Navigating UK internal medicine training applications: 10 essential tips

Abstract

Internal medicine training applications in the UK have become increasingly competitive. This article provides ten tips for optimizing internal medicine training applications covering portfolio development, teaching experience, project selection, and interview preparation. We outline strategies for maximizing application scores through efficient resource allocation, effective project selection, and structured interview preparation. These tips are designed to help candidates navigate the competitive selection process while developing skills valuable for their future medical careers.

Introduction

Securing a place in internal medicine training (IMT) is a critical step for doctors aspiring to specialize as physicians within the UK healthcare system. Following completion of Foundation Year Two (F2) training, or its equivalent for international medical graduates (IMGs), doctors become eligible to apply for IMT positions [1]. While the program typically spans three years, certain specialties offer accelerated pathways that are accessible after two years of training. Competition for IMT positions has intensified substantially over the past decade and is expected to continue to increase year-on-year. In 2015, the competition ratio for medical training was 1.7:1, increasing to 3.69:1 in 2024 with 6273 applications for 1698 posts [2]. This trend reflects several significant changes in the UK medical training landscape.

A primary factor is the equitable application process that places UK graduates and IMGs on equal footing for post-foundation training positions. This policy has contributed to workforce diversity, with IMGs constituting more than half of NHS physicians as of 2022 [3] .The General Medical Council projects that IMGs will represent one-third of all UK doctors by 2036, despite planned increases in domestic medical school capacity [3]. The competitive environment is further intensified by application patterns, with approximately 50% of post-F2 trainees simultaneously applying to multiple training programs. Finally, with reduced post-F2 options for trainees, e.g. clinical fellowships and locums, doctors may be more attracted to the stability of training posts. [4].

The IMT selection process, conducted through the Oriel recruitment system, employs a comprehensive assessment framework that includes clinical competencies, academic achievements, and interview performance. A candidate's final ranking determines not only their likelihood of securing a position but also their priority in the allocation of preferred training locations and rotations. This tiered allocation system means higher-ranking candidates have greater flexibility in shaping their training journey to align with their career aspirations and geographical preferences. Therefore, for prospective applicants, understanding these dynamics is essential for developing effective application strategies. Success requires careful attention to application optimization and awareness of how the selection process influences training opportunities. This article presents ten tips to help candidates navigate the competitive IMT application process and maximize their chances of securing preferred training positions.

Tips

The initial application

Tip #1: Start early

Planning your IMT application well in advance is crucial for maximizing success. The optimal time is at least 12 months before the application window opens, allowing time to thoroughly understand the scoring matrix and identify opportunities to strengthen your portfolio. Early preparation enables applicants to systematically review and address gaps in their application, gather necessary documentation, and strategically participate in activities that align with the scoring criteria. Furthermore, completing the application early provides valuable time to focus on interview preparation, including clinical scenarios and management questions. Even for those uncertain about pursuing IMT immediately, submitting an application offers multiple benefits: it maintains career flexibility through a potential training offer, provides essential experience of the interview format, and helps identify areas for professional development.

Tip #2: Establish a professional network

Building strategic professional relationships is a cornerstone of a successful IMT application. The process begins with proactive self-advocacy – making your career aspirations known to senior colleagues and consultants through clear communication and demonstrated enthusiasm. This visibility often leads to opportunities, such as research projects, quality improvement projects (QIPs), and teaching responsibilities, which are frequently allocated to juniors who have established strong departmental connections. A robust professional network serves multiple purposes: experienced colleagues can offer career guidance, recently appointed IMTs can provide invaluable insights into the current application process, and senior clinicians can facilitate mock interviews. The combination of mentorship and practical opportunities that come from a strong professional network can significantly enhance an applicant’s chances of success.

