This article was contributed by Dr Jonathan Scott. He's currently an IMT trainee in the East of England Deanery, and ranked highly in the 2022 application cycle. In this article, he explains how the IMT application and interview processes work and gives his tips for maximising your chances of success.

‍Internal medicine training (IMT) replaced the previous core medical training in 2019 as a two to three-year programme required for all trainees before progressing into higher specialty medical training.

Applications for both IMT and acute care common stem: internal medicine (ACCS-IM) must follow the same recruitment process and use the same scoring system. So, whether your career interests align more with acute medicine or a sub-specialty, this application process will be your route to reaching your specialty of choice.

Entry into ‘group 1’ specialties, in which you'll dual-accredit both in your specialty of choice and internal medicine, requires the completion of a three-year programme (including an IMT three-year) before higher specialty entry at ST4 level. ‘group 2’ specialities, on the other hand, require only the completion of a two-year IMT programme before entering a higher specialty programme at ST3 level.

For further information on the structure of IMT, please refer to the Joint Royal Colleges of Physicians Training Board (JRCPTB) website.

IMT Applications

IMT applications are made through the online Oriel system. The selection process consists of three key points of assessment:

    1️⃣  Eligibility or long-listing, showing you're eligible for IMT.

    2️⃣  Short-listing, where points are awarded based on your achievements to date, which then determine whether you receive an invitation to interview.

    3️⃣  Interview, where a total score is awarded based on performance over four stations, with a national ranking of applicants to establish whether you receive an offer.

Competition for IMT posts has become increasingly intense in recent years, with over 3,900 applicants in the 2022 entry cycle, up from 2,700 just two years previously in 2020.

Therefore, it's vital to plan ahead to ensure you get enough points to secure an interview, and prepare as effectively as possible to maximise your score at the interview stage.

The application timeline usually begins in November, when applications open, with offers made in the following April for entry in August. The IMT recruitment website contains updates on the exact dates for the 2023 cycle.

The scoring matrix used to shortlist applicants ahead of interviews has changed significantly for 2023 entry onwards. Previous points awarded for degrees achieved prior to medicine or intercalated degrees have now been removed from the scoring system, with some minor adjustments to other scoring categories also being made. A full explanation of the updated system is available in the document library on the IMT recruitment website.

IMT Interview Format

The current IMT interview format consists of four stations:

    1️⃣  Clinical scenario (nine minutes)

    2️⃣  Ethical scenario (five minutes)

    3️⃣  Suitability and commitment (three minutes)

    4️⃣  Application and Training (three minutes)

Interviews are currently being conducted remotely by recruiting regions over Microsoft Teams or similar video-call software, although this is subject to change based on the COVID-19 pandemic. All four stations are conducted by the same interview panel (usually two interviewers), with an initial virtual candidate holding area in which the format is explained and ID checks are conducted before the interview itself begins.

Each interview station will be scored out of five by each interviewer independently, to give a total raw interview score. Weighting is then applied, giving a maximum total score of 80:

The clinical scenario station consists of eight minutes of questioning on a clinical scenario, followed by a one-minute handover role-play to a senior colleague. The brief scenario will be provided a few minutes prior to entering the interview room, giving you time to gather your thoughts before the questions begin.

This is immediately followed by an ethical scenario in which you'll have five minutes to answer questions based on a hypothetical ethical dilemma. The examiner will read out this scenario and you'll be expected to start discussing it immediately, without any private preparation time.

The second part of the interview consists of questions covering suitability and commitment for three minutes, followed by application and training for three minutes. In practice, these sections aren't separated by a break and occur effectively as a six-minute conversation. This covers your personal skills, application information, and medical career to date. Despite their short length, these are still strongly weighted, so ensure you give yourself plenty of time to prepare for these sections too.

How to Prepare for Your Interview

Practice makes perfect. While it may feel like the interview content is out of your control, you'll greatly improve your performance with high quality practice.

We recommend finding a partner, ideally also applying for IMT, with whom to schedule regular practise interview sessions with, answering questions out loud, under real time constraints. The Medibuddy IMT interview question bank contains a large number of practise scenarios for this purpose.

👉  Clinical Scenario

Each clinical scenario can be approached in a similar manner. The interviewers are looking to see that you'd be a safe and competent trainee who knows how to approach an unwell patient, but also know when to call for help.

Most scenarios will start off with a question about how you'd conduct an initial assessment of the patient, so learning to repeat a high quality verbal description of an A-E assessment will allow you to start your interview with confidence and demonstrate your ability.

