Questions to Ask Internal Medicine Residency Programs
These are questions for a fourth-year medical student, or any other applicant, to put to residents, faculty and the program director on an internal medicine interview day. They begin on the general medicine wards, with team size, caps and how admissions arrive, then move through the ICU and nights, the X+Y schedule and continuity clinic, teaching and supervision, and the fellowship, hospitalist and primary care paths, and they end with what the residents themselves would change. The list assumes the US match, and because caps, call rules and procedure requirements are set by the accrediting body, the board and each hospital, the questions ask how each one stands at the program in front of you.
The questions
Each question, and why to ask it
Wards
How is a general medicine ward team made up here, and how many patients does it carry on an ordinary day?
Why ask it
The usual shape is an attending, a senior resident, one or two interns and students, but the numbers differ from one hospital to the next. Ask for the census the team had this morning, not the one on the slide. A team that lives at its ceiling teaches differently from one that sits a few patients under it.
What is the cap on an intern's patients, and how often do the teams sit at it?
Why ask it
The accrediting body sets a ceiling and some programs set their own below it, so ask which number is in force here. The second half matters more: a cap reached most days is the real workload, and a cap rarely touched is only a rule. Put it to an intern, who will know how last week went.
How do admissions reach a team: all on a long-call day, a few every day, or through a separate admitting resident?
Why ask it
Call days bunch the work into one long day and leave quieter ones for teaching. A few every day, which you may hear called a drip system, spreads it out and leaves no day for catching up. Residents who have worked under both will tell you which they would design if it were up to them.
Is there a hospitalist or non-teaching service that takes patients once the resident teams are capped?
Why ask it
Where one exists, the cap can hold and the teaching teams can be given the patients worth learning from. Where it does not, ask what happened the last time the hospital was full, because that is when a firm cap turns soft.
How much of the inpatient time is general medicine, and how much is subspecialty services such as cardiology, oncology or liver?
Why ask it
The block schedule on the program's website usually shows the split, so count the months before you ask. A heavy subspecialty load suits someone heading for fellowship, while a future hospitalist or generalist may want more months of undifferentiated medicine. A senior resident can say which mix they got and whether they would rebalance it.
On the subspecialty ward services, does the resident run the patient's care or carry out a fellow's plan?
Why ask it
On a cardiology or oncology service the fellow may teach you the field, or may stand between you and every decision. Two details settle it: who calls the consults, and who the nurses page first. If it changes from service to service, get the names of the ones where the resident is in charge.
Which hospitals do medicine residents rotate through, and what does each one teach that the others do not?
Why ask it
Medicine programs often use more than one site, such as a university hospital, a veterans hospital and a public or community hospital, each with its own records system, patients and pace. Get the number of months at each and the travel between them. Residents usually have a favorite, and their reason tells you what they came to learn.
Are rounds at the bedside, in the hallway or around a table, and what time are they usually done?
Why ask it
A program tends to have a house style, and each style favors something: the exam at the bedside, the reasoning at the table. The finishing time decides whether an intern's afternoon is for doing the work or for catching up on it. Ask about a post-call day as well as a quiet one.
Are a team's patients kept on one unit, or spread across the hospital?
Why ask it
Geographic teams know their nurses and lose less of the day to stairwells and elevators. Scattered lists are common when a hospital is full. If the program says its teams are geographic, ask what share of this week's list was on the home unit.
On an admitting day, how many new patients does an intern work up, and do they see them before the plan is already set?
Why ask it
An admission that arrives with the workup finished and the orders written overnight is a patient to inherit, not one to think through. Ask how many of the last call day's admissions the intern met first. That count is closer to the real learning than the total.
When the emergency department wants to admit a patient and the medicine resident disagrees, who settles it?
Why ask it
Medicine tends to be the default admitting service, so the disagreement comes up on most call days. Some hospitals give the call to a triage attending or a medical admitting resident, and at others the team's senior argues it out between admissions. A second-year's most recent example shows how much of a call day goes to the phone.
ICU and nights
How many months of intensive care do residents do, and in which units?
