Essential Questions for US Citizen IMGs in Preliminary Surgery Residency

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

As a US citizen IMG and an American studying abroad, your path into surgery often starts with a preliminary surgery year rather than a categorical position. That makes your residency interviews especially strategic. You’re not just trying to impress programs—you’re also gathering critical information to decide where you’ll have the best chance to grow, be supported, and convert your prelim surgery residency into a longer-term surgical career or another suitable path.

Thoughtful, targeted questions to ask residency programs are one of your strongest tools. The right interview questions for them can:

• Clarify how the program supports prelims (versus categorical residents)
• Reveal your real chances of getting a categorical spot later
• Expose red flags in workload, culture, or treatment of IMGs
• Demonstrate your maturity, insight, and preparation as an applicant

This guide focuses specifically on what to ask program director, faculty, and residents during interviews for preliminary surgery. It’s tailored to the needs and concerns of a US citizen IMG looking at a prelim surgery residency in the US.

---

Core Strategy: How to Approach Asking Questions

Before diving into specific questions, it helps to know the strategy behind them.

1. Prioritize Your Objectives as a US Citizen IMG

For American students studying abroad, preliminary surgery often serves one of three purposes:

1. Stepping stone to categorical general surgery
2. Bridge to another specialty (anesthesia, radiology, EM, etc.)
3. Year of US training and experience to strengthen your overall profile

Your questions should reflect which of these is your primary goal, and you should know that goal before your first interview.

2. Ask Different People Different Questions

You’ll usually meet:

• Program Director (PD)
• Associate PD or faculty
• Current categorical and prelim residents
• Sometimes chief residents or coordinators

Use your time wisely:

• Save “big picture” and policy questions for the PD/faculty
• Ask about day-to-day realities, culture, and workload with residents
• Clarify logistics and processes with the coordinator, either before or after interview day

3. Make Questions Specific and Data-Oriented

Programs often say “We value our prelims,” but you want evidence:

• Ask for numbers and outcomes
• Ask about structures and policies, not just intentions
• Look for patterns across multiple people’s answers

Whenever possible, phrase questions to avoid yes/no answers. Use:

“Can you walk me through…”
“How often does…”
“In the last 3–5 years, how many…”

---

Essential Questions to Ask the Program Director

The PD is the best person to clarify the structure, philosophy, and outcomes of the prelim surgery residency. These are high-yield questions to ask residency leadership as a US citizen IMG.

A. Program Philosophy and Role of Prelim Residents

1. “How do preliminary surgery residents fit into the overall structure and mission of your program?”

   • Listen for: whether prelims are seen as “service only” or as truly valued trainees.

2. “What distinguishes the prelim experience here from the categorical experience?”

   • Good sign: formal teaching opportunities, research access, and performance evaluations for prelims that mirror categoricals.

3. “What made you decide to include preliminary positions in your program, and what do you see as success for your prelims?”

   • You want a thoughtful answer that goes beyond “coverage.”

B. Outcomes and Advancement Opportunities

For a US citizen IMG hoping to transition into a categorical slot, this is critical.

4. “In the past 3–5 years, how many preliminary residents have transitioned into categorical general surgery positions, either at your institution or elsewhere?”

   • Ask for numbers, not just “many” or “some.”

5. “How often do categorical positions open internally, and how are prelims considered for them?”

   • Look for a transparent process and specific examples.

6. “Can you describe any recent prelims who successfully matched into categorical surgery or another competitive specialty, and what paths they took?”

   • This gives you real-world examples.

7. “If a prelim resident is performing strongly, how do you advocate for them—within this institution or with other programs?”

   • A supportive PD should discuss letters, calls, and networking.

C. Structure, Supervision, and Education for Prelims

8. “Are preliminary residents included in all educational activities that categorical residents attend—didactics, M&M, skills labs, simulation?”

   • If prelims are regularly excluded, that’s a red flag.

9. “How is feedback delivered to prelim residents, and how often?”

   • Look for structured evaluations at least every rotation, ideally with formal mid-year and end-of-year meetings.

10. “Do preliminary residents have identified faculty mentors or advisors?”

• Particularly important for IMGs who may need guidance navigating US systems.

11. “What opportunities exist for prelim residents to get involved in research or quality improvement projects?”

• Ask this even if you’re not research-heavy; research can improve your future applications.

D. Expectations, Workload, and Support

12. “How do duty hours and call responsibilities for prelims compare with those of categorical residents?”

• You want parity, not extra burden because “you’re only here a year.”

13. “When prelim residents struggle—whether clinically, academically, or with adjusting to the system—what support mechanisms are in place?”

