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

Why Your Questions Matter as a Non-US Citizen IMG in a Preliminary Medicine Year

As a non-US citizen IMG entering a preliminary medicine year (prelim IM), the questions you ask programs can be just as important as how you answer theirs. A prelim year is one intense year with long-term implications: it can affect your visa status, your ability to secure a categorical position later, and how competitive you appear for your advanced specialty.

You’re not just trying to “look good” in the interview; you’re gathering information for high-stakes decisions:

• Will this program truly support a foreign national medical graduate on a visa?
• How will this prelim IM year impact your future applications (e.g., neurology, anesthesiology, radiology, PM&R)?
• Will you get the clinical exposure, letters, and mentorship you need in only 12 months?

The most effective approach is to prepare structured, targeted questions for different people: program directors, chief residents, current interns, coordinators, and possibly faculty in your intended advanced specialty. This article breaks down what to ask, whom to ask, and why it matters, tailored for the non-US citizen IMG in preliminary medicine.

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Core Strategy: How to Plan Your Questions

Before getting into specific examples, it helps to structure your approach:

1. Clarify your priorities as a non-US citizen IMG

   • Visa sponsorship and stability
   • Educational quality and supervision
   • Opportunities to strengthen your CV for your advanced specialty
   • Well-being and support in a new country/system
   • Track record with IMGs and prelim residents

2. Identify the right person for each type of question

   • Program Director (PD): curriculum, evaluation, visa policy, program philosophy, institutional support.
   • Associate/Assistant PD or Core Faculty: teaching quality, feedback, research, mentoring.
   • Chief Residents & Current Interns (especially prelims): real working conditions, culture, schedules.
   • Program Coordinator: administrative and visa details, logistics, onboarding.
   • Faculty from your target specialty (if available): how they view prelim residents and collaboration.

3. Prepare 3–5 high-impact questions per group You won’t have time to ask everything. Rank questions based on:

   • Impact on your visa and future career
   • Clarity on day-to-day experience
   • Whether you can find the answer online vs. only from insiders

4. Use questions to show insight The best interview questions for them also demonstrate that:

   • You understand what a prelim year is.
   • You are thinking ahead about your advanced specialty.
   • You know the challenges of being a non-US citizen IMG and are proactive about solving them.

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Key Questions to Ask the Program Director

When you’re thinking about what to ask program director, focus on strategy, structure, and support. These conversations can be brief, so choose questions that reveal a lot of information at once.

1. Questions About Program Fit and Philosophy

Example questions:

• “How do you see the role of preliminary medicine residents within your program? What distinguishes a successful prelim resident here?”
• “What are the main differences between the experience of a categorical and a preliminary medicine intern in your program?”
• “For a non-US citizen IMG planning to apply for [your target specialty, e.g., neurology], how does your program help us maximize this one year?”

Why this matters:
You want to know whether prelim residents are truly integrated – or treated as temporary, lower-priority interns. The answer will show whether they invest in your teaching and development, or simply in having warm bodies to fill service needs.

2. Questions About Educational Structure and Supervision

Example questions:

• “Could you describe the supervision model for interns on general medicine and ICU rotations? How accessible are senior residents and attendings in complex cases?”
• “How are teaching conferences and academic half-days structured, and are prelim residents fully included?”
• “What systems do you have in place to make sure prelim residents receive regular feedback and know where they stand during the year?”

What to listen for:

• Protected didactic time that includes prelims, not just categoricals.
• Clear evaluation processes; mid-year reviews; remediation support.
• Attendings and seniors that are present and approachable, not just “on paper.”

3. Questions About Visa Sponsorship and Institutional Policy

As a foreign national medical graduate, this is non-negotiable.

Example questions:

• “For non-US citizen IMG residents, which visas does the program sponsor (e.g., J-1, H-1B), and has there been any recent change in that policy?”
• “Have any residents had visa-related problems in the last few years (delays, denials), and how did the institution support them?”
• “For residents on J-1 visas, how do you help them navigate the timing of visa extensions or transitions to advanced positions?”

Red flags:

• Vague, evasive answers like “We’ll figure it out” without clear examples.
• No recent experience sponsoring visas, or a statement that “administration is reviewing this” with uncertainty.
• History of residents losing positions for visa issues with minimal institutional response.

You can ask the PD higher-level questions and then confirm practical details with the program coordinator.

4. Questions About Outcomes for Prelim Residents

You must understand a prelim program’s track record.

Example questions:

• “Over the last few years, what have your preliminary medicine residents gone on to do after this year—both in terms of specialties and institutions?”
• “Do you track how many prelims successfully match into categorical or advanced positions, especially among non-US citizen IMGs?”
• “Are there opportunities for a prelim resident to transition into a categorical internal medicine position here, if one becomes available?”

