Top Questions for US Citizen IMGs: Your Anesthesiology Residency Guide

Why Your Questions Matter as a US Citizen IMG in Anesthesiology

As a US citizen IMG (American studying abroad), your residency interviews in anesthesiology are not just about answering questions—they’re a critical chance for you to ask smart, targeted questions that show insight, maturity, and a genuine understanding of the specialty.

For anesthesiology in particular, the anesthesia match is competitive, and programs often have limited experience with American students who trained overseas. The questions you ask programs can:

• Signal that you understand anesthesiology as a career (not just OR time and procedures)
• Address concerns programs may have about your training background
• Help you identify programs that truly support US citizen IMGs
• Give you concrete data to make a realistic rank list

This guide focuses on questions to ask residency programs—faculty, residents, and especially what to ask the program director—tailored specifically to the US citizen IMG applying to anesthesiology residency.

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Strategy First: How to Approach Asking Questions

Before jumping into lists of questions, you need a strategy.

1. Know Your US Citizen IMG “Angle”

Programs will assume:

• You may have less exposure to US health systems
• You might have gaps in clinical training or differences in documentation, EMR, or team structure
• You may be highly motivated but need more onboarding support

Your questions should quietly reassure them that you’ve thought through these issues and are ready to integrate quickly.

Example positioning questions:

• “As a US citizen IMG, what have you found helps incoming residents from non-US schools transition smoothly into your system?”
• “How does your orientation prepare residents who trained abroad for the expectations of your hospital and OR workflows?”

These show self-awareness and readiness, without sounding defensive or insecure.

2. Match Questions to WHO You’re Talking To

You’ll usually speak with:

• Program Director (PD) – big-picture, policies, selection philosophy, resources
• Associate/Assistant PDs – curriculum, assessments, remediation, mentorship
• Residents – culture, workload, ‘real life’ experience
• Chair/Department leadership – research, departmental vision, fellowships
• Coordinators – logistics, visas for non-citizens, onboarding, scheduling details

Have different interview questions for them, not the same generic list for everyone.

3. Use Questions to Show You Understand Anesthesiology

Good anesthesiology questions reflect:

• Perioperative medicine
• Critical care exposure
• Airway management and crisis response
• Patient safety, quality improvement, and teamwork
• Fellowship and career planning

Poor questions sound like you just want procedures or light call.

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Core Categories of Questions Every US Citizen IMG Should Cover

To make your list of questions purposeful (not random), group them into a few core themes:

1. How they view and support IMGs and US citizen IMGs
2. Clinical training and case mix in anesthesiology
3. Education, evaluation, and remediation
4. Resident wellness, culture, and support
5. Career outcomes, fellowships, and board pass rates
6. Program logistics and structure

Under each theme, you’ll find example questions to ask residency programs, with special notes for the US citizen IMG and for anesthesiology.

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Theme 1: Questions About How the Program Views IMGs and US Citizen IMGs

As an American studying abroad, you’re not asking whether IMGs are “allowed”—you’re trying to understand whether they’re truly integrated and supported.

Questions for the Program Director

These are prime “what to ask program director” items because they reveal philosophy and track record.

Targeted questions:

• “How many current residents are IMGs or US citizen IMGs, and how have they integrated into the program?”
• “What qualities have you seen in successful residents from international schools, and what challenges have they faced initially?”
• “Have you noticed any patterns in how US citizen IMGs perform in your program compared with US MD/DO grads?”

Why this helps:
You get a clear sense of whether they’re used to working with applicants like you and whether they view you as an asset or as a risk to be managed.

Questions for Residents

Residents will be more candid about culture and subtle biases.

Examples:

• “Do you feel that residents from international medical schools are treated any differently, positively or negatively?”
• “Are there any extra supports available for residents who might need more orientation to the US system, like documentation or EMR workflows?”
• “Have you seen IMG colleagues take on leadership roles—chief resident, committees, QI projects?”

Look for concrete examples, not vague reassurance.

