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

  • Programme details - the IMT programme is made up of a number of different rotations, typically lasting four or six months. This page provides information on what detail will be available when selecting preferences.
  • 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-AM vs IMT - the recruitment for both ACCS-AM 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.

In addition to this, there is information in the document library about the relative competitiveness of each region using data from the 2018 recruitment round. 

Programme details for trainees to support the selection of rotation preferences

All HEE 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 HEE Local Office/Deanery as years 1 and 2 and some regions will be providing specific information about programmes when preferences are selected. All regions will provide more information for their programmes over the coming months.

Some examples of the information that will be available when you preference can be found at the foot of this page.

How will IMY3 allocations be made?

Each HEE Local Office or Deanery 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 (document available to download on the right-hand side of the screen. 

  • The training programme director (TPD) for Internal Medicine will hold interim reviews in year 2 of IMT 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 trainee and the needs for service provision across the HEE Local Office or Deanery.
  • 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.

Changes in the number of trainees and service pressures mean that 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 acute medicine

Those undertaking an ACCS acute medicine training programme who wish to progress to a group 1 specialty that requires the full three years of IMT, will need to do an additional year in medical specialties. They will be offered a stand-alone third year IMT programme within the same region as their ACCS programme. The process for allocating rotations will be managed locally by each region.

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 at the same rate 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.

Information to support preferencing

The PSRO has compiled data on the relative competitiveness of each region based on data from 2018 recruitment. This data has been published in a document which can be found in the document library section of this site which can assist IMT applicants with choosing their preferences.

Sample preference information

The table below gives an example of the level of detail that will be on offer for programmes when you preference. This is expected to be the minimum level of information that will be available, with some regions in a position to offer information about IMY3 at this stage.

Region Sub-region Sector Example description

North East



IM1 Carlisle: Stroke - Resp - Renal
IM2 Queen Elizabeth Hospital, Gateshead: Gastro - Cardio - Geris

(Rotate every 4 months)

Northern Ireland



4 months Belfast City Hospital Geriatric Medicine (IMT1)
4 months Royal Victoria Hospital Cardiology (IMT1)
4 months Royal Victoria Hospital Endocrinology (IMT1)
3 months Craigavon Area Hospital Intenstive Care Medicine (IMT2)
3 months Craigavon Area Hospital General Medicine (IMT2)
6 months Daisy Hill Hospital General Medicine (IMT2)
IMT3 to be preferenced at a later date.


Scotland Deanery - East Region


Aug 19 - Dec 19 - Respiratory Medicine, Victoria Hospital, Kirkcaldy
Dec 19 - Apr 20 - General Medicine, Western General Hospital, Edinburgh
Apr 20 - Aug 20 - Haematology, Western General Hospital, Edinburgh
Aug 20 - Dec 20 - Geriatric Medicine / Bone Health, Victoria Hospital, Kirkcaldy
Dec 20 - Apr 21 - Gastroenterology, Royal Infirmary of Edinburgh
Apr 21 - Aug 21 - Acute Medicine, Royal Infirmary of Edinburgh

Wales Wales - South Cardiff area


August 2019 to Feb 2020 – Royal Gwent Hospital, Newport – GIM & Geriatrics
Feb 2020 to Aug 2020 – Royal Gwent Hospital, Newport – GIM & Cardiology


Aug 2020 to Feb 2021 – University Hospital of Wales, Cardiff – GIM & Gastroenterology
Feb 2021 to April 2021 – University Hospital of Wales, Cardiff – ITU
May 2021 to July 2021 – University Hospital of Wales, Cardiff – GIM & Haematology & OPC’s

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.

Supplementary information
East Midlands

Please go to the East Midlands website to download a document which will show the rotation details for the East Midlands. All IMY3 rotations are six months and one specialty will be acute internal medicine. The document shows the possible specialties which could make up the other IMY3 rotation, depending on the hospital in which you will be based.

