Dr. Shervin Mortazavi | Building Your Future: A Residency Success Guide for International Medical Graduates

How IMGs Can Prepare, Present, and Persevere in the U.S. Medical System

For International Medical Graduates (IMGs), the journey to a U.S. residency can feel both thrilling and overwhelming. You’ve already worked incredibly hard to earn your medical degree—often in challenging environments and with limited resources. Now, you're navigating a new system, new expectations, and high competition. But the truth is, your background is not a disadvantage. It’s your greatest asset—if you learn how to use it strategically.

Understanding the U.S. Residency Landscape

The U.S. residency application process is rigorous for all applicants, but IMGs face some unique obstacles. These include navigating visa concerns, understanding cultural differences in healthcare delivery, and proving themselves through U.S.-based clinical experience.

What many IMGs don’t realize is that they bring qualities highly valued by residency programs: perseverance, cross-cultural competence, global clinical exposure, and the ability to adapt quickly. But these strengths must be communicated clearly—in your application, in your interviews, and throughout your interactions with programs.

Step 1: Start with Clarity and Self-Assessment

Before you begin applying, take time to assess who you are as a physician. What are your strongest clinical areas? What patient populations inspire you? What kind of work environments do you thrive in? Understanding your professional identity will help you craft a more focused application and target the right programs.

You should also review your U.S. clinical experience (USCE), licensing exam scores, and letters of recommendation. If you’re missing key elements—like hands-on U.S. exposure or strong letters from American attendings—plan ahead and fill those gaps before the application season begins.

Step 2: Gain Meaningful U.S. Clinical Experience

U.S. clinical experience isn’t just a checkbox—it’s your opportunity to prove that you can thrive in American hospitals. Whether through externships, observerships, or internships, these rotations help you adjust to the pace, documentation standards, and communication style of U.S. medicine.

Choose clinical sites where you can interact directly with patients and work under supervision. Build relationships with supervising physicians—these connections often result in the high-quality recommendation letters that U.S. programs expect.

Step 3: Craft a Compelling Application Story

Think of your application as a narrative, not just a list of qualifications. Your personal statement, CV, and supplemental materials should tell a consistent story of who you are, why you chose medicine, and why you're pursuing training in the U.S.

Dr. Shervin Mortazavi, a Bronx-based Internist and renowned IMG mentor, emphasizes the importance of creating a unified application. “Everything must connect,” he says. “Your personal statement should echo the themes in your letters of recommendation, and your interview answers should reinforce the values you’ve expressed on paper.”

Avoid generic statements like “I want to help people” or “I love science.” Instead, be specific. Describe how your clinical work in underserved areas, your experience during public health crises, or your exposure to different healthcare systems has shaped your goals.

Step 4: Master the Residency Interview

The residency interview is not just a formality—it’s the key to your match. Even with strong credentials, your interview performance often determines whether you’re ranked.

In the U.S., interviews are conversational. Programs want to know if you’ll be a good fit for their team, not just whether you’re smart. They’re looking for warmth, adaptability, emotional intelligence, and strong communication skills.

Practice answering common questions like:

• “Tell me about yourself.”

• “Why did you choose this specialty?”

• “What’s your biggest weakness?”

• “Why did you come to the U.S.?”

• “What makes you a good candidate for our program?”

Dr. Mortazavi advises candidates to go beyond surface-level answers. “You need to show passion, clarity, and humility,” he says. “Interviewers are choosing future colleagues. Be confident, but also show that you’re ready to learn.”

Mock interviews, especially with mentors or peers familiar with U.S. expectations, can make a huge difference. Focus on nonverbal cues too: eye contact, posture, tone, and smiling go a long way in building rapport.

Step 5: Embrace Cultural Fluency

Residency is more than clinical skills—it’s also about fitting into the culture of American medicine. This means learning how teams collaborate, how patients expect to be treated, and how feedback is given and received.

In some countries, hierarchy dominates clinical settings. In the U.S., teamwork is key. Residents are expected to take initiative, but also to ask questions, admit when they don’t know something, and receive feedback with openness.

Language is another important factor. Even if your English is fluent, American idioms, abbreviations, and tone can be tricky. Watching medical dramas, reading case studies, and shadowing American physicians can help you adjust. More importantly, listen closely to how others interact with patients and colleagues.

Step 6: Follow Up and Stay Connected

After interviews, send a professional thank-you email to each interviewer. Mention something specific from your conversation to reinforce the connection. While not all programs weigh thank-you notes heavily, it’s a gesture of respect—and it may just keep you top of mind.

Stay in touch with attendings and residents you've worked with. A simple update about your progress or application status may encourage them to put in a good word for you, which can be influential behind the scenes.

Step 7: Be Resilient Through the Process

Even the best applicants may not match the first time. This is not failure—it's part of the journey for many IMGs. If it happens, analyze what went wrong, revise your strategy, and strengthen your application for the next cycle.

Dr. Mortazavi encourages unmatched applicants to gain more U.S. experience, pursue research, volunteer, or enroll in courses that enhance their skill set. Many unmatched candidates who remain proactive go on to match the following year, stronger and more confident than before.

A Final Word of Encouragement

You chose a challenging path—not because it was easy, but because your commitment to medicine is deep. The journey of the IMG is one of courage, sacrifice, and vision. You’ve already overcome obstacles many will never understand.

But you’re not alone. With guidance, preparation, and community, success is entirely possible. Your future patients are waiting, and your journey is one the medical community deeply needs.