Questions for the Coordinator (if appropriate)

• “Are there any additional onboarding steps or supports you use for residents coming from non-US schools?”
• “From your perspective, what helps US citizen IMGs settle in smoothly here?”

Red flags:

• They “can’t remember” if they’ve ever had an IMG.
• They say, “We’re open to IMGs,” but there are none in the current or recent classes.
• Residents hedge or look uncomfortable when talking about IMGs.

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Theme 2: Clinical Training and Case Mix in Anesthesiology

As an anesthesia applicant, you need to understand whether you’ll get enough case volume, case complexity, and graduated responsibility to become an independent anesthesiologist.

Questions About Clinical Exposure

For PD or APD:

• “How would you describe the balance between routine cases and high-acuity cases (cardiac, thoracic, vascular, neuro, OB) in your program?”
• “Do you track individual case numbers or exposure to key procedures, and how do you ensure all residents meet ACGME minimums with comfort, not just bare numbers?”
• “What is the typical experience with complex airways and emergencies by the end of CA-1 and CA-2 years?”

For Residents:

• “By the end of CA-1 year, roughly how many intubations, arterial lines, and central lines had you done independently?”
• “Are there cases that are mostly done by fellows, and if so, how do residents still gain sufficient exposure?”
• “If you seek more experience in a particular area (e.g., regional anesthesia, OB, cardiac), how flexible is the program in arranging additional rotations?”

Questions Specific to US Citizen IMGs

If your international medical school had limited anesthesia exposure, your transition might be steeper.

Consider:

• “Are there any structured ‘on-ramp’ experiences or early CA-1 bootcamps, simulation, or shadowing to help residents who may not have had extensive anesthesia time in medical school?”
• “How is supervision structured early on, particularly for residents who might have less OR or perioperative experience?”

Programs that are thoughtful about onboarding can make a huge difference for IMGs.

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Theme 3: Education, Evaluation, and Support When You Struggle

Residency is demanding for everyone, but as a US citizen IMG, you may feel extra pressure to “prove” yourself. It’s crucial to understand how programs teach, evaluate, and remediate.

Questions About Teaching and Curriculum

For PD/APD:

• “What does your formal didactic curriculum look like for anesthesiology residents—frequency, format, and protected time?”
• “How do you incorporate simulation into training—particularly for crisis resource management, airway emergencies, and rare events?”
• “How do you prepare residents for the BASIC and ADVANCED exams?”

For Residents:

• “Do you actually get protected time for lectures, or are you frequently pulled away for clinical duties?”
• “What teaching methods or resources have been most helpful for passing the ABA exams here?”

Questions About Evaluation and Feedback

For PD/APD:

• “How are residents evaluated—who provides feedback, and how often is it formally reviewed with each resident?”
• “If a resident is struggling—clinically, academically, or with communication—what does your support and remediation process look like?”
• “Can you share an example (without names) of a resident who struggled initially and how the program helped them succeed?”

IMG-oriented angle:

• “Have you noticed any recurring differences in how IMGs adjust to documentation, communication style, or team dynamics, and how do you address those early?”

You’re signaling insight and readiness to work on areas that often trip up IMGs (e.g., documentation speed, note style, “speaking up” in a US environment).

Questions for Residents About Support

• “When someone is having a tough rotation or personal challenge, how does the program typically respond?”
• “Have you seen anyone placed on a remediation plan? How did the program handle it—was it supportive or punitive?”
• “Do you feel safe asking for help if you’re unsure about a case or skill?”

Programs that answer these clearly and calmly are usually confident and supportive.

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Theme 4: Resident Culture, Wellness, and Day-to-Day Life

You’re not just matching to a program—you’re matching to three or four years of your life. Anesthesia is physically and mentally demanding; the culture matters.

Questions About Workload and Call

For Residents:

• “What does a typical day look like during CA-1 year? Start time, end time, pre-op work, sign-out?”
• “How is call structured—frequency of overnight call, weekend call, and how post-call days are handled?”
• “Are there rotations that feel consistently overwhelming, and how does the program respond to concerns about workload?”