Why ask it
Medical and cardiac units are the common ones, and some programs add others. Find out in which year the first unit month falls, and whether the unit is closed, with its own team writing every order, or open to each patient's outside attending. Anyone leaning toward critical care or cardiology should ask whether extra unit time can be arranged.
Do residents place the central lines and arterial lines in the ICU, or do fellows and a procedure team take them?
Why ask it
Applicants differ on this as much as programs do: some want every line they can get and some are glad to skip them. A third-year can tell you how many of each they have done and whether they would be comfortable doing one unsupervised. Procedure requirements change, so ask what the program itself expects by graduation.
Is an intensivist in the unit overnight, or is the resident phoning one at home?
Why ask it
Neither arrangement is better in itself. An attending in the building means more help at 3 a.m. and sometimes less room to decide, and home call means the reverse. Listen for how the residents feel about making that call, and whether anyone has been made to regret it.
Is night float a block of its own or a week inside the ward month, and how many weeks of it are there each year?
Why ask it
The total matters, and so does the spacing. Six nights in a row once a month and a two-week block twice a year are both called night float and feel nothing alike. Ask how the switch back to days is handled and whether a day off sits on either side.
Overnight, is cross-cover separate from admitting, or does one resident do both?
Why ask it
A resident who is admitting while answering pages for several teams' patients is doing two jobs at once. Get the number of patients the cross-cover person holds and the point at which they are expected to wake the senior. Then ask a night intern whether the split survives a busy night.
Does any rotation still have 24-hour call, and which one?
Why ask it
Some programs have moved entirely to shifts and others keep long call in the ICU or at one site. Applicants are divided on which they prefer, so ask what the residents think the long call buys them. If the answer is continuity with the patient, ask what time the post-call resident really leaves.
When the night team admits a patient, who presents that patient in the morning?
Why ask it
If the admitting resident stays for rounds, the day team hears the reasoning and the night resident finds out whether they were right. If the patient is handed over on a list, both are lost. A good follow-up is whether night residents ever hear how their admissions turned out.
Who leads codes and rapid responses on the medicine floors, and from which year?
Why ask it
In many hospitals this falls to medicine residents, and graduates tend to remember whether they felt ready for it. Ask whether there is simulation before the first real one, and whether someone talks it through with the team afterward.
X+Y and clinic
Is the schedule X+Y, and which version: 4+1, 6+2, 3+1 or something else?
Why ask it
The first number is the stretch of inpatient or elective weeks and the second is the clinic stretch. In general a shorter cycle brings you back to your own patients sooner, and a longer one means fewer changes of team on the wards. If the program still runs a weekly clinic half day through ward months, ask how an intern gets out of the hospital for it.
What fills the clinic week besides continuity clinic?
Why ask it
The ambulatory week often holds subspecialty clinics, an academic half day, quality improvement time and an administrative half day. Ask to see one resident's actual week. If every half day is booked, it is not the breather it gets described as.
Are the weekends around the clinic week free, or is that when residents cover the wards and nights?
Why ask it
A free weekend on either side of the clinic week is one of the things X+Y is sold on, and some programs draw their weekend ward and night coverage from that same pool. Ask a resident how many of their last four clinic weekends they had to themselves. For the ward weeks, the matching figure is days off in the block.
Does every resident have the same continuity clinic site, or are there several with different patients?
Why ask it
A hospital-based faculty practice, a veterans clinic and a community health center are three different educations in outpatient medicine. Ask how sites are assigned, whether a preference counts, and whether you keep one site for all three years.
When a third-year graduates, who takes over their clinic patients?
Why ask it
A panel handed down from a named resident, with a note on each complicated patient, means you start with people who expect a doctor. Ask how many of an intern's first-month visits are inherited patients and how many are whoever was on the schedule.
During the inpatient weeks, are you still answering clinic messages and refill requests?
Why ask it
X+Y is meant to keep the two jobs apart, but the inbox does not know what week it is. Some clinics pair each resident with a partner in the opposite cohort. Ask the resident in front of you who covered their inbox last month and whether anything was missed.
Does the same attending precept you each clinic week?
