Top Questions to Ask Residency Programs in Preliminary Medicine

Preparing for residency interviews as a preliminary medicine applicant is different from applying to categorical internal medicine or other specialties. Your priority is to secure a solid, supportive preliminary medicine year (prelim IM) that aligns with your long-term career goals—whether that’s neurology, anesthesiology, radiology, dermatology, PM&R, or another advanced specialty.

One of the most powerful tools you have on interview day is your ability to ask thoughtful, targeted questions. The right questions help you:

• Understand what your day-to-day year will actually look like
• Identify programs that will support your learning rather than just your labor
• Clarify expectations around schedules, wellness, and culture
• Assess how prelims are treated relative to categorical residents
• Decide how to rank programs intelligently

This guide organizes questions to ask programs in preliminary medicine into major themes, with sample wording, explanations of what to listen for, and how to interpret different types of answers. It’s written specifically for prelim IM applicants but will be useful to anyone doing a one-year transitional or medicine-based internship.

---

Understanding the Role of Prelim Residents in the Program

Before you dive into granular details, you need a high-level view of how prelims fit into the program’s ecosystem.

Key Questions to Ask

1. “How are preliminary residents integrated into the program compared with categorical internal medicine residents?”
What you’re trying to learn:

• Do prelims share the same rotations, call structure, and educational curriculum as categoricals?
• Or are they primarily service providers on the busiest rotations?

Good signs:

• “You have the same teaching conferences, same inpatient teams, and similar responsibilities as categorical residents.”
• “We make no distinction in clinical responsibilities, supervision, or educational access.”

Red flags:

• “You’re mostly on the high-volume services where we need extra hands.”
• “Prelims don’t usually go to noon conference; it’s hard with their workload.”

---

2. “What are the main goals of the program for your preliminary medicine residents?”
Look for clarity and intentionality:

• Are they explicitly committed to preparing you for your future advanced specialty?
• Do they emphasize core IM skills, procedural exposure, or transitions to advanced training?

Stronger programs will say things like:

• “Our goal is for you to finish confident managing acutely ill patients and ready to hit the ground running in your advanced specialty.”
• “We coordinate with advanced departments (e.g., Neurology, Anesthesia) to ensure prelim training maps to your future work.”

Vague or generic answers (e.g., “They help us staff the wards”) suggest a service-heavy, education-light experience.

---

3. “How do you tailor the experience for prelims planning to enter different specialties?”
This is especially relevant if you’re going into:

• Neurology
• Anesthesiology
• Radiology
• PM&R
• Ophthalmology
• Dermatology, etc.

Examples of what to listen for:

• Electives commonly used by future anesthesiologists (e.g., ICU, pulmonary, pain)
• Additional neurology or stroke exposure for future neurologists
• Procedures and ICU time for interventional or critical-care–oriented fields

Programs that recognize these differences and build deliberate pathways show they value your long-term development, not just your one-year contribution.

---

Schedule, Workload, and Call: The Questions You Must Not Skip

Your preliminary medicine year can set the tone for your early career—for better or worse. Knowing the true workload is essential.

Questions About Rotations and Structure

4. “Can you walk me through a typical rotation schedule for a preliminary resident?”
Ask for detail:

• Months on inpatient wards
• ICU rotations (medical ICU, cardiac ICU, etc.)
• Night float or night call
• Emergency medicine, electives, consult services
• Any clinic requirements

Follow-ups:

• “Is this schedule typical for most prelim residents?”
• “How much variation is there from one prelim to another?”

Watch for:

• Balanced mix of inpatient, ICU, and some electives
• Reasonable exposure to outpatient medicine or consults (even if limited)

Be cautious when:

• The majority of the year is heavy inpatient wards with minimal electives.
• Prelims consistently have the heaviest rotations the program offers.

---

5. “How does the call schedule differ for prelims versus categorials, if at all?”
Important details include:

• Frequency of night float, 24-hour calls, or long shifts
• Weekend calls and post-call days off
• Whether prelims are disproportionately assigned nights or “scut-heavy” shifts

Listen for:

• “We distribute call equitably between prelim and categorical residents.”
• “Prelims have the same day-off structure and duty hour protections as everyone else.”

Red flags:

• “Prelims often fill in for gaps on nights since they’re only here for a year.”
• “We don’t really track call differences; it just depends on what the schedule needs.”

---

Questions About Electives and Flexibility

6. “How many elective weeks do prelims typically get, and how much control do we have over our elective choices?”
You’re looking for:

• Exact number of elective weeks or blocks
• How far in advance you choose electives
• Whether electives relevant to your future field are accessible to prelims

Positive signs:

• Prelims have at least some say in electives.
• Access to ICU, consult services, or specialty clinics linked to your ultimate specialty.

Be cautious if:

• Prelims have few or no elective weeks.
• “Electives are usually given to categoricals first; prelims get what’s left over.”

---

7. “How often do schedules change at the last minute, and how is that handled?”
Frequent schedule instability may signal:

• Poor program organization
• Chronic understaffing
• Higher burnout risk

Follow-ups:

• “Do prelims often get pulled from electives to cover inpatient services?”
• “How does the program protect scheduled time off or important dates (e.g., moving, licensing exams)?”

