Essential Questions for US Citizen IMGs Applying to General Surgery Residency

As a US citizen IMG (American studying abroad) applying to general surgery, your questions during interviews can significantly shape how programs see you—and how you evaluate them. You’re not just being interviewed; you’re also interviewing them. Asking thoughtful, targeted questions shows maturity, insight into surgery as a career, and an understanding of the unique challenges an IMG may face in the surgery residency match.

Below is a structured guide to the best questions to ask residency programs—program directors, residents, and coordinators—tailored specifically for US citizen IMGs applying in general surgery.

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Why Your Questions Matter as a US Citizen IMG in General Surgery

General surgery is demanding, competitive, and very culture-dependent. For an American studying abroad, you’re often fighting three battles at once:

1. Proving your clinical readiness for a US surgical environment
2. Overcoming concerns about your medical school’s reputation or system differences
3. Demonstrating you understand the rigors and culture of surgical training

Strong, focused questions help you:

• Signal that you understand what matters in surgical training (case volume, autonomy, operative exposure, mentorship, fellowships, outcomes)
• Show you’re thinking beyond “just matching somewhere” and toward becoming a competent, employable surgeon
• Evaluate if the program will genuinely support IMGs and help you succeed

Think of your questions in three categories:

1. What will my training actually look like here?
2. Will I fit and be supported as a US citizen IMG?
3. Does this program set me up for my future goals (fellowship, practice, academic career)?

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Strategic Question Themes for General Surgery Applicants

Before diving into scripts, understand the core themes interviewers expect serious general surgery applicants to care about:

• Operative volume and autonomy
• Trauma and emergency exposure
• Breadth of cases (complex, open vs. minimally invasive)
• Resident independence vs. supervision
• Didactics, simulation, and board preparation
• Research infrastructure and mentorship
• Culture: resident wellness, hierarchy, teaching quality
• Outcomes: ABSITE scores, board pass rates, fellowship placement
• Program track record with IMGs / US citizen IMGs

Your goal is never to “fill silence.” Your goal is to ask things that a serious future general surgeon should care about. Below, you’ll find concrete examples of “interview questions for them,” organized by who you’re speaking to and what you want to learn.

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Questions to Ask Program Directors & Associate Program Directors

When you think, “what to ask program director?” focus on big-picture structure, training quality, and how they evaluate and support residents—especially IMGs.

1. Training Structure, Autonomy, and Case Volume

These questions show you understand what makes or breaks surgical training:

• “How would you describe the progression of operative autonomy from intern year to chief year?”
  Why it’s strong: Signals that you care about becoming an independent surgeon, not just logging cases.

• “What are the typical case numbers for your graduating chiefs in key areas like trauma, colorectal, minimally invasive, and complex foregut?”
  What you’re listening for: Real numbers and pride in their graduates’ experience, not vague reassurances.

• “How is operative experience distributed among residents when there are fellows present? Do residents still get meaningful cases?”
  When to ask: At academic centers with many fellowships; clarifies your hands-on experience.

• “Can you describe how junior residents are integrated into the OR early on? Are interns getting primary surgeon experience or mostly first-assist roles?”
  Why it matters for IMGs: Shows you want early engagement, which can be critical if you feel behind due to different training systems abroad.

2. Education, Didactics, and ABSITE/Board Preparation

Programs serious about training care about metrics and structure:

• “What does your formal didactic curriculum look like for general surgery? How often are conferences, and are they protected?”
• “How do you support residents who may be struggling with the ABSITE or in-service exams?”
• “What have your board pass rates been over the last few years, and how do you address any trends you’re concerned about?”

These are direct but professional “questions to ask residency” that indicate you see yourself as a long-term investment.

3. Expectations & Support for IMGs / American Studying Abroad

As a US citizen IMG, you must tactfully assess how they work with candidates like you:

• “As a US citizen IMG, are there particular qualities you’ve seen in successful IMG residents here? How do you support them in adapting to this training environment?”
  Why this works: It’s not defensive; it’s forward-looking and emphasizes success.

• “Have you trained US citizen IMGs or other IMGs in your program recently? How have they done in terms of performance and fellowship/job placement?”
  What you’re listening for: Specific examples of successful IMGs, not generic “we’re IMG friendly.”

• “Is there any additional support—clinical orientation, documentation, EMR training—that you provide to residents who trained in different health systems?”

This directly addresses the “American studying abroad” reality: you might be stronger or weaker in certain clinical skill sets depending on your school’s system.

4. Program Direction, Stability, and Vision

You’re evaluating whether the program is moving in a positive direction:

• “What changes or improvements are you most excited about in the program over the next 3–5 years?”
• “Have there been any recent major changes in leadership, hospital ownership, or case mix that applicants should be aware of?”
• “What traits do you see in your most successful surgery residents, and how do you select for those during the match?”

