Internal Medicine Training (IMT) is the largest hospital-based training program outside of the foundation program and is second only to GP training in size, with 1677 posts available in 2025.
Whether you want to become a world-class generalist or fancy yourself a career in the medical specialities, the traditional training pathway is through IMT.
In this article, we'll walk you through:
- How to Apply
- Competition Ratios
- The Application Process
- How to Choose Your Preferences
Experience and Advice from High-Scoring Candidates
Justin, Priyanka, and Sashi have generously contributed to this article with their tips, advice, and experience. They all aced their applications and work with Optimise Interviews to help applicants nail their IMT Application and Interview.
Dr Justin Chiong
Justin studied medicine at the University of Edinburgh and did his foundation years in Scotland, during which he successfully completed a part-time MSc in Clinical Education.
He subsequently moved to the Northwest to continue his training as an NIHR Cardiology Academic Clinical Fellow, and IMT.
Dr Priyanka Gandhi
Priyanka studied Medicine at the University of East Anglia. She enjoys teaching and pursued an intercalated degree in Medical Education at the University of Leeds.
Now she teaches in various capacities from face-to-face to online-based platforms. More recently, she has started as an IMT 1 trainee in the North West.
Dr Sashiananthan Ganesananthan
Sashi studied Medicine at Cardiff University. Following graduation, he completed the academic foundation programme at Imperial College London.
He enjoys teaching and has completed a PgCert in Clinical Education at the University of Edinburgh, leading a 9-month international teaching programme.
If this advice is useful, you should also check out the Optimise IMT course to help you nail your IMT application.
Key Documents
- Oriel User Guide
- IMT Person Specification 2026
- IMT Recruitment 2026 Round 1: Applicants’ Guide
IMT Recruitment Timeline
August 2026 Start Date (Round 1)
| Stage | Date / Time |
|---|---|
| Vacancies published | Wednesday 22nd October 2025 by 5pm |
| Applications open | Thursday 23rd October 2025 at 10am |
| Applications close | Thursday 20th November 2025 at 4pm |
| Longlisting close | Tuesday 16th December 2025 |
| Invitation to interview | By Thursday 18th December 2025 |
| Interview booking deadline | First invites – Monday 22nd December 2025Second invites – Monday 29th December 2025 |
| Interview window | Monday 12th January – Friday 13th February 2026 |
| Rankings released | Tuesday 24th February 2026 |
| Programme preferences | Tuesday 24th February – Monday 16th March 2026 |
| Initial offers out | Tuesday 24th March 2026 |
| Hold deadline | Thursday 2nd April 2026 at 1pm |
| Upgrade deadline | Wednesday 8th April 2026 at 4pm |
| Post start date | Wednesday 5th August 2026 |
The IMT Application in 2026
IMT application takes place via the Oriel portal, similar to foundation training. In the portal, you can register your application, fill in all your personal and professional details, and manage your application – book interviews for IMT, preference programmes, and manage offers. The Oriel portal allows you to register for IMT recruitment after the application open date.
When registering for an account make sure you use an email you check often – interview confirmation and offer updates will be sent through to this email, and you will only have 48 hours to respond to offers from the time the email was sent!
How Competitive is IMT?
The application process for IMT is indeed competitive, with a competition ratio of 5.27 in 2025. In last year's application process, there were 8841 applicants for 1677 posts. This has been rising significantly since 2021.
All is not lost.
In our application scoring article, we calculated that the score required on the application form that meant you got an interview was roughly 10/40.
Priyanka's Advice on Building a Competitive Application
If you know what you need for your application, then you can treat it like a checklist.
By December I had been asking many different consultants whether they had a QI project. I could get involved in and was able to start this in January and then present our findings in June. So I had this all sorted and ticked off in foundation year one.
Conducting a QIP on a psychiatry rotation won me an award at a local meeting and the skills from this were transferrable for IMT. It just helped that I prepared early, I would not have been able to take off all these boxes before it came time for submitting my application.
The IMT application form window opens in November (the application for the workshop course by Optimise Interviews is in October) so you really need to have as much as possible finished by then so you can start focusing on interview practice.
The IMT Recruitment Process
IMT medical recruitment is usually held in two rounds. However, due to high fill rates and competition ratio, in 2023/24 only one round of recruitment will be held.
The training programme is designed to recruit directly from the foundation programme, and from those who have achieved foundation competencies either through the foundation programme or through International Medical Graduates (IMGs) who have at least 12 months of experience following full GMC registration.
Eligibility Criteria for IMT Recruitment
- MBBS or equivalent medical qualification
- Full registration with the GMC at the intended start date
- Evidence of foundation competencies in the previous 3.5 years from the start date. Those eligible includes:
- Currently in a UKFPO-affiliated foundation program
- Evidence of completion of a UKFPO-affiliated foundation program (FPCC or FACD 5.2)
- 12 months of medical experience following full GMC registration and completion of “Certificate of Readiness to Enter Specialty Training” (CREST)
- English language skills as required for GMC registration
- Health & fitness to practise requirements as per GMC standards
- Evidence of employment history
If you have previously left a medical core training programme (IMT, CMT, or ACCS-AM) you must provide evidence of exceptional circumstances to apply. If you have left a foundation programme and thus failed to gain an FPCC or FACD 5.2 certificate, you must also provide prove exceptional circumstances in addition to evidence of appropriate remediation.
