Essential Questions for Non-US Citizen IMGs in Preliminary Surgery Residency

Why the Questions You Ask Matter as a Non‑US Citizen IMG

As a non-US citizen IMG applying for a prelim surgery residency, the questions you ask programs are not just a formality—they are strategic tools. They help you:

• Evaluate how a program treats prelims vs. categoricals
• Understand visa sponsorship, career outcomes, and real chances for advancement
• Demonstrate maturity, insight, and genuine interest
• Protect yourself from ending up in a program that burns you out without helping you match

For a foreign national medical graduate in a one-year preliminary surgery year, every detail matters: visa stability, operative exposure, support for the ABSITE, and realistic pathways to categorical positions. Thoughtful, targeted questions can help you compare programs and decide where you can truly grow.

Below is a structured guide to what to ask program directors, residents, coordinators, and yourself—with specific example phrases and explanations tailored for non-US citizen IMGs.

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Core Strategy: How to Approach Asking Questions

Before diving into specific examples, you need a framework. Otherwise you risk asking generic, recycled “interview questions for them” that don’t actually help you.

1. Prioritize Your Objective as a Prelim and Non-US Citizen

For a non-US citizen IMG in prelim surgery, your big-picture goals usually include:

1. Securing a stable visa (J-1 vs H-1B, timing, renewals)
2. Maximizing your chances to obtain a categorical position (internal or external)
3. Building a strong application for a future match (US clinical experience, letters, research, ABSITE score)
4. Avoiding burnout or exploitation in service-heavy, educationally weak programs

Your questions should repeatedly connect back to these four priorities.

2. Ask Different People Different Types of Questions

• Program Director / Chair / Associate PD
  Ask: policy-level, outcomes, advancement, institutional support, expectations.

• Current Residents (especially prelims and IMGs)
  Ask: what the culture is really like, workload, schedule, mistreatment, actual operative experience, and how fair the program is.

• Program Coordinator / GME Office
  Ask: visa logistics, onboarding, HR issues, licensure, contract, start dates.

3. Use Specific, Data-Oriented Questions

Avoid:

• “How is your program?”
• “Is there good operative exposure?”

Instead ask questions that force specifics:

• “On average, how many major cases do PGY-1 prelims log by the end of the year?”
• “In the last 3–5 years, where have your prelims gone after finishing here?”

These questions make it harder to give vague or overly positive answers.

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High-Yield Questions for Program Directors (Especially for Non‑US Citizen IMGs)

Program directors (PDs) control resources and set expectations. You should arrive with a clear set of focused, respectful, but probing questions.

1. Questions About Visa Sponsorship and Institutional Support

Since you are a non-US citizen IMG, visa questions are essential and completely appropriate.

Key questions to ask program directors or coordinators:

• “What types of visas do you sponsor for prelim surgery residents? J-1 only, or also H‑1B?”
• “Have there been any recent changes or limitations in your institution’s visa policies?”
• “For H‑1B sponsorship (if applicable), who handles the legal and filing process—the GME office or an external firm?”
• “Are there any restrictions on prelim residents compared to categorical residents regarding visa type or renewal?”

What to listen for:

• Clear, confident answers (not confusion or hesitation)
• Evidence of recent successful sponsorships
• No hidden “unofficial” policies like “We prefer US citizens even if we say we sponsor visas”

If answers are vague, follow-up with:

• “In the last 2–3 years, how many non-US citizen IMGs have matched here as prelims, and what visa did they use?”

2. Questions About Outcomes for Prelim Surgery Residents

This is the single most important area for a preliminary surgery year. You must know whether prior prelims actually move forward or stay stuck.

Essential questions:

• “Over the past 3–5 years, what have been the typical outcomes for your prelim surgery residents?”
• “Approximately what percentage of your prelim residents go on to:
  – a categorical general surgery spot here,
  – a categorical spot at another institution,
  – a non-surgical residency, or
  – leave training altogether?”
• “Can you share a few examples of what your last few prelim classes are doing now?”
• “Do you rank prelim residents for internal categorical openings? If so, how is that process structured and how early in the year does it begin?”

