Essential Pre-Interview Guide for US Citizen IMGs in General Surgery Residency

Understanding the General Surgery Interview Landscape as a US Citizen IMG

As a US citizen IMG (American studying abroad), your path to a general surgery residency is absolutely attainable—but it requires strategic, disciplined pre-interview preparation. General surgery is competitive, and programs pay close attention to how well-prepared, polished, and realistic applicants are during the interview season.

Before you log into Zoom or walk into a hospital for interview day, you need to understand:

• How you’re perceived: Programs know you’re American but trained abroad; they will evaluate whether your background prepares you for the intensity of US surgical training.
• What they’re worried about: Clinical readiness, communication, understanding of US healthcare, long-term commitment to surgery, and reliability.
• Where you add value: Broader clinical exposure, adaptability, maturity, cultural competence, and often strong motivation.

This article focuses on pre-interview preparation for the general surgery residency match, specifically tailored to a US citizen IMG. You’ll learn how to prepare for interviews, build strong narratives, anticipate interview questions for residency, and present yourself as a capable future surgeon.

---

Step 1: Strategic Self-Assessment and Application Audit

Before you rehearse answers, you need full command of your own story and application. The best interview performance starts with honest self-assessment.

1.1 Clarify Your Overall Narrative

Programs want a coherent “story” that makes sense:

• Why medicine?
• Why surgery?
• Why in the United States?
• Why as a graduate of an international school?

Spend time outlining:

1. Your Origin Story

   • Where you grew up in the US.
   • Why you chose to attend medical school abroad (cost, opportunity, family, competitiveness).
   • How this shaped your resilience and independence.

2. Your Path to Surgery

   • Key turning points: a particular surgical rotation, mentor, case, or hands-on experience.
   • What you specifically like about surgery (immediacy of impact, anatomy, procedures, team environment, etc.).
   • What you understand about the lifestyle—early mornings, long cases, high stress—and why you accept it.

3. Your Trajectory

   • What you see yourself doing in 10–15 years: community practice, academic surgery, fellowship (e.g., trauma, colorectal, minimally invasive).
   • How the program you’re interviewing at fits into that path.

Write this narrative out in bullet form. You will reuse it for many answers.

1.2 Know Your Application Inside Out

Every line on your ERAS can become a question. Before interviews start:

• Print or save a PDF of your ERAS application, CV, and personal statement.
• Highlight:
  • Research projects
  • Leadership roles
  • Volunteer work
  • Clerkships and sub-internships
  • Gaps, leaves, or transitions

For each entry, prepare to answer:

• What exactly did you do?
• Why did it matter?
• What skills did you gain (especially relevant to surgery: teamwork, communication, resilience, manual dexterity, procedural familiarity)?
• What challenges did you face and how did you handle them?

If you have red flags (exam failures, gaps, low Step scores), develop:

• A direct, non-defensive explanation
• A clear statement of what you learned
• Evidence of improvement (Step 2 score increase, better clerkship performance, recent US clinical experience).

Programs value self-awareness and growth much more than excuses.

---

Step 2: Clarifying Your Identity as a US Citizen IMG

Being an American studying abroad is a specific category of US citizen IMG, and programs will quietly evaluate how your background affects your readiness.

2.1 Anticipate Questions About Your Training Path

Common questions:

• “Why did you choose to attend medical school outside the US?”
• “How has international training prepared you for surgical residency here?”
• “Why are you returning to the US now?”

Plan honest, positive responses that:

• Avoid negativity about US or foreign systems.
• Emphasize opportunities you gained: exposure to diverse pathology, early procedural experience, resourcefulness.
• Show that you stayed connected to US medicine (USMLE early, electives, observerships, conferences).

Example framing:

“I chose to study abroad because it allowed me to pursue medicine despite financial and competitive constraints in the US at the time. Training in [Country] has made me adaptable and resourceful, and I sought out US clinical experiences and USMLE preparation early to ensure I would be ready to train in an American general surgery residency.”

2.2 Address US Clinical Experience (USCE) and Transitions

Programs often worry whether IMGs truly understand US hospital systems. You should be ready to discuss:

• Electives/sub-Is in US hospitals
• Observerships or externships
• Any US-based research or quality improvement projects

For each experience, highlight:

• The differences between your home system and US system.
• How you adjusted to EMR, multidisciplinary rounds, documentation demands, and communication.
• Examples showing you can function smoothly in a US-style team.

If you lack strong USCE in surgery, strengthen your preparation by:

• Doing case-based discussion practice with US residents or faculty.
• Participating in virtual observerships or surgical education webinars.
• Studying typical US perioperative workflows and order sets.

---

Step 3: Deep Program Research and Targeted Preparation

Strong pre-interview preparation means you never ask questions you could have answered with a 10-minute website review.

3.1 Build a Structured Program Research System

Create a spreadsheet or document for each program with:

• Program name, location, type (community vs academic, hybrid).
• Number of categorical positions, presence of prelim spots.
• Major clinical strengths (trauma level, transplant, MIS, surgical oncology).
• Call schedule, rotation structure, operative exposure.
• Research infrastructure (protected time? mandatory? optional?).
• Residents’ backgrounds—pay attention to how often they match US citizen IMG or other IMGs.
• Recent changes: new chair, PD, mergers, growing subspecialties.

Sources:

• Program websites
• FREIDA
• Residency explorers
• Resident-led social media (Instagram, X, YouTube)
• Virtual open house recordings

3.2 Identify Your “Genuine Fit” Talking Points

For each program, list 3–5 specific reasons you’re interested that go beyond “good training”:

• “Strong trauma and acute care surgery exposure with a busy Level I trauma center.”
• “Early operative exposure for PGY-1s as documented in your case logs and resident testimonials.”
• “Track record of placing graduates into [X] fellowships.”
• “Close-knit resident culture and emphasis on wellness in a smaller program.”

During the interview, you want to be able to answer smoothly:

• “Why this program?”
• “What aspects of our training structure appeal to you?”
• “Where do you see yourself fitting into our program?”

3.3 Prepare Intelligent Questions for Faculty and Residents

Generic questions waste valuable face time. Show you’ve done your homework. Examples:

For faculty:

• “I noticed your program offers early exposure to vascular and thoracic surgery. How do you see that shaping residents’ operative confidence by PGY-3?”
• “How does the program support US citizen IMG residents transitioning into the US system—are there specific orientation or simulation resources?”

For residents:

• “How would you describe the autonomy you have in the OR at different PGY levels?”
• “As someone who trained internationally, I’m curious: how has the program supported residents with diverse training backgrounds?”

Prepare 5–8 questions, then choose 2–3 per encounter depending on what’s already been discussed.

---

Step 4: Mastering Core Interview Content and Behavioral Questions

Even for the most competitive applicants, the surgery residency match often hinges on how well you communicate under pressure. Your goal: appear organized, self-aware, and coachable.

4.1 Core General Surgery Interview Questions

You will almost certainly be asked variants of these:

• “Tell me about yourself.”
• “Why general surgery?”
• “Why this program?”
• “What are your strengths and weaknesses?”
• “Describe a challenging clinical situation and how you handled it.”
• “Tell me about a time you made a mistake.”
• “Where do you see yourself in 10 years?”
• “How do you handle stress or long working hours?”
• “What do you do for fun outside of medicine?”

For US citizen IMG applicants, you should also expect:

• “How did your training abroad prepare you for residency here?”
• “What challenges do you anticipate transitioning back to the US?”
• “How have you maintained your clinical and procedural skills since graduation?” (if there is a gap or you’re an older graduate)

4.2 Structuring Your Answers: The 3-Part & STAR Framework

To avoid rambling:

1. 3-Part Introductory Answers (e.g., “Tell me about yourself”):

   • Present: Where you are now (final-year student, recent graduate, current research).
   • Past: Key experiences that led you here (training abroad, major clinical moments).
   • Future: What you want in residency and surgical career.

2. STAR for Behavioral Questions:

   • Situation: Brief context.
   • Task: What needed to be done.
   • Action: What you specifically did.
   • Result: Outcome and what you learned.

Example for a mistake:

S: “During my surgery rotation in [country], I was responsible for pre-op consent on the ward…
T: I needed to ensure patients understood the procedure and risks.
A: I realized during post-op rounds that one patient was unclear about a possible ostomy. I immediately clarified with the attending, spoke with the patient again, documented the discussion, and then reviewed our consent process with the team.
R: Since then, I’ve adopted a structured consent checklist and I’m more proactive about confirming patient understanding. It reinforced my belief that communication is just as critical as technical skill in surgery.”

4.3 Highlighting IMG-Specific Strengths Without Apologizing

Frame your IMG status as an asset:

• Emphasize adaptability: adjusting to different systems, limited resources, and varied patient populations.
• Emphasize resilience: navigating distance from home, visas (if applicable to classmates), and high-stakes exams.
• Emphasize maturity and independence: functioning with greater responsibility during rotations abroad.

Example integration:

“Training internationally has prepared me well for general surgery in the US. I’m used to high clinical responsibility, I’ve worked with limited resources, and I learned to advocate for patients in systems that can be complex to navigate. Coming back to the US, I bring that resilience and problem-solving mindset to a setting with more resources and more structured teams.”

---

Step 5: Intensive Practical Preparation: Mock Interviews, Communication, and Video Setup

Even the best content won’t land if your delivery is disorganized or your video setup is distracting. Pre-interview preparation also means rehearsal and logistics.

5.1 Schedule Multiple Mock Interviews

Aim for at least:

• 2–3 formal mock interviews with:
  • Faculty (if available)
  • Surgical residents
  • International graduate advisors or mentors

Try to simulate:

• 20–30 minutes per session
• A mix of behavioral and traditional questions
• Immediate feedback on content and style

Ask specifically for feedback on:

• Clarity and conciseness
• Professionalism and poise
• How your IMG story is coming across
• Whether your interest in surgery and this specialty feels genuine and informed

If live mentors are limited:

• Use institutional career services or alumni groups.
• Contact current residents through networking (politely and briefly).
• Use video recording of self-practice and review critically.

5.2 Refine Your Communication Style

General surgery faculty often value:

• Direct, clear communication
• Evidence that you can both lead and follow
• Comfort with uncertainty and tough situations

Practice:

• Speaking in organized, short paragraphs—not monologues.
• Avoiding filler (“um, like, you know”) and overly casual language.
• Maintaining eye contact (camera lens) and a calm tone even when answering hard questions.

Work on phrases that transition gracefully:

• “That’s a great question” is optional, but more important is:
  • “From my perspective…”
  • “In my experience during [rotation]…”
  • “One example that stands out is…”

5.3 Optimize Your Technical and Physical Setup (Virtual Interviews)

Most general surgery programs still use virtual interviews. Before interview day:

• Camera: Eye level, stable, with enough light on your face.
• Lighting: Natural light from in front of you, or a ring light. Avoid backlighting.
• Sound: Test headphones or microphone; avoid echoing rooms.
• Background: Neutral, uncluttered—simple wall, tidy bookshelf, or desk.
• Internet: Test connection at the same time of day as your actual interviews.

Dress as you would for an in-person interview:

• Professional attire (suit jacket, dress shirt/blouse).
• Conservative colors, minimal jewelry.
• Ensure your posture conveys alertness and engagement.

Have within reach:

• Printed copy or digital quick notes of your ERAS, personal statement, and program-specific notes.
• A notepad and pen (to jot down interviewer names, key points).
• Water, in a simple, non-distracting cup or bottle.

---

Step 6: Personal Logistics, Mindset, and Day-Before Planning

Your interview performance depends heavily on preparation outside of pure content.

6.1 Organize Your Interview Calendar and Time Zones

As a US citizen IMG, especially if you’re still abroad, time zone confusion is a high-risk problem.

• Confirm all interview times in US Eastern and your local time.
• Use calendar apps with automatic time zone conversion.
• Set two alarms: one 60–90 minutes before, one 20–30 minutes before.

If you have back-to-back interviews:

• Plan short breaks for food, bathroom, and brief reset.
• Have a simple routine (stretching, deep breathing, short walk) between sessions.

6.2 Prepare a Pre-Interview Routine

To maintain consistency across multiple interviews:

• The night before:

  • Re-skim the program’s website and your notes.
  • Review your own ERAS and key stories.
  • Lay out your clothes and test your setup one more time.
  • Go to bed early; avoid heavy late-night study.

• The morning of:

  • Light, familiar breakfast.
  • Run a quick tech check (sound, video, background).
  • 5–10 minutes of warm-up talking (practice answers out loud, even to yourself).

Mentally rehearse:

• Your “Tell me about yourself” answer.
• One or two strong patient stories that reflect your clinical maturity.
• One challenge/mistake story and what you learned.

6.3 Handling Anxiety as a High-Stakes IMG Candidate

It’s normal to feel extra pressure as a US citizen IMG trying to match into general surgery. To manage this:

• Focus on controllables: preparation, research, sleep, environment.
• Reframe interviews as conversations to find mutual fit, not interrogations.
• If you stumble on a question:
  • Pause briefly, breathe.
  • Clarify: “Let me just take a second to think about a good example.”
  • Deliver your best structured answer.
• After each interview:
  • Take 5 minutes to jot down impressions, people you met, and what stood out.
  • Avoid replaying every sentence. Make small adjustments, not major overhauls, unless feedback repeatedly indicates a problem.

---

Frequently Asked Questions (FAQ)

1. As a US citizen IMG, do I need to prepare differently for general surgery interviews than US MD/DO graduates?

Core interview preparation—knowing your application, practicing behavioral questions, researching programs—is the same. However, you should pay particular attention to:

• Explaining why you trained abroad and how it helped you grow.
• Demonstrating readiness for US clinical practice through USCE, research, and familiarity with EMR and team-based care.
• Addressing any gaps or exam issues in a confident, non-defensive way.
• Showing a clear, realistic understanding of surgical lifestyle and expectations.

Your goal is to reassure programs that your path is non-traditional, but you are fully prepared and committed.

2. What interview questions for residency are especially important for general surgery?

In addition to standard residency interview questions, general surgery applicants should be especially ready for:

• “Why surgery and not another procedural specialty?”
• “Tell me about a time you dealt with high stress or long hours.”
• “Describe a situation where you had to work within a team under pressure.”
• “How do you handle feedback, especially critical feedback?”
• “Tell me about a difficult patient or family interaction and how you managed it.”

Programs want to see that you can remain calm under pressure, accept critique, and communicate effectively—core surgical traits.

3. How can I show programs I’m serious about general surgery and not using it as a backup?

Your pre-interview preparation should translate into clear evidence of commitment:

• Surgical electives, sub-internships, and USCE in surgery.
• Surgery-related research or quality improvement projects.
• Mentors and letters from surgeons.
• A personal statement and interview answers that reflect specific interest in surgical disease, operations, and team structures—not generic “I like procedures.”

During interviews, describe specific surgical cases that impacted you and emphasize that you understand the demands—physically, emotionally, and time-wise.

4. What should I avoid doing during general surgery residency interview preparation?

Common pitfalls:

• Over-memorizing answers so they sound robotic.
• Failing to research individual programs and asking basic questions easily answered online.
• Downplaying your IMG status with apologetic language instead of framing it as an asset.
• Ignoring logistics: poor sound/video, messy background, or time zone confusion.
• Neglecting personal well-being—sleep, nutrition, and breaks—leading to burnout mid-season.

Balanced, authentic, and structured preparation will help you present as the capable, resilient, and motivated candidate you already are.

---

Thorough pre-interview preparation is your best tool as a US citizen IMG aiming for a general surgery residency. By understanding your narrative, anticipating program concerns, mastering core interview content, and organizing your environment and mindset, you significantly improve your chances in the surgery residency match and demonstrate that you are ready to train as a future surgeon in the US.