Internal Medicine Training (IMT) – Where Should you Apply?

Published on: 11 Aug 2022

Internal Medicine Training IMT

A key stage in the recruitment process for Internal Medicine Training (IMT) is preferencing training programmes. Programme preferences, alongside interview scoring, determine how offers are made.

Applicants are invited to preference training programmes via the Oriel system towards the end of the interview period. This is time-consuming; in 2019, 75% of applicants reported spending more than three hours completing preferencing.1 



There is a short period, typically two weeks in each recruitment round, in which applicants must complete preferencing. Applicants are provided a list of all the IMT and Acute Care Common Stem – Acute Medicine (ACCS-AM) training programmes in the UK.

Information detailed for each training programme includes the region, hospitals/locations, specialties covered and the number of posts available. Applicants must divide the options into two groups: preferences and not wanted. Initially, all the training programmes appear in the not wanted list.1

All, and only, training programmes that applicants want to be considered for must be moved into the preferences list in rank order, that is, their most preferred training programme being number one on the list, their second most preferred training programme being number two on the list and so on.

Training programmes that have no vacancies can also be included in the preferences, as training posts may become available at later dates.1 Applicants will not be considered for training programmes that they have listed as not wanted.1 Preferences can be revised as many times as required before the deadline.

Applicants are ranked in order of their interview score. Ranking is disclosed to applicants in time to allow them to consider this before preferencing.2 After the preferencing deadline has passed, an algorithm matches applicants to their highest available training programme preference. Offers are made, and responded to, via the Oriel system. The first offer is made to the highest-scoring applicant, the second is made to the second highest-scoring applicant and so on until all vacancies have been filled or there are no more applicants to whom an offer for a particular training programme can be made.3

Applicants are advised to ensure that their preferences truly reflect where they would like to work. For example, ranking a training programme higher only because it is expected to be popular has no benefit.1 Once an applicant’s rank is reached, they will be considered for all their preferences, including those lower on their list, before another applicant whose interview score is lower but who has ranked that training post higher in their preferences.

If, by the time an applicant’s rank is reached, none of their preferences are available, they are placed on a reserve list and are considered when declined offers are recycled.

If an offer is declined, an offer for that training programme is made to the next ranked applicant who applied for it. If applicants accept an offer, there is the option to upgrade. This allows applicants to adjust their preferences and, if a training programme they now rank higher becomes available, they are automatically upgraded to this.1

All applicants, including those who are not made an offer, may revise their preferencing ranking and move options between their preferences and not wanted lists during short intervals during the offers period. Emails are sent to inform applicants when they can do this. 


Choosing where to apply

Trainees are advised to conduct research on the locations and trusts, programme features and life in the geographical locality, for example, house prices, transport links and leisure opportunities in each deanery/HEE local office before completing preferencing.

Results of the annual National Training Survey (NTS) conducted by the General Medical Council (GMC) can be used to inform decisions regarding preferencing. The NTS collects data on trainees’ views on the training they receive, for example, clinical supervision, workload, curriculum coverage and facilities.4 The overall satisfaction of IMT trainees by deanery/HEE local office in 2021 is listed in Table 1.

Table 1 – National Training Survey 2021 IMT trainees’ overall satisfaction by deanery/HEE local office (data from General Medical Council, 2021)

(Each value is a score out of 100 which represents how positively or negatively trainees answered the questions regarding overall satisfaction)


Deanery/HEE local office

Overall satisfaction

Health Education East Midlands


Health Education East of England


Health Education Kent, Surrey and Sussex


Health Education North Central and East London


Health Education North East


Health Education North West


Health Education North West London


Health Education South London


Health Education South West


Health Education Thames Valley


Health Education Wessex


Health Education West Midlands


Health Education Yorkshire and the Humber


Health Education and Improvement Wales


NHS Education for Scotland


Northern Ireland Medical & Dental Training Agency



In 2021, the competition ratio for IMT was 2.29.5 Competition ratios by deanery/HEE local office are not available as recruitment is conducted nationally. However, the median rank of candidates who accepted an offer, the number of accepted offers and the overall fill rate can be used in conjunction to estimate the popularity of each region.6 This data is available on the IMT Recruitment website (



  1. Programme preferences [Internet]. IMT Recruitment. [cited 5 October 2021]. Available from: 

  2. After the interview [Internet]. IMT Recruitment. [cited 5 October 2021]. Available from: 

  3. How are offers made? [Internet]. IMT Recruitment. [cited 5 October 2021]. Available from: 

  4. Welcome to the education data reporting tool [Internet]. General Medical Council. 2021 [cited 5 October 2021]. Available from: 

  5. 2021 Competition Ratios [Internet]. Health Education England. [cited 5 October 2021]. Available from: 

  6. Document library [Internet]. IMT Recruitment. [cited 5 October 2021]. Available from:

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