Applications open around November the year before the August start date. Recruitment to IMT takes place in two rounds, with the second round advertising any unfilled places and new places that weren’t available for round 1 (unlikely with a near 100% fill rate).
Following application submission, your application will be checked to ensure you meet the eligibility criteria above. If you meet the requirements, you will be longlisted, and if not, you will be asked to supply further information.
Shortlisting for IMT medical application is essentially the process of cutting down from the longlist so that all shortlisted candidates can be interviewed. If the interview capacity allows, all longlisted candidates will also be shortlisted, but generally, some candidates have their applications rejected at this point based on their self-assessment application score.
The IMT Application Form
The application form contains text boxes, drop-down menus, and checkboxes for you to fill in the relevant details for each section. You can save your application as you go along, so if you don’t have all the information to hand or want to review it before you submit you should save the application and come back to it later.
Sashi's Advice for the Application
Look at the application criteria/points scores as early as possible for both core speciality and speciality training as many things do overlap.
The more you can get done earlier (even as a student!), the less pressured you will be towards the application period.
With this, write a CV for yourself, editing it every month with any achievements and get all the paperwork to satisfy this there and then.
We all end up with more achievements than we ever remember and putting it all in one place makes application periods a lot easier and less stressful. It’s a bane to do at first but gets easier over time.
The application form is split into four parts, each of which has details to fill in.
Part 1 – Personal and Employment Details
This part requires basic personal details and facts about your employment to date.
| Personal | Contact information, personal details, and details of your right to work in the UK (citizenship, visa etc). |
| Equality and Diversity | Anonymised details around ethnic origin, gender, sexuality, religious beliefs etc. You can choose not to answer most of these questions by selecting “I don’t want to disclose my ____”. |
| Employment History | 3 years of employment history including any gaps of over 28 days. If you were still at university for the past 3 years you can explain this on the form. |
Part 2 – Eligibility and References
This part asks for more details on your eligibility to apply for IMT and references from consultants.
| Training History | Details about whether you have previously left a core medical training programme, require disability arrangements, and what your GMC registration status is. |
| References | Details of three referees who have supervised your clinical training during the past two years of employment, or undergraduate training, including your most recent consultant or educational supervisor. |
| Fitness to practice | Questions on your fitness to practice including criminal record and previous fitness to practice tribunals. |
| Declarations | Declarations you must agree to before you apply. |
| Competence and Eligibility | Details of evidence you have for foundation competence and primary medical qualification. For IMGs this might include if you have taken the PLAB exam. This is also where you should detail any reductions you seek in training for previous experience in specialities that have transferable competencies (ACCS subspecialties). |
Part 3 – Evidence and Supporting Information
This part asks for evidence of the score you are claiming in part 4 – self-assessment. It also asks for more written information to support your application. You should answer part 4 first, then use this section to give evidence for your claims.
In the evidence question, you will be asked for supporting text to justify why you have chosen the score for each section of the self-assessment form. You don’t have to upload the evidence, but you should have it available as you may be asked to supply this.
In the supporting section, you will also be asked about MRCP(UK) examinations, commitment to speciality, interests outside of medicine, and training courses you have attended.
These questions don’t affect your application score but can be addressed during the interview. For this reason, it’s worth thinking about what you include in this section, making sure you list any achievements or impressive feats that you’ll want to bring up in the interview.
Part 4 - Portfolio Self-Assessment
This is the big one - your self-assessment score will determine whether you get an interview or not.
In this section, you will be asked to choose the most appropriate point-scoring category for each of the 8 domains assessed during your application. Based on this information, you will be given a score out of 40 which will be used to remove candidates from the process when there isn't capacity to interview everyone (roughly 15% were removed due to their score in 2023).
This is probably the most important part of the whole application process, right up until you get to the interview. If you want to know how you can ace the self-assessment, see our article.
Justin's Advice on Maximising Your Score
My advice would be to look at the scoring criteria as early as possible.
Compare it against your current CV, identify the gaps and see how you can maximise your points. This must fit in realistically with the amount of time left till the application deadline, so the earlier the better!
For instance, coming out of medical school, I looked at the IMT and ST applications and noticed that I did not have any post-graduate qualifications, teaching experience or teaching qualifications – 3 domains worth of points!
I identified this in good time and realised that I would be able to complete a part-time MSc in Clinical Education (which I funded with the help of a bursary I had applied for) that would tick all 3 boxes, putting me in a much stronger position as an applicant. This would not have been possible had I not looked at the scoring matrixes early.
Also worth noting that even if you didn’t look at things as early, there will almost always be ways that you can score easy wins i.e through short courses/QIPs/presentations in a short amount of time.