Red flags:

• “We don’t really track that.”
• “Most just figure things out on their own.”
• “We almost never convert prelims to categorical.”

These may signal that the program uses prelims mainly for service, with little commitment to your future.

3. Questions About Internal Categorical Opportunities

If one of your goals is to transition to categorical surgery, you need clarity.

Targeted questions:

• “In the last 3–5 years, how many preliminary residents have successfully transitioned to categorical positions at this institution?”
• “When categorical positions open (due to attrition or expansion), are prelims given structured consideration?”
• “Does performance as a prelim here influence how likely we are to be interviewed for your categorical track in future cycles?”
• “Are prelim residents invited to the same educational and professional development activities as categoricals, or are there differences?”

Interpretation tips:

• Listen for language like “We actively advocate for our prelims” versus “If something opens, they can apply like anyone else.”
• Ask a follow-up if needed: “Do you have any recent non-US citizen or IMG prelims who successfully became categorical? What helped them stand out?”

4. Questions About Educational and Operative Experience for Prelims

Many prelims are overworked and under-trained. Get specifics.

Examples of strong questions:

• “How is operative experience distributed between categorical and prelim residents?”
• “By the end of the prelim year, what is the typical range of case numbers for your prelim PGY-1s?”
• “Are there particular services where prelim residents consistently get more operative opportunities (e.g., trauma, acute care surgery, transplant)?”
• “Are there any rotations reserved only for categorical residents? If so, which ones and why?”

Why these matter:

You want to avoid being “the note-writing, scut-only” intern with little operative exposure, which weakens your future applications.

5. Questions About Evaluation, Feedback, and Support

Your preliminary surgery residency is short; you need quick, targeted growth.

Ask program leadership:

• “How often do residents receive formal feedback, and in what format?”
• “Is there a transparent system for identifying a prelim resident who is struggling early and providing support?”
• “If a prelim resident is aiming for a categorical position, how do you advise and mentor them regarding the timing of applications, letters, and ABSITE performance?”

ABSITE and mentorship-specific examples:

• “Do prelim residents receive structured preparation for the ABSITE, similar to categorical residents?”
• “Who typically writes letters of recommendation for your prelims who are re-applying to General Surgery or other specialties?”

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Essential Questions to Ask Current Residents (Especially Prelims & IMGs)

Residents, especially current preliminary surgery interns, will give you the clearest window into the true culture and workload. These are your most critical conversations.

1. Questions About Reality vs. Recruitment

Residents can help you see beyond brochure language.

High-yield questions:

• “What do you think this program does very well for its prelims, and where does it fall short?”
• “If you had to decide again, would you choose this prelim surgery residency?”
• “What surprised you the most after you started—good and bad?”

These open-ended questions often reveal the most honest feedback.

2. Questions About Workload, Schedule, and Burnout

As a non-US citizen IMG, you may be especially vulnerable to overwork if you feel pressure to “prove yourself.” Understand realistic expectations.

Ask residents:

• “On a typical ward or ICU month, what are your work hours and how often do you violate duty hours?”
• “How manageable is the call schedule for prelims compared with categoricals?”
• “Do prelims feel like they are used mainly for service, or do you feel the program protects your educational time?”
• “How approachable are attendings and senior residents if you’re feeling overwhelmed or struggling?”

What to listen for:

• Consistent stories among multiple residents
• Whether prelims are consistently assigned the least desirable tasks or services
• Signs of a toxic culture (yelling, public humiliation, chronic duty hour violations)

3. Questions About Operative and Procedural Experience

Resident accounts of OR time will be more realistic than official numbers.

Specific questions:

• “On your current or last rotation, how often do you get into the OR as a prelim? What roles are you usually in—primary surgeon, first assist, or observer?”
• “Do you feel prelims and categoricals are treated fairly in the OR assignment?”
• “Can you give a rough estimate of how many major cases you logged by the midpoint of the year?”
• “Are there any rotations you would recommend strongly as especially educational for prelims?”

