IMT Recruitment - Full, comprehensive guidance on applying to IMT posts in UK ACCS-AM and CMT training programmes

Offers & beyond

Programme preferences

This section of the website gives guidance on the selection of preferences for IMT posts. There are five main areas; please click on the relevant tab for more information on each.

Choosing preferences - if your interview was successful you will be invited to select your preferences before offers are made. This section covers how to preference offers on the Oriel system.
Preferences guidance - the selection of your preferences is an important stage in the recruitment process as it directly impacts what offers you will be made. This section provides guidance on some of the commonly queried steps in the process.
ACCS-IM vs IMT - the recruitment for both ACCS-IM and IMT takes place through the same application and interview process. Preferences for both programmes will be visible to all applicants that progress to this stage.
Programme details - all UK regions will supply information about their internal medicine training (IMT) programmes to support you with preferencing rotations.
Supplementary information - additional information from regions has been provided about their internal medicine programme, particularly what will happen in regard to rotations in IMY3.

In addition to this, there is information in the document library about the relative competitiveness of each region using data from previous recruitment.

Choosing preferences

Towards the end of the interview period you will be contacted and invited to make your programme preferences. This will be done by logging in to your account on the Oriel application system.

This is a complex and time-consuming area of the process; a recent applicant survey had 79% of candidates reporting that completion of the programme preference process took over 3 hours, with 37% reporting that it took more than 10 hours. Reading the guidance below about how to choose preferences on Oriel, as well as some general guidance on the 'Preferences guidance' tab, will help you navigate this part of the process.

You will be able to see all of the programmes for both ACCS-IM and IMT for the whole of the UK, and two sections into which you can divide these posts: preferences and not wanted.

Preferences

You should move all posts for which you wish to be considered into the preferences section. All posts you move into this section must be put into rank order; ie the post you want most at the top as #1, next-most at #2, etc.

Should you come to be made an offer, you will be considered only for posts you have included in this section, and you will be offered your highest-ranked post which is available.

Unfortunately the drag and drop method for making your preferences on Oriel is not usually compatible with phones and tablets so please use a laptop or desktop computer for this part of the process.

Not wanted

The not wanted section is where you should move any posts for which you do not wish to be considered.

All posts are included in this not wanted section to begin with. So please note - if you do not give any preferences, you cannot receive a post offer.

Upgrades

If you receive an offer of a post and choose to accept or hold the offer, you will be given the option to be considered for offer 'upgrades'.

If you accept/hold a post with upgrades, you will be able to revise the order of your programme preferences and, should one of your higher-ranked preferences become available, your offer will be upgraded automatically to the higher preference.

The responding to offers page of this section has more information about upgrading.

Timing for selecting programme preferences

The timing for each round is included in the timeline section of the website. In this period you will need to select your preferences if you are to be considered for offers.

However, if you have not been made an offer, there will be short periods during the offering period where you will be able to reconsider your preferences. This will include reordering your list and changing whether a programme is included in your 'preferences' or 'not wanted' lists. You will be emailed at the time when preferences are available to revise.

All programmes in the UK included

As noted above, programmes from all regions in the UK will be available; in round 1 of 2023 recruitment there were 1633 options from which to choose.

Whilst this is great in terms of maximising the choices available to you, it does mean that it could be a big task to select your preferences. Consequently some guidance and notes about how to manage this have been added below.

Tips for inputting your preferences

On the screen where you select programme preferences, you can download a spreadsheet containing all the programme options. This is a better format for deciding on your preferences due to the presentation and sorting options this format allows. It is recommended to rank them first in this format, before ordering them on the system. You can also search for particular specialties if that is something which is particularly important to you.
Ordering of preferences - programmes will be ordered in a logical way based on geography. For example, all West Midlands' programmes will be grouped together and within this they will be ordered into the region's distinct sectors.
Filtering - the preference system enables you to filter by the information given for each choice. Therefore, if you only want to look at one region you can filter all others out.
Programme tagging - this is function gives a 'tag' to the specialty rotations within a programme. If you are interested in having a particular specialty as one of your rotations, you can filter by specialty. Please note that we cannot guarantee all regions will supply tags, though most did in 2024, so we advise checking the download before assuming a region does not have any programmes with a particular specialty included.
Bulk preferencing - the preference system works by dragging and dropping individual options into the preferred column. However, you can bulk drag options by using the 'Select All' feature or holding the control button and highlighting all the ones you wish to move. A way you could use this is:
- You select your most preferred programmes in order of preference.
- After this you would consider another region as a back up but do not wish to spend the time sorting all these programmes into order.
- You filter programmes for that region.
- 'Select All' and drag them over to the bottom of your preferenced programmes.
If you are not interested in a region you can just ignore it as it will start in the not wanted section. Whilst there will be around 1500 options, there is no requirement to be considered for this many unless you wish to be.
As noted in the 'timing' section above, if you are not offered a post initially, there will be opportunity to review your preferences after offers start, so you could then look at other regions at that stage if you want to change your mind.

