Applying to Internal Medicine Training (IMT)

The path to becoming a physician in the UK in a medical specialty starts with internal medicine training, a 2-3 year training programme that serves as a gateway to a large range of specialities including cardiology, oncology, and dermatology. In this training programme, doctors are exposed to a wide range of medical specialties, developing doctors with strong clinical acumen in managing acute medical emergencies.

However, over the years, entry to this training programme has become increasingly competitive. This escalating competition reflects the growing number of  physicians aspiring to do a medical specialty. In 2025, >8000 applications were received for roughly 1700 job openings, reflecting an increase of almost 30% of applications.

For early-career resident doctors, this means that simply meeting the minimum requirements is no longer sufficient.

Prior to starting IMT training, I ranked 8th in the country among 4292 applications, scoring full marks in the interview. Having been through the process myself, I know how competitive and rigorous the process is. However, with early consideration and thorough preparation, you can give yourself a good chance.

In this post, I'll share tips about the application process and how you can prepare for the most crucial stage - the interview.

The Application Process

The process of applying for an IMT job is as follows:

1. Application submission
2. Longlisting to check elibility
3. Shortlisting candidates based on scoring
4. Interview
5. Ranking and job matching

It's worth checking the recruitment page for details including key dates. Applications are normally submitted on Oriel. On the form, you will need to include personal details, employment history, as well as self-score on key domains that will be used to shortlist candidates against each other for interview.

Shortlisting

With several thousand applications every year and only 3000-4000 interview slots, the programme use a shortlisting criteria to select candidates for interview. This is an objective (if not arbitrary) assessment of your involvements relevant to a medical career and encompass various domains of governance.

The IMT criteria can be found in more detail here, but the main domains you can score points in are:

• Postgraduate degrees and qualifications
• Presentations/Posters
• Publications (with PubMed ID)
• Teaching Experience
• Training in Teaching
• Quality Improvement Projects

In 2025, from a total of 30 points, the cut-off to get an interview was 15/30.

Use this number as a way to assess your application. Aim above this as it is possible (likely, even) that this will go up as application numbers continue to increase in subsequent years. Also bear in mind that they may change how they shortlist at any point so ensure you check their specific criteria in the year you're applying.

The key is to be aware of this 1-2 years before you plan to submit your application, and start planning your involvements:

• Go through each domain and see how many points you currently score
• Identify whether this is likely enough to get an interview
• Identify domains that are low in points, AND are feasible to increase through a small or short-term project within the timeframe to applications
• Make it a priority to do such a project by reaching out incessantly to senior colleagues

One final note about this is that in the previous few years, candidates were only required to upload evidence of their achievements if they were selected through an audit process. How they select candidates for this audit is unclear. Either way, ensure that you obtain clear documentation and evidence in case this is needed.

Preparing for the Interview

Preparing for the interviews can be stressful, given how important they are in the application process and the vast quantity of scope that can be assessed.

The IMT interview consists of 3 main parts:

1. Portfolio: asking about your previous involvements and why you want to do IMT
2. Clinical scenario: a  scenario which assesses how you approach an acutely unwell patient
3. Ethical scenario: a situation that demands consideration of ethical principles.

I’ve been asked by a few people for advice around interviews, so wanted to share how I prepared and my top tips to stand out. Most of these tips are relevant to other specialties applications as well. I’m hugely indebted to the people who helped me on my journey, so I hope to support those applying in subsequent years.

So here are my key tips for standing out and being that 1%.

Plan and Research

• Planning and researching is key. Know what to expect in the interview, including the separate parts and durations per section. Know where the marks are, and where to focus your revision time. Several weeks before your interview, figure out how much work you want to do and divide that by the number of available days to keep yourself accountable. Speak to current IMTs to know what the expectation is, what typically comes up.
• Know what the expectation is. They are recruiting you to be IMT trainees - you need to demonstrate you are good enough to be one. Skim through the IMT person specification. If you’re an overseas trainee without much experience in the NHS, it’s worthwhile speaking to medical SHOs to understand their job roles.
• Find the right resources: there are loads out there. I used the ISCMedical Interview book, and Medibuddy for clinical and ethical scenarios. You don't need to do any courses as I think it’s more about presentation style and learning content, but I’d really recommend finding a study buddy (or multiple) applying on your cycle to practice regularly.
• Compile a list of every possible question that can come up. Portfolio questions are the typical ones you find in the interview book. Clinical questions are scenarios that they would expect you to have the competency to manage as an IMT1. Ethical questions are the typical ones such as in SJTs but you have to be comfortable explaining through them. I liked Medibuddy as a resource because it gave a pretty comprehensive list of clinical + ethical scenarios.

Portfolio

People love stories, so turn your journey into a convincing narrative of why you want to do internal medicine, what you’ve learned from your experiences, and why you would be a good fit.

PERFECT your 2 pre-prepared minute portfolio presentation. You already know this will be an important part of your application, there’s no excuse not to. People love stories, so turn your journey into a convincing narrative of why you want to do internal medicine, what you’ve learned from your experiences, and why you would be a good fit. Be broad and cover CAMP: Clinical, Academic, Managerial, Personal. Align it to the IMT person specification (you can namedrop certain aspects from this document as a ‘desirable quality’). Practice it, over and over, to as many different people as you can. Rewrite it, and perfect the delivery (one useful technique is recording yourself).