These help you judge how much real surgical training you will gain in 12 months.

4. Questions on Culture, Inclusion, and Treatment of IMGs

As a foreign national medical graduate, you must consider whether the environment is supportive of IMGs and non-US citizens.

Examples:

• “How many non-US citizen IMGs are currently in the program? Do they seem well-integrated?”
• “Have you seen any differences in how IMGs vs US grads are treated in terms of responsibilities, OR time, or evaluations?”
• “How does the program respond to concerns about mistreatment or bias?”
• “Do you feel that prelims are respected and included in conferences, M&Ms, and academic activities?”

You want to hear that IMGs succeed and that concerns are taken seriously.

5. Questions About Career Guidance and Outcomes for Prelims

Residents often know where previous prelims have landed.

Key questions:

• “Do you know what most of the recent prelim classes are doing now?”
• “Have many of your prelim colleagues successfully gotten categorical surgery positions? In this program or elsewhere?”
• “How involved is the program in helping prelims find their next position—letters, networking, calling other programs?”
• “How early in the year did your co-prelims start working on their next match applications?”

If residents say “Everyone handled it by themselves,” that suggests limited support.

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Questions for Program Coordinators and GME: Logistics, Visas, and Red Tape

Program coordinators are extremely valuable, especially for non-US citizen IMGs dealing with complex logistics.

1. Visa and Immigration Process Details

Once you’ve confirmed visa sponsorship exists, drill into the process.

Questions to ask:

• “For J-1 or H-1B visas, how early does the visa process begin after Match Day?”
• “What documents do you need from me, and what is the typical timeline to avoid delays?”
• “Have you had any recent cases where visa issues caused a resident to start late? How was that handled?”
• “Do you provide guidance for residents who are changing status (e.g., F‑1 to J‑1) or coming from outside the US?”

These help you evaluate how experienced and organized the institution is with foreign nationals.

2. Hospital Credentialing and State Licensure

If you’re new to the US system, these administrative steps can be confusing.

Practical questions:

• “Do prelim residents rotate at multiple hospitals? If so, how does credentialing work and how long does it usually take?”
• “Is a training license sufficient, or do I need a full state license?”
• “Are there any exam or paperwork deadlines that have historically caused problems for IMGs?”

This helps you avoid surprises that could delay your clinical start.

3. Onboarding, Orientation, and Support Services

Settling into a new country and healthcare system is challenging.

Ask:

• “Is there an orientation for international graduates or new foreign national residents?”
• “Does the institution provide support services for things like social security numbers, banking, housing, or driving license applications?”
• “Are there any institutional resources specifically for international medical graduates?”

This may not make or break a program, but it can significantly affect your stress level.

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Smart Ways to Phrase Your Questions (Without Sounding Demanding)

You want to ask strong, honest questions, but also remain professional and collaborative. Here are ways to frame questions to ask residency programs that sound mature and thoughtful.

1. Show Self-Awareness and Goals

Instead of:

• “Can you guarantee I’ll get a categorical spot?” (No program can)

Try:

• “My long-term goal is a categorical general surgery position in the US. As a non-US citizen IMG, what have you seen work best for prior prelims at this program who had similar goals?”

This communicates ambition and realism.

2. Use Data-Oriented Follow-Ups

When PDs give broad positive statements, gently request specifics:

• “That’s encouraging to hear. Could you share approximate numbers or outcomes for your last few prelim classes so I can better understand what to expect?”

You remain polite but still obtain concrete information.

3. Link Questions to Patient Care and Team Contribution

Programs want residents who care about patients, not just their own careers.

For example:

• “I want to be an effective intern and also grow my surgical skills. How does your program balance service needs with educational time for prelims?”

This shows that you are thinking about the entire system, not just yourself.

4. Time and Place: When to Ask What

• Ask detailed visa/logistics questions to the coordinator or via follow-up email, not necessarily in a group PD session.
• Save deeper outcome and culture questions for smaller resident-only breakout rooms or one-on-one PD meetings.
• Before asking “hard” questions, briefly affirm your interest:
  “I’m very interested in your program and I appreciate your time. I’d like to ask a few specific questions to understand how a prelim year here would position me for the future.”

