Acute Internal Medicine (ST4) practice

How to prepare for the Acute Internal Medicine (ST4) interview

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.

What happens in the Acute Internal Medicine (ST4) interview: parts, timings and marking An example Acute Internal Medicine (ST4) station, with example feedback Acute Internal Medicine (ST4) recruitment dates

Step by step

  1. 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. 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. 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. 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. 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. 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. 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. 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

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
  • 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
  • Over-claiming on your application: interviewers may ask about anything in it, and blatant or persistent over-claiming leads to a probity investigation. source
  • Using AI tools during the interview: applicants found doing so are disqualified and may be referred to their regulator. source

Practise with MedMock

MedMock runs both AIM stations as examiner-led spoken practice: Station 1 combines a pre-read clinical scenario with medical registrar suitability, opened by your one-minute presentation on managing the acute unselected take, with communication assessed throughout; Station 2 covers suitability and commitment to acute internal medicine and an ethics, professionalism and governance hypothetical given verbally.

Practise your Acute Internal Medicine ST4 interview Free trial, no card needed.

Questions candidates ask

How is the total score made up?

Each of the five areas is marked 1 to 5 by both interviewers, giving a raw score out of 50. Weightings of 2.0 for the clinical scenario and for suitability and commitment, 1.5 for registrar suitability and for professionalism and governance, and 1.0 for communication give an interview score out of 80. Half your application score (out of 40) is added, for a total out of 100.

What level am I judged against?

PHST scores against the level expected of a UK core trainee one level below the post, which is CT3 for Group 1 specialties such as acute internal medicine. A 3/5 is satisfactory.

Do I need the full MRCP(UK) to apply?

Not when you apply. The 2027 person specification accepts MRCP(UK) Part 1 at the time of application with the full diploma by the offer date, or other listed routes such as eligibility for the specialist register in general internal medicine.

When are the interviews?

NHS England's 2027 round mainly for ST3/ST4 posts takes applications from 19 November to 4pm on 10 December 2026, with interviews between 11 January and 9 April 2027. PHST posts each specialty's own interview dates on its specialty page before applications open.

Is the format changing for 2027?

PHST says its site describes 2026 recruitment, will be updated in October for 2027 and the process will be largely unchanged. The format is confirmed by the date of interview, so check the specialty page again before you prepare.

Sources

Checked on 27 September 2026.

Exams and their regulations change. MedMock is not affiliated with any examining body; always check the current guidance on the official site before you apply.