Preparing for U.S. residency as an IMG

On this page
Before residency begins: Prepare for your next chapter
Understanding U.S. residency training
Your first weeks of residency
Getting established: Build a life outside residency

Navigate the transition to U.S. residency, from preparing for your move to finding your footing.

Matching into a U.S. residency program is an exciting milestone. It's also the beginning of a new chapter that may involve adjusting to a different health care system, professional expectations and community.

As an international medical graduate (IMG), you bring valuable experiences and perspectives to your training. Whether you're moving from another country or already living in the United States, preparing for the transition can help you approach your first weeks of residency with greater confidence.

Use these resources and practical tips to prepare for residency, understand what to expect and begin building your support network.

Before residency begins: Prepare for your next chapter

The months between Match Day and the start of residency are an important time to complete requirements, plan your move and get familiar with your new program.

What to do after Match Day

Your residency program will provide instructions about onboarding, documentation and other requirements before training begins.

Use this checklist to organize your next steps:

Confirm your onboarding requirements. Review deadlines for employment paperwork, background checks, immunizations, credentialing and other documentation.
Complete licensing requirements. Work with your program to understand the state training license or permit process, if applicable.
Review visa requirements, if applicable. Coordinate with your sponsoring organization and program about documentation, travel and arrival dates.
Confirm orientation details. Ask when orientation begins, what activities are required and whether any preparation can be completed remotely.
Plan your relocation. Research housing, transportation and other essentials in your new community.
Review available benefits. Ask about health insurance, leave policies, employee assistance programs and other resident benefits.

For additional guidance, explore the AAFP's residency preparation checklist.

Preparing to relocate

Moving to a new city—or a new country—requires planning beyond residency paperwork.

As you prepare, consider:

Housing
Research neighborhoods, rental costs, lease requirements and proximity to your hospital or clinic. Ask whether your program offers housing resources or can connect you with current residents.
Transportation
Find out whether you'll need a car, what public transportation is available and how you'll travel between training sites.
Banking and finances
Research how to open a U.S. bank account, receive your salary, establish credit and manage initial moving expenses. Some services may require identification or documentation you won't have until after arrival.
Insurance and health care
Review when your employer-sponsored health insurance begins and whether you'll need coverage during the transition. Ask about options for dependents.
Partner and family needs
If you're relocating with family, consider housing, schools, child care, transportation, health care and available community resources. If immigration authorization is involved, confirm any requirements affecting accompanying family members.

Your residency coordinator may be able to direct you to institutional or community resources.

Questions to ask your residency program before arriving

What paperwork and training must I complete before my start date?
Who should I contact about licensing, credentialing or visa questions?
What is the orientation schedule, and are there activities I can complete remotely?
Are there recommended neighborhoods, housing resources or transportation options?
What benefits and support services are available to residents and their families?
Can I connect with a current resident or mentor before orientation?

Understanding U.S. residency training

Even if you have previous clinical experience, U.S. graduate medical education (GME) may introduce unfamiliar systems, workflows and professional expectations.

Learning how your program operates—and knowing where to ask questions—can make the transition easier.

How U.S. graduate medical education works

Residency combines supervised patient care with structured education, progressive responsibility and ongoing assessment.

Residents work with faculty physicians and other health professionals while developing the knowledge, skills and competencies required for independent practice.

Programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) follow accreditation requirements that establish expectations for training, supervision, evaluation and the learning environment.

Your program will explain its specific policies, curriculum and expectations during orientation.

Clinical systems and documentation

You may encounter new approaches to patient care, including electronic health records (EHRs), clinical documentation, order entry, referrals and care coordination.

Ask your program about:

EHR training and documentation standards
Expectations for patient notes and clinical orders
How laboratory results, referrals and follow-up are managed
Differences between hospital and outpatient clinic workflows
Where to find clinical protocols and institutional policies

You don't need to know every system before arriving. Take advantage of training opportunities and ask questions as you learn.