A strong program will have:

• Clear policies on schedule changes
• Efforts to protect your planned electives and time off

---

Education, Supervision, and Evaluation: Ensuring It’s Not Just a Service Year

A well-structured prelim IM year should still be an educational experience, even if it is intense.

Questions About Teaching and Learning

8. “What formal educational activities are prelims expected or encouraged to attend?”
Examples:

• Morning report
• Noon conference
• Grand rounds
• Journal clubs, resident lectures, board review sessions

Ask specifically:

• “Are prelims protected to attend noon conference?”
• “Does the workload realistically allow attendance?”

Good sign:

• “We protect your time for core educational sessions, and attendings support that expectation.”

Red flag:

• “Technically you can attend noon conference, but on most rotations the work makes it hard.”

---

9. “What is the typical level of supervision on inpatient and ICU services for prelim residents?”
You want details on:

• How often attendings round
• Senior resident presence on teams
• Back-up coverage at night
• Accessibility of help for acutely ill patients

Follow-ups:

• “As a new intern, how supported will I be when managing very sick patients or codes?”
• “Are there senior residents or fellows physically present overnight?”

Strong programs will emphasize:

• Close supervision, especially early in the year
• A culture where asking for help is encouraged

---

Questions About Feedback, Evaluation, and Remediation

10. “How are prelims assessed throughout the year, and how often do we receive formal feedback?”
Ask about:

• Frequency of written evaluations
• Scheduled one-on-one meetings with PD or APDs
• Mid-year check-ins or progress reviews

Listen for:

• Systems that catch issues early and provide supportive remediation, rather than punitive surprises late in the year.

---

11. “If a prelim is struggling—clinically, professionally, or personally—what kind of support or remediation process is in place?”
You’re assessing:

• Whether the program is invested in helping you succeed, not just replacing you.
• Availability of mentorship, coaching, or remediation plans
• Non-punitive approaches to early difficulty

Red flag:

• “We expect residents to figure it out; medicine is tough.”
• “If someone is struggling, they might not be renewed or could be removed from service.”

---

Culture, Wellness, and How Prelims Are Treated

One of the biggest differences between programs is how they view and treat prelim residents. This is where asking the right questions—and watching body language—matters most.

Questions to Ask Residents About Culture

12. “How would you describe the culture toward prelims here?”
Ask current prelims if possible:

• “Do you feel included by categorical residents?”
• “Are prelims invited to the same retreats, wellness activities, and social events?”
• “Are prelims ever treated as ‘just prelims’ or less important?”

Green flags:

• Prelims feel fully integrated, included in retreats, parties, leadership opportunities.
• Categorical residents refer to prelims fondly and by name, not just as numbers.

Red flags:

• Comments like, “You’re only here for a year, so…”
• Prelims clearly excluded from major events, committees, or leadership roles.

---

13. “What are the program’s efforts to support wellness and prevent burnout, especially for prelims on heavy rotations?”
Look for concrete examples, not buzzwords:

• Protected days off
• Wellness days, mental health resources
• Group debriefings after difficult events
• Easy access to counseling or employee assistance programs

Follow-ups:

• “Are these wellness initiatives actually used by interns, or do they exist only on paper?”
• “Is there a culture that supports taking time off for illness or mental health?”

---

Questions to Ask Program Leadership About Inclusivity

14. “What steps do you take to ensure that prelims feel valued during their year here?”
Program directors who value prelims may mention:

• Including prelims in recognition awards
• Ensuring prelims are invited to retreats, graduation ceremonies
• Soliciting prelim feedback in program improvement

---

15. “Can you share how you handle violations of professionalism or mistreatment, including when it involves prelims?”
You want to know:

• Is there a clear, confidential process to report issues?
• Do prelims have equal protection from harassment or mistreatment?
• How is retaliation prevented?

A reassuring answer:

• “We have anonymous reporting mechanisms, and we investigate all reports. We explicitly emphasize that prelims have the same protections as any categorical resident.”

---

Career Planning, Communication, and Logistics: Setting Yourself Up for a Smooth Transition

Because a prelim year is only 12 months, you must ensure the program will set you up well for your advanced specialty and for life logistics.

Questions About Future Specialty Preparation

16. “How do you support prelims as they transition to their advanced specialties?”
Ask for specific practices:

• Communication with your advanced program about your performance and strengths
• Timing of end-of-year evaluations
• Letters or summary evaluations you can carry forward

Follow-ups:

• “Do you have a track record of prelims successfully entering [your specialty] after this year?”
• “Do faculty or PDs provide letters of recommendation if needed for fellowship or another application year?”