In addition to these notes it is recommended to review the 'preferences guidance' tab in this section of the website. This has further notes to take into account when deciding upon your programme preferences.

Preferences guidance

In each recruitment round, we receive a large number of queries from candidates regarding preferences and offers. The guidance in this section covers the most common areas where issues arise.

Only include preferences you would accept if offered

There is no benefit to including programmes which you would definitely not accept and this could even reduce your chances of being offered a programme you do want as, once an offer is declined, you can no longer be in contention for the specialty.

If you can't be made an offer initially you will go on the reserve list and be considered when declined offers are recycled. You are better to be on the reserve list than holding an offer you do not want and hoping for an upgrade. By the holding deadline you will need to decline the offer and be out of the running, whereas if you had not yet been made an offer you would remain in contention.

Meet deadlines

As all programmes default as 'not wanted', if you do not select your initial preferences by the deadline, you cannot be made an offer. Although there will be opportunity to select or revise preferences later, it may be too late to get one of your most preferred programmes.

Ensure your selection is accurate

Oriel makes offers on the basis of your rank and programme preferences, if anything is not in accordance with your wishes, you may miss out on something you did want, or be offered something you do not want.

Although there will be opportunities to revise your choices during the offers process, getting them right first time will maximise your chances of being offered what you most want.

You can revise your options as much as you wish before the preference deadline and it is advisable to log back in after selecting them to check you are happy with your selection.

Programmes with zero places

If an option has zero places when you come to preference, you should include it in the order which you would wish to be offered it if there were places. Sometimes places cannot be declared at the point preferences are chosen but they may be added later on, if you have not included it in your preferences you cannot be considered for it.

There is no penalty to including a programme with zero places, all the offers matching algorithm will do is skip this choice and move onto your next one.

Will my choice of preferences affect whether I will receive an offer?

The more programmes you include in your preferences, the more likely it is you can be made an offer but the order in which you rank them will not. Whether or not you will be made an offer will be determined solely by your total score, and resulting ranking, the number of programmes available and your preferences of these.

When offers are made, candidates are considered in rank order and assigned their highest available preference. Once your rank is reached, your preferences will be considered to see which can be offered to you. If all your preferences are offered by the time it comes to your rank, you will not be offered and go on a reserve list.

Don't try gaming the offers process

If you believe a certain post will be unpopular, then ranking this as your #1 preference will not mean you are more likely to receive an offer, nor at an earlier stage, than would be the case if it were your #50 preference.

Your preferences only come into play once it is 'your turn' to be made an offer. Therefore you will be considered for all your preferences before any candidates ranked below you. This means that you will be considered for your #50 preference before a candidate who is lower-ranked but has your #50 preference as their first.

Give honest preferences

Our overall advice is to:

Only preference programmes you would genuinely consider accepting if offered.
Do not preference programmes you would definitely not accept.
Rank them in the order which genuinely reflects your preference of the posts available.

The offers process is designed in such a way that to give you the best chance possible of being offered your highest-available preference without the need to second guess the process.

Both ACCS-IM and IMT programmes will be considered alongside each other within the preferences.

This means that you are welcome to give just ACCS-IM posts within your preferences and disregard all IMT posts, or vice versa; or to rank any mixture of the two you see fit.

Please note that not all regions have ACCS-IM programmes available; for details of the number of programmes for each specialty in each region, see the dates & posts page of this website.

Programme details for trainees to support the selection of rotation preferences

All NHSE local offices and Deaneries will supply information about their internal medicine training (IMT) programmes to support you with preferencing rotations.

All regions will provide full rotation information for the first two years of the programme, including the hospital, specialty information and duration of each post. Internal medicine year 3 (IMY3) will be within the same region as years 1 and 2 and regions have provided additional information, which is available on the 'Supplementary information' tab in this section. Regions will take one of two approaches regarding the IM3 year: all three years included in the offer details or where it will be allocated during the second year and usually within a limited geographical area.

How will IMY3 allocations be made?

