The Essential IMG Residency Guide: Questions for Preliminary Surgery Year

Understanding Your Goal as an IMG in a Preliminary Surgery Year

For an international medical graduate (IMG), a preliminary surgery year can be a powerful stepping stone—but only if you choose the right program and ask the right questions. Unlike categorical surgery residents, you do not have guaranteed progression within the same program. That makes the interview conversation especially critical.

You are not just trying to “sound interested.” You are gathering data for a high‑stakes decision about where to invest a year of intense work, immigration complexity, and career opportunity. This IMG residency guide focuses on questions to ask programs so you can evaluate fit, advocacy, and realistic outcomes.

Your questions should help you determine:

• How prelims are treated compared with categoricals
• Whether the program truly supports IMGs
• What graduates of the prelim surgery residency actually go on to do
• How you will be evaluated and mentored
• Whether the environment is safe, educational, and sustainable for you

The sections below give you targeted interview questions for them (program directors, faculty, chiefs, and current residents), tailored specifically to IMGs considering a preliminary surgery year.

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1. Big-Picture Strategy: How to Approach Questions as an IMG

Before breaking down specific questions, it helps to understand your strategy for each conversation.

A. Principles for Strong Questions

Aim for questions that are:

• Specific – Show you understand prelim vs categorical differences
• Outcome-oriented – Focus on what happens to graduates
• Data-seeking – Ask for numbers, not just impressions
• Self-aware – Reflect your situation as an IMG (visa, US experience, goals)
• Respectful and professional – Curious, not confrontational

Example framing:

“As an international medical graduate interested in ultimately matching into categorical surgery, I want to make sure I choose a program that will help me get there. May I ask you a few detailed questions about how your prelims typically do after completing the year?”

That short statement accomplishes three things:

1. Clarifies your goal
2. Signals you are planning strategically
3. Sets up deeper, more honest discussion

B. Who to Ask What

Different people are better suited for different questions:

• Program Director (PD) – Policies, selection, evaluation, advocacy, outcomes
• Chair / Faculty – Culture, expectations, opportunities, research
• Chief residents / senior residents – Day‑to‑day reality, workload, fairness
• Current prelims (ideally IMGs) – How prelims are treated, real support, red flags
• Program Coordinator – Logistics, visas, onboarding, schedule, housing support

Plan 3–5 tailored questions for each group. This makes you look prepared and mature, not scripted.

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2. Critical Outcome Questions: Where Do Your Prelims End Up?

For any prelim surgery residency, the single most important issue is what happens after the year ends. As an IMG, you cannot afford to treat this as an afterthought.

Key Questions to Ask the Program Director

1. “Over the last 3–5 years, what have your preliminary surgery residents typically gone on to do?”

   • Follow‑ups:
     • “How many matched into categorical general surgery?”
     • “How many matched into other specialties (e.g., anesthesia, radiology)?”
     • “How many did not match or left medicine?”

   What you are looking for:

   • Specific numbers or clear percentages, not vague phrases like “many” or “most”
   • Outcomes for IMGs specifically, if possible

2. “Can you share examples of recent prelims—especially IMGs—who successfully transitioned into categorical positions?”

   • Follow‑ups:
     • “Were those categorical positions within this program or elsewhere?”
     • “What did those residents do that made them successful?”

   Why this matters:

   • You want to see that IMGs, not just US grads, have succeeded
   • You gain a roadmap for what behaviors and achievements are valued

3. “Does your department ever convert prelims to categorical if a slot opens? How often has that happened in the last 5 years?”

   • Follow‑ups:
     • “What criteria do you use to decide which prelim to promote?”
     • “Is there a formal pathway or is it more ad hoc?”

   Interpretation:

   • Frequent internal conversions can be good, but:
     • If they signal frequent categorical attrition, that can reflect deeper issues
   • If they never convert prelims, you rely more heavily on external match prospects

4. “Do you provide structured support for prelims applying to the Match or SOAP—such as letters, advising meetings, and interview prep?”
   Look for:

   • Scheduled meetings about applications
   • Letter‑writing routines for prelims
   • Help with ERAS strategy and specialty selection

Questions for Current Prelims About Outcomes

5. “Have graduating prelims from this program been able to secure positions that meet their goals?”

   • Follow‑ups:
     • “Do you know where last year’s prelims ended up?”
     • “Did they feel supported by the program in that process?”

6. “Have you received specific guidance about how this prelim year will be viewed by other programs when you apply next cycle?”

If residents struggle to name successful outcomes, that is a warning sign.

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3. IMG-Specific Questions: Visas, Support, and Culture

As an international medical graduate, you must be very intentional about what to ask the program director and coordinator regarding immigration, credentialing, and cultural support.

Visa and Contract Questions

7. “Do you sponsor J‑1 visas, H‑1B visas, or both for preliminary surgery residents?”

