Essential Questions for US Citizen IMGs in Preliminary Medicine Residency

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

As a US citizen IMG or American studying abroad, you are often evaluated a bit differently from US MD/DO graduates—fairly or not. One of the few places you can directly shape how programs see you is during interviews, especially through the questions you ask them.

For a Preliminary Medicine (prelim IM) position, this matters even more. You’re often planning to go into another specialty (e.g., neurology, anesthesiology, radiology, dermatology) and using the prelim year as a foundation. The questions you ask residency programs can:

• Signal that you understand what a prelim year actually involves
• Show you’re serious, mature, and prepared
• Help you identify programs that will genuinely support your long‑term goals
• Clarify how well they treat prelims relative to categorical residents

This guide is built specifically for US citizen IMGs in preliminary medicine, with focused, practical interview questions for them—program directors, faculty, and residents—that will help you evaluate programs and present yourself as a strong, thoughtful candidate.

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Core Strategy: How to Approach Asking Questions as a US Citizen IMG

Before you memorize a list, you need a strategy. The same question can make you look either generic or sharp, depending on how you use it.

1. Know Your Priorities as a US Citizen IMG

As an American studying abroad, some priorities are especially important:

• Visa is not your issue – Unlike many non‑US IMGs, you don’t need sponsorship. That’s an advantage; don’t waste questions on visas. Instead, focus on:
  • Educational quality and supervision
  • Culture and support for IMGs
  • Opportunities to stand out in a one‑year role
• Perception and bias – You may still face bias as an IMG. The right questions can:
  • Show insight into your situation (e.g., needing strong letters for a PGY‑2 match)
  • Demonstrate you’re proactive and organized
  • Clarify whether the program has a track record of supporting IMGs successfully

2. Align Your Questions With the Interviewer

You should never ask every question on a generic list. Instead:

• To the Program Director (PD):
  Focus on program structure, expectations, evaluation, and how they view prelims.
• To Associate Program Directors / Faculty:
  Ask about education, supervision, teaching, and feedback.
• To Current Residents (especially prelims):
  Ask about daily life, culture, workload, fairness, and whether promises match reality.
• To Coordinators or Admin Staff:
  Clarify logistics (orientation, schedules, onboarding, housing support).

3. Avoid Red Flag Questions

Avoid questions that:

• Are easily answerable from the website (e.g., “How many residents do you have?”)
• Sound entitled or purely transactional (e.g., “How easy is it to moonlight?” as your first question)
• Focus only on getting out of work rather than learning (e.g., “How often can I get out early?”)

Instead, ask specific, thoughtful questions based on information you’ve already reviewed.

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Essential Questions to Ask the Program Director (and Why They Matter)

When thinking about what to ask the program director, prioritize questions that reveal how they view prelim residents, how they support them, and how they help them reach their PGY‑2 goals.

A. Questions About the Role and Value of Prelim Residents

1. “How do you see the role of preliminary medicine residents within your program?”
Why it matters: Some programs treat prelims as equal members of the team; others see them as extra bodies to fill call schedules. Their answer tells you which they are.

Follow‑up examples:

• “Are prelims included in the same educational activities and opportunities as categoricals?”
• “Are there any aspects of the curriculum designed specifically with prelims’ future specialties in mind?”

2. “What differences exist, if any, between the experiences of prelim and categorical residents here?”
You want clarity on:

• Team assignments and rotations
• Access to electives
• Inclusion in didactics and conferences
• Opportunities for QI or research

Red flag: If they emphasize service and call but are vague about education for prelims.

B. Questions About Educational Structure and Supervision

3. “How is supervision structured for interns, especially early in the year?”
Why: As an IMG, you may be adjusting to a new healthcare system. You want to know:

• How quickly you’ll be expected to function independently
• Whether there is senior/attending back‑up that’s accessible and approachable

4. “Can you describe how feedback is provided to interns and how often we receive formal evaluations?”
Follow‑ups:

• “Are there specific milestones or goals you expect interns to achieve by mid‑year?”
• “How do you support residents who are struggling in a specific area?”

For a US citizen IMG, structured feedback is critical because you’re often aiming to secure strong letters and show progression during a single year.

C. Questions About Supporting Your Long-Term Career Plans

Most prelims are using the year to transition into another specialty. Emphasize that you are committed to learning medicine deeply, but also realistic about your trajectory.

5. “How do you support prelim residents in obtaining strong letters and positioning themselves for their PGY‑2 specialty?”
Why: You want a program that expects prelims to move on and takes pride in sending them into strong programs elsewhere.

Clarify:

• “Do faculty commonly write letters for prelims applying to PGY‑2 positions?”
• “Is there formal career advising for prelims as they navigate the Match again?”

6. “Do you track where your prior prelim graduates match for their PGY‑2 positions, and could you share some recent examples?”
This directly tests whether they:

• Keep track
• Care about prelim outcomes
• Have a pattern of graduates successfully going into competitive specialties

For a US citizen IMG, this helps you compare how supportive programs are toward people with non‑traditional backgrounds.

