[Correspondence] Time to Change Internal Medicine Training for UK Resident Doctors

Why It Matters

The current weighting threatens to exclude capable early‑career doctors, skewing the physician pipeline and potentially compromising patient‑centred care across the NHS.

Key Takeaways

• Median IMT shortlisting score rose to 21 in 2026.
• Five‑point bonus favors single‑track internal medicine applications.
• Portfolio focus sidelines clinical apprenticeship and ward continuity.
• Early‑career doctors lack resources for publications and qualifications.
• Proposed reforms: reduce double‑counting, value NHS service, Royal College membership.

Pulse Analysis

The 2026 IMT recruitment cycle illustrates a shifting landscape where quantitative portfolio scores dominate candidate selection. With applications hovering above eight thousand, the NHS introduced a five‑point incentive for those who apply solely to internal medicine roles, hoping to streamline interview logistics. However, the median score’s jump to 21 signals an escalating arms race in self‑assessed achievements, pushing candidates to amass publications, presentations and teaching credentials—often beyond what a junior doctor can realistically attain in a single post‑graduation year.

This portfolio‑centric model raises equity concerns. Early‑career physicians, especially those in institutions lacking protected research time or mentorship, find themselves disadvantaged against peers with institutional support or personal resources to fund conference travel and journal fees. The overlap between teaching activities and formal qualifications creates a de‑facto pay‑to‑win bias, rewarding time and money rather than bedside competence. As a result, the very qualities essential for acute internal medicine—clinical judgment, continuity of care, and rapid response to deteriorating patients—risk being under‑recognised in the shortlisting process, potentially eroding the quality of future consultants.

Stakeholders suggest a recalibration that aligns selection criteria with the core mission of IMT: producing empathetic, clinically adept physicians. Removing double‑counting across portfolio domains, weighting sustained NHS service, and granting points for objective milestones such as Royal College Part 1 membership would shift incentives toward genuine clinical development. These reforms dovetail with the Medical Training Prioritisation Bill, which aims to protect UK graduates while valuing experienced international doctors. By refocusing on bedside performance and measurable competence, the NHS can ensure a more diverse, capable cohort of internal medicine trainees, ultimately enhancing patient outcomes.