These “interview questions for them” show maturity and long-term thinking.

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Questions to Ask Residents: Culture, Lifestyle, and Reality-Check

Residents are your most honest source of information. With them, your questions to ask residency can be more targeted, practical, and candid.

1. Day-to-Day Life and Workload

You need a realistic sense of what your life will look like:

• “Can you walk me through a typical day for a PGY-1 on general surgery here?”
• “How often are you coming in early or staying late beyond scheduled hours?”
• “On average, how many days off do you get per month, and are they truly protected?”

You’re not asking “Is your lifestyle good?” (they’ll say yes). You’re asking for data.

2. OR Experience and Teaching Quality

Find out if residents feel they’re actually learning:

• “How would you describe the teaching culture in the OR? Are attendings invested in letting residents operate and learn, even when cases are complex?”
• “At your level, what kinds of cases do you typically perform as primary surgeon?”
• “Do you feel comfortable with your operative autonomy for your PGY level? Are there any rotations where you feel underutilized?”

These questions show you understand that surgical identity develops in the OR, not just in conferences.

3. Trauma, Acute Care Surgery, and Breadth of Exposure

General surgery residencies vary a lot in trauma/acute care exposure:

• “How is the trauma call structured here, and who typically runs trauma activations at night?”
• “Do you feel your exposure to emergent general surgery and trauma is adequate to make you comfortable managing very sick patients after graduation?”

If you’re considering trauma, critical care, or acute care fellowships, these questions are essential.

4. Culture, Support, and IMG Experience

US citizen IMGs need to understand how inclusive the culture is:

• “How would you describe the resident culture—collaborative, competitive, supportive?”
• “Have there been US citizen IMGs or other IMGs in the program recently? How were they integrated into the team?”
• “If a resident is struggling—whether clinically, academically, or personally—how does the program usually respond?”

Look for authentic answers, not scripted ones.

5. Logistics: Housing, Commuting, and Life Outside the Hospital

These questions matter more than many people think:

• “Where do most residents live, and what’s the typical commute?”
• “Is it realistic to have a partner or family here on a resident salary?”
• “What do you do on your days off? Is there enough time and mental energy to maintain some kind of personal life?”

Your goal is to understand not just surviving, but sustainability.

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Questions to Ask About Outcomes: ABSITE, Boards, and Fellowships

Serious surgery applicants care deeply about outcomes. These questions to ask programs apply to both leadership and senior residents.

1. ABSITE and Board Outcomes

• “How do residents typically perform on the ABSITE, and how does the program respond if scores decline?”
• “What structured board preparation do you offer, especially in the later years?”
• “Have you noticed any patterns among residents who struggle with exams, and how does the program intervene?”

As a US citizen IMG, this is especially relevant if your school’s curriculum was different from typical US-based preclinical and clinical teaching.

2. Fellowship and Job Placement

You want to ensure the program sets you up for the future you want:

• “What kinds of fellowships have your graduates matched into over the past 5 years?”
  • Trauma/ACS
  • Surgical oncology
  • Colorectal
  • MIS / Bariatric
  • Transplant
  • Vascular
• “For residents who want to go directly into practice, what types of jobs are they getting and where?”
• “How actively involved are faculty in helping residents with letters, networking, and fellowship preparation?”

Strong answers here are a positive sign for any candidate, but especially important for IMGs who may rely more heavily on structured mentorship and advocacy.

3. Research and Academic Development

If you’re interested in academic surgery or competitive fellowships:

• “What research infrastructure is available—statistical support, databases, ongoing projects?”
• “Is a dedicated research year optional or strongly encouraged? How many residents take that path?”
• “How many presentations or publications do residents typically have by graduation?”

As an American studying abroad, strong research during residency can help offset any perceived disadvantage from your medical school.

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Tailoring Your Questions as a US Citizen IMG

Not every question needs to reference your IMG status, but you should consciously use your background as a strength: resilience, adaptability, familiarity with different systems, and often strong cultural competence.

1. FramING Your Background Positively

Instead of asking, “Will I be at a disadvantage as a US citizen IMG?”, frame questions around success and support:

• “From your experience, what has helped residents coming from non-US medical schools succeed quickly in your program?”
• “Are there any additional resources or early rotations you’d recommend for someone trained abroad to get oriented to the system here?”

These show insight and humility without insecurity.

2. Evaluating Genuine IMG-Friendliness

Look beyond the “we welcome IMGs” line:

• Ask: “How many of your current or recent residents are US citizen IMGs or IMGs in general?”
• Clarify: “Do IMGs here typically face any consistent challenges, and how has the program addressed them?”
• Request examples: “Is there a recent IMG grad whose path you’re particularly proud of?”

You’re working out whether you’ll be an exception or part of a familiar pattern.