   • Follow‑ups:
     • “How many current residents are on visas?”
     • “Has any prelim lost a position due to visa issues in recent years?”

8. “Is there any difference in support or expectations for IMG residents compared with US graduates?”
   You are listening for:

   • Clear statement of equal expectations and support
   • Awareness of potential challenges IMGs face (documentation, exams, systems)

9. “If a prelim wants to stay in the U.S. long term, how do you advise them regarding visa strategy and long‑term planning?”

Integration and IMG Culture

10. “How many of your current or recent prelims are IMGs?”

    • Follow‑ups:
      • “How well integrated are they into the team?”
      • “Are there IMG graduates among the faculty?”

11. (To current IMGs) “Do you feel respected here as an IMG? Have you ever felt your background was a disadvantage in evaluations or opportunities?”

12. “Is there orientation or onboarding tailored to people who are new to the U.S. healthcare system?”

    • Examples:
      • EMR training
      • Documentation expectations
      • Cultural and communication norms

Programs that can clearly articulate IMG‑friendly structures are typically safer choices.

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4. Day-to-Day Reality: Workload, Education, and Treatment of Prelims

You need to know not only what the program promises, but what your daily life will actually be like as a preliminary surgery resident.

Questions About Workload and Rotations

13. “How are rotations structured for prelims compared to categorical residents?”

    • Follow‑ups:
      • “Do prelims get ICU time? Night float? Ward months? OR exposure?”
      • “Are there any rotations that are categorical-only?”

14. “What is a typical day like for a PGY‑1 prelim on your main surgical service?”
    Listen for:

    • Start and end times
    • Rounding structure
    • Amount of time in the OR vs floor vs consults

15. “How do you ensure prelims get sufficient operative experience and not just scut work?”

    • Specific follow‑up:
      • “Could you share approximate case numbers for a typical prelim by the end of the year?”

16. “What is your approach to duty hours for prelims? How is compliance monitored and enforced?”

Questions About Education and Feedback

17. “Do prelims participate fully in didactics, M&M, and simulation sessions alongside categoricals?”

18. “How is feedback delivered to prelims, and how often?”

    • Follow‑ups:
      • “Is there a formal mid‑year evaluation or mentoring meeting?”
      • “Who reviews your performance and helps you improve?”

19. “Are prelims included in resident retreats, wellness events, and scholarly activities?”

Questions to Ask Current Residents About Culture

20. “Do prelims get the same teaching and bedside supervision as categoricals?”

21. “Have you seen prelims being given unfairly heavy workloads or fewer educational opportunities compared to categorical residents?”

22. “If a prelim is struggling—clinically or personally—how does the program usually respond?”

Patterns you do not want to hear:

• “Prelims mostly cover all the nights”
• “Prelims do a lot of floor work but not much OR”
• “We sometimes forget prelims are only here for a year”

Positive themes to look for:

• “Our prelims are part of the team; we can’t function without them”
• “Several faculty really champion prelims when applying for categorical spots”
• “Prelims are evaluated using the same milestones as categoricals”

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5. Advocacy, Mentorship, and Letters: Will This Program Fight for You?

An excellent preliminary surgery year for an IMG is not just about surviving; it is about maximizing your chances of a strong PGY‑2 or categorical match. That depends heavily on mentorship.

PD and Faculty Advocacy

23. “How do you personally support prelims during the application season—for example, with letters, phone calls, or networking?”

24. “Do you write individualized letters for your prelims? How many such letters do you typically write each year?”

25. “Are there faculty members known for mentoring prelims toward specific specialties (e.g., vascular, anesthesia, radiology)?”

26. “When a prelim performs very well, how does the department help them stand out to other programs?”

• Listen for:
  • Phone calls to PD colleagues
  • Invitations to present at conferences
  • Protected time to interview

Questions About Research and Scholarly Work

27. “Are there realistic opportunities for prelims to engage in research or quality improvement projects during the year?”

28. “Have any prelims co‑authored publications or presented at conferences recently?”

For IMGs, academic productivity can be a differentiator in the next application cycle. Programs that say “there’s no time for anything besides service” may still be valuable, but they limit one avenue of competitiveness.

Questions for Current or Former Prelims

29. “Did you receive strong letters from this program? Were they detailed and personal?”

30. “Did faculty or PDs make calls on your behalf when you applied for categorical positions?”

If prior prelims describe weak or generic letters, that is an important signal—especially for an IMG relying on strong advocacy to overcome lack of U.S. medical school connections.

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6. Asking Smart, Honest Questions as an IMG: Style and Strategy

Knowing what to ask program directors and residents is only half the battle; you also need to ask in a way that builds your reputation rather than harms it.

