By Medibuddy Editorial Team, Medical education specialists, Medibuddy. Last updated: June 2026.

The Palliative Medicine ST4 Application is one of the more distinctive routes into UK higher specialty training: you’re applying not just to a single CCT, but to a dual programme with Internal Medicine Stage 2, run nationally through the Physician Higher Specialty Training (PHST) recruitment office and overseen by the JRCPTB. If you’re preparing for the 2026 round, this guide walks you through eligibility, the application process, self-assessment scoring and the portfolio evidence you’ll need to put a strong case together. We’ve kept the interview side brief here and covered it in depth on the Palliative Medicine ST4 Interview Question Bank page. Here’s a quick snapshot before we dig into the detail.

Key Facts at a Glance

• Competition ratio (2025): 2.34:1 (136 applications, 58 posts, NHS England)
• Training length: 4 years full-time (ST4–ST7), dual CCT with Internal Medicine
• Key entry requirements: Full GMC registration, MRCP(UK), completed IMT stage 1 or equivalent
• Recruitment platform: Physician Higher Specialty Training (PHST) national recruitment
• 2026 Round 1 applications: 20 November – 11 December 2025 (verify on the current PHST page; some sources cite an earlier 23 October opening)
• 2026 Round 1 interview window: 5 January – 10 April 2026

What Is Palliative Medicine ST4 Higher Specialty Training?

Palliative Medicine is a four-year higher specialty training programme entered at ST4, delivered as a dual programme alongside Internal Medicine Stage 2. You’ll progress through ST4 to ST7 and finish with a dual Certificate of Completion of Training (CCT) in Palliative Medicine and Internal Medicine, which is your route onto the GMC’s Specialist Register. The curriculum is overseen by the Joint Royal Colleges of Physicians Training Board (JRCPTB) on behalf of the Federation of Royal Colleges of Physicians, with a Specialty Advisory Committee (SAC) for Palliative Medicine. National recruitment runs through the Physician Higher Specialty Training (PHST) recruitment office, while day-to-day training sits with local deaneries and schools of medicine.

Training is uncoupled, so you’ll need to complete a core stage first, most commonly Internal Medicine Training (IMT) Stage 1 or ACCS-Internal Medicine, and hold full MRCP(UK) before applying at ST4. Once in post, you’ll rotate across hospital specialist palliative care teams, inpatient hospice units and community services, and contribute to specialty palliative care on-call rotas. Most trainees start ST4 on an inpatient unit to build core symptom-control and communication skills.

Worth knowing: training is now delivered under the 2022 curriculum, which uses Capabilities in Practice (CiPs) and, for the first time, names specific key procedural skills. Rotation patterns vary meaningfully by deanery, so check the local trainee handbook for the regions you’re applying to.

Is Palliative Medicine ST4 Competitive and What Is the Lifestyle Like?

Palliative Medicine is a relatively small but consistently sought-after Group 1 specialty, which means since August 2022 you dual-accredit with Internal Medicine Stage 2 across the four-year ST4–ST7 programme. Posts are limited nationally, so while it isn’t headline-grabbing in the way some surgical specialties are, you shouldn’t underestimate it. Strong evidence of commitment (hospice taster weeks, audits in symptom control, end-of-life care projects) is what separates appointable candidates.

Lifestyle: Trainees often cite work-life balance as a key draw. Much of your week is daytime work across hospice inpatient units, hospital palliative care teams and community settings, with most ST4s starting in an inpatient hospice to build core symptom-control skills. The catch is the IM Stage 2 component: you’ll do blocks on the acute medical take as a medical registrar, plus hospice first on-call rotas (often around 1:6 in advertised posts). It’s lighter than purely acute specialties, but it isn’t on-call free.

Pay: ST4 sits at nodal point 4 of the resident doctor pay scale, basic pay around £61,825 in England under the 2024 scales, with a further 4% uplift from April 2025, plus on-call allowance (roughly £4,946/year) and additional-hours supplements. Scotland, Wales and Northern Ireland use separate scales.

After CCT: You’ll need to pass the Specialty Certificate Examination in Palliative Medicine. Most trainees move into NHS or hospice consultant roles; SAS and clinical fellow routes are realistic alternatives. Less-than-full-time training is well-established here and extends the programme pro-rata.