• Especially relevant if you trained abroad and are adapting to US medical culture.

14. “From your perspective, what type of resident tends to thrive in your preliminary year, and what traits are less compatible with your program?”

• This can help you honestly assess fit.

E. IMG-Specific and US Citizen IMG Considerations

As an American studying abroad, you occupy a middle ground: you’re a US citizen but also an IMG.

15. “How many of your current or recent preliminary residents have been US citizen IMGs or other IMGs, and how have they done here?”

• Look for programs with a track record of supporting IMGs.

16. “Are there any additional supports or resources you offer IMGs to help with system acclimation or board exams?”

• Some programs provide extra orientation or test prep resources.

17. “When writing letters for prelims applying to categorical spots, what qualities do you emphasize, and how do you position US citizen IMGs in particular?”

• This shows how actively they advocate for applicants in your situation.

---

High-Impact Questions to Ask Residents (Prelim and Categorical)

Residents provide the closest view of reality. Make sure you talk to at least one current preliminary surgery resident if possible. Their answers can override everything you heard from leadership.

A. Day-to-Day Life and Culture

1. “Can you walk me through a typical day on your busiest rotation as a prelim? Start to finish.”

   • Ask this specifically of prelims if available.

2. “How often do you feel you’re in the OR versus doing floor work or scut?”

   • Pay attention to prelim vs categorical experiences.

3. “Do you feel that preliminary residents are treated differently from categorical residents—in teaching, opportunities, or respect?”

   • Ask for examples, both good and bad.

4. “How approachable are attending surgeons and chiefs when you need help?”

   • You need a safe learning environment, especially as an IMG.

5. “Have you ever felt unsafe or unsupported while taking care of patients? How was that addressed?”

   • Culture of safety is crucial.

B. Education, OR Experience, and Autonomy

6. “How is OR time distributed between prelim and categorical interns?”

   • Some programs prioritize Categoricals for cases; others are more equitable.

7. “By the end of the prelim year, what level of operative experience do most prelims have? For example, how many logged cases do they usually reach?”

   • This helps you gauge how marketable you’ll be afterward.

8. “Do attendings and seniors actively teach in the OR and on the wards, or is most learning self-directed?”

   • A balanced program should offer both.

9. “How much autonomy do interns have by the middle and end of the year, both clinically and in procedures?”

   • You want progressive responsibility, not being stuck doing only scut all year.

C. Support, Wellness, and Realistic Challenges

10. “What’s the most challenging aspect of being a preliminary resident here?”

    • Listen for honesty without bitterness.

11. “When residents are exhausted or overwhelmed, what actually happens? Are switch days, coverage, or mental health resources accessible?”

    • Programs differ widely in how they respond.

12. “How strictly are duty hours followed in practice?”

    • Compare different residents’ answers for consistency.

13. “As a US citizen IMG or as someone who trained abroad, did you feel any bias—positive or negative—when you started?”

    • Crucial insight if you ask a current or former IMG.

D. Outcomes and the Future

14. “Where have prelims from the past few years ended up—categorical surgery, other specialties, research years?”

    • Get resident perspectives on real outcomes versus official statistics.

15. “If a prelim resident is strong, how hard does the program work to help them find a spot for the next year?”

    • Ask for specific stories: “Can you tell me about someone who…”

16. “If you had to choose a program again for a preliminary year, would you choose this one, and why or why not?”

    • One of the most telling questions you can ask.

---

Targeted Questions for Faculty and Associate PDs

Faculty and associate PDs sit between policy and day-to-day reality. They can reveal how decisions are actually made about prelims.

A. Evaluation and Advancement

1. “From a faculty point of view, how are prelims evaluated and compared to categorical interns?”

   • Look for objective, structured evaluations.

2. “When you consider a prelim for a letter or an internal categorical spot, what specific qualities stand out to you?”

   • This tells you what to prioritize in your behavior and performance.

3. “How much input do faculty have when the program decides who to support for categorical positions or other specialties?”

   • A wider base of input can help strong prelims be noticed.

B. Mentorship and Professional Development

4. “Do faculty routinely mentor prelims on career planning—whether for general surgery or other fields?”

   • You need guidance on long-term options.

5. “Are there structured meetings or check-ins where residents can discuss future plans, letters of recommendation, or research ideas?”

   • This is especially important around mid-year when you’ll be applying again if needed.

6. “How do you perceive US citizen IMGs in your program? Are there any common strengths or gaps you see, and how do you help address them?”

   • A thoughtful answer shows experience working with IMGs and commitment to development.

C. Clinical and Research Opportunities

7. “What kinds of cases or rotations typically give prelims the best chance to stand out to faculty?”