Why this matters:
For non-US citizen IMGs, a prelim IM year is often a bridge to another match cycle. Knowing that past prelims (especially IMGs) successfully matched into specialties like neurology, anesthesia, radiology, or categorical IM is strong evidence that the program supports career progression.

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Questions to Ask Residents and Fellows: The Unfiltered Reality

Residents will show you what the website can’t. When you think about questions to ask residency team members, focus on culture, workload, and support—especially as they relate to being an IMG and visa holder.

1. Day-to-Day Workload and Schedules

Example questions for current interns or seniors:

• “On a typical ward month, what does your day look like from start to finish?”
• “How often do duty hours come close to or exceed the 80-hour limit, and how does the program respond when that happens?”
• “What is the call structure for prelims? Is it different from the categorical interns?”

Key points to clarify:

• Frequency of night float and 24-hour calls.
• How admissions and cross-cover are distributed.
• Whether prelims get disproportionately heavier service compared to categoricals.

2. Support for Non-US Citizen IMGs and Cultural Integration

Example questions:

• “How many current residents are non-US citizen IMGs, and how well integrated do they feel in the program?”
• “As an IMG new to the US system, how supported did you feel in your first few months—clinically, culturally, and socially?”
• “Have you seen any challenges or bias toward IMGs, and how did the program handle it?”

What their answers reveal:

• Whether the program has experience with non-US citizen IMGs.
• If there are informal support systems: WhatsApp groups, IMG mentorship, social activities.
• Whether IMGs are represented in chief roles or leadership (a positive sign).

3. Education, Feedback, and Board Preparation

Example questions:

• “Do you feel you receive enough bedside teaching and feedback on your clinical decisions?”
• “How often do you have protected educational time, and is it truly respected or often canceled due to workload?”
• “For prelims applying to advanced specialties, do attendings know your goals and help you tailor your experiences?”

This helps you assess whether you’ll grow clinically and be ready to impress advanced program directors or fellowship directors.

4. Career Planning and Letters of Recommendation

You only have one year. You need meaningful letters quickly.

Example questions:

• “How easy is it to get to know attendings well enough for strong letters of recommendation in just one year?”
• “Do residents usually find mentors who help them with ERAS applications, personal statements, and interview prep?”
• “For prelims who matched into advanced specialties, what helped them the most here?”

Look for:

• Faculty known to write detailed, supportive letters.
• A culture where residents are expected—and encouraged—to ask early for letters.
• Examples of prelims getting multiple strong letters within 6–8 months.

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Questions About Your Future Specialty and Advanced Positions

For many IMG applicants, the prelim medicine year is a stepping stone to an advanced specialty like neurology, anesthesiology, radiology, PM&R, or dermatology. Your interview questions for them should show that you are thinking about how to use this year strategically.

1. Questions About Relationships With Advanced Programs

If the same institution has advanced programs:

• “How closely does the prelim medicine program work with the [neurology/anesthesiology/etc.] department?”
• “Do prelim residents have opportunities to rotate on their future specialty here?”
• “Have prelim residents from your program matched into the advanced programs at this institution?”

If advanced programs are at other institutions:

• “Do you have strong connections or a history of sending prelim residents to certain advanced programs elsewhere?”
• “How do you help prelim residents communicate with potential advanced programs—through faculty calls, emails, or shared networks?”

This helps you judge how much institutional capital is available to open doors for you.

2. Questions About Research and Scholarly Opportunities

Even in a single year, you can sometimes complete small projects, case reports, or QI work.

Example questions:

• “What types of research or quality improvement projects have prelim residents successfully been involved in, given the time constraints of a one-year program?”
• “Are there faculty members who are particularly open to involving prelim residents in ongoing projects?”
• “How realistic is it to complete at least one presentable or publishable project during the prelim year?”

Clarify whether they’re being honest about workload. Some high-service programs make research almost impossible; others actively protect time for it.

3. Questions About Timing and Logistics of the Next Application Cycle

As a non-US citizen IMG, timing is especially crucial because of visa and match timelines.

Example questions:

• “When do prelim residents typically start preparing for their next round of applications, and what structured support does the program offer for that process?”
• “Do faculty review personal statements and CVs for residents applying to advanced or categorical positions?”
• “How early in the year do you recommend we request letters of recommendation?”

You want a program that understands that prelim residents are in a compressed timeline and actively plans for it.

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Practical Questions for the Program Coordinator and Admin Team

The program coordinator can be a powerful ally for a non-US citizen IMG. Ask them targeted, practical questions before or after the interview day.

1. Visa and Licensing Logistics

Example questions:

• “Could you walk me through the typical visa timeline for incoming non-US citizen residents—when you start paperwork and when approvals usually come through?”
• “Have there been any recent delays in ECFMG certification or state licensing that affected residents starting on time?”
• “Which state license or training permit will I be working under, and what documents do you require from IMGs?”

You’re trying to avoid unpleasant surprises—like starting late because of paperwork.