D. Questions About Culture, Support, and IMG Experience

7. “How would you describe the culture of your program, especially with regard to wellness and teamwork?”
You want more than “we’re like a family.” Listen for specific examples:

• Formal mentorship systems
• Resident‑run wellness initiatives
• How they handle conflicts or overwhelmed interns

8. “How much experience does your program have with US citizen IMGs or Americans studying abroad?”
Follow‑ups:

• “Have you noticed particular strengths or challenges that IMGs bring, and how does the program help them adjust?”
• “Are there any structured supports—like orientation to the US healthcare system or additional early supervision—used for IMGs?”

You’re not just fishing for reassurance. You’re asking if they have a track record and a system, not just vague goodwill.

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High-Impact Questions to Ask Current Residents (Especially Prelims)

Current residents—particularly those in a preliminary medicine year—are your most honest source of information. They know what’s really happening on the ground.

A. Questions About Daily Life and Workload

9. “What does a typical day look like for a prelim intern on the wards here?”
Ask them to walk you through:

• Start and end times
• Patient load
• Call or night float structure
• How often they stay past their shift’s end

Follow‑up: “How does that change across different rotations (ICU, nights, electives)?”

10. “How manageable do you feel the workload is, and do you feel it allows you to learn while maintaining a life outside the hospital?”
You’re trying to see:

• Are they burnt out?
• Are people resentful, or do they feel challenged but supported?
• Does their facial expression match their words?

As a US citizen IMG, you may be far from your support system; a toxic or relentlessly exhausting program can quickly erode your performance and well‑being.

B. Questions About How Prelims Are Treated

11. “Do prelims feel like full members of the team, or more like an extra body?”
Residents will usually answer this honestly with:

• Stories (“On my ICU month, I…”)
• Comparisons to categoricals
• Comments about how attendings address or include prelims

12. “Are prelims included in all conferences, retreats, and teaching sessions?”
You want to know:

• Are prelims excluded from anything major (e.g., retreats, board review, leadership roles)?
• Are they allowed to join mentorship groups or special tracks?

If residents say, “We technically can go, but we’re usually too busy to attend,” that’s a sign that service might overshadow learning.

C. Questions About Help, Mentorship, and Feedback

13. “When you were struggling, whether clinically or personally, did you feel comfortable asking for help? How did leadership respond?”
This reveals program culture far more than a formal “wellness committee” slide.

You’re listening for:

• Concrete examples (schedule adjustments, real support, non‑punitive approaches)
• Whether people fear retaliation for needing help

14. “How easy is it to get informal feedback from seniors and attendings, and do they actually give constructive feedback?”
Follow‑up: “Did you feel that your performance was fairly evaluated?”

For a one‑year prelim, quality feedback is crucial because you might be applying to your PGY‑2 specialty quickly, sometimes early in the year.

D. Questions About Career Support and Next Steps

15. “For the prelims here, how supportive has the program been in helping them match into their PGY‑2 specialty?”
Ask specifically:

• “Do attendings know that prelims are applying out and still advocate for them?”
• “Do prelims get time to interview in the fall/winter?”
• “How many interviews did people usually manage while still handling their schedule?”

16. “If you could go back, would you choose this prelim program again?”
This honest reflection often tells you more than any polished answer.

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Specialty-Specific Questions for Prelim IM (Especially if You’re Applying to Another Field)

If you’re doing a prelim IM year as a bridge to another specialty, you need to align your questions with both medicine training and your target field.

A. For Applicants Aiming at Another Specialty (e.g., Neurology, Anesthesia, Radiology)

17. “How do you help prelims schedule rotations that support their future specialty goals?”
Explore:

• Ability to schedule electives that align with your PGY‑2 specialty
• Flexibility in the second half of the year if interviews pick up
• Coordination with other departments (e.g., neurology, anesthesia)

18. “Are there opportunities for prelims to connect with faculty from other departments they’re applying into?”
For example:

• Neurology attendings who can write letters
• Radiology or anesthesia mentors
• Cross‑department teaching conferences

As a US citizen IMG, linked mentorship can significantly enhance your competitiveness for a PGY‑2 spot.

B. Questions About Schedule Flexibility and Interviews

19. “How do you handle schedule changes when prelims need to travel for interviews for their PGY‑2 positions?”
You want specifics:

• Is there a formal policy?
• Are there a limited number of interview days?
• Do co‑residents get burdened and resentful, or is there a smooth system?

20. “Are prelims allowed to cluster lighter rotations or electives around interview season when possible?”
A program that acknowledges your re‑application needs—and helps you manage them—is far more likely to be a good fit.

C. Questions About Evaluations and Letters

21. “Which rotations typically generate the strongest letters for prelims here, and how do you recommend we plan for that?”
This confirms that:

• The program understands the “application calendar” you face as a prelim
• They can advise on when to schedule key rotations for strong letters

22. “Do faculty have experience writing letters for IMGs who are applying into competitive PGY‑2 specialties?”
As a US citizen IMG, letters that explicitly address concerns about training background, adaptability, and performance in the US system are extremely valuable.

