Essential Questions for Family Medicine Residency: A Guide for US Citizen IMGs

Understanding Why Your Questions Matter as a US Citizen IMG

As a US citizen IMG or an American studying abroad, the questions you ask programs can significantly shape how faculty perceive you—and how well you evaluate them. Your questions do three critical things:

1. Show insight and maturity
   Thoughtful questions signal that you understand family medicine, the FM match, and what it takes to succeed as an IMG.

2. Help you compare programs realistically
   Not all family medicine residency programs are equally supportive of IMGs. Your questions help uncover fit: training quality, culture, and IMG success.

3. Demonstrate genuine interest
   Programs can tell when you’re using a generic list versus questions clearly tailored to their program.

For a US citizen IMG in family medicine residency, the goal is not just to have “some questions,” but to have the right questions—aligned with your needs, red flags, and long-term goals.

Below is a structured guide of interview questions for them—what to ask program directors, residents, and coordinators—plus strategies to adapt questions specifically as a US citizen IMG.

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Strategy First: How to Use Questions Effectively

Before diving into question lists, it helps to understand how to use them strategically during the interview process.

1. Prepare Questions by Role

You’ll interact with different people on interview day:

• Program Director (PD) / Associate PD
• Core Faculty
• Current Residents
• Program Coordinator
• Sometimes Behavioral Health, Clinic Manager, or Department Chair

You should have:

• 4–6 questions for the PD/faculty
• 5–7 questions for residents
• 2–3 questions for the coordinator/administration

Not all will be asked; you’ll choose based on time, flow, and what’s already been answered.

2. Avoid “Googleable” or Superficial Questions

Do your homework first:

• Read the program website
• Check their ACGME data (if available)
• Review social media (Instagram, X/Twitter, YouTube)

Avoid questions like:

• “What is your board pass rate?” (if it’s on the website)
• “How many residents per year?” (usually obvious)

Instead, ask follow-ups:

• “I saw your board pass rate is consistently high. What systems or support structures do you have in place to help residents who may be struggling academically, particularly those with non-traditional backgrounds like IMGs?”

3. Tailor for US Citizen IMG Concerns

As an American studying abroad, you have specific issues:

• Transition back to US healthcare system
• Visa (less of an issue for you, but still helpful in understanding diversity of trainees)
• State licensing and board exam support
• Preparation for fellowship or community practice
• Support for any gaps, attempts, or nontraditional timeline

Frame questions to address:

• How they support IMGs academically and culturally
• Their track record with IMGs in the FM match and beyond
• Mentoring and advocacy for career goals (fellowship vs community)

4. Phrase Questions Positively and Professionally

Avoid sounding defensive or anxious about being an IMG. Instead of:

• “Do you accept many IMGs?”

Try:

• “I’m a US citizen IMG and very interested in understanding how your program supports residents coming from international schools. Can you share how IMGs have integrated into your residency and what has helped them thrive here?”

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High-Yield Questions to Ask the Program Director and Faculty

When thinking about what to ask the program director, focus on training quality, IMG support, and long-term outcomes. These questions help you evaluate whether the program can truly train you into the kind of family physician you want to be.

A. Questions About Training, Curriculum, and Autonomy

1. “How would you describe the progression of resident autonomy from intern year to third year?”

   • Follow-up for an IMG:
     “As someone trained abroad, I know there can be variability in clinical exposure. How do you assess and support incoming interns who may have different levels of hands-on experience?”

2. “What makes your curriculum distinct from other family medicine programs in this region?”

   • Listen for: strong outpatient focus, inpatient experience, behavioral health integration, procedures, obstetrics, community medicine.

3. “How flexible is the curriculum for residents with specific interests—for example, geriatrics, sports medicine, or underserved care?”

   • If you’re considering fellowship, ask directly:
     “What kind of individualized opportunities are available for residents pursuing fellowship?”

4. “How much continuity clinic time do residents get, and how do you ensure we’re ready to manage a full outpatient panel by graduation?”

5. “What opportunities are there for procedures in the outpatient setting, and are there any procedural tracks or concentrations?”

   • Helpful if you want broad-scope FM or rural practice.

B. Questions About Evaluation, Feedback, and Academic Support

6. “How are residents evaluated, and how frequently do they receive structured feedback?”

7. “If a resident is struggling—academically, clinically, or with exams—what does your remediation or support process look like?”

   • For US citizen IMG:
     “Are there specific supports you’ve found especially helpful for IMGs adjusting to documentation, EMR, or US system-based practice?”

8. “What resources are available for board preparation—such as funded question banks, in-house review sessions, or protected board study time?”

9. “Have any residents failed boards in recent years? If so, how did the program support them through retaking and passing?”

   • This gives insight into how they treat residents under stress.

C. Questions About Program Culture and Resident Well-Being

10. “How would you describe the culture of the program? What kind of resident tends to thrive here?”

