Essential Questions for IMGs in Preliminary Medicine Residency Interviews

Understanding Why Your Questions Matter as an IMG in Preliminary Medicine

As an international medical graduate (IMG) applying to a Preliminary Medicine year, the questions you ask programs can significantly influence both how you are perceived and how well you assess program fit. A prelim IM year is often just one step in a longer journey (e.g., neurology, anesthesiology, radiology, PM&R, dermatology), and your needs differ from those of categorical internal medicine residents.

This IMG residency guide focuses on questions to ask residency programs—and how to tailor them as an IMG seeking a preliminary medicine year. Knowing what to ask program directors, faculty, residents, and coordinators will help you:

• Show you understand the unique nature of a prelim IM year
• Clarify how the program supports IMGs in licensing, visas, and U.S. adaptation
• Choose a program aligned with your long‑term specialty goals
• Avoid “blind spots” (high burnout, poor support, bad scheduling, weak preliminary‑to‑advanced coordination)

Your questions communicate preparation, insight, and professionalism. Thoughtful interview questions for them often leave as strong an impression as your answers to their questions.

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Core Principles for Asking Smart Questions as an IMG

Before listing specific questions, it helps to understand some key principles so you can adapt the wording and timing to each interview.

1. Prioritize Questions You Cannot Answer from the Website

Program websites and the FREIDA listing usually cover:

• Number of positions, call schedule in broad strokes
• Basic benefits, salary, vacation weeks
• Affiliated hospitals and clinics

Avoid asking questions that show you have not done basic research (“How many prelim positions do you offer?” if it’s clearly listed). Instead, dig deeper:

• “I saw that you have X prelim positions and Y categorical positions. How are prelims integrated into the larger medicine residency?”

This shows preparation and curiosity.

2. Tailor Questions to Your IMG and Prelim Status

As an international medical graduate, you have additional needs:

• Visa sponsorship (J‑1 vs H‑1B)
• Support with state licensure and paperwork
• Orientation to U.S. healthcare culture and EMR systems
• Potentially fewer local mentors or support networks

As a prelim (not categorical):

• Your training is one year, with limited room for electives and research
• You may be simultaneously committed to or pursuing an advanced specialty
• You need strong clinical training and supportive evaluation to succeed in your PGY‑2 field

Your questions should highlight that you understand these realities and are planning ahead.

3. Direct Questions to the Right Person

Not every question is ideal for every interviewer. For example:

• Program Director (PD): Vision, training philosophy, evaluations, remediation, policy, IMG support, how prelims are viewed
• Associate/Assistant PD or Faculty: Education structure, rotations, supervision, teaching culture
• Current Residents (especially prelims): Day‑to‑day life, call burden, culture, mentorship, real workload
• Program Coordinator: Logistics, visas, onboarding, credentialing, exam deadlines

You can ask the same topic from different angles to get a complete picture.

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Essential Questions for Program Directors (and Leadership)

Program directors shape the culture and structure of your training. As a prelim IMG, you want to understand how they view preliminary medicine residents and how they support IMGs in general.

Below are targeted questions to ask residency leadership, with explanations and optional follow‑ups.

A. Questions About the Role and Value of Prelim Residents

1. “How do you see the role of preliminary medicine residents within your program?”

   • Why it matters: You want a program that sees prelims as integral team members, not just service coverage.
   • Follow‑up: “Are prelims included in the same educational activities and conferences as categorical residents?”

2. “Can you describe how preliminary residents are integrated into teams and teaching activities?”

   • Look for: Shared conferences, equal teaching opportunities, joint morning reports, and not being excluded from key learning.

3. “Do you receive feedback from advanced specialty programs (e.g., neurology, anesthesia, radiology) about how well your prelims are prepared?”

   • Why it matters: This shows whether the program actively collaborates with downstream specialties and tracks performance of former prelims.