For PD/APD:

• “How have you adjusted scheduling or call structures to support resident well-being in recent years?”
• “Do you regularly track duty hours and wellness metrics, and has that led to concrete program changes?”

Look for specifics, not just “We care about wellness.”

Questions About Culture and Camaraderie

For Residents (best asked in social or resident-only sessions):

• “How would you describe the resident-resident culture—collaborative, competitive, or somewhere in between?”
• “How approachable are attendings in the OR and ICU? Can you ask ‘basic’ questions without feeling judged?”
• “Do residents spend time together outside the hospital, and is that something you enjoy or feel obligated to?”

As a US citizen IMG, also consider whether you’ll feel culturally comfortable:

• “Have you felt the program is welcoming to people from different backgrounds, including those who trained abroad?”
• “Have you seen any issues around microaggressions or bias, and how did leadership respond?”

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Theme 5: Career Outcomes, Fellowships, and the Future

You’re investing years of your life; you need to know what doors will be open afterward.

Questions About Fellowship and Career Paths

For PD/Chair:

• “What percentage of your graduating residents over the last 3–5 years have pursued fellowships, and in which areas (cardiac, critical care, pain, pediatric, regional, etc.)?”
• “Do your residents typically match into competitive fellowships, and are those mostly internal or external placements?”
• “How do you support residents who want academic careers versus those who are more interested in community practice?”

For Residents:

• “What are recent graduates doing now—fellowships or jobs, and in what types of practice settings?”
• “How supported do you feel in exploring career options—mentorship, networking, and letters of recommendation?”

Questions About Research and Professional Development

If you’re interested in academics—or want to strengthen your profile as a US citizen IMG—research and scholarly work can be important.

• “What kinds of research or quality improvement opportunities are available to residents in anesthesiology?”
• “Are there structured supports—research mentors, statisticians, protected time—for residents who want to take on projects?”
• “How many residents present at national meetings each year (ASA, subspecialty societies)?”

Programs with strong support here can elevate your long-term career options.

Questions About Board Performance

• “What has your ABA Basic and Advanced board pass rate been over the past several years?”
• “If someone doesn’t pass on the first attempt, what support do you provide them?”

This is a reasonable and important question—even if it feels awkward. Programs should be able to answer confidently.

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Theme 6: Program Structure and Logistics That Matter (Especially for US Citizen IMGs)

Logistical questions often get overlooked, but they can significantly impact your experience—especially if you’re coming from abroad and relocating to a new city or state.

Questions About Program Structure

• “Is this a categorical program or advanced only? If advanced, how do residents typically arrange their prelim or TY year?”
• “How much time is spent outside the main hospital—community sites, ambulatory centers, VA—and how does that affect commute time and call responsibilities?”
• “How is the rotation schedule structured across CA-1 to CA-3 years? Is there early exposure to specialty areas, or mostly general cases initially?”

Questions About Transition for US Citizen IMGs

You might have unique needs related to:

• US licensure processes
• Living in the US after time abroad
• Documentation and credentialing

Consider asking:

• “What does your onboarding look like for residents returning to the US system from international schools? Do you provide guidance on state licensure, documentation, and hospital credentialing?”
• “Are there any additional exams or requirements specific to this state that I should prepare for as a US citizen IMG?”
• “Do you connect incoming residents with current residents before they start—for housing advice, relocation tips, and local logistics?”

Questions About Location and Life Outside the Hospital

Residents are often honest and practical here:

• “What’s the typical cost of living, and does the salary feel adequate for the area?”
• “Where do most residents live, and what is the average commute like?”
• “What do you like most about living in this city/region? What’s been challenging?”

As an American studying abroad, you may be moving back to the US but not necessarily to your home state or city. The environment and support system will affect your resilience.