2. Onboarding, Housing, and Local Support

Example questions:

• “Do you provide any specific assistance for international residents, such as guidance on banking, phone plans, or housing in the area?”
• “Are there other residents who have recently moved from abroad that I might connect with about the transition?”
• “Is there an orientation period before clinical work starts, and does it include training on the US healthcare system and EMR?”

This shows you’re planning your relocation—and allows you to compare how supportive different programs are.

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How to Ask Smart Follow-Up Questions in Real Time

Even with a prepared list, the most revealing questions often come from following up on what you’ve just heard.

Techniques for Effective Follow-Up

1. Ask for specific examples.

   • “You mentioned that the program is very supportive of prelims—could you share a specific example of how that support looked for a recent resident?”

2. Clarify ambiguous statements.

   • If someone says “We work hard, but it’s manageable,” ask:
     “On average, how many hours do you work on a typical ward day, and how many weekend days off do you get per month?”

3. Compare policy to practice.

   • “You mentioned that didactics are protected—how often are residents actually able to attend all of them during a busy month?”

4. Relate answers back to your situation as a non-US citizen IMG.

   • “As someone who will be new to the US system and on a visa, how would you recommend I prepare before July 1 to transition smoothly here?”

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Example Question Sets You Can Adapt

Below are consolidated question sets you can print or save, then tailor to each program.

For the Program Director

• “How do you define success for a preliminary medicine resident in your program, and how do you help them achieve it within just one year?”
• “What has been your experience with non-US citizen IMG residents, and what support systems are in place for them?”
• “Which visas do you sponsor, and how stable has that policy been over the past few years?”
• “What have your recent prelim graduates gone on to do, particularly those seeking advanced positions or categorical IM spots?”
• “Are there opportunities for a prelim resident to transition into a categorical position here if circumstances allow?”

For Current Residents (Especially Prelims and IMGs)

• “Can you describe a typical week on wards or ICU—hours, admissions, cross-cover?”
• “How approachable are attendings and senior residents when you feel uncertain about a case?”
• “As an IMG, what have been your biggest challenges here, and how has the program helped you with them?”
• “Do prelim residents feel fully part of the team, or more like temporary visitors?”
• “How easy has it been for prelim residents to get strong letters and prepare for their next applications?”

For Program Coordinators

• “What does the visa process usually look like for incoming non-US citizen residents, and when would you start working on it?”
• “Have there been any residents who had difficulty starting on time because of licensing or paperwork, and how was that handled?”
• “Are there resources or contacts you provide to help international residents adjust to living in this city?”

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Final Tips: Prioritizing and Using the Answers You Get

1. Create a comparison sheet.
   After each interview, write down:

   • Visa policy details
   • Culture impressions (support for IMGs, prelim respect)
   • Workload reality
   • Outcomes for previous prelims
   • Support for research/letters/advanced matching

2. Pay attention to consistency.
   If the PD says one thing and the residents say another, believe the people working the shifts. Consistency across multiple voices is a good sign.

3. Notice how they respond to tough questions.
   Programs used to working with non-US citizen IMGs will answer visa and support questions calmly and specifically. Evasive or defensive answers are warning signs.

4. Use your questions to show you’re intentional.
   Framing your questions around using this preliminary medicine year to grow, contribute, and prepare for your advanced specialty can leave a strong positive impression.

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FAQ: Common Questions from Non-US Citizen IMGs About Prelim Medicine Interviews

1. Is it okay to ask directly about visas in the interview?

Yes. For a non-US citizen IMG, visa sponsorship is essential. Phrase it professionally, especially with the PD or coordinator:

• “As a non-US citizen IMG, understanding visa sponsorship is very important to me. Could you share which visas you currently sponsor and how often you’ve worked with residents on that visa type?”

Programs expect this question. You are evaluating them as much as they are evaluating you.

2. How many questions should I ask during each interview?

Aim for 2–3 focused questions per conversation slot (PD, residents, coordinator). It’s better to ask a few strong, specific questions than many generic ones. If time is short, prioritize:

1. Visa and support for IMGs
2. Outcomes for prelims
3. Workload and culture

3. Should I mention my intended advanced specialty when asking questions?

Yes, if you are reasonably sure of your direction. It helps programs see your trajectory and frame their answers. For example:

• “I’m very interested in pursuing anesthesiology after this prelim year. How have you supported previous residents with similar goals?”

This also signals that you have a clear plan for using your prelim IM year.

4. What if residents give very negative answers about workload or support?

Take their feedback seriously, especially if multiple residents express the same concerns. Ask follow-up questions to clarify:

• “Has the program made any changes in response to these concerns?”
• “Despite the challenges, what has kept you here or what do you see as the main strengths of the program?”

Then, compare that information with other programs. Your well-being, visa security, and career trajectory all depend on choosing a prelim medicine program that is not just reputable on paper, but truly functional and supportive in reality.