Understanding health care team roles

U.S. health care teams often include attending physicians, residents, nurses, pharmacists, social workers, medical assistants, care managers and other professionals.

Roles and responsibilities may differ from those in your previous clinical experiences.

During orientation and your first rotations, learn how team members work together, who is responsible for specific tasks and how to communicate concerns.

Communication, handoffs and asking for help

Clear communication is essential to patient safety and effective teamwork.

Your program may use structured approaches to patient handoffs, clinical updates and escalation of urgent concerns.

Ask your faculty and colleagues about:

Expectations for presenting patients and discussing care plans
How to communicate during shift changes and patient handoffs
When to contact a supervising physician
How to raise a concern or clarify an instruction
Which communication tools are used for routine and urgent issues

Asking for help is part of safe clinical practice. If you're uncertain about a clinical decision, workflow or expectation, seek clarification from the appropriate team member or supervisor.

Evaluation, feedback and professional expectations

Residency programs regularly assess clinical performance, professional development and progress toward training milestones.

Feedback may be delivered through formal evaluations, direct observation, coaching and conversations with faculty.

Ask how your program approaches assessment, how often you'll receive feedback and what resources are available if you need additional support.

Professional norms—including communication styles, documentation practices, teamwork and expectations for independence—can vary across institutions and training environments. Don't hesitate to ask your program to explain expectations that may be unfamiliar.

Your first weeks of residency

Orientation and the first weeks of training are opportunities to learn your new environment, meet colleagues and begin developing routines.

What to expect during orientation

Orientation often includes administrative requirements, introductions to program leadership, clinical systems training and information about institutional policies.

Depending on your program, you may also receive training in patient safety, documentation, supervision, emergency procedures and team communication.

Review the schedule in advance and identify any questions you want to ask.

Get familiar with your hospital and clinic

As you begin training, focus on learning the practical details that support daily patient care.

These may include:

Where to find supplies, equipment and clinical resources
How to navigate the EHR and institutional systems
How patient care responsibilities are assigned
Where to find schedules, policies and contact information
How to reach supervisors and other team members

Keep a list of helpful contacts and commonly used resources as you learn.

Build relationships with your team

Introduce yourself to fellow residents, faculty and other members of the health care team.

Learn how your colleagues prefer to communicate and look for opportunities to ask questions, share experiences and support one another.

Connecting with a senior resident or mentor can also help you understand program expectations and navigate unfamiliar situations.

Establish a feedback routine

Consider checking in regularly with your supervising physicians or mentors during your first months.

Questions such as "What am I doing well?" and "What should I focus on improving?" can help you turn feedback into specific learning goals.

Begin exploring your new community

Getting familiar with your surroundings can make everyday life easier.

Find essential services, learn your commute and explore opportunities to connect with people outside your residency program.

Getting established: Build a life outside residency

Adjusting to a new community takes time. Building routines and connections outside work can support your well-being throughout residency.

Find local services and resources

As you settle in, identify nearby grocery stores, pharmacies, health care services, transportation options and other essentials.

Your program, colleagues and local community organizations may be able to recommend resources.

Build social and professional connections

Look for opportunities to connect with fellow residents, mentors and people who share your interests.

Community groups, volunteer organizations, cultural associations and recreational activities can help you establish a sense of belonging outside work.

You can also explore opportunities to connect with the family medicine community through the AAFP.

Support your partner or family

If you're relocating with a partner, children or other family members, ask about resources that can help them adjust to the new community.

These may include school information, child care resources, community organizations and opportunities to meet other resident families.

Stay connected with family and friends

Maintaining relationships with people who are important to you can provide support during a busy and sometimes stressful transition.

Consider establishing regular opportunities to connect with loved ones while also making time to build relationships in your new community.

Take care of your well-being

Residency can be demanding, especially while adjusting to a new environment.

Learn about your program's wellness resources, mental health support, leave policies and employee assistance services. Reach out when you need support.