Tip #3: Focus your efforts where they matter most

Understanding and strategically approaching the IMT scoring matrix is fundamental to a competitive application [5]. The matrix, which defines the weighting of scoring across various domains, should serve as a roadmap for portfolio development. It is important to balance personal interest while also being pragmatic about what can be achieved in the time frame. For instance, a single PubMed-indexed second-author paper scores more favorably than multiple incomplete first-author works in progress. Similarly, while large-scale research projects might seem impressive, smaller, well-executed QIPs can often provide better returns within the application timeframe. The key principle is balanced achievement across all scoring domains—prospective applicants should avoid the common pitfall of over-investing in certain areas while neglecting others. For example, pursuing multiple oral presentations beyond the maximum scoring threshold diverts valuable time from other scoring opportunities, such as teaching experience or leadership roles. To maximize your application’s competitiveness, regularly compare your portfolio against the scoring matrix, identify the highest-yield outstanding requirements, and prioritize activities that efficiently close these gaps.

Tip #4: Develop your teaching portfolio

Teaching excellence represents a significant component of the IMT application scoring matrix, offering substantial points through readily accessible opportunities. A strategic approach to teaching can yield high returns while developing essential skills for your medical career. Early engagement with educational supervisors and department leads can help formalize teaching responsibilities, transforming routine clinical interactions, such as bedside teaching, into documented educational achievements. Beyond informal teaching, structured educational activities provide additional scoring opportunities: delivering regular departmental teaching sessions, creating educational resources, participating in formal teaching programs, and obtaining teaching qualifications all contribute to a robust educational portfolio. While gaining formal qualifications like a PGCert or Masters in Medical Education may be unrealistic in the available timeframe, targeted teaching courses, which are often available online, can fulfill the “formal training in teaching” requirement efficiently.

Tip #5: Double up on points

Maximizing your application score often depends on selecting projects that can score points across multiple domains. This approach requires careful planning and identifying projects that can realistically be completed to a high standard within the application timeframe. For example, a well-executed QIP can generate points through multiple scoring sections: the completed project itself, poster presentation at conferences, oral presentations, and potential publication. Similar opportunities exist with clinical audits and research projects. The key is to maintain high quality while targeting multiple scoring domains—a single excellent project that scores in several areas is more valuable than multiple incomplete or rushed projects. Early project planning allows sufficient time to capitalize on all potential scoring opportunities, from initial completion through to presentation and publication stages.

The interview

Tip #6: Interview preparation: the critical success factor

The interview component constitutes 100% of the total IMT selection score and plays a critical role in determining your final ranking and job allocation [6]. The interview format comprises two 11-minute stations, each assessing three distinct areas: Station 1 evaluates application achievements, IMT suitability, and ethical scenarios, while Station 2 focuses on clinical scenarios, including diagnosis, communication, and handover skills [7]. Like preparing for a clinical examination, interview preparation requires systematic study and extensive practice. Candidates should dedicate time to both theoretical preparations—reviewing clinical scenarios, management protocols, and ethical frameworks—and practical interview skills through mock sessions. Utilizing your professional network to arrange full-length mock interviews is essential; experiencing the complete set of interview stations before the actual day provides invaluable preparation. These sessions can help familiarize you with the varying station formats and help identify areas needing improvement. With the complete interview process lasting approximately 30 minutes, every minute must be maximized through focused preparation. It is important to remember that strong candidates often fall short due to interview performance alone, making this preparation crucial for success.

Tip #7: Stand out through effective presentation

The interview offers a crucial opportunity to differentiate yourself from other candidates. Communication skills are paramount and your delivery style should demonstrate the clarity and confidence expected of an IMT trainee. While many candidates will cite common examples of teamwork or time management, scoring highly requires presenting unique experiences that showcase these qualities. Structure your responses using established frameworks like STAR (Situation, Task, Action, Result) to ensure clarity and impact. For example, rather than discussing routine ward leadership, consider highlighting specific and memorable challenging scenarios you have managed effectively, using reflective techniques like “What, So What, Now What” to demonstrate insight and personal development. The key is mastering the “humble brag” technique: every example should strategically demonstrate both a concrete achievement and an essential IMT quality. For instance, when describing a QIP, outline the specific situation (what), explain its significance for patient care (so what), and discuss how this experience shaped your approach to service improvement (now what). This structured approach ensures your examples showcase leadership abilities, analytical skills, and commitment to improvement while demonstrating reflective practice. Remember the interview panel assesses many candidates—your presentation should be memorable for both its content and delivery.