B. Questions About Education, Evaluations, and Feedback

4. “What are your educational priorities for a preliminary medicine year?”

   • Good signs: Emphasis on clinical reasoning, independent management, communication, and system‑based practice rather than pure service.

5. “How are preliminary residents evaluated, and how often is feedback provided?”

   • Ask about:
     • Frequency of formal evaluations
     • Mid‑rotation feedback
     • Access to evaluation reports
     • How feedback is used to support growth

6. “If a resident is struggling, what support systems or remediation processes do you have in place?”

   • Important as an IMG: You want a program that recognizes challenges and supports improvement, rather than punitive responses.

C. Questions About IMG Support and Visa Issues

These are critical interview questions for them from an IMG perspective.

7. “How many of your current residents are international medical graduates, and how have IMGs historically performed in your program?”

   • Look for: Comfort with IMGs, honesty about performance, and pride in IMG achievements.

8. “What types of visas do you sponsor for residents, and have there been any recent changes in your visa policies?”

   • Clarify: J‑1 vs H‑1B, institutional caps, and whether they’ve successfully navigated complex visa cases.

9. “What structured support do you provide for IMGs in adapting to documentation, communication styles, and the U.S. healthcare system?”

   • Examples: Extended orientation, simulation, EMR training, feedback on notes and handoffs, communication workshops.

10. “Is there guidance or assistance for residents regarding USMLE Step 3 timing and state licensure, especially for those on visas?”

    • Critical for J‑1s and future H‑1B transitions.

D. Questions About Schedule, Workload, and Well‑Being

11. “Could you describe a typical month for a preliminary resident in terms of rotation mix, call, and night float?”

    • Ask for specifics: Number of inpatient months, ICU exposure, night shifts, average patient load.

12. “How do you monitor and support resident well‑being, especially during intensive rotations like ICU or night float?”

    • Good signs: Wellness initiatives, mental health resources, responsive leadership, backup systems for illness.

13. “Are there differences in workload or expectations between prelim and categorical residents?”

    • You want: Similar expectations and support, not heavier workload with fewer benefits.

E. Questions About Outcomes for Prelim Residents

14. “Where have recent preliminary graduates gone for their advanced training, and how do you support them during the transition?”

    • Shows: Track record, networking, and how they maintain relationships with advanced specialties.

15. “Do you have any specific partnerships or common pathways with advanced specialties (e.g., neurology, anesthesia, radiology programs) that your prelims typically enter?”

    • Particularly useful if your advanced spot is at the same institution.

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Questions for Residents: Daily Life, Culture, and Hidden Realities

Current residents—especially those currently in or recently out of a preliminary medicine year—will provide the clearest picture of reality. When you meet them on interview day, social events, or virtual meet‑and‑greets, focus on open, conversational questions.

A. Daily Workflow, Autonomy, and Supervision

16. “As a prelim, what does a typical day look like on a ward or ICU rotation?”

    • Ask about:
      • Pre‑rounding and sign‑out times
      • Number of patients
      • How often they present to attendings vs senior residents
      • How much documentation and administrative work they do

17. “Do you feel you have appropriate supervision while still being able to develop independence?”

    • You want: Support for complex decisions with room to make and learn from your own assessments and plans.

18. “How approachable are attendings and senior residents when you have clinical questions or need help?”

    • Culture of safety is crucial—especially as an IMG adjusting to a new system.

B. Program Culture and Inclusivity for IMGs

19. “As an IMG (or working with IMGs), how supported do you feel in this program? Are there any particular challenges you’ve faced?”

    • Look for:
      • Honest discussion of initial adaptation
      • How colleagues helped
      • Presence of bias vs inclusivity

20. “How integrated are IMGs into social and academic activities? Do they typically feel part of the core resident community?”

    • Healthy programs: IMGs are leaders, chief residents, committee members.

21. “Have you ever experienced or observed discrimination or bias, and how did the program respond?”