Why ask it
A preceptor who knows your patients can let you manage more, and can say in the third year how you have changed since the first. Rotating preceptors give variety and less of both. Either way, find out how many residents one preceptor supervises in a session.
Is jeopardy pulled from the clinic week, and how often were you called in from it last year?
Why ask it
Someone has to cover when a resident is ill, and the clinic week is where many schedules look first. Ask for a count, and ask whether a jeopardy call is paid back with a day off. The patients who were booked to see that resident have to go somewhere too, and where they go says how the clinic is valued.
Which outpatient subspecialty clinics can a resident choose, and from what year?
Why ask it
Rheumatology, endocrinology and allergy are practiced largely in clinic, so a resident curious about them needs outpatient time early. Ask whether those half days are picked by the resident or assigned, and whether one clinic can be repeated so that you see the same patients come back.
Teaching
On rounds, who proposes the plan: the intern, the senior resident or the attending?
Why ask it
Listen for the order. Where the intern commits first and is corrected, people learn to decide. Where the attending announces and the team writes it down, rounds are quicker and the learning is thinner. If the day includes sitting in on rounds or morning report, you will see which it is without asking.
What changes between the last month of intern year and the first month as the team's senior?
Why ask it
The move from carrying patients to running the team usually comes at the start of the second year, and how much preparation comes with it is up to the program. It might be a transition retreat, a stretch paired with an outgoing senior, or nothing at all. New second-years remember exactly how ready they felt.
Are ward attendings mostly hospitalists, general internists or subspecialists doing their weeks on service?
Why ask it
Hospitalists know the building and its systems, subspecialists bring depth in their own field, and a generalist who also has a clinic thinks about what happens after discharge. How long an attending stays with a team counts as well, since two weeks with one teacher is different from a change every Monday.
Is there morning report, noon conference or an academic half day, and who holds the pager while you are in it?
Why ask it
The format matters less than whether residents can attend with their attention intact. Ask who presents at morning report and whether interns get there. If pagers are handed off during teaching, ask to whom, and whether the nurses know.
How often does an attending watch you examine a patient or lead a hard conversation, and tell you what they saw?
Why ask it
Feedback built on a presentation measures how well you present. Ask residents when they were last observed at the bedside. If nobody can remember, the evaluations are being written from the hallway.
Do residents use bedside ultrasound on the wards, and does anyone review their images?
Why ask it
The word curriculum covers a lot here, so ask what a second-year can do with the probe that an intern cannot. Saved images that a faculty member goes over are the sign that someone is checking. Count the machines too: one shared among every ward team is hard to get hold of on rounds.
Is there a procedure service, and can a resident who wants paracentesis, thoracentesis and lumbar puncture experience rotate on it?
Why ask it
A procedure team can mean supervised practice, or it can mean residents never pick up a needle. Find out which by asking who did the last paracentesis on a ward team's patient. A future hospitalist should also ask what graduates are signed off to do when they start work, since each hospital decides that for itself.
What is the program's first-time pass rate on the internal medicine boards over the last three years?
Why ask it
Program pass rates are generally published by the certifying board, so look the figure up first and ask about the story behind it. One poor year in a small program can be two people. The part to listen for is what the program did next, and what follows a low score on the in-training exam.
Careers
Can I see the fellowship match list for the last three years, including the residents who did not match?
Why ask it
A list of where people went leaves out who applied and missed. Ask how many applied in each field and what the unmatched residents did the following year. Three years evens out a class that happened to be full of cardiologists.
Of the last graduating class, how many went to fellowship, how many into hospital medicine and how many into primary care?
Why ask it
Ask for counts, not a slide of hospital logos. A class that nearly all subspecializes raises the question of who advises the resident who wants general medicine. A class with few fellows raises the opposite one: how hard the program works for those who do apply.
Which kind of internist does this program train best: a subspecialist, a hospitalist, a primary care doctor or a physician-scientist?
Why ask it
Put this one to the program director. 'All four equally' is not an answer, so follow up by asking which outcome the program is proudest of and which it is still building. Then weigh that against the doctor you expect to be, allowing that many residents change their minds.
How many residents stay for this institution's own fellowships, and how many leave to train elsewhere?
