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Its challenging to understand which programs are more research-oriented vs clinical focused. Its a catch because you don't want to look unappealing to a program because of "saying the wrong thing" on your personal statement. As an IMG you dont really have the option to pick and chose region, research focus, size, etc. I didnt have a lot of exposure to transplant hepatology or advanced endoscopy in my community residency program and I hope to join a fellowship that is able to provide this. To think that some programs with these opportunities will filter me out because of where I did my residency seems unfair because residency selection was only partially in my hands. The disadvantage is real.The program wants to be sure that 1. They fill every spot and 2. You’d be a good match. In that order.
If it’s a regional program then they are worried that you will not rank them high if you clearly have no ties. They will likely ask you in the interview why you want to be in that region to see if there’s more to it then you are just applying everywhere. Or if you are overqualified or looking for something more research oriented then you might not come if they are more of a regional program (usually less research oriented). They don’t want to be your “backup”.