11. “What changes have you made to improve resident wellness or workload over the past few years?”

    • This reveals responsiveness to feedback.

12. “How does the program address burnout, especially during high-intensity rotations like inpatient or night float?”

13. “What mechanisms exist for residents to give feedback about the program, and can you share an example where resident feedback led to a meaningful change?”

D. Questions About US Citizen IMG and Diversity Support

14. “As a US citizen IMG, I’m particularly interested in how IMGs have integrated into your program. About what proportion of your residents are IMGs, and how have they performed overall?”

15. “Can you share examples of recent IMGs in your program and the types of careers they pursued after graduation—fellowship, academic, rural, or urban practice?”

16. “What aspects of your program do you think make it especially supportive—or challenging—for IMGs?”

    • Listen for honest reflection versus vague reassurance.

E. Questions About Career Outcomes and the FM Match

17. “Where have your graduates gone in the last 3–5 years—in terms of geographic location, types of practice, and fellowships?”

18. “If a resident is interested in a competitive fellowship (sports, palliative, OB, addiction, etc.), how does the program support them in that process?”

19. “How involved are faculty in mentorship for job search or fellowship applications during PGY-2 and PGY-3?”

20. “Are there alumni networks that help with job placement, especially for residents who trained abroad and are re-entering the US system?”

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Questions to Ask Current Residents (Your Best Source of Truth)

Residents give you the clearest picture of daily life, hidden challenges, and whether a program is genuinely IMG-friendly. This is where many of your highest-yield interview questions for them should be aimed.

A. Workload, Workflow, and Schedule

1. “What does a typical day look like on inpatient? On clinic-heavy blocks?”

2. “How often are you staying late to finish notes or sign-out? Is that the norm or the exception?”

3. “How manageable are duty hours in reality? Do you feel you can rest adequately between shifts?”

4. “How is cross-cover and night float structured? Do you feel adequately supervised at night?”

B. Support, Teaching, and Supervision

5. “Do you feel comfortable asking questions when you’re unsure, or is there a culture of ‘figure it out yourself’?”

6. “How approachable are attendings and senior residents when you make a mistake or need help?”

7. “Is there protected didactic time, and is it truly protected or often interrupted by pages and clinical duties?”

8. “How well do you feel the program prepares you for independent practice or fellowship?”

C. Culture: How They Treat IMGs and Nontraditional Residents

9. “As someone trained abroad, I’m wondering: how have IMGs integrated here? Do they feel included socially and academically?”

   • Listen for specifics, not vague “everyone’s fine.”

10. “Have you seen any differences in expectations or support between US grads and IMGs?”

11. “Do IMGs here tend to pass boards on the first attempt and find good jobs or fellowships?”

12. “As a US citizen IMG, I’ll be transitioning back to the US system. How does the program help with EMR learning, documentation, and adapting to US-style rounds?”

D. Wellness, Morale, and Red Flags

13. “If you could change one thing about the program, what would it be?”

    • A very revealing question; pay attention to tone and whether multiple residents give the same answer.

14. “Is there anything about the culture that you wish you had known before ranking this program?”

15. “What do you like most and least about the residency?”

    • Ask several residents; patterns matter.

16. “How often do residents leave the program early or fail to be promoted on time?”

    • A sensitive but important question.

E. Life Outside of Residency

17. “Are you able to maintain hobbies, relationships, or family responsibilities?”

18. “How affordable is it to live here on a resident salary? Any neighborhoods you recommend or avoid?”

19. “How family-friendly is the program for residents with partners or children?”

20. “Do residents hang out together outside of work, or is it more of a ‘come to work and go home’ culture?”

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Practical Questions for the Program Coordinator and Administrative Staff

The program coordinator sees everything behind the scenes. They are an excellent source of information on logistics and systems that will affect your quality of life.

A. Logistics and Onboarding

1. “What does the onboarding process look like for new interns, especially those who trained abroad?”

2. “How early do new residents need to arrive before the official start date for orientation, credentialing, and EMR training?”

3. “Are there any additional steps that US citizen IMGs commonly need to complete for licensing or credentialing, and how does the program assist with those?”

B. Scheduling, Time Off, and Benefits

4. “How is vacation time scheduled, and how flexible is it? Are there restrictions for PGY-1 vacation?”

5. “How does the program handle parental leave or extended medical leave for residents?”

6. “What benefits do residents receive—health insurance details, CME funds, exam fee coverage, etc.?”

7. “Is there institutional support for attending conferences or presenting research—travel funds, days off, etc.?”

C. IMG-Related Processes

Even as a US citizen IMG (no visa needed), questions about IMG processes give insight into how familiar the institution is with international paths.

8. “How many of your current residents are IMGs, and are there specific administrative issues that tend to arise for them?”

9. “Do you assist residents with state licensing paperwork and deadlines, especially if their medical school is abroad?”