Why ask it
A high stay-on rate can mean the fellowships value their own residents, or that other places do not know them. Ask which of the home fellowships regularly take internal candidates. If the field you want has no fellowship here, ask who those residents worked with and where they ended up.
Does the intern-year schedule leave room to work with the subspecialty I want before fellowship applications are due?
Why ask it
Residents who go straight on to fellowship usually apply around the start of the third year, so the months that produce letters fall in the first two. A schedule that saves its electives for the end is no help with that. Check the current application calendar yourself, since the dates move.
Who writes the program's letter for fellowship applications, and how do they come to know each resident well enough?
Why ask it
In a large class the director or chair may be writing about someone they have met a handful of times. Ask whether there are regular one-to-one meetings, and whether an associate director or advisor follows each resident through all three years. Chiefs know how the letters get made.
How does an intern with no contacts here find a research mentor, and how long before a project is under way?
Why ask it
Programs that take this seriously tend to have a list of faculty with projects sized for a resident, a director of resident research, or a matching event early in the year. Ask a second-year how they found theirs. If they emailed around for months, plan on doing the same.
Does the program offer a research pathway that shortens clinical training, and how are residents chosen for it?
Why ask it
Some programs support a physician-scientist route that moves a resident into fellowship and the lab sooner. The rules belong to the certifying board and the details to the program, so ask how it works here and when the decision has to be made. Ask as well what happened to the last resident who started it and changed their mind.
How is a primary care track resident's schedule different from a categorical resident's, month by month?
Why ask it
A track can be a different residency or a label on the same one. Ask how much more outpatient time it has, where that clinic is, and whether it is ranked separately in the match. Then ask what the track's graduates are doing now, since some tracks send plenty of their residents to fellowship.
What does the program offer a resident who plans to be a hospitalist, beyond more ward months?
Why ask it
Look for what the teaching wards leave out: consult medicine, care around surgery, billing and documentation, a rotation at a community hospital with no other residents. It also helps to know whether the hospital medicine group mentors residents and whether it hires them.
Is the chief year a fourth year after graduation, and what have recent chiefs gone on to do?
Why ask it
Some medicine programs keep chiefs on for an added year and others place the role inside the third year, so ask which it is here. The answer tells you who runs the schedule and morning report, and whether you might want that year yourself. A chief is also a good person for nearly every question in the Wards group.
The residents
If the medicine residents could change one thing about the program this year, what would it be?
Why ask it
Ask more than one resident, separately if you can. The same answer twice is the program's known weak spot, and the next thing to find out is whether leadership knows it too. A resident who can think of nothing is being polite.
What is the most recent change that came from resident feedback, and how long did it take?
Why ask it
A date and a concrete change, such as a moved night float week or a new admitting rule, show that the route from complaint to decision works. Ask the director the same thing and compare the two versions.
Which month of intern year is the hardest here, and what makes it hard?
Why ask it
Listen for the reason. Hard because the patients are sick and the teaching is intense is what you came for. Hard because of thin staffing, a difficult site or work nobody learns from is a cost, and it is fair to ask what is being done about it.
What do you know about this program now that you could not have learned on your interview day?
Why ask it
It invites whatever is not on the slides, good or bad, without asking anyone to complain. Interns give the freshest answers, because they sat where you are sitting a year ago.
With the class divided into clinic cohorts, how well do you know the residents outside yours?
Why ask it
X+Y scheduling puts the same group in clinic together every cycle, which makes for a close cohort and can leave the rest of a big class as names on a list. Ask what brings the whole class into one room and how often it happens.
How many preliminary interns are in the class, and do they share teams and call with the categorical interns?
Why ask it
Preliminary interns leave after a year for another specialty, which changes who is on the wards beside you and how many seniors there are later. Ask whether their schedule matches yours or leans toward ward months. If you are applying for a preliminary spot yourself, ask which electives it allows.
Sizing up a medicine program on interview day
Practical guidance for the conversation itself
Start from the block schedule
Count the months before you ask
Most medicine programs post a sample schedule for each year. Count the general ward months, the subspecialty ward months, the ICU months, the night weeks and the electives, and bring the totals with you. Then a question can start from what is printed: 'The sample shows five ward months for interns. How many of those are at the main hospital?'
