief residents

1. Breadth and Depth of Clinical Exposure

   • “What are the most common patient populations med psych residents work with—inpatient, outpatient, and consult settings?”
   • “How do med psych residents’ responsibilities differ from categorical internal medicine and psychiatry residents on shared rotations?”
   • “Are there dedicated med-psych services (e.g., inpatient units, consult teams, integrated clinics) where we consistently rotate?”

2. Supervision and Autonomy

   • “How would you describe the level of supervision and autonomy for interns compared with senior residents on medicine and psychiatry rotations?”
   • “Are there specific supports in place for IMGs during the first months (e.g., closer supervision, additional feedback) as we adjust to the U.S. system?”
   • “Can you share an example of how a struggling resident was supported and helped to improve?”

3. Procedures and Skills

   • “How do med psych residents meet internal medicine procedure and ICU exposure requirements—is it comparable to categorical medicine?”
   • “On psychiatry rotations, are there opportunities to learn and practice psychotherapy modalities as well as psychopharmacology?”
   • “Are there any additional skills med psych residents are encouraged to develop (e.g., motivational interviewing, collaborative care, addiction medicine)?”

Example of a well-phrased IMG-specific question

“As an international medical graduate, I want to make sure I develop confidence in both the clinical content and the U.S. healthcare system. How does your program help IMGs quickly adapt to local documentation, EMR use, and interprofessional communication expectations?”

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3. Educational Culture, Wellness, and Resident Support

Culture determines whether you survive or thrive. Ask precise questions that reveal how people interact, how feedback is given, and how residents are supported when life gets difficult.

Questions for current residents (especially PGY-2 and above)

1. Culture and Collegiality

   • “How would you describe the relationship between med psych residents and categorical medicine and psychiatry residents?”
   • “Do you feel med psych residents are fully integrated into both departments, or do you ever feel ‘in between’?”
   • “When things are busy or stressful, how do faculty typically respond to residents?”

2. Feedback and Mentorship

   • “How often do you receive formative feedback, and is it helpful and specific?”
   • “Do all med psych residents have formal mentors in both internal medicine and psychiatry? How often do you meet?”
   • “Can you give an example of a time a mentor helped you make a significant educational or career decision?”

3. Workload and Wellness

   • “What does a typical week look like in terms of hours, call, and documentation for an intern? For a senior?”
   • “If someone feels overwhelmed or burned out, what actually happens—who can they go to and what kind of response can they expect?”
   • “Are there wellness initiatives or specific supports for IMGs who may be far from their families?”

Red flags to watch for

• Residents hesitate, look at each other before answering, or give very vague responses.
• Comments about “that one med psych resident who burned out” without describing systemic solutions.
• A pattern of “You just push through it” rather than concrete, structured support.

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IMG-Specific Questions: Visa, Support, and Career Outcomes

For an international medical graduate, an effective IMG residency guide must address critical non-clinical aspects of training: visa sponsorship, adaptation to U.S. practice, and long-term career planning. These are non-negotiables you should feel comfortable asking about directly.

4. Visa, Licensing, and Administrative Support

Questions to ask program leadership or GME office

1. Visa Sponsorship and Experience with IMGs

   • “Which visas do you currently sponsor (e.g., J-1, H-1B), and do you anticipate any changes in the next few years?”
   • “Approximately what proportion of your current residents and recent graduates are international medical graduates?”
   • “Who in the program or institution helps IMGs navigate visa paperwork, renewals, and deadlines?”

2. Licensing and Credentialing

   • “Is there structured support to help residents through state licensing, Step 3 timing, and credentialing processes?”
   • “Do you have guidance on when IMGs should take Step 3, particularly given visa considerations?”
   • “Are there any challenges specific to IMGs in your state that we should know about?”

3. Transition to U.S. Clinical Practice

   • “Do you offer any orientation focused specifically on adapting to U.S. clinical workflows, documentation standards, and communication expectations?”
   • “How do attendings and seniors typically support IMGs during their first months to ensure safety and confidence?”