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Putting It Together: Example Question Lists You Can Use

Here are sample, ready-to-use lists you can adapt for different people on interview day.

For the Program Director / Associate PD

• “As a non-US citizen IMG, what types of visas do you typically sponsor for prelim surgery residents, and have there been any recent institutional changes regarding visas?”
• “Over the last 3–5 years, what have been the usual outcomes for your prelim PGY‑1s in terms of categorical surgery positions, other specialties, or non-clinical paths?”
• “When categorical positions open, is there a structured process for considering prelims, and have any non-US citizen or IMG prelims successfully converted here recently?”
• “On average, how many major cases do your prelim PGY‑1s log by the end of the year, and how do you ensure they have meaningful operative exposure?”
• “How does the program support prelims who are reapplying—particularly with mentorship, letters of recommendation, and ABSITE preparation?”

For Current Prelim and Categorical Residents

• “Can you describe a typical week for a prelim intern in terms of hours, call, and responsibilities?”
• “Do prelims feel like integral members of the team, or more like extra coverage? Can you give examples?”
• “How fair is the distribution of OR time between prelims and categoricals in your experience?”
• “Have many of your former prelim colleagues been able to secure categorical spots? What seemed to make the difference for those who succeeded?”
• “As an IMG or having worked with IMGs, how inclusive and supportive have you found the program culture?”

For Program Coordinators / GME

• “What is the timeline for starting the visa process after Match Day, and what documents will you need from me?”
• “Have there been any recent delays or problems with visas for incoming residents, and how were those resolved?”
• “Do you offer any orientation or resources specifically for international graduates adjusting to the US system?”

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Final Checklist: How to Use Your Questions Strategically

When preparing interview questions for them, focus on:

1. Before Interviews

   • List 10–15 key questions total.
   • Categorize them by audience: PD, residents, coordinator.
   • Rank top 5 must-ask questions for each program you care most about.

2. During Interviews

   • Ask 2–4 thoughtful questions in each session (virtual or in-person).
   • Take quick notes on answers immediately after.
   • Pay attention to not just the content, but how honestly and comfortably people respond.

3. After Interviews

   • Compare answers between programs:
     – Visa support clarity
     – Prelim-to-categorical conversion history
     – Operative experience specifics
     – Resident culture and burnout
   • Use this to build a realistic rank list that balances opportunity with well-being.

For a non-US citizen IMG in preliminary surgery, the right questions can reveal which programs will truly invest in your future—and which will simply use you to fill service gaps. Approach every interaction with curiosity, professionalism, and a clear sense of your long-term goals.

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FAQ: Questions to Ask Programs for Non‑US Citizen IMG in Preliminary Surgery

1. Is it appropriate to ask directly about visa sponsorship during my interview?
Yes. As a foreign national medical graduate, visa sponsorship is fundamental. It’s best to ask fact-based questions calmly and professionally, ideally to the program coordinator or PD: “What visa types do you sponsor for prelim surgery residents?” Programs expect these questions and it does not hurt your candidacy when asked respectfully.

2. How many questions should I ask during each interview session?
Aim for 2–4 well-chosen questions per major interaction (PD session, resident room, etc.). Quality matters more than quantity. Avoid rapid-fire questioning; pick the ones that will most help you compare programs and understand your fit as a non-US citizen IMG in a prelim surgery role.

3. What if the program gives vague answers about prelim outcomes or case numbers?
That can be a warning sign. Gently follow up: “Could you share approximate numbers or examples from recent years?” If answers remain vague or evasive, assume outcomes may not be strong or well-tracked. Use that information when building your rank list.

4. Should I tell programs that I hope to become a categorical resident?
Yes, but be realistic and professional. You might say: “My long-term goal is a categorical general surgery position. I understand prelim spots don’t guarantee that, but I’d like to know how prelims here have been supported in pursuing categorical positions.” This demonstrates ambition, honesty, and awareness of the system without sounding entitled.