# Practising for Acute Internal Medicine (ST4) with MedMock

Canonical page: https://medmock.com/exams/acute-internal-medicine-st4

## What is the Acute Internal Medicine ST4 interview, and how do you practise for it?

Physician Higher Specialty Training national ST4 selection: two examiner-led stations — Station 1 (15 min) combines a pre-read Clinical Scenario (~7 min) with a Medical Registrar Suitability viva (~8 min) opened by a one-minute presentation on managing the acute unselected medical take; Station 2 combines Suitability & Commitment to acute internal medicine (~7 min) with an Ethical, Professionalism and Governance hypothetical (~8 min) given verbally. A parallel communication-skills mark runs through Station 1. MedMock lets you practise it out loud against an AI interview panel, with examiner-style feedback on any station you finish.

An illustrative example station, written by MedMock with example feedback, is at https://medmock.com/exams/acute-internal-medicine-st4/example

## About Acute Internal Medicine (ST4) recruitment (official sources, checked 2026-10-13)

- 2025 recruitment round, NHS England figures for Acute Internal Medicine ST4: 443 applications for 100 posts, a competition ratio of 4.43.
- The lead recruiter for acute internal medicine is West Midlands.
- The interview has two stations of 15 minutes each, with four questions and a communication mark, giving five scored areas in total.
- Acute internal medicine is a Group 1 specialty: applicants need to have completed the internal medicine training (IMT) stage 1 programme or equivalent, and all programmes dual specialise with general internal medicine.
- Current intensive care medicine trainees applying to dual train in this specialty are an exception to the usual requirement to have completed the full Internal Medicine Stage 1 curriculum.
- Training includes mandatory attachments in respiratory medicine, cardiology, acute elderly care and intensive care.
- The specialty assesses commitment to specialty as part of shortlisting.
- To be appointable at interview, none of the ten interview scores can be 1/5, no more than two can be 2/5, and the raw interview score must be 30 or above.

Sources: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2025-competition-ratios https://www.phstrecruitment.org.uk/specialties/acute-internal-medicine

## What happens in the real Acute Internal Medicine (ST4) (checked against the official source on 2026-09-26)

The Acute Internal Medicine ST4 national interview (2026 recruitment, Physician Higher Specialty Training) is held online on Qpercom Recruit and has two stations of 15 minutes each, lasting about 40 minutes including the time between stations. There are four questions of about 7 to 8 minutes each, and each station has its own pair of scoring interviewers. You are marked 1 to 5 by both interviewers on the four questions and on your communication skills: five scored areas in total.

- **Station 1: clinical scenario and medical registrar suitability** (15 minutes): About 7 minutes on a brief written clinical scenario (two or three sentences) that you are given a short while to review beforehand, then about 8 minutes on the non-clinical side of being the medical registrar, opened by a one-minute presentation: 'A summary of your experience managing the acute unselected medical take as the medical registrar.' Your communication is marked across the whole station.
- **Station 2: suitability and commitment, then ethics, professionalism and governance** (15 minutes): About 7 minutes on your suitability for and commitment to acute internal medicine, expanding on your application form, then about 8 minutes on an ethical, professionalism and governance scenario that is not given to you before the station and is put to you verbally by the interviewers.

Marking: Each of the five areas is marked 1 to 5 by both interviewers, giving ten marks and a raw interview score out of 50; 3/5 is satisfactory, the level expected of a core-level trainee applying to the specialty. The areas are weighted (clinical scenario x2.0, medical registrar suitability x1.5, communication x1.0, suitability and commitment x2.0, professionalism and governance x1.5) to give an interview score out of 80, which is added to half your application score (out of 40) for a total out of 100, used for ranking.

Passing: To be appointable, none of your ten interview scores can be 1/5, no more than two can be 2/5, and your raw interview score must be 30 or above.

Sources: https://www.phstrecruitment.org.uk/specialties/acute-internal-medicine https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-general-format https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-scoring https://www.phstrecruitment.org.uk/recruitment-process/planning-your-application/future-recruitment https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/person-specifications/person-specifications-2026/acute-internal-medicine-st4-2026
Full format page: https://medmock.com/exams/acute-internal-medicine-st4/format

## How to prepare for the Acute Internal Medicine (ST4) interview (facts checked against official sources on 2026-09-27)

The Acute Internal Medicine ST4 interview, as PHST publishes it for 2026, is two 15-minute online stations with four questions and a communication mark: a pre-read clinical scenario, medical registrar suitability opened by a one-minute presentation on running the acute unselected take, suitability and commitment to the specialty, and an ethics, professionalism and governance scenario. Prepare concrete registrar-level examples for each: you are judged against a CT3-level core trainee, and one score of 1 or more than two scores of 2 makes you not appointable.