Where IMY3 information is not available within the offered programme, each region will manage a locally-run process for allocating rotations for IMY3. Some indicative information is below, in addition to this, the JRCPTB have published guidance for schools of medicine on how to manage allocation to IMY3 rotations (see the 'Forms and guidance' section).

The training programme director (TPD) and/or College tutors, for Internal Medicine will hold interim reviews in year 2 of the programme to gauge your (non-binding) intentions for plans to undertake year 3.
Within each geographic region indicated for IMY3, the TPD and workforce team will request preferences for the available rotations from all trainees considering a progression into year 3.
When finalising allocations, the TPD will take into account the training needs of the resident doctor and the needs for service provision across the region.
Further information about allocation processes will be made available at a later date by each region.

Important points to note:

The specialties undertaken in IMT will not limit your eligibility for recruitment into ST4 higher specialty training.

It is not possible to absolutely guarantee that advertised rotations and processes will not change. All regions will make efforts to ensure that any changes are minimised and managed as fairly as possible.

ACCS internal medicine

ACCS internal medicine training is a four year programme and those who wish to progress to a Group 1 specialty will need to complete all four years. Usually, the region will only be able to confirm the rotations for the first two years of the programme. The process for allocating rotations in years three and four will be managed locally by each region with the fourth year happening alongside IMY3 allocations.

Less than full time (LTFT) trainees; gaps in training; deferrals

Some trainees are working less than full time (LTFT) and will not be ready to progress into year 3 to the same calendar timescale as other colleagues; other trainees may have chosen to defer their entry into IMY3 or had a gap in training. Each region is aware of these issues and will seek to work with trainees within the programme, to allow them to have an equal chance to select suitable rotations in year 3.

The information in the table below is additional information some regions have provided about their internal medicine programme. This is supplementary to the details provided in their programme preference options.