With practise, you'll become more comfortable and be able to tailor these to different presentations, but the underlying approach can remain unchanged. Revising the management of common acute medical presentations would also be useful to avoid any knowledge gaps that could result in a mistake.

Finally, it's crucial to nail the one-minute handover at the en, which is worth a disproportionately high number of marks. Using the SBAR framework (or equivalent) for handovers will allow you to deliver the key information under such time constraints and secure that all-important five out of five mark.

👉  Ethical Scenario

Preparing for an ethical scenario is challenging due to the wide range of possible topics, but an underlying structure can usually be applied to help your answer.

‍The Medibuddy IMT interview question bank contains a large number of practice scenarios and tips on how to approach these. Be sure to take your time before going into your answer, as the five-minute slot is relatively generous, but many scenarios will contain delicate situations in which your choice of words is vital.

👉  Suitability and Commitment and Application and Training

You can prepare for these two stations together because they're grouped together in the interview. Doctors are often poor at answering questions about themselves in a succinct and effective manner, so more than any other station it's important to practise your interview technique.

Start by collecting a mental framework of the key CV points you want to convey to your interviewers, and to work these into your answers, providing examples backing up your claims.

The time pressure is arguably tightest in these short sections, so learning how to talk concisely about your achievements is essential to securing a high mark. The topics covered in this section are also generally very predictable. Bear in mind that all interviewees need to have something to say in order to make questions for this section consistent. Therefore, by preparing an effective answer for common questions, such as why you've applied for IMT, your QI/audit experience, and your current career aspirations, you can cover a great deal of the likely content ahead of time and avoid under-selling yourself on the day.

Our Top Tips

✅  Shortlisting Scores

Make sure you know the potential areas to score points within the IMT recruitment scoring matrix as soon as possible ahead of your decision to apply. Many scoring options will take six to 12 months, or more, to actually achieve, so an awareness of how to maximise these at an early stage will give a big advantage when the Oriel advert comes around. Remember to collect evidence, like certificates, for any claims you plan to make, in case this is required to justify your selections.

✅  ‘White Space’ Questions

These open questions in the Oriel application form may provide your interviewers with topics to discuss. However, if the interviews are cancelled or altered for any reason, as they were in the 2020/21 cycle, these could become even more crucial and be scored in their own right. It's therefore vital to think very carefully about what to include, and ensure you're ticking as many boxes as possible as a prospective trainee in the limited number of characters available.

✅  Interview Hardware

Ahead of your interview, make sure you have selected a room, laptop, microphone, and other equipment suitable for an interview that promotes an image of professionalism. Conducting at least one mock interview remotely is a good way to ensure this. Poorly functioning or inappropriate interview locations will immediately disadvantage you, and make examiners less likely to award high marks, as you may appear unprofessional.

✅  Timing Interview Answers

When practising for interviews, whether alone or with colleagues, it's important to ensure you always time yourself to get a sense of the amount of detail you can provide each time. This is particularly true of sections three and four, where you likely need to deliver an effective answer in just 60 to 90 seconds, to gain as many points as possible.

✅  Templates for Interview Answers

Establishing memorable frameworks for common question styles will make your answers more effective, and will ensure all your key points are covered. In the clinical scenario, for example, having an effective surgical sieve for differentials, or being able to split investigations into bedside, bloods and imaging, and dividing management plans into conservative, medical, and surgical will make you sound more confident and knowledgeable. Equally, splitting your reasoning in sections three and four into logical categories will improve the structure of your answers, and consequently improve your scores.

✅  Interview Weighting

Not all the interview sections are created equal. Given the time afforded to them, the clinical handover (one minute), suitability and commitment (three minutes), and application and training (three minutes) sections are worth a great deal of points. Ensure you don’t neglect these in favour of practising more clinical and ethical scenarios alone.

✅  Ranking Jobs

After your interview, there will be a window in which all the available IMT programmes are released and you're asked to rank your preferences. This huge list can be daunting, so knowing your preferences of specialities and geographical areas will be helpful. You can filter the programmes based on the area and specialities included, so if you have specific preferences then make sure to utilise these functions to avoid wasting hours of trawling!

✅  Judging Your Application Strength

The IMT recruitment website has a document library in which large amounts of data are published about the points scores in previous cycles, the number of posts filled, and break-downs by region.

It can be useful to review these during, or after, your application, to make a rough assessment of your potential ranking and whether you're likely to secure an interview or an offer. However, keep in mind there are significant variations each year.

Good Luck!

If you’re considering applying for IMT in the upcoming round, we wish you the best of luck. We'd strongly recommend checking out the Medibuddy IMT question bank in preparation. It’s a great resource which will help you improve your answers, focusing on both content and delivery.

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