    • You’re assessing: Whether the program recognizes and actively addresses these issues.

C. Workload, Burnout, and Work–Life Balance

22. “On your busiest rotations, how many hours per week do you realistically work?”

    • You want: Honest estimates, not only ACGME‑compliant theory.

23. “How manageable is the workload? Do you have time to read or study?”

    • As a prelim heading into an advanced specialty, you want a balance of intense clinical exposure and self‑directed learning time.

24. “Have you or your co‑residents ever had trouble with duty hour violations or feeling unsafe due to fatigue?”

    • Ask: “How did the program respond?” as a follow‑up.

D. Educational Quality and Support

25. “How regularly do you have protected educational time, and is it truly protected?”

    • Good sign: Residents are excused from non‑urgent clinical duties for conferences, morning report, and key teaching sessions.

26. “Do prelims have equal access to conferences, workshops, and procedural training as categorical residents?”

    • Watch for: Any hints that prelims are excluded or constantly pulled from teaching for service.

27. “What kind of feedback do you receive (verbal, written), and does it help you improve?”

    • Well‑run programs: Residents can describe specific, actionable feedback.

E. Transition to Advanced Specialty

28. “For those going into specialties like neurology, anesthesia, or radiology, do you feel your prelim year here has prepared you well?”

    • Ask for examples: Preparedness for ICU, cross‑cover, emergency situations, and overall confidence.

29. “Do prelims get any special guidance on what skills are most important for their advanced specialties?”

    • Bonus: Some programs tailor electives or provide advising based on your future field.

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Questions for Coordinators and Administrative Staff: Logistics, Visas, and Onboarding

Program coordinators are often your best source of information about practical details that heavily impact IMGs.

A. Visa, Licensing, and Administrative Support

30. “Can you describe the typical timeline and process for visa paperwork for incoming IMG residents?”

    • Clarify:
      • When they initiate paperwork
      • Any recurrent delays or common issues
      • What they expect from you

31. “Do you provide guidance on state medical licensure applications, especially for IMGs who may not be familiar with the process?”

    • States differ widely; structured support can save you major stress.

32. “For residents on visas, how do you coordinate timing for USMLE Step 3 and any required documentation?”

    • Important for future fellowship or employment.

B. Orientation, EMR Training, and Early Support

33. “What does orientation look like, especially for residents who are new to the U.S. system?”

    • Look for: EMR training, billing and coding basics, introduction to U.S. clinical documentation standards.

34. “Is there any early support or mentorship specially focused on IMGs during the first few months?”

    • Examples: Pairing with senior IMG mentors, additional training on communication and expectations.

C. Scheduling and Flexibility

35. “How far in advance do you provide rotation and call schedules, and how flexible can the program be regarding important personal or immigration‑related appointments?”

    • Critical if you anticipate embassy visits or legal appointments.

36. “Are there any common challenges that new IMGs face during onboarding, and how does the program help navigate them?”

    • You’re seeking: Realistic preparation and reassurance that they’ve done this many times.

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Specialty‑Specific, Strategic Questions: Aligning Prelim IM with Your Future Field

Your preliminary medicine year is a foundation for your advanced specialty. Programs will be impressed if your questions reflect long‑term thinking.

A. Connecting the Prelim Year to Your Future Specialty

37. “I will be entering [your specialty] for PGY‑2. How does your prelim curriculum support residents heading into that field?”

• Example:
  • For Neurology: Emphasis on stroke, neuro‑ICU exposure, neurologic exam training.
  • For Anesthesia: ICU time, airway exposure, hemodynamic management.
  • For Radiology: Strong internal medicine fundamentals, pattern recognition, communication with consultants.

38. “Have previous prelims going into [your specialty] given feedback on what parts of this program were most or least helpful for their PGY‑2 year?”

• Demonstrates you want to optimize your training, not just survive the year.