• The questions that typically come up are very predictable portfolio questions. It’s worth writing down an answer / key bullet points for as many as you can. You’ll need them for registrar interview preparation anyways. This includes having example scenarios prepared for the common ‘tell me about a time you demonstrated…’. questions. This includes but is not limited to: leadership, problem-solving, good communication, kindness and compassion. You can adapt the same scenario for several of these.
• When talking about experiences, have a structure and always find the reflective takeaways to link back to relevance to IMT. A good way is to phrase it is: I did 'x' which involved me doing… I learned that… I believe this experience has equipped me well for IMT because…
  

Clinical Scenario

The extra thoughtful points are what separates the top candidates - aspects of consideration that make the interviewers go ‘I would like them as my IMT1’.

• Know the basics inside out. There is no margin for error for bread and butter things like A-E (rehearse this to perfection as it comes up in >50%) and management of common conditions like pneumonia, PE, or ACS. Be well rehearsed in talking through these common scenarios.
• Have a systematic structure for how you approach scenarios. This can be something like A-E -> Investigations -> Diagnosis -> Management -> Other. I wrote out each of these subsections and made a tickbox of things so I wouldn’t forget - for example, in ‘other’ it would be things like specialty referral, explaining treatments + side effects to patient, updating family, MDT involvement (OTPT, SALT), treatment escalation planning. I then rehearsed it through my scenarios and finessed it.
• The interviewers want to know that you are safe and competent as an IMT1. However, the extra thoughtful points are what separates the top candidates - aspects of consideration that make the interviewers go ‘I would like them as my IMT1’. One helpful way to picture this is to try to think ahead of your level: what would your registrar would say in this situation? Demonstrate you are thinking about the next steps beyond the acute management.
• Examples of ways to demonstrate this: sending off comprehensive blood tests (where relevant), including things like vitamin B12+folate/bone profile,iron. If you are thinking about other differentials, mention them and say how you would test for them. For geriatrics patients, asking for a comprehensive geriatric assessment and assessing falls/osteoporosis risk. For strokes - considering nutrition, SALT, and rehabilitation. Knowing specific relevant guidelines like King’s College Liver Transplant criteria for paracetamol overdose, and scoring systems for UGI bleed. Finally, a big one if they are old/unwell: ESCALATION PLANNING (a good one because it is commonly a senior-led decision so you can demonstrate proactive thinking). Have you thought about patient wishes and updating family?
• PRACTICE HANDOVERS: it’s only 1 minute but worth valuable marks. Have a clear structure (like SBAR) but be comfortable adapting. It can be hard to remember all the key details to handover in the heat of the moment: the way I got around this was underlining important aspects of the clinical scenario as I went along the interview, and using any small pockets of time during to write out a very brief summary handover in the top right-hand corner.

Ethical Scenario

• Common sense and calm mannerism play a big role in this station, but there’s a good amount of preparation you can do too.
• There are several broad categories of scenarios that can come up - confidentiality, challenging colleague or conflict, safeguarding etc. - make sure you are familiar with them. Have a good understanding of the core issues behind each of them, and be confident in discussing in detail why it’s a problem and what you would do about it. Know when to escalate, who to escalate to.
• Get used to identifying which ‘category’ of question it is as quick as possible as this will allow you to have a mental template ready for the discussion. In your interview, you’ll have to listen to the prompt and respond without any down-time. Practice highlighting the pertinent issues immediately as the interviewer reads it out (I wrote down key points on my paper during the read-out).
• The way I structured my answers was 1) state the key issues and what area of ethics there are concerns about such as confidentiality, patient safety 2) explain why each of them are issues and any foreseeable consequences 3) Immediate actions 4) next steps, escalation 5) provide support to involved colleague/patient.
• It’s definitely worth skimming through Good Medical Practice. Ensure you reference it in your answer at least once.

Additional Points

• Unfortunately with the arbitrary marking there is very little room for error if you want your top choice job - it pays to be prepared.
• PRACTICE: Ultimately, the more practice you do, the better prepared you will be for a wider range of scenarios and questions. It’s helpful to practice with a few people - also observe how other people answer questions and absorb any good techniques.
• Try to have a systematic framework for most things you approach in the interview such as clinical and ethical scenarios, specific portfolio questions. This ensures you don’t get caught out on the day.
• On the day: Try to build a rapport with your interviewers. Remember to smile, sit forwards, seem enthusiastic and caring. Give them a reason to want to see you succeed!

Summary

Whilst a rigorous application process, it's possible to plan thoroughly and prepare for the interview in a way that gives you the best chance of success. With the increasing competition ratios, this is becoming essential, particularly if are hoping to remain in a specific region or hospital.

I hope this guide has been valuable to you in some way, and wish you all the best of luck in your applications. If this has been helpful, I'll consider releasing more articles and content on interviews and MRCP preparation so please do let me know!