Write down the clinic pattern
Note whether the program runs 4+1, 6+2, 3+1 or a weekly half day, and what the sample says happens in the clinic week. The grid gives you the rhythm. It leaves out who answers the inbox during ward weeks and where weekend coverage comes from, which is what the X+Y and clinic group is for.
Look up what is public
Board pass rates, accreditation status and the fellowships the institution runs can usually be found without asking anyone. Keep the interview for what cannot be looked up: how often the cap is reached, whether a full hospital bends it, what the residents would change.
Sort the questions by who can answer
Caps, admitting days, cross-cover and the clinic inbox belong with interns, who are living them this month. Second and third-years know how the step up to leading a team went and how their fellowship applications were supported, and chiefs build the schedule, so they know how jeopardy is used. A faculty interviewer can speak to how they teach on rounds and whether they take residents onto their projects.
What to press on, by where you are headed
Toward a subspecialty fellowship
Spend your time on Careers and on the subspecialty services under Wards. What you need to leave with is when the first elective comes, who the residents in your field worked with, and the match record with the misses counted. If the field you want has no division here, ask where those residents found their mentors.
Toward hospital medicine
Press on the general medicine wards: the census, the admitting system, who leads codes and which procedures graduates are signed off to do. A program where fellows direct most of the inpatient services may leave a future hospitalist short of patients who were theirs to manage. Ask whether the hospital medicine group teaches residents and whether it hires them.
Toward primary care
The X+Y and clinic group is yours. One site or several, an inherited panel, a steady preceptor and a choice of outpatient subspecialty clinics decide how much office medicine a resident learns. Ask a recent graduate in practice what the first month on their own showed they had and had not been taught.
Not sure yet
Plenty of applicants are, and plenty who feel sure change course during training. You do not have to name a fellowship in every room. Say what you are curious about, ask how residents here made up their minds, and look at whether recent classes scattered across fellowship, hospital medicine and primary care or all went one way.
For a preliminary year
Your year is mostly wards and nights, so those two groups carry the weight. Ask whether preliminary interns get the same teams, caps and conferences as categorical ones, and which electives the year allows.
Words that mean different things at different programs
'Cap'
It may mean the accrediting body's limit, a lower number the program chose, or a figure that bends when the hospital is full. Ask which, and ask how a team finds out it has reached it.
'X+Y'
Two programs with the same numbers can run very different clinic weeks. One fills it with continuity clinic and teaching, and another treats it as the pool for covering sick calls. The label tells you the rhythm, and only a resident's calendar tells you the content.
'Night float'
Find out whether it admits, cross-covers or both, how long a stretch lasts, and whether interns and seniors do the same number of weeks.
'Graduated autonomy'
Every program says it. The version worth having can be described in steps: what an intern decides alone in the first months, what changes by spring, what a senior does without calling. If nobody can describe the steps, ask for the last decision a resident made that the attending heard about afterward.
'Strong fellowship match'
Strong in what, and for whom? A program can place well in one field through one well-connected division and have little to say about the others. Ask about your own likely field by name.
Easy ways to waste the day
Asking the director what an intern knows better
Keep the director for direction: the kind of internist the program trains best, the match record with the misses included, the pass rate and what was done about a bad year, and what is about to change. How many patients an intern carried last Tuesday is an intern's question, and asking it there spends the one conversation with the person who sets the course.
Taking the flagship hospital for the whole program
Interview days tend to show the main hospital. If a third of the ward months are at a veterans or county hospital, the caps, the records system and the night coverage may all be different there, so find a resident who has just come back from it.
Reading a heavy census as good training, or a light one
Volume with no time to think is service, and a quiet service with no decisions to make is not training either. You are looking for the program where residents are busy and can still say what they learned last week.
Letting the programs run together
After the fourth program the 4+1 schedules and the cap numbers blur. That evening, write down the figures you were given and who gave them, in the same order each time, and the one thing a resident said that you did not expect.