Region	Supplementary information
East Midlands	Please visit the East Midlands website for further information on our IMT programme including the IM3 year. The East Midlands are excited to offer an innovative programme for a select number of IMT1 trainees starting in August 2023. Trainees will be able to undertake the ‘Enhance’ programme in Leadership and Social Medicine alongside Internal Medicine Training, receiving specialist training in areas such as health inequalities and public health. The ‘Enhance’ programme will span the 3 years of IMT Stage 1 training, with allocated time dedicated to ‘Enhance’ activities. Trainees will have the unique opportunity to rotate into a four month community placement, whilst also undertaking acute hospital on-calls. They would also be offered immersive experiences with voluntary organisations, to work on projects aimed at making tangible changes for the local community and tackling health inequalities. Time spent in community placements will still count towards IMT Stage 1 training. These programmes will be clearly indicated within the region's preferences when available for selection. An HEE video detailing potential future opportunities available for trainees undertaking this program is available. If you require further information, please email [email protected]
East of England	The IM3 year will consist of 2 x 6-month posts in Group 1 Specialities, and allocation will take place mid-way through the IM2 year. Efforts will be made to accommodate trainees in posts either in or as close as is possible to the base Trust that trainees have trained in for their IM1 and IM2 years. Further information on how this allocation process will take place will be communicated to trainees as it becomes available.
KSS	This three-year IMT programme consists of either 3 x 4-month rotations or 2x 6-month rotations with each IMY1-2 programme offering exposure to Intensive Care and Geriatric Medicine as required in the curriculum. IMY3 will consist of 2x 6-month rotations in either the same Trust or location as IMY1-2. The excellent regional and local teaching programmes are mapped to ensure coverage of your curriculum and offer a diverse range of training which are very popular and highly rated by trainees. We offer all trainees Simulation training at IM1 on procedural skills, IM2 human factors and acute medical scenarios, aimed at preparing you to be a medical registrar. There is easy access to study leave, PACES teaching and a local conference supporting QIP and research undertaken by our trainees. In addition, there is the opportunity to arrange clinics in other departments and taster weeks to increase your training exposure. The majority of rotations are fixed for the first two years within one KSS trust. The IMY3 rotations are in the same trust, and are tailored to the individual trainee and allocated with the Local Faculty group. Please note speciality rotations are subject to change due to service reconfigurations, and changes in line with the shape of training. In the event of a change in rotation being required for these reasons, these will be communicated as early as possible before a change takes place. This message may contain confidential information. If you are not the intended recipient, please inform the sender that you have received the message in error before deleting it. If the email was not meant for you, please do not disclose, copy or distribute the information it contains or take any action based on its contents, apart from notifying the sender you have received it in error. Any other action is prohibited and may be unlawful.
London	This three-year IMT programme consists of diverse rotations to ensure broad curriculum coverage and good training exposure in General Internal Medicine. Each year consists of either 3 x 4-month rotations or 2x 6-month rotations with each 2-year IMY1-2 programme offering exposure to Intensive Care and Geriatric Medicine as required in the curriculum. IMY3 will consist of 2x 6-month rotations in either the same Trust or location as IMY1-2. Our IMY3 rotations ensure broad curriculum coverage and good training exposure in General Internal Medicine. The regional and local teaching programmes are mapped to ensure coverage of your curriculum requirements that are not covered by your rotation(s). The Pan-London regional training programmes are currently run digitally using the Zoom and Microsoft Teams platforms and offer a diverse range of training which are very popular and highly rated by trainees. We offer all trainees an excellent simulation and skills training day each year and there is easy access to study leave for which the programmes have been highly rated. In addition, there is the opportunity to arrange clinics in other departments and taster weeks to increase your training exposure. The majority of rotations are fixed within one region of London, but some rotations within the training programme will cross London regions. An example would be rotations across Barnet Hospital and the Royal Brompton Hospital. Please note speciality rotations are subject to change due to service reconfigurations, and changes in line with the shape of training. In the event of a change in rotation being required for these reasons, these will be communicated as early as possible before a change takes place.
North East	For further information about Internal Medicine Training in the North East and Cumbria please visit their website.
North West	The IMT3 posts will all be based in hospitals which will be able to provide resident senior support at all times to an IMT3. IMT3s in HEE North West will not work alone as the only resident medical registrar. Each IMT3 will be allocated two 6-month posts. It is expected that IMT3 posts will be available in the following locations; Manchester Royal Infirmary, Wythenshawe, Salford Royal, Oldham, Preston, Blackburn, Blackpool and Royal Liverpool, Aintree, Arrowe Park, Whiston, Chester The posts will all be in Group 1 Internal Medicine specialties and will be on the medical registrar rota. IMT3 will be paid at nodal point 4 on the salary scale. Please note that due to individual Trust service reconfigurations, occasionally some post specialties may change.
Northern Ireland	This is a 3-year rotation aiming to give wide experience in a range of medical specialties. IMT1 will comprise of three four-month rotations to include elderly care medicine and will be based in one of the five trusts – Belfast, South Eastern, Southern, Western and Northern. IMT2 will be a mixture of three and six-month rotations in one trust, this will be in a different trust to your IMT1 year and will include a 3-month post in ICU. The IMT3 year will be based in two of the five trusts. It will be made up of two different six-month posts attached to a particular medical specialty. The trainee will gain experience in that specialty during daytime working hours and will participate in the general medical take out of hours as a GIM registrar. Allocation to IMT3 year will be decided during the second part of IMT2.