East of England

The process of allocation of IM3 years will begin in the early part of 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 in their IM1 and IM2 years. Further information on how this allocation process will take place will be communicated to trainees as it becomes available throughout the IM1 year. 


This new two-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 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 regional training programmes in London 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. Local rotation swaps may be agreed on a case by case basis for your CT2 year provided this does not result in specialties being repeated and allows curricular requirements to be met. The majority of rotations are fixed within one region of London, but there are a few rotations whereby the two-year 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. 

For trainees who decide to enter into a Group 1 specialty in Higher Specialty Training, there will be a process in IMY2 to fairly allocate trainees to a 1-year IMY3 training programme in 2020. 

North East

For further information about Internal Medicine Training in the North East and Cumbria please see  their website

North West

The allocation of IMT year 3 posts will take place in the 2nd half of IMT2. It is expected that those wishing to take up an IMT3 post will continue in the same part of the IMT programme that they were placed in IMT1 and IMT2 ie Mersey or North Western. 

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. 

Northern Ireland

This is a new 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, including a 3-month post in ICU. The IMT3 year will be based in one 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.


The rotation for Year 3 IMT in Scotland will be confirmed during year 2 of the programme. For more information on IMT in Scotland please visit the Scottish Medical Training website .

South West – Peninsula

IMT Year 3 = Minimum of 2 x 6-month placements in specialities primarily included in the acute take and functioning as the “medical registrar”. Placement details to be confirmed and may include a rotation to another trust. 

South West – Severn

This new IMT programme consists of diverse rotations to ensure broad curriculum coverage and good training exposure in General Internal Medicine. Year 1 consists of 3 x 4 months’ placements, year 2 consists of 4 x 3 months’ placements including exposure to Intensive Care Units. The regional and local teaching programmes are mapped to ensure coverage of your curriculum requirements that are not covered by your rotation(s). An IMT3 year will be mapped by the IMT 2 nd year in the Autumn. 

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.  

Thames Valley

Thames Valley are only providing 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 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. 

IMY3 placements are not yet confirmed and are being looked at over the next few months. We cannot therefore provide any details of rotations for IM3. It is likely that you will move to a different Trust for this third year.  


This new 3-year IMT programme consists of diverse rotations to ensure broad curriculum coverage and good training exposure in General Internal Medicine. Our IMT programme consist 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.  

The regional training programmes in Wales offer a diverse range of training and highly rated by trainees. We offer all trainees free PACES and free IMPACT courses. Trainee requests for rotation swaps may be agreed on a case-by-case basis providing this allows curricular requirements to be met.

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 ie if appointed to North Wales, you will remain at one site for three years; if appointed to South East Wales, you will remain in Cardiff and/or Newport. We will guarantee that during the IMT3 year you will therefore remain within the same region.

Our rotations have been matched to an IMT3 year. These IMT3 rotations 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. Discussions around IMT3 placements will take place around the mid-point of IMT2 training year.

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 .

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 2020.

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.

Yorkshire and the Humber

We expect to be offering approximately 100 IM3 posts across Yorkshire and the Humber in the first instance. IM3 will consist of two six-month placements to include Acute Medicine/GIM on-call.  One of the placements is likely to be in the same location as the trainee was placed either for IM1 or IM2.  Wherever possible, IM3 will include one placement in a specialty not included in the trainee’s IM1 or IM2 placements.  Trainees will be invited to express preferences for the available IM3 rotations, and we will try to ensure as many trainees as possible get their first choices.

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. 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-AM and IMT for the whole of the UK, and two sections into which you can divide these posts: preferences and not wanted.


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.


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. This will usually be an initial period of about 7-10 days in which 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 2018 recruitment there were 1426 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:

  • 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 regions' 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.
  • 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 particular region you can just ignore it as it will start in the not wanted section. Whilst there will be over a thousand 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 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

Orie 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.

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 the order in 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-AM and IMT programmes will be considered alongside each other within the preferences.

This means that you are welcome to give just ACCS-AM 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-AM programmes available; for details of the number of programmes for each specialty in each region, see the dates & posts page of this website.