   • This helps you strategize your year once you match.

8. “If a prelim is very research-focused, is it realistic for them to be involved in any projects during the year?”

   • Time is limited, but even small involvement can help.

---

Crafting Your Own Tailored Question List

Not every question is right for every program or for every applicant. As a US citizen IMG targeting a preliminary surgery year, customize your list based on:

1. Your Primary Goal

• If you want categorical surgery eventually:
  Focus on advancement pathways, internal opportunities, and operative experience.
• If you aim for another specialty:
  Ask about how often prelims match into anesthesia, radiology, EM, etc., and how the program supports those transitions.
• If your goal is to strengthen your overall application:
  Emphasize teaching, mentorship, letters, and research/QI involvement.

2. The Program’s Profile

Before interview day, research:

• Current and past residents (LinkedIn, program website)
• How many prelims vs categoricals they have
• Whether they list former prelims who matched elsewhere

Then adapt:

• For programs with many IMGs:
  Ask how they specifically support IMGs and what outcomes they’ve seen.
• For highly academic programs:
  Ask about research feasibility for prelims and how often they progress to research years or categorical slots.
• For community-heavy programs:
  Focus on hands-on experience, autonomy, and OR time.

3. The Order and Tone of Your Questions

During the interview:

• Start with broader questions, then move to specifics based on answers.
• Be genuine, not confrontational. You’re evaluating fit, not cross-examining.
• Avoid questions with answers easily found on their website (it may signal you haven’t prepared).

Example sequence for PD:

1. “How do prelims fit into the program’s mission?”
2. “What outcomes have your prelims had over the last several years?”
3. “How is OR time and education structured for them?”
4. “What support do you offer prelims when they’re applying for their next positions?”

---

Practice Scenarios: Applying These Questions in Real Time

Scenario 1: The “We Support Prelims” Program

The PD says: “We really value prelims; many of them move on successfully.”

Follow-up questions:

• “Could you share approximately how many prelims have moved into categorical surgery positions over the last 5 years?”
• “And among those who didn’t go into categorical surgery, what paths did they typically take?”

If they can’t answer with numbers or give vague replies, be cautious.

Scenario 2: Heavy Service Load Concern

Residents mention long hours and heavy floor work.

Clarifying questions for residents:

• “How does OR time for prelims compare to categorical interns when service needs are high?”
• “Do you feel you still get adequate operative exposure despite the workload?”

For PD/faculty:

• “When service demands increase, how do you prioritize maintaining OR and educational time for your residents, especially prelims?”

Scenario 3: You Are a US Citizen IMG Focused on Categorical Conversion

You might ask:

• “As a US citizen IMG, how have similar residents in your program fared in terms of converting to categorical surgery or matching into other specialties?”
• “Are there any additional steps you recommend for someone in my situation to maximize the chance of moving into a categorical role?”

These questions show self-awareness and seriousness about your trajectory.

---

Frequently Asked Questions (FAQ)

1. How many questions should I ask each interviewer?

Aim for 3–5 meaningful questions per interviewer. Quality matters more than quantity. Prepare a longer list, then choose the most relevant based on what has already been covered. Avoid repeating the same question to multiple faculty unless you’re intentionally cross-checking something critical (like outcomes for prelims).

2. Is it okay to directly ask about chances of getting a categorical spot?

Yes, but phrase it professionally. For example:

“In recent years, how often have prelims here been able to move into categorical surgery positions, and what factors made that possible?”

Avoid asking, “What are my chances?” on interview day—it’s too personal and hypothetical. Focus on historical patterns and processes instead.

3. As a US citizen IMG, should I explicitly mention my background when asking questions?

You don’t have to, but it can be helpful. You might say:

“As a US citizen IMG who trained abroad, I’m particularly interested in how you’ve supported others with similar backgrounds. Can you share examples of how the program helps IMGs adjust and succeed?”

This gives them context and invites a more tailored answer.

4. What if the program seems annoyed or evasive when I ask about prelim outcomes?

That’s significant information in itself. Programs that truly support prelims usually welcome questions about outcomes and can share at least approximate numbers or examples. If you sense defensiveness, vague answers, or obvious discomfort, consider it a red flag. Your preliminary surgery year is too important to spend in a place that doesn’t transparently support its prelim residents.

---

Thoughtful, well-structured questions to ask programs are not just a formality; they’re your main diagnostic tool to determine whether a prelim surgery residency will genuinely advance your career as a US citizen IMG. Go into each interview with a prioritized list, adjust dynamically, and treat every answer as valuable data for your ranking decisions.