A few extra points go a long way in ranking, especially in IMT applications where there are a large number of applicants.
The Interview
Interviews are usually held in the first few months of the year. Previously interviews were performed face to face with three stations involving questions on your experience, a clinical scenario, and an ethical scenario.
During COVID this was moved to a single 25-minute virtual interview with two interviewers. IMT recruitment has confirmed that all interviews will be online for the 2025 application process. Learn more about the interview in our IMT Interview guide.
IMT Ranking and Programme Preferences
Following your interview, you will receive a weight-adjusted interview score which is then turned into a ranking. Each candidate is ranked in the order of their interview score, which is then used to allocate programmes based on each candidate’s programme preferences.
When choosing your programme preferences, you will be presented with a list of all the available programmes in the UK. For 2021 recruitment there were 1468 options to choose from. To help with the process, you can download a spreadsheet on Oriel with all the relevant information.
With so many options, it’s probably best to start by selecting geographical areas you don’t wish to be considered for. There are 14 regions you can apply to in the UK. Be mindful of your rank – if your rank is towards the lower end and you only choose competitive deaneries, you risk missing out on a place and will have to apply again next year.
You should also consider what specialities are a must-have, which you’d enjoy but aren’t a necessity, and which you’d rather avoid. It’s important to look at whether your chosen specialities are at teaching or district general hospitals. Workload varies from site to site, so it’s best to ask around and do some internet research on which hospitals provide the best opportunities for trainees (and which has the best mess).
Teaching hospitals tend to provide more opportunities for career development and gaining points for speciality applications. They may also be better supported and have a more interesting patient cohort. However, district general hospitals might be better at equipping you with skills to manage a broader range of speciality conditions.
IMT Deaneries UK
- East Midlands
- East of England
- Kent, Surrey, and Sussex
- London
- North East
- North West
- South West
- Thames Valley
- Wessex
- West Midlands
- Yorkshire & Humber
- Northern Ireland
- Scotland
- Wales
IMT rotations available for preferencing only include years 1 & 2, with IMY3 rotations being decided on a local level by the deanery. IMY3 rotations will generally be in the same area of the deanery as the previous two years, though this is not guaranteed.
Each programme option will contain several specialities and the hospitals to which you will be attached for each speciality. You must first divide the programmes into preferences and not wanted. For all in the preferences section, you can then rank each one in your preferred order.
You don’t need to be tactical when choosing your preferences. The process of making offers goes numerically through each rank and gives them the top preference that is still available. Rank #1 is guaranteed to get their top preference, whereas rank #50 will only get it if rank #1-49 hasn’t already filled that slot. If rank #50’s top preference has already been filled, the algorithm will then look at their second preference and check if it has been filled. Therefore, there is no benefit to “gaming the system” and you should choose the exact order of preferences that you want.
When it comes to the release of offers, you must be vigilant – you have 48 hours to accept an offer, and missing the email isn’t a good enough excuse. Set a reminder for yourself on the programme offer release date and check Oriel on the day. There is an option to “hold” an offer for a couple of weeks while you wait for decisions from other specialities, though you must be mindful of the hold deadline.
After you have accepted an offer, or currently have one on “hold”, you will be considered for upgrades. This means that if a programme that you ranked higher becomes available, either through a candidate dropping out or accepting an upgrade themselves, you will be offered this programme as an upgrade.
Frequently Asked Questions
When does IMT application 2026 open?
Round 1 recruitment for the August 2026 IMT start date will open at 10am on 23rd October 2025, with vacancies posted the day prior.
How competitive is IMT UK?
For the past few years, IMT has had a near 100% fill rate, meaning that you are not guaranteed a place even if you are eligible. In 2023 the competition ratio was 2.64, meaning that more than twice the number of doctors applied than places available. This was significantly more than in 2020, and is likely due to the inclusion of International Medical Graduates in round 1 recruitment.
How can I improve my IMT application Score?
Some sections of the IMT application scoring matrix are based on achievements for which the opportunity has already passed (such as degrees) or which would take a long time to come to fruition (such as publications).
To improve your score, look at areas for which you are not scoring (or haven't reached the maximum) and work out how quickly you could fulfil the requirements for more points. For example, if you have not scored well in the quality improvement section, you may be able to score maximum points within 4-8 weeks if you choose the right project.
Check out our Application Scoring Guide for more information.
How many people apply to IMT?
In 2015-2020, around 2500 candidates applied for the ~1600 places. However, in 2021 and 2022 there was a big increase in applications. In 2023 there were 4406 candidates applying for 1670 posts meaning the competition ratio was 2.64.
Do you need MRCP to apply for IMT?
MRCP part 1 is part of the "desired" criteria in the 2024 person specification for IMT. You do not need to have undertaken any part of the MRCP exam in order to apply to IMT, and it will not increase your points score.
You are expected to pass MRCP part 1 by the end of IMY1, and complete the full exam (part 1, part 2 written, and PACES) by the end of IMY3.
When can I apply for IMT?
Applications for IMT round 1 recruitment (the only round of application) open on 26th October 2023.