A. How to Phrase Tough Questions Diplomatically

You may worry that blunt questions—like “How many prelims failed to match?”—sound aggressive. You can soften them while still being direct:

Instead of:

“Do your prelims usually fail to get jobs?”

Try:

“As someone considering investing a year of hard work here, it’s essential for me to understand realistic outcomes. Could you share how many prelims have successfully matched into their desired fields over the past few years, and what challenges some have faced?”

Instead of:

“Are prelims just used as cheap labor?”

Try:

“I know prelims often play a major role in clinical coverage. How do you balance service needs with ensuring prelims still receive meaningful education and operative opportunities?”

Programs that react defensively to fair, professional questions are often not the best environments.

B. Prioritizing Your Questions

You won’t have time to ask everything. Aim for:

• PD interview: 3–5 high‑impact questions
• Resident Q&A: 3–5 real‑world culture and workload questions
• Coordinator / follow‑up emails: Logistics, visas, start dates, housing

High‑impact questions almost always address:

1. Outcomes
2. Treatment of prelims
3. IMG support
4. Mentorship and advocacy

C. Questions to Avoid or Reframe

Avoid questions that:

• You could easily have answered from the website (schedule basics, bed numbers)
• Focus excessively on salary or vacation early in the conversation
• Sound like you’re only interested in using the program as a short‑term visa stop

If you care about lifestyle (which is reasonable), ask it in the context of education and safety:

“Surgical residency is intense everywhere, but burnout can really affect learning and patient safety. How does your program monitor workload and support resident well‑being, including prelims?”

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7. Sample Question Lists You Can Use Tomorrow

Below are tailored lists you can adapt directly for your interviews and emails. These align with common interview questions for them that signal maturity and insight.

A. For Program Directors (5 Core Questions)

1. “Over the last 3–5 years, what have your preliminary surgery residents—especially IMGs—typically gone on to do after completing the year?”
2. “Do you ever convert strong prelims to categorical positions, and what criteria do you use when deciding whom to promote?”
3. “How do you and your faculty advocate for prelims when they apply to categorical positions or other specialties?”
4. “What kinds of operative and ICU experiences can a typical prelim expect by the end of the year?”
5. “How do you support IMG residents in terms of visas, orientation to the U.S. system, and long‑term career planning?”

B. For Current Residents (Categorical and Prelims)

1. “How are prelims integrated into the team day‑to‑day? Do they get similar teaching and OR opportunities as categoricals?”
2. “Have you seen prelims from this program successfully match into categorical spots? What seemed to make the difference for them?”
3. “When service is heavy, who usually carries the extra load—prelims, categoricals, or is it shared fairly?”
4. “Do you feel the PD and faculty really know the prelims well enough to write strong, personalized letters?”
5. “If you were an IMG choosing a prelim year again, would you pick this program? Why or why not?”

C. For Program Coordinators

1. “What visa types do you currently sponsor for preliminary surgery residents, and have there been any visa‑related disruptions in recent years?”
2. “What does onboarding look like for new IMGs—especially those new to the U.S. system?”
3. “How is the rotation schedule built for prelims, and when is it usually finalized?”
4. “Are there resident resources for housing, transportation, and acclimating to the city?”

Use these as a starting point and personalize them to reflect your background and goals.

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FAQs: Questions to Ask Programs for IMGs in Preliminary Surgery

1. How many questions should I ask during each interview?
Aim for 3–5 thoughtful questions per encounter (PD/faculty, resident Q&A). Quality matters more than quantity. Prioritize outcomes, treatment of prelims, and IMG support. It is better to ask a few well‑chosen, specific questions than a long list of generic ones.

2. Is it okay to ask directly about match rates and unsuccessful prelims?
Yes—professionally. Frame it around planning and transparency:

“To make an informed decision, I’d like to understand both the successes and challenges your prelims have faced in securing positions afterward. Could you share some recent data and examples?”
Programs accustomed to prelims will expect this question. Evasive or defensive answers are a red flag.

3. As an IMG, should I bring up my visa needs early?
Yes, but briefly and matter‑of‑factly. You can state:

“As an IMG on a [J‑1/H‑1B] visa, I need to be sure I can complete the year without immigration issues. Could you tell me how your program typically handles visas for prelim residents?”
This helps avoid future complications and shows you understand logistical realities.

4. What if a program discourages too many questions or seems annoyed when I ask?
If respectful, on‑topic questions about education, outcomes, and support are unwelcome, that often predicts a culture where feedback and advocacy are limited. This is especially risky for an IMG in a preliminary surgery year, who depends heavily on program support for the next step. Consider that reaction itself as valuable data when building your rank list.

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By approaching interviews with a clear strategy and specific, outcome‑oriented questions, you transform yourself from a passive applicant into a proactive future colleague. For an international medical graduate considering prelim surgery, the questions you ask today can shape your career options for years to come.