Scotland	IMT in Scotland starts with two years of four-month block rotations in medical specialties. Critical care placements and palliative care experience are provided. There is a highly rated national teaching programme with recording of all sessions, a three-day simulation bootcamp in year 1 including non-technical skills, practical procedural simulation and a national QI conference. Trainees are asked in year 2 to preference specialties and hospitals for year 3 which includes two blocks of six months experience in the same region of Scotland as the first two years. More details are available at the Scottish Medical Training website including some information about the bootcamp.
South West – Peninsula	Please visit the Peninsula Deanery website for further information about the programme and IMT preferences.
South West – Severn	Please visit the Severn Deanery website for further information about the programme and on their IMT preferences.
Thames Valley	Thames Valley can provide IMT1 and IMT2 rotations at this stage. Most posts are in the same trust for both years. A few posts are split across Trusts and these are noted on the description. Please read the descriptions carefully. Please note speciality rotations are subject to change due to service reconfigurations, and changes in line with the shape of training. In the event of a change in rotation being required for these reasons, these will be communicated as early as possible before a change takes place. Exact IMY3 placements (2 specialities of 6 months duration) will be confirmed during the IMT2 year if required. These may be in any Trust in the region, but trainees will be able to give preference prior to allocation.
Wales	Our 3-year IMT programme consists of diverse rotations to ensure broad curriculum coverage and good training exposure in General Internal Medicine. Our IMT programme consists of 6-month placements along with a guaranteed 3-month block in an Intensive Care Unit (without medicine on-call) during IMT2. This will ensure that trainees are exposed to Intensive Care Units as outlined in the curriculum. All trainees will undertake 6 months in Geriatrics, usually in year 1 or 2 as per curriculum requirements. The regional training programmes in Wales offer a diverse range of training and highly rated by trainees. Trainees when appointed will remain in one of the four regions of Wales for the entirety of the 3-year programme allowing home/family stability. You will therefore not be expected to travel around all of Wales i.e. if appointed to North Wales, you will remain at one of the training sites for three years; if appointed to South East Wales, you will remain in Cardiff and/or Newport; West Wales is Hywel Dda health board at two of the three sites and South West Wales covers Swansea and Cwm Taf Morgannwg. We will guarantee that during the IMT3 year you will therefore remain within the same region. All programmes are pre-planned for the three years and you will know at offer the exact location of your three-year programme. Additional information that is specific to internal medicine training at Wrexham Maelor Hospital and the Aneurin Bevan Health Board can be downloaded from the region's website.
Wessex	The Wessex IMT Programme consists of diverse rotations to ensure broad curriculum coverage and good training exposure in General Internal Medicine. IMT1 and IMT2 years consist of 3 x 4-month rotations. All new starters from August 2022 are guaranteed a 4 month ITU placement during the first two years of IMT training. Many of our rotations have been matched to an IMT3 year. These are provisional and may change due to service reconfigurations, changes in line with the shape of training or if there is a high proportion of trainees that leave after IMT2. Any changes to rotations will be communicated as early as possible before a change takes place. Other rotations have not been matched to an IMT3 year, however these will be matched in due course to a geographically sensible Trust. Please note that the placements offered are only available on the assumption of taking 36 calendar months to complete the programme. For example, your CT1 placements are guaranteed for you across the 3 x 4 month blocks between August 2024 and August 2025, likewise for CT2 placements between August 2025 and August 2026 and for the 2 x 6 month CT3 blocks are provisionally allocated to you from August 2026 to August 2027. Any delay to reaching the grades in line with this timeframe for whatever reason may mean that the specific post advertised is not available to you at the point you actually reach that grade. This to ensure no one is displaced in future cohorts to you and thus the principal ringfences these placements for you from previous cohorts. We will endeavour to match the hospital and specialties as closely as possible to your original offer in this scenario.
West Midlands	IMT is a three-year programme with IMY1 and IMY2 consisting of 3x4-month placements and IMY3 2x6-month placements, Intensive Care Medicine is undertaken as part of a placement in IMY2 and IMY3. One of the rotations in IMY3 will be Acute Internal Medicine. Please note speciality rotations are subject to change due to service reconfigurations, and changes in line with the shape of training. In the event of a change in rotation being required for these reasons, these will communicated as early as possible before a change takes place. For trainees continuing in to IMY3 there will be a process in IMY2 to fairly allocate trainees to IMY3 training programme in 2021. The West Midlands Region has been divided into a number of geographies and at initial preferencing for IMY1 and 2 posts trainees will be aware of which posts (specialty, location and number) are available in each geography. Choice of IMY3 post preferences will normally be restricted to the same region as IMY1 and IMY2 posts. Please see the West Midlands deanery website for more information. The West Midlands are excited to offer an innovative programme for a select number of IMT1 trainees starting in August 2023. Trainees will be able to undertake the ‘Enhance’ programme in Leadership and Social Medicine alongside Internal Medicine Training, receiving specialist training in areas such as health inequalities and public health. The ‘Enhance’ programme will span the 3 years of IMT Stage 1 training, with allocated time dedicated to ‘Enhance’ activities. Trainees will have the unique opportunity to rotate into a four month community placement, whilst also undertaking acute hospital on-calls. They would also be offered immersive experiences with voluntary organisations, to work on projects aimed at making tangible changes for the local community and tackling health inequalities. Time spent in community placements will still count towards IMT Stage 1 training. These programmes will be clearly indicated within the region's preferences when available for selection. An HEE video detailing potential future opportunities available for trainees undertaking this program is available. If you require further information, please email [email protected]
Yorkshire and the Humber	As part of the three year IMT Training Programme, Yorkshire and Humber offers 3x4 months placements across a diverse range of medical specialities in IMY1 and IMY2. The majority of posts are spilt across different Trusts within the chosen locality. In most cases, details of the full three years of rotations can be found in the post description. There are a small number of programmes where the IMY3 placement will confirmed at a later stage, expected to be during IMY2. Further details can be found on HEE Yorkshire and Humber website - Health Education Yorkshire and Humber \| (yorksandhumberdeanery.nhs.uk)