3. Licensing, Step Exams, and Remediation

For programs that may worry about exam performance:

• “For residents who may have taken a non-traditional path or needed extra attempts on exams, how does the program support their progression and ensure they meet all licensing/board requirements?”

This is a subtle way to gauge whether they support growth or simply weed out.

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How to Use Your Questions Strategically on Interview Day

Asking smart questions is not just about content—it’s about timing, tone, and strategy.

1. Prioritize 3–5 Core Themes per Program

You’ll likely only get time for a few meaningful questions in each conversation. Before each interview, identify your top priorities for that specific program:

• Is this a community vs. university program?
• Heavy trauma vs. more elective surgery?
• Known for fellowships vs. strong community training?

Then prepare 1–2 targeted questions for each of:

• Program director / APD
• Senior resident
• Junior resident or current intern
• (Optional) Coordinator

2. Avoid Questions That Backfire

Don’t waste time or risk negative impressions with questions like:

• “How competitive is your program?” (comes across as uninformed)
• “What’s your salary/vacation?” (easily found online; can seem overly focused on perks)
• “So, how did I do?” or “Do you think I’ll match here?” (puts interviewers in an awkward position)

Instead, ask deeper variations:

• Instead of salary: “How manageable is the cost of living here on a resident salary?”
• Instead of competitiveness: “What kind of applicant do you feel thrives in your program?”

3. Match Your Questions to the Interviewer

• Program Director/APD: Big picture, training quality, outcomes, vision
• Senior Residents (PGY-4/5): Autonomy, fellowships, real case numbers, culture
• Junior Residents (PGY-1/2): Transition from med school, intern year expectations, support
• Program Coordinator: Logistics, onboarding timeline, licensure, housing suggestions

4. Take Notes Immediately After

During the interview, keep your eyes up and maintain the conversation. After each session, jot down:

• Key phrases or numbers (board pass rates, case volumes)
• Names of residents/faculty you connected with
• Any red or green flags (e.g., “chief said: ‘We are in the hospital constantly, no time off’”)

This is invaluable when you build your rank list later.

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Putting It All Together: Sample Question Lists

Below are ready-to-use sets you can adapt for your own general surgery interviews as a US citizen IMG.

For Program Directors

1. “How do you see operative autonomy progressing from intern to chief year here, specifically in complex cases?”
2. “What are you most proud of about your graduates’ outcomes—board pass rates, fellowships, or practice readiness?”
3. “Have you trained many US citizen IMGs or IMGs in general, and what has helped them succeed in your program?”
4. “What major changes or improvements do you anticipate in the next few years for this program?”

For Senior Residents (PGY-4/5)

1. “What kinds of cases are you doing independently now as a chief?”
2. “Do you feel prepared for the path you’re planning—fellowship or practice?”
3. “How would you describe the attendings’ approach to resident autonomy in the OR?”
4. “Have you seen IMGs in the program, and how have they integrated and performed?”

For Interns/Junior Residents

1. “What was the hardest part of the transition from medical school to intern year here?”
2. “How much supervised operating did you get as an intern?”
3. “Do you feel supported when you’re on a steep learning curve or make mistakes?”
4. “If you had to decide again, would you choose this program, and why?”

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FAQs: Questions to Ask Programs as a US Citizen IMG in General Surgery

1. How many questions should I ask in each interview?

Aim for 2–3 thoughtful questions per 20–30 minute interview, adjusting based on how conversational the session is. Quality matters more than quantity. Prepare a longer list, then choose the most relevant in the moment.

2. Should I mention that I’m a US citizen IMG directly when asking about support?

Yes, but do it confidently and constructively. For example:
“As a US citizen IMG, I’m particularly interested in how residents from non-US schools adapt here. What has helped them succeed in your program?”
This frames your background as a natural part of your identity and shows insight into your needs.

3. Are there any questions I should always ask in every general surgery interview?

Try to always cover:

• Operative autonomy and case volume (“How do you ensure strong operative experience across all residents?”)
• Resident culture (“How would residents describe the culture here?”)
• Outcomes (“Where have your recent graduates gone for fellowship or practice?”)

You can adjust the wording, but these themes should appear somewhere in your day.

4. Is it okay to ask tough questions about workload or burnout?

Yes—if you ask them professionally and respectfully. For example:

• “General surgery is demanding everywhere. How does your program balance high expectations with sustainability and resident wellness?”
  This acknowledges reality while still sounding like a serious, thoughtful applicant.

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By approaching your residency interviews with deliberate, high-yield questions, you’ll stand out as a mature, well-prepared US citizen IMG who understands what it takes to become a competent general surgeon. Just as importantly, you’ll gather the information you need to choose a program that will train you well, support you as an IMG, and set you up for a successful surgical career.