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Practical Tips for Using These Questions Effectively

Having good questions to ask residency programs is only half the battle; you must use them well.

1. Prepare 2–3 Priority Questions for Each Interviewer Type

For each interview day, outline:

• Program Director:
  2–3 questions about structure, prelim support, and IMG experience
• Residents:
  3–4 questions about reality of daily life, culture, and prelim treatment
• Other Faculty:
  2–3 questions about teaching, supervision, and career development

Keep a notepad (or digital document) where you tailor questions based on what you’ve already heard.

2. Customize Based on the Program’s Website and Brochure

Before the interview:

• Read the program site and avoid asking obvious questions.
• Instead, reference what you’ve read:
  • “I noticed you have a strong focus on QI. Are prelims able to participate in QI projects even during a one‑year position?”

This shows you’re serious and did your homework.

3. Use Questions to Highlight Your Strengths and Goals

Frame some questions to subtly communicate your priorities as a US citizen IMG in prelim IM:

Example:

• “Because I went to medical school abroad, I’m particularly interested in developing strong clinical reasoning in the US system. How does your program specifically help interns grow in this area during the first few months?”

This both asks for concrete information and emphasizes your self-awareness and motivation.

4. Listen Actively and Ask Logical Follow-Ups

Programs notice when you:

• Pick up on details
• Ask follow-up questions that show insight
• Compare answers from different people (PD vs residents)

If someone mentions an “intern support group” or “prelim check‑ins,” that’s an opportunity for a follow-up:

• “Can you tell me more about those prelim check‑ins—how often they happen and who leads them?”

5. Watch for Consistency vs. Contradictions

If:

• The PD says prelims are valued and fully included
• But residents say prelims are treated like second‑class citizens

…that’s a major warning.

As you go through multiple interviews, keep brief notes about:

• How prelims are described
• How IMGs are supported
• Whether residents’ and leadership’s stories match

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Example Question Sets You Can Use or Adapt

Below are sample sets you can borrow and slightly customize for different interviewers. These are phrased to sound natural for a US citizen IMG applying to a preliminary medicine year.

For Program Directors

• “How do you differentiate the educational experience of prelim and categorical interns, and how do you ensure prelims still get a robust year of training?”
• “What characteristics do you value most in a successful prelim here, and how do you help them grow over the year?”
• “How has your program historically supported IMGs—particularly US citizens who trained abroad—as they adapt to your system?”
• “Can you share examples of where recent prelims have matched for PGY‑2 positions, and how your faculty helped them during that process?”

For Residents (Preferably Current or Recent Prelims)

• “From your perspective, what are the biggest strengths and biggest challenges of being a prelim at this program?”
• “How fair do you feel the call schedule and workload are between prelims and categoricals?”
• “When someone is overwhelmed or falling behind, what actually happens—who steps in and how?”
• “Did you feel supported in scheduling interviews and managing applications for your PGY‑2 specialty?”

For Faculty or Associate Program Directors

• “How would you describe the teaching culture on the wards here? Are attendings generally hands‑on teachers or more hands‑off?”
• “What opportunities exist for prelims to participate in QI or small scholarly projects, if they’re interested?”
• “How do you approach giving feedback to interns, and how early do you address concerns if someone is struggling?”

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FAQs: Questions to Ask Programs as a US Citizen IMG in Preliminary Medicine

1. As a US citizen IMG, should I bring up my IMG status when asking questions?
Yes, but do it strategically. You don’t need to over‑explain your background, but you can frame thoughtful questions like:

• “As someone who completed medical school abroad, how do you support residents in adjusting to documentation and communication expectations in the US system?”
  This acknowledges your context and shows insight and maturity, without sounding apologetic.

2. Is it okay to ask about match outcomes for prior prelims and IMGs?
Absolutely. It’s appropriate and smart to ask:

• “Could you share examples of where your recent prelims have gone for their PGY‑2 specialties?”
• “Have prior US citizen IMGs from your program generally matched successfully into their desired fields?”
  You’re evaluating whether the program has a proven history of supporting people like you.

3. Can I ask about schedule flexibility for interviews during my prelim year?
Yes, but time it correctly. Avoid making it your first or only question. Later in the conversation, you might say:

• “Since prelims often re-enter the Match during the year, how does the program help them manage interview schedules while still meeting training requirements?”
  This shows awareness of responsibilities while still advocating for your future.

4. What are red-flag answers I should watch for when asking these questions?
Caution signs include:

• Vague or evasive responses like, “It depends,” without examples
• Leaders who can’t name where prelims have matched recently
• Residents saying prelims “do all the scut work” or are treated differently
• No mention of structured feedback, mentorship, or support systems
• Conflicting descriptions between leadership and residents about workload or culture

If you consistently see these across multiple conversations, that program may not be the best environment for a one‑year prelim as a US citizen IMG.

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By approaching your interviews with clear, focused questions to ask residency programs, you not only gather important information—you also present yourself as a thoughtful, serious candidate. As a US citizen IMG in preliminary medicine, the right questions can help you find a program that respects prelims, truly supports IMGs, and actively prepares you for success in your PGY‑2 specialty and beyond.