Internal Medicine Training: Preferences & Offer

IMT ranking

You’ve stressed and toiled over the entire process of internal medicine training, and you’re finally rewarded with an email to rank your preferences. And now it’s time to sit down and decide on where you’d like to go and what rotations you’d like to have. This is an extremely important and crucial step in your IMT selection, so don’t think you can do it all in one night. Dedicate at least 3 days of level-headed scanning, browsing, searching, and arranging.

Please check our other posts regarding Internal Medicine Training (IMT), IMT interview, and IMT portfolio.

What should I look at when I rank?

It’s great that you can now see the hospitals and rotations from the deanery’s you’ll be applying to so that you know exactly what to expect. Use this to your advantage. If you find the arranging process to be tedious, you can first use the spreadsheet option given and then manually arrange as you want it to be.

As IMT is the stepping stone towards specialty training, you want to make sure the rotations you choose have what you wish to eventually specialize in. It’s not that if you don’t get your desired specialty in your IMT rotations that you cannot apply for specialty training in that same post, but it’s just better for you as you will have an idea of what to expect, and you can talk about your experience in that department during your specialty training interview. If you’re still unsure about what field you eventually want to train in, try and pick rotations that have a good variety. Keep in mind that good rotations mean you’ll have more exposure and will allow you to be a more confident medical registrar one day.

The next thing (in my opinion) to take into account is the location. This may be your first priority if you have familial commitments, but if not, I would not put too much concern into location to the extent that it restricts you from pursuing rotations you would want. The standard of training is the same across all of the UK.

Please keep in mind that if you enter IMT in Scotland, Wales, or Northern Ireland, you would be able to apply for Round 1 specialty training in their respective slots only. What I mean by this is that you will not be able to apply in Round 1 outside of your region. For example, if you do IMT in England, you cannot apply in Round 1 for specialty training in Wales, but you can apply for Round 1 of specialty training in England.

internal medicine training preferences
An example of what you may see when ranking your preferences.

How to rank preferences for Internal Medicine Training

The following steps are to follow when you are ranking the preferences:

  1. Your preference for location

    Where do you want to do your training? For some people, the location matters a lot as they may have family or social ties.

  2. The rotations you want to do

    IMT will have different rotations other than some mandatory ones like geriatric medicine, intensive care medicine, etc. You should be able to see which rotations you have in your preferences. Choose accordingly as working in a department that you want to specialize in helps you in your ST application in the future.

  3. Types of hospitals you will be training in

    There should be a mix of district general hospital and university hospitals in the rotations (if your rotations are in separate hospitals). Resource-wise university hospitals have sometimes more opportunity to learn, on the other hand, you may get more attention in the less-busy DGH.

If you’ve put no bar on your location, it would be smart to rank every single program from most desired to least in order to increase your chances of securing a seat. That being said, if you know with some amount of certainty that you would not be willing to work in a certain area or hospital, please do not rank it. Don’t bank on upgrades. If you don’t get what you want, and an upgrade is not secured, and you choose to refuse an offer, you don’t have a seat for IMT. So think before you rank.

There will be two columns, one where you rank the programs you wish to enter, and one where you keep the ones you don’t even want to consider. All of the programs will start out in the not wanted section, and if you don’t choose to move any to your wanted list, you will not be ranked. Again, please let me emphasize that this is not a task you can complete in one night. Keep in mind that the decisions and rankings you make will potentially affect you for the next 2-3 years, so do not take it lightly. Put aside some time to map out your best plan and then rank accordingly.

So how will I be ranked?

You are ranked in order of the total score awarded to you. A matching algorithm is used to match you to your highest available preference. The first offer will be made to the highest-scoring candidate, the next to the second-highest and so on until all offers have been made. You’ll be able to see your offer and your rank on Oriel. You have 48 hours to respond, so don’t dilly dally. By not responding, you are effectively rejecting the offer received, and you will not get another one.

If you reject an offer, you will not get another, and your application to this specialty will be regarded as withdrawn. Rejecting an offer from one specialty will not affect any applications you have made elsewhere. DO NOT accept a post if you know you will not follow through with it.

As outlined in Good Medical Practice:
‘Patient care may be compromised if there is not sufficient medical cover. Therefore, you must take up any post, including a locum post, you have formally accepted, and you must work your contractual notice period, unless the employer has reasonable time to make other arrangements.’

After everyone who has been offered to rank is done, those posts that were leftover will be re-offered to the next ranked candidate in contention for that program. This process will continue until either all available vacancies have been filled, or there are no more candidates to the left to offer a program to.

A live seesion regarding this topic

Frequently Asked Questions

What does it mean to hold an offer but not accept it?

If you’ve perhaps applied for two training programs (ex: GP and IMT), holding an offer allows you to consider the offer given to you beyond the 48-hour deadline. You will still need to mention within the initial 48 hours that you want to ‘hold’ your offer, but it will allow you to keep the post for consideration until you hear back from any other applications.

What does it mean to upgrade?

When an offer is made, you will be offered the highest of your preference which is available after ranking is done. If you choose to be considered for an upgrade, and a higher ranked preference becomes available, your offer can be upgraded to the highest available preference that you’ve put down.

Can I change any preference ranks when I upgrade?

Yes. You can:
-decide to include in the program of your preference that you did not originally want
-move your internal medicine training preferences to the ‘not wanted’ column (except for the one that you’re holding)
-move programs initially ranked higher than your current offer to a lower rank
-move programs initially ranked lower than your current offer to a higher rank 

How can I make sure my spouse/partner/best friend and I end up in the same place?

Firstly you both should rank the same preferences for internal medicine training, as this will increase your likelihood of obtaining the same offer region. If still you all fall short, use the upgrade tool to re-rank to an area that may be more feasible for the both of you. If that still doesn’t work, you can contact IMT and, if deemed necessary, they will try and work with you all to ensure similar placement regions.

Can I defer my start date?

The Gold Guide states that:
“…the start of training may only be deferred on statutory grounds (eg maternity leave, ill-health).”
If you’re unable to achieve the mandatory competencies on time, you may be permitted to defer until you complete the time/competencies missed. Extended training will need to be organized to cover the time that was missed.
If you need to defer for a reason not already mentioned, please contact the region you will be working in.
Upon receiving an offer, you should contact the region of an offer to ensure they are aware of your desire to defer your start date and ensure this will be permissible. The final decision on whether a start date can be deferred is at the discretion of the region.

If I decline my IMT offer and then decide to reapply next round, will I be at a disadvantage for having declined before?

No. All recruitment rounds are independent of each other and a decision made in one round will have no bearing on a future application or your likelihood of being made an offer.


If you have any further questions or queries not covered above, please check out the FAQ section of the IMT website. Don’t worry, you will get the post you are aiming for without any problems whatsoever. Good luck!

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