B. Electives, Research, and Scholarly Activities

39. “Are there any elective opportunities available to prelims, and are they allowed in subspecialties that might be relevant to my future field?”

• Some prelim programs limit electives; others allow 1–2 months. Clarify early.

40. “Do prelims have the opportunity to participate in research or quality improvement projects, or is the year too clinically intense for that?”

• Helpful if you are still building your CV or aiming for academic career paths.

C. Letters of Recommendation and Career Support

41. “Do your faculty often write letters of recommendation for prelim residents—for fellowships, advanced programs, or academic positions?”

• Even with a secured PGY‑2, strong IM letters can help with future fellowships or jobs.

42. “Is there structured career advising available to prelims, or is it mainly for categorical residents?”

• Ideal: Access to similar career support, even within a one‑year timeframe.

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How to Ask Your Questions: Strategy, Timing, and Etiquette

Knowing what to ask program directors and residents is only half the battle. How you ask them influences how you are perceived.

A. Prioritize and Personalize

Make a short list (8–12) of your highest‑priority questions. Consider:

• 3–4 for the Program Director
• 3–4 for residents
• 2–3 for the coordinator
• 1–2 specialty‑specific questions

Tailor these based on each program’s details (size, setting, known strengths or weaknesses).

B. Avoid Redundant or Website‑Level Questions

You signal preparation when your questions:

• Reference details from their website or brochure
• Build on what they shared in their presentation

Example:

• Instead of: “Do you have a night float system?”
• Say: “You mentioned a night float system during the presentation. For prelim residents specifically, how is the night float experience structured, and how often do they rotate on nights?”

C. Stay Professional and Positive

Even when asking tough questions (burnout, workload, discrimination), keep a professional tone:

• “How does the program handle…” rather than “Do you have problems with…”
• “What support is available when residents are overwhelmed?” rather than “Are people burnt out here?”

Avoid questions that sound transactional or ranking‑obsessed, such as:

• “How will you rank me?”
• “What are my chances here compared to other applicants?”

D. Take Notes and Reflect

During or shortly after the interview day:

• Write down key answers
• Note emotional impressions (e.g., residents seemed tired vs energized, PD was approachable vs dismissive)
• Compare across programs using a structured list: support for IMGs, prelim integration, workload, educational quality, visa friendliness

These reflections will help when you create your rank list.

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Frequently Asked Questions (FAQ)

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

Aim for 3–5 substantive questions per major interview segment (PD, residents, coordinator), but adapt to the time available. It is better to ask fewer, well‑thought‑out questions than to rush through a long list. Have a “reserve list” of questions you can skip if time is short.

2. Is it appropriate for an IMG to ask directly about visa sponsorship and support?

Yes, absolutely. As an international medical graduate, visa status is a critical factor. Programs expect you to ask about it. Phrase it professionally, for example:

• “Could you tell me about your current policies on J‑1 and H‑1B sponsorship for residents?”
• “How has your experience been in successfully securing visas for IMG residents?”

3. Should I ask different questions for a preliminary medicine position compared to categorical IM?

Yes. For a prelim IM position, emphasize:

• Integration of prelims into the program
• Educational goals of the one‑year experience
• How the program prepares residents for their future specialties
• Whether prelims have access to key educational opportunities and support

While some questions overlap with categorical applicants, your focus is on maximizing a single, intense clinical year.

4. Can I email follow‑up questions after the interview?

Yes, within reason. If something crucial was not covered, a short, focused email to the coordinator (or occasionally to the PD if invited) is appropriate. Keep it concise, professional, and limit follow‑ups to truly important topics (e.g., clarifications about visa support, schedule structure, or IMG orientation).

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By intentionally planning your questions to ask residency programs, you transform the interview from a one‑sided evaluation into a real conversation. For an international medical graduate in a preliminary medicine year, strong, targeted questions are not just a formality—they are one of your most powerful tools to find a program that will train, support, and launch you successfully into your chosen specialty.