---

17. “Do prelims ever stay on here as categorical if they need another position or change plans?”
Even if you have an advanced spot, it’s useful to know:

• Whether the program values you enough to consider internal transfers if open positions arise
• If prior prelims have transitioned successfully into categorical IM or other programs at the institution

This can matter if:

• Your advanced spot falls through
• You discover you’d rather stay in IM
• You need a backup plan

---

Questions About Communication and Transparency

18. “How is important information communicated to residents—especially prelims—throughout the year?”
Examples:

• Weekly or monthly newsletters
• Regular town halls or check-ins
• Direct emails from the PD or chiefs

You’re checking whether:

• Prelims are kept in the loop (not forgotten when major changes occur)
• Program leadership is accessible and communicative

---

19. “What should a successful prelim year look like here, from your perspective?”
This is a powerful question for the program director. It reveals:

• Their expectations of work ethic and professionalism
• What they most value in residents (e.g., reliability, teamwork, curiosity, efficiency)
• Whether they see prelims as part of the program’s success story

Their answer can help you decide if your style and values match the program’s culture.

---

Practical and Logistical Questions

20. “Are there any unique logistical challenges for prelims (e.g., contract timing, benefits, credentialing) compared with categorical residents?”
Key elements:

• Does your contract length align cleanly with your advanced position start date?
• Are health insurance and benefits continuous through the end of your year?
• Do you receive moving support or housing assistance?

---

21. “How does the program help prelims navigate licensing exams, Step 3, and state licensing if needed?”
You want to know:

• Is there time or flexibility to take Step 3?
• Do they provide guidance on licensing required to start an advanced position?
• Any in-house prep or protected days?

---

How to Use These Questions Strategically on Interview Day

Asking questions isn’t just about collecting data—it’s about making a positive impression and building relationships.

Prioritize and Personalize Your Questions

You won’t have time to ask every question listed above at each program. Prioritize:

• What worries you most about your prelim IM year (e.g., workload, mistreatment)?
• What’s most important to your future specialty (e.g., ICU time for anesthesiology, neurology exposure for neurology)?
• Gaps in information from the website or pre-interview materials.

Consider grouping your questions into categories:

• For residents: culture, workload, actual schedule reality, how prelims are treated
• For program leadership: vision for prelims, education, support systems
• For chiefs or coordinators: logistics, scheduling, clinic/electives details

---

Examples of Polished, High-Yield Questions

Here are some refined versions you can use almost verbatim:

• To the program director:

  • “What would you say differentiates your preliminary medicine year from other programs—especially for residents heading into [your specialty]?”
  • “From your perspective, what characteristics do your most successful prelims share?”

• To current prelims:

  • “If you were deciding again, would you choose this prelim IM program, and why or why not?”
  • “Can you describe a time when you felt the program leadership advocated for prelim residents?”

• To senior residents or chiefs:

  • “How has the role of prelims evolved over the past few years here?”
  • “Are there any unspoken expectations for prelims that you wish you had known before starting?”

---

Reading Between the Lines

The answers themselves matter, but so do the tone, consistency, and body language:

• Do different people give consistent answers to the same question?
• Do residents hesitate, look at each other, or seem uncomfortable when you ask about workload or culture?
• Is there a noticeable difference between how leadership and residents describe the program?

Inconsistencies don’t automatically mean a bad program, but they warrant probing:

• “I’ve heard different impressions about [X]. Can you help me understand that better?”

---

Frequently Asked Questions (FAQ)

1. How many questions should I ask during a prelim IM interview?

Aim for 2–4 thoughtful questions per interviewer, depending on time. It’s better to ask a few well-chosen, meaningful questions than to rush through a long list. Prioritize questions that:

• Aren’t already answered on the website
• Reflect your personal priorities and specialty goals
• Show that you’ve done your homework on the program

Have a larger “master list” and adapt to the flow of each interview.

---

2. What are good “interview questions for them” that work at almost any prelim program?

Some versatile options:

• “How would you describe the role of prelims in this program’s mission?”
• “What qualities make a prelim particularly successful here?”
• “What changes have you made recently in response to resident feedback, especially from prelims?”
• “If you could improve one thing about the preliminary medicine year here, what would it be?”

These questions work across settings and reveal a lot about culture and leadership responsiveness.

---

3. What should I ask the program director specifically?

When deciding what to ask program director versus residents, save the “big-picture” items for leadership:

• Vision and goals:
  • “Where do you see this program and the prelim year in 3–5 years?”
• Role of prelims:
  • “How do you ensure prelims are both well-trained and well-supported, given the intensity of a single-year experience?”
• Outcomes and reputation:
  • “How do other departments here view residents who complete the preliminary medicine year with you?”

Avoid asking PDs about minor logistics that coordinators or residents can answer more precisely (e.g., parking details, call room specifics) unless it organically comes up.

---

4. How can I tell if a preliminary medicine year will be too heavy or malignant?

Pay close attention to:

• Resident body language when discussing hours, nights, or wellness
• Whether prelims freely share their experiences or seem guarded
• Comments like, “It gets better after intern year,” without specifics
• Lack of clear support structures for struggling residents
• Discrepancies between rosy leadership descriptions and residents’ lived experiences

Use multiple data points—your questions, informal chats, reputation, and alumni feedback—to decide whether a prelim year will provide robust training without sacrificing your well-being.

---

By preparing high-yield, targeted questions to ask residency programs about their preliminary medicine year, you position yourself to choose a prelim IM program that fits your needs, supports your growth, and respects your time and effort. Thoughtful questions not only give you vital information but also show programs that you are reflective, prepared, and serious about your training.