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Turning Questions Into a Tool for the Anesthesia Match

Your questions shouldn’t be a checklist you rush through. Instead, use them strategically in the anesthesia match process:

1. Before Interview Season

   • Research each program’s website and any anesthesiology-specific info.
   • Draft 10–15 core questions, then customize 3–5 per program.
   • Mark which questions are for PDs, which for residents, and which for coordinators.

2. During Interviews

   • Ask open-ended questions, then listen carefully.
   • Notice how comfortable people are discussing IMGs, remediation, and workload.
   • Pay attention to whether different people give consistent answers.

3. After Each Interview

   • Within 24 hours, write down:
     • Specific data points (case numbers, call schedule, fellowship matches)
     • Subjective impressions (resident happiness, PD transparency)
   • Note how they responded when you disclosed being a US citizen IMG (if discussed).

4. When Making Your Rank List

   • Revisit:
     • How did they talk about IMGs and US citizen IMGs?
     • Did they have concrete systems to support newcomers to the US system?
     • Do you see a path to the kind of anesthesiology career you want?

The questions you ask aren’t just about looking good—they’re about protecting your future.

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Sample “Short List” of High-Yield Questions to Use on Interview Day

Here is a condensed, high-yield set you can adapt, especially focused on questions to ask residency programs and what to ask program director:

For the Program Director

1. “How have US citizen IMGs and other international graduates historically done in your program—in terms of clinical performance, board pass rates, and fellowship or job placement?”
2. “What do you see as the defining strengths of your anesthesiology residency, and what improvements are you actively working on?”
3. “How do you ensure residents gain sufficient exposure to high-acuity and subspecialty cases while still feeling supported and not overwhelmed?”
4. “When a resident is struggling—whether with clinical skills, exams, or personal challenges—what does your support and remediation process look like in practice?”

For Residents

1. “What aspects of the program’s culture make it a great place to train—and what are the most challenging parts of training here?”
2. “Do you feel the program is responsive when residents give feedback about workload, scheduling, or teaching?”
3. “Have you seen residents from international schools thrive here, and what helped them succeed?”
4. “Looking back, would you choose this anesthesiology residency again, and why or why not?”

Use these as a backbone, then add more specific items based on each program.

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FAQs: Questions to Ask Programs for US Citizen IMG in Anesthesiology

1. As a US citizen IMG, should I directly mention my IMG status when asking questions?
You don’t need to open every question by labeling yourself an IMG, but it’s reasonable—and often helpful—to frame a few questions from that perspective. For example: “As a US citizen IMG returning from an international medical school, I’m curious how you’ve supported residents who are new to the US system initially.” This shows insight and allows them to address your situation specifically.

2. Are there any questions I should avoid asking during anesthesiology residency interviews?
Avoid:

• Questions that you could easily answer from the website (“How many residents are there?”).
• Questions that appear self-centered early on (“How much vacation do I get?” as your first question).
• Anything implying you don’t understand basic anesthesiology training (e.g., “Will I get to do any ICU?” at a program with a clearly listed ICU curriculum). You can and should ask about wellness, call schedules, and vacation—but after you’ve asked about education and training first.

3. How many questions should I ask each interviewer?
Typically, you’ll have 15–20 minutes per interviewer. Aim for 3–5 thoughtful questions per person, depending on how long their answers are. It’s better to ask fewer, deeper questions and engage in a real conversation than to rush through a long list.

4. How can my questions help me stand out positively in the anesthesia match?
Programs notice when your questions:

• Demonstrate a clear understanding of anesthesiology (perioperative care, crisis management, critical care, long-term career paths).
• Reflect insight into your background as a US citizen IMG and how you’ll integrate.
• Are tailored to their program (citing something you saw on their website or heard in the intro session). Residents and faculty often remember applicants who asked insightful, practical, and respectful questions—this can subtly influence how they advocate for you when ranking applicants.

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Used thoughtfully, the right questions will not only help you evaluate programs, but also help programs see you as a mature, prepared, and self-aware future anesthesiologist—exactly the kind of resident they want in their ORs and ICUs.