1. **Check eligibility against the 2027 person specification** — You need evidence of Internal Medicine Stage 1 capabilities, for example by completing IMT or ACCS-IM, and normally MRCP(UK) Part 1 when you apply with the full diploma by the offer date. The Medical Training (Prioritisation) Act applies at both shortlisting and offers.
2. **Build your commitment evidence early** — AIM assesses commitment to specialty at shortlisting as well as at interview, and your verified application score makes up 20 of the 100 points used for ranking. The person specification asks for interest in and commitment to the specialty beyond the mandatory curriculum, so collect evidence you can talk about in detail.
3. **Write the one-minute take presentation** — Station 1's second question opens with a one-minute presentation: 'A summary of your experience managing the acute unselected medical take as the medical registrar.' Cover your roles and their duration, your responsibility and supervision, the teams you led, your patient numbers and your non-clinical duties. You are stopped at one minute, and slides are not allowed.
4. **Prepare examples on the two registrar capabilities** — The rest of that question explores the non-clinical side of being the medical registrar through two Internal Medicine Stage 1 capabilities: managing an acute unselected take, and managing a multidisciplinary team including effective discharge planning. You will be asked to draw on your own experience, so prepare specific situations you have handled on the take.
5. **Practise the pre-read clinical scenario** — You get a brief written scenario of two or three sentences and a short while to consider it, then about 7 minutes of questions. Plan the steps you would take, possible treatments, the further information you would gather and how you would communicate with the people involved, and ask a consultant to put acute medical cases to you in the same way.
6. **Prepare for suitability and commitment** — Station 2 opens with about 7 minutes on your suitability for and commitment to the specialty, expanding on your application form. Interviewers may ask about anything in your application, so review it and be ready to explain why acute internal medicine is the right specialty for you.
7. **Practise ethics and governance scenarios** — The last question is a hypothetical situation given verbally, lasting about 8 minutes. It is not a clinical question: it deals with the moral, ethical and legal issues and is assessed against GMC Good Medical Practice, so practise talking such cases through aloud.
8. **Aim for consistency and clear communication** — Communication is marked across all of Station 1, both how you would communicate in the scenario and how you communicate with the interviewers. A 3/5 means performing at the level expected of a core trainee applying to the specialty, and to be appointable you need no 1/5, no more than two 2/5 and a raw score of at least 30 out of 50. The format page has the timings and weightings.

Official resources:

- PHST Recruitment: Acute internal medicine (https://www.phstrecruitment.org.uk/specialties/acute-internal-medicine): The specialty page with the 2026 interview content, scoring, weightings and interview dates.
- PHST Recruitment: Interview preparation (https://www.phstrecruitment.org.uk/recruitment-process/interview/preparing-for-interview): Identity documents, technical set-up, probity and reasonable adjustments for the interview.
- PHST Recruitment: General format (https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-general-format): How PHST interviews run, including the rules on notes and on sharing interview content.
- Acute Internal Medicine ST4 2027 person specification (https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/person-specifications/person-specifications-2027/acute-internal-medicine-st4-2027): The eligibility and selection criteria for the 2027 round.
- Acute Internal Medicine (JRCPTB, The Federation) (https://www.thefederation.uk/training/specialties/acute-internal-medicine-aim): The 2022 AIM curriculum, the specialty skills and the ARCP decision aid.
- Internal Medicine (JRCPTB, The Federation) (https://www.thefederation.uk/training/specialties/internal-medicine): The Internal Medicine Stage 1 curriculum, which defines the capabilities in practice the registrar question draws on.
- GMC Good medical practice (https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice): The principles the ethics, professionalism and governance question is assessed against.

Common mistakes examiners report:

- Running over one minute or preparing slides: the presentation is stopped at one minute, and visual aids and screen sharing are not allowed. (source: https://www.phstrecruitment.org.uk/specialties/acute-internal-medicine)
- Reading prepared answers from notes: PHST warns against relying on notes so much that it disrupts the interview, or using them to recite everything you have prepared. (source: https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-general-format)
- Over-claiming on your application: interviewers may ask about anything in it, and blatant or persistent over-claiming leads to a probity investigation. (source: https://www.phstrecruitment.org.uk/recruitment-process/planning-your-application/assessment-methods)
- Using AI tools during the interview: applicants found doing so are disqualified and may be referred to their regulator. (source: https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-general-format)

Sources: https://www.phstrecruitment.org.uk/specialties/acute-internal-medicine https://www.phstrecruitment.org.uk/recruitment-process/interview/preparing-for-interview https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-general-format https://www.phstrecruitment.org.uk/recruitment-process/interview/interview-scoring https://www.phstrecruitment.org.uk/recruitment-process/planning-your-application/assessment-methods https://www.phstrecruitment.org.uk/news/phst-2027-website-update https://www.phstrecruitment.org.uk/recruitment-process/timeline https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/person-specifications/person-specifications-2027/acute-internal-medicine-st4-2027 https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/overview-of-specialty-training/recruitment-timelines https://www.thefederation.uk/training/specialties/acute-internal-medicine-aim https://www.thefederation.uk/training/specialties/internal-medicine https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice
Full guide: https://medmock.com/exams/acute-internal-medicine-st4/prepare

Recruitment dates: Applications 19 November 2026 to 10 December 2026 (national Round 2); Interviews within the national Round 2 window, 11 January 2027 to 9 April 2027 (source: Physician Higher Specialty Training Recruitment (PHST), checked 2026-09-24).
All Acute Internal Medicine (ST4) dates: https://medmock.com/exams/acute-internal-medicine-st4#dates