Palliative Medicine ST4 Eligibility Criteria and Entry Requirements

Eligibility for Palliative Medicine ST4 is set out in the annual NHS England Person Specification, underpinned by the JRCPTB-managed 2022 Palliative Medicine curriculum. The 2026 Person Specification is the document to work from before you start your Oriel application. The long-listing team checks every essential criterion against the evidence you provide.

Here’s what you’ll need in place by the relevant deadlines:

• Primary medical qualification: MBBS, MBChB or equivalent recognised by the GMC.
• GMC registration: Full registration with a licence to practise by the post start date. International medical graduates typically achieve this via PLAB, MRCP(UK) or sponsorship after completing your Foundation Programme equivalent.
• MRCP(UK): Part 1 must be passed by the application deadline, with the full MRCP(UK) Diploma held by the offer/post start date. A limited alternative route exists for candidates without MRCP(UK) who have at least 12 months of post-foundation acute medical experience, though MRCP is the standard expectation.
• Core training competences: Completion of Internal Medicine Training (IMT) stage 1 (or equivalent, typically core medical training or ACCS Acute Medicine) signed off by the post start date. If your core training was outside the UK, you’ll usually need an Alternative Certificate of Eligibility from NHS England confirming equivalence.
• English language ability: Demonstrated through GMC-recognised routes (e.g. academic IELTS or OET) unless you qualify for an exemption.
• Right to work: Settled status, UK/Irish nationality, or a Skilled Worker visa (NHS England can act as the sponsoring body).

Unlike some ST1 run-through specialties, there’s no maximum cap on months of post-foundation experience, so applying later in your career doesn’t disqualify you.

One reminder: the Person Specification is updated each year, so always cross-check against the current handbook before you submit.

How to Apply for Palliative Medicine ST4 National Recruitment

Palliative Medicine ST4 recruitment runs as a single national annual round coordinated by the Physician Higher Specialty Training (PHST) office on behalf of NHS England, with applications submitted through the Oriel portal. The specifics below reflect the 2026 cycle; check the current ST4 applicant handbook on the PHST recruitment site for any updates before you submit.

Here’s how the process works step by step:

1. Check eligibility against the 2026 person specification: You’ll typically be applying with around 24 months of post-Foundation Programme medical experience via Internal Medicine Training (IMT), Core Medical Training (CMT) or ACCS, plus the required MRCP progress and GMC registration.
2. Register on Oriel (oriel.nhs.uk): if you haven’t already. This is the single national platform for UK specialty recruitment, and there’s no application fee.
3. Choose your specialties carefully: From the 2025/26 cycle onwards, Round 1 candidates can submit a maximum of five applications across specialties (down from around twelve in earlier years), and only one application is allowed per specialty. You can usually rank multiple deanery preferences within your Palliative Medicine ST4 application.
4. Complete the application form sections: Expect personal details, eligibility declarations, employment history, qualifications, fitness-to-practise questions, and three referees (contact details only; references are pulled by Oriel after offer, not at submission). Your first referee should be your current or most recent clinical employer covering the last two years.
5. Complete the self-assessment / supporting information: This is the scored part of the form, mapping your evidence against the ST4 person specification domains. Your claims must be verifiable against portfolio evidence at interview.
6. Upload supporting documents: GMC registration, evidence of IMT/CMT/ACCS competencies, and, if you’re reapplying, a signed “support for reapplication” form from your Training Programme Director.
7. Submit before the deadline: Round 1 for the 2026 intake opened in autumn 2025 and closed in mid-December, with first offers due by 31 March 2026 and posts commencing August 2026. Round 2 typically follows mid-year for residual vacancies, which matters here because Palliative Medicine has been undersubscribed at points (only 34 of 54 England posts filled in 2024).

If you’re unsuccessful, you can reapply in a future cycle. There’s no lifetime cap. After two unsuccessful attempts, you’ll need a “support for reapplication” form signed by your Training Programme Director and educational supervisor. PHST also runs a formal complaints and appeals route for procedural concerns about the recruitment process itself, though appeals can’t challenge selection scoring judgements.

Palliative Medicine ST4 Recruitment Timeline and Key Dates (2026)

National recruitment for Palliative Medicine ST4 is run through Physician Higher Specialty Training (PHST) via Oriel, on a single timeline shared across England, Scotland and Wales. For the 2026 cycle, official PHST guidance shows Round 1 applications opened at 10am on 20 November 2025 and closed at 4pm on 11 December 2025, with interviews held within a long national window