Tip #8: Prepare unique portfolio answers

The portfolio section requires thorough preparation and is often neglected in favor of clinical preparation. Well-structured portfolio discussions can significantly impact your overall performance. Your motivation for pursuing IMT should be articulated through a clear, memorable structure —the “rule of three” approach is particularly effective. For example, rather than generic statements about enjoying acute medicine, structure your answer around three distinct aspects: the diagnostic challenges in acute presentations, the opportunity to develop procedural competencies, and the satisfaction of longitudinal patient care through outpatient clinics.

Familiarity with the IMT curriculum [8] is essential—be prepared to discuss specific elements that align with your career aspirations. Candidates should be ready to discuss what interests them about the curriculum and demonstrate an understanding of how they will achieve the required competencies e.g. making time to attend clinics. This demonstrates both enthusiasm for IMT and realistic understanding of training demands. Remember that interview panels hear numerous similar answers—your response should stand out through memorable, specific examples and personal insights.

Tip #9: Master clinical scenarios: core knowledge and beyond

The clinical stations require systematic preparation and a structured approach. Scenarios typically cover both acute presentations (like the deteriorating patient with respiratory distress) and chronic conditions (such as outpatient anemia management). Your approach should demonstrate core competencies and the “top 1%” difference. Mastering core competencies is essential. Your approach should demonstrate structured assessment using established frameworks (A–E approach), knowledge of key investigations and their interpretation, and familiarity with essential scoring systems (e.g. CHA₂DS₂-VA, CURB-65). Develop systematic management plans that follow current evidence-based guidelines. These fundamentals form the foundation of a strong performance.

To achieve top marks, candidates must go beyond the basics to demonstrate deeper clinical insight. After establishing core competency, distinguish yourself by highlighting critical considerations others might miss. For example, in managing atrial fibrillation with rapid ventricular response, while most candidates will outline standard rate and rhythm control, exceptional candidates will discuss specific contraindications like avoiding beta-blockers in severe asthma. Remember, the interview panels are physicians and assess many candidates—these additional insights help demonstrate clinical maturity and attention to patient safety.

Tip #10: Don’t neglect the ethical scenarios

The ethics question in the interview requires a demonstration of both theoretical understanding and practical application. Applicants should have a key understanding and readiness to discuss the four ethical principles: autonomy, beneficence, non-maleficence, and justice [9]. The General Medical Council’s document “Good Medical Practice” shares professional standards in relation to these ethical principles and should be read as part of interview preparation [10]. Questions can be challenging, and therefore, we recommend answering them using the SPIES structured framework.

Seek information: What is the problem? Gather all relevant facts.

Patient safety: It is critical that this is assessed. Address immediate safety concerns.

Initiative: Can you do anything yourself? What is appropriate?

Escalate: Identify appropriate senior support.

Support: Can you support the individual/team?

Your initiative should demonstrate both practicality and system-wide thinking. For example, in a scenario involving multiple cannula-related infections, while most candidates might suggest individual feedback, exceptional candidates would propose departmental solutions like organizing phlebotomy teaching sessions or developing new cannulation protocols. Remember to demonstrate an understanding of both immediate actions and longer-term quality improvement opportunities.

Conclusion

Successfully securing an IMT position requires careful preparation, strategic planning and a comprehensive understanding of the application process. As competition for training posts intensifies, it’s crucial for candidates to optimize every aspect of their application. The tips outlined in this article provide a framework for approaching both portfolio development and interview preparation systematically. Time is an applicant’s most valuable commodity, and early preparation, strategic project selection, and thorough interview practice are fundamental to success. However, applicants should remember that while scoring highly is important, the skills and experiences gained through this process, from teaching abilities to clinical acumen, contribute to their development as physicians regardless of the immediate outcome. We wish all applicants the best of luck in their applications.

Conflict of interest statement

None to declare.

Funding

None declared.

Data availability

No new data generated or analyzed in this work.

References