## Stations you can practise

- **Station 1** — Q1 Clinical Scenario (~7 min, pre-read): examiner-led discussion of an acute internal medicine case — what steps you would take, possible treatments, further information you would gather, and how you would communicate with patients, family and colleagues. Q2 Medical Registrar Suitability (~8 min): opens with a one-minute candidate presentation — 'A summary of your experience managing the acute unselected medical take as the medical registrar' — covering roles and duration, level of responsibility and supervision, MDT size and profile, patient numbers, and non-clinical duties, followed by examiner expansion questions on the two CiPs (managing an acute unselected take; managing a multi-disciplinary team and effective discharge planning). Q3 Communication mark assessed in parallel throughout the station.
- **Station 2** — Q1 Suitability & Commitment (~7 min): examiner-led probe on suitability for and commitment to acute internal medicine, expanding on application-form material. Q2 Ethical, Professionalism and Governance (~8 min): verbal hypothetical scenario (not pre-read) testing moral, ethical and legal reasoning anchored in GMC Good Medical Practice.

## Sample Acute Internal Medicine (ST4) questions

- *Station 2:* What experiences demonstrate your commitment to acute medicine?
- *Station 1:* How would you assess and manage neutropenic sepsis?

## Example scenarios

- *Station 1:* A 78-year-old woman is in AMU with new fast atrial fibrillation, rate 165, BP 88/56, cold and clammy. Walk us through your assessment and immediate management, and how you would set up the team to support you. Then a one-minute presentation on your experience managing the acute unselected take, followed by questions on running a busy AMU take.
- *Station 2:* Tell us why you have chosen Acute Internal Medicine over General Internal Medicine, and what experience supports that choice. Then a hypothetical: you discover a senior colleague has been documenting a NEWS2 score they have not actually measured, in order to meet a trust audit target — how would you handle it?

## How a practice session works

1. **Choose a station** — Choose the kind of question or scenario you want to rehearse — ethics, motivation, a role-play, and more.
2. **Have the conversation** — Speak naturally, out loud. The AI interviewer listens and asks the demanding follow-ups, just as a real interviewer would.
3. **Get instant feedback** — The moment you finish, you get specific, examiner-style feedback and a score — what you did well, what cost you marks, and precisely what to fix before the next attempt.

## Price

Start with a one-off £5 taster: 30 credits (30 minutes of speaking practice), not a subscription. After that, or instead, £69 per month for 350 credits. One credit is one minute of spoken practice, or two typed exchanges, and where the examiner or patient speaks first, that opening line is free. Examiner scorecards, mark schemes and model answers for finished sessions are included at no extra credit cost. Cancel at any time. Full details: https://medmock.com/pricing

## Frequently asked questions

### How does the feedback work?

When you finish a station you can have it marked, and the scorecard comes back in seconds — what you did well, what cost you marks, and exactly what to work on next. Scorecards, mark schemes and model answers are included at no extra credit cost.

### Can I practise specific Acute Internal Medicine ST4 stations?

Yes. You can pick either station to drill a weak area, or run a mixed set to simulate the real interview.

### How much does it cost?

You can start with a one-off £5 taster: 30 credits, which is 30 minutes of speaking practice, with no subscription. After that, or at any time, you can choose a monthly plan, which includes a monthly credit allowance. Current prices are on the pricing page.

## About MedMock

MedMock is a web app for practising the spoken parts of UK medical and dental exams and interviews out loud. The candidate talks; an AI patient, examiner or interview panel answers in real time by voice; and when the station ends MedMock marks the performance against that exam's assessment domains and shows the model answer.

It covers 104 spoken exams and interviews — OSCEs, vivas, structured oral exams, simulated consultations, and specialty-training and consultant interviews. It does not cover written or multiple-choice papers, and it is not a question bank.

It was founded by Mr Sam Nahas, MBBS BSc MEd FRCS (Tr & Orth), a practising consultant orthopaedic surgeon in the UK, with co-founder and CTO Arjan Jandu. It is operated by VirtualPatients Ltd (company no. 16303492).

Pricing: a one-off £5 taster of 30 credits to try it (not a subscription, one per account), and a monthly subscription from £20 to £129 depending on the exam (student exams cost least, fellowship exit exams and consultant interviews most), or £199 to £275 for the Intensive plans, which carry more credits. One credit is one minute of spoken practice, or two typed exchanges, and where the examiner or patient speaks first, that opening line is free. Examiner scorecards, mark schemes and model answers for finished sessions are included at no extra credit cost. Subscriptions can be cancelled at any time.

It runs in a web browser on a laptop or phone; spoken practice needs a microphone. There is no public demo: practice needs an account with credits, usually from the taster or a monthly plan.

MedMock is for adults aged 18 or over. Sign-up asks every new account to confirm it.

MedMock is a revision tool. The patients, examiners and cases are fictional and AI-generated; it is not clinical guidance and is not affiliated with or endorsed by any Royal College, the GMC, the GDC or any examining body.

Start with the £5 taster: https://medmock.com/auth/signup