What strong answers sound like

• Clear, consistent policies on visas and a track record of working with IMGs.
• Dedicated GME or HR staff who manage immigration issues.
• Concrete examples of prior IMGs they have successfully supported.

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5. Career Development, Fellowship, and Job Placement

A central purpose of your questions to ask residency programs is to understand what happens after graduation. Medicine-psychiatry opens multiple pathways, and as an IMG, immigration and job market realities matter.

Questions to ask program director and senior residents

1. Career Paths of Recent Graduates

   • “Where have your most recent graduates gone—what percentage are in academic medicine, community practice, integrated care, or fellowship?”
   • “Do you have recent graduates who are IMGs, and what kinds of positions or fellowships did they secure after residency?”
   • “Are there alumni in med-psych leadership roles or innovative models of care that residents can connect with?”

2. Fellowship Opportunities

   • “How competitive are your graduates for fellowships such as addiction psychiatry, consult-liaison psychiatry, geriatrics, or critical care?”
   • “Do med psych residents receive support for fellowship applications, such as letters, research opportunities, and networking?”
   • “Are there any medicine psychiatry combined or related fellowships you have a particular track record with?”

3. Research, Teaching, and Leadership

   • “What research opportunities are available that specifically leverage the med psych skill set?”
   • “Can residents easily get involved in quality improvement projects or scholarly work early in training?”
   • “Are there structured opportunities for teaching medical students or junior residents in both medicine and psychiatry departments?”

4. IMG-Specific Career Issues

   • “How do you advise IMG residents who want to remain in the U.S. after training in terms of job search timing and visa transitions?”
   • “Do you have institutional or alumni connections that help IMGs find positions that sponsor appropriate visas after graduation?”

Why this matters for IMGs

For many international medical graduates, your ability to remain in the U.S. as a practicing physician depends on finding an employer who understands both your med psych training and your immigration status. Programs that openly discuss these realities and provide concrete examples are more likely to support you effectively.

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Practical “Interview Questions for Them”: By Interview Role

To make this IMG residency guide actionable, here are organized, ready-to-use questions to ask residency stakeholders, tailored to their roles. You can mix and match based on your priorities.

Questions to Ask Program Director

Focus on vision, structure, policies, and long-term outcomes.

• “What makes your medicine-psychiatry program distinct from other med psych residency programs nationally?”
• “How do you see the role of a dually trained physician evolving in your institution and healthcare system over the next 5–10 years?”
• “When a resident is struggling—clinically, academically, or personally—what is your approach as program leadership?”
• “Looking back at the last few years, what specific changes have you implemented based on resident feedback?”
• “As an international medical graduate, I value clear expectations. How do you communicate performance expectations and milestones to residents across both specialties?”
• “What qualities do your most successful med psych residents tend to share?”

Questions to Ask Core Faculty

Focus on day-to-day teaching, supervision, and integration.

• “On a typical rotation, how often do you interact with and directly observe residents?”
• “What does excellent performance look like to you for a PGY-2 or PGY-3 med psych resident on your service?”
• “How do you help residents integrate medical and psychiatric thinking, rather than treating them as separate domains?”
• “Are there faculty-led projects—clinical, research, or QI—that med psych residents commonly join?”
• “How do you personalize supervision for residents with different backgrounds, such as IMGs with heterogeneous prior experiences?”

Questions to Ask Current Residents

Focus on lived experience, culture, and practical realities.

• “If you had to re-rank programs today, would you still rank this one first? Why or why not?”
• “What has been your biggest challenge as a med psych resident here, and how were you supported in addressing it?”
• “Do you feel your dual identity as a medicine-psychiatry physician is genuinely valued by both departments?”
• “How easy is it to switch between the ‘medicine mindset’ and ‘psychiatry mindset’ when rotations alternate?”
• “As an IMG, I’m curious: how have IMGs been received here—by nursing staff, other residents, and attendings?”
• “How manageable is life outside of work—housing, cost of living, time for family, or personal interests?”

Questions to Ask Current IMGs (If Available)

Leverage their specific experience navigating your path.

• “What surprised you most about training in this program as an international medical graduate?”
• “Were there any unspoken expectations you wish you’d known during your first year?”
• “How did the program support you with visa questions, Step 3, and long-term career planning?”
• “Have you ever felt treated differently as an IMG—positively or negatively—and how did the program respond?”

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Turning Answers into Decisions: Evaluating Programs as an IMG

As you gather answers, you’ll need a method to compare programs systematically. Use these steps to transform a long list of responses into a clear med psych residency rank list.

1. Create a Simple Comparison Table

For each program, rate or briefly summarize:

• Integration of medicine and psychiatry
• IMG support (visa, onboarding, cultural)
• Resident culture and wellness
• Clinical depth and autonomy
• Academic and career development
• Location and personal fit

After each interview day, complete your notes the same evening while memories are fresh.

2. Reflect on How Answers Were Given

Content matters, but tone and body language also provide information:

• Did leadership seem defensive when asked about wellness or IMG support?
• Were residents consistent with each other, or did you hear conflicting narratives?
• Did anyone actively encourage you to connect with current IMGs or alumni?

3. Watch for “Alignment” with Your Goals

For example:

• If your goal is academic consult-liaison psychiatry, prioritize programs with strong CL services, research mentoring, and fellowship placements.
• If you want to practice in underserved settings, look for robust safety-net hospital exposure, integrated community clinics, and public psychiatry experiences.
• If career stability in the U.S. is your top concern, focus on programs with a well-documented history of supporting IMGs into jobs or fellowships that handle visas.

4. Use Questions to Clarify Red Flags Early

If something feels off, return to it with follow-up questions:

• “Earlier you mentioned high workload on certain rotations. Could you elaborate on how that’s managed and whether any changes are being considered?”
• “I heard that previous med psych residents sometimes felt pulled between departments. How has that been addressed?”

A strong program will welcome these questions and answer with transparency.

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FAQ: Common Questions IMGs Have About Asking Programs

1. Is it acceptable to ask directly about visa sponsorship during interviews?

Yes. For an international medical graduate, visa details are essential, not optional. Phrase it professionally, such as:

“As an IMG, visa sponsorship is a critical factor for me. Could you share which visa types you currently sponsor for residents and whether you anticipate any policy changes?”

Most program directors expect this question. If they appear uncomfortable or vague, treat that as important data.

2. How many questions should I ask during each interview?

Aim for 2–4 thoughtful questions in each individual interview, plus more informal questions during resident socials or Q&A sessions. Quality matters more than quantity. Prioritize the questions you cannot answer from the website, and always adapt to the flow of conversation.

3. What if someone already answered my planned question earlier in the day?

Acknowledge it and deepen the topic:

“Earlier, you mentioned that med psych residents have a combined continuity clinic. Could you share an example of the types of patients you see there and how that clinic has evolved over time?”

This shows you’re listening and synthesizing information, not just working from a script.

4. Should I adjust my questions based on whether I’m interviewing at my ‘top choice’ programs?

You should always come prepared with high-quality questions, but you can dig deeper into details at programs you’re particularly interested in. For example, ask more about long-term mentorship structures, research collaborations, or specific clinical niches (e.g., integrated HIV-psychiatry care, addiction, or psychosomatic medicine) that align with your career vision.

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Thoughtful, well-structured questions are one of the most powerful tools you have as an IMG applying to medicine psychiatry combined programs. Use them not only to impress interviewers, but to ensure that the program you ultimately choose is a place where you can grow into the kind of med psych physician you aspire to be—clinically strong, intellectually integrated, and fully supported in your unique journey as an international medical graduate.