10. “If there are delays in ECFMG or licensing paperwork, how does the program handle start dates and payroll?”

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Customizing Questions to Your Priorities as a US Citizen IMG in Family Medicine

Not every question fits every applicant. You should build your own “short list” tailored to your priorities. Here’s how to organize your questions based on common IMG goals.

1. If You Want a Broad, Full-Scope Family Medicine Practice

Ask more about:

• Inpatient experience
• OB and women’s health
• Procedures
• Rural or underserved rotations

Example questions:

• “What is the scope of practice of your graduates who work in rural areas—are they doing inpatient, OB, or ER shifts?”
• “How many continuity deliveries per resident do you typically see? Is there an OB track?”
• “What procedural skills are graduates most comfortable with by the end of residency?”

2. If You’re Considering Fellowship (Sports, Geriatrics, Palliative, Addiction, etc.)

Ask more about:

• Research or scholarly activity
• Faculty mentorship
• Fellowship match history

Example questions:

• “Do residents interested in fellowship have protected time for scholarly projects or quality improvement?”
• “Is there a formal research curriculum or mentorship program?”
• “Can you share recent fellowship placements from this program and how the program supported those applications?”

3. If You’re Focused on Outpatient, Lifestyle, and Location

Ask more about:

• Continuity clinic structure
• Work-life balance
• Local job market

Example questions:

• “How busy is a typical clinic session for PGY-3s—number of patients per half-day?”
• “Do graduates commonly stay in this region, and what types of outpatient jobs do they obtain?”
• “How supportive is the program of residents who prioritize part-time or lifestyle-friendly positions after graduation?”

4. If You’re Worried About Transitioning Back to the US System

Ask more about:

• Orientation
• EMR and documentation training
• Simulation and early support

Example questions:

• “How do you structure intern orientation, particularly for those who have not recently worked in the US system?”
• “Is there simulation training or boot camps early in PGY-1 for procedures, codes, and communication skills?”
• “How are interns supported in learning US-style documentation, billing, and coding, especially if they’ve trained abroad?”

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How to Ask Questions Without Running Out of Time

During virtual or in-person interviews, time is limited. Here are some tactics so that your best questions actually get asked.

Prioritize 3–4 “Must Ask” Questions Per Interview

For example, your essentials might be:

1. IMG support and outcomes
2. Daily workload and autonomy
3. Board prep and academic remediation
4. Culture and wellness

If time is short, ask the highest-yield one or two questions that matter most to you.

Use “Batching” to Ask Multi-Part Questions Efficiently

Instead of three separate questions:

• “How do residents give feedback?”
• “Has anything changed because of it?”
• “Can you give an example?”

Combine:

• “How do residents provide feedback to leadership, and can you share one or two changes you’ve made in the last few years in response to that feedback?”

Adapt in Real Time

If the PD already answered part of your question in their initial overview, adapt:

• “You mentioned that you made schedule changes based on resident feedback—could you talk more about what specifically changed and how residents are feeling about it now?”

Always Have One “Closer” Question

If they ask, “Do you have any final questions?” you might say:

• “We’ve covered most of what I hoped to ask. My last question is: What are you most proud of about this program, and what are you most excited to improve in the next 3–5 years?”

This leaves a positive impression and often reveals the leadership’s true priorities.

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FAQs: Questions to Ask Programs as a US Citizen IMG in Family Medicine

1. As a US citizen IMG, should I explicitly mention that I’m an IMG when asking about support?
Yes—briefly and confidently. For example:
“I’m a US citizen IMG, so I’m particularly interested in how you support residents transitioning from international schools.”
This frames your questions as thoughtful, not defensive, and encourages honest, IMG-specific responses.

2. How many questions should I ask in each interview session?
Aim for:

• PD/faculty: 2–4 well-chosen questions, depending on time
• Residents: 3–6 questions across a group session
• Coordinator: 1–3 targeted logistics questions via email or during the interview day
  Quality and relevance matter more than quantity; don’t force questions just to fill silence.

3. Is it okay to ask directly about board pass rates and IMG performance?
Yes, but phrase it professionally:

• “Could you share your recent board pass rates and any trends you’ve noticed?”
• “How have IMGs in your program historically performed in terms of boards and job placement?”
  Programs that are transparent and supportive will answer comfortably.

4. What are red flags in how programs respond to my questions?
Be cautious if you notice:

• Evasive answers when you ask about board failures, remediation, or IMG outcomes
• Residents giving very different or guarded answers from leadership
• Dismissive responses to concerns about wellness or workload
• No clear examples of changes made in response to resident feedback
  These signals suggest you might struggle to find support, especially as an IMG re-entering the US system.

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Thoughtful, well-structured questions show programs that you’re serious about becoming an excellent family physician—and help you identify where you’ll be supported, respected, and able to thrive as a US citizen IMG in family medicine residency. Use this guide as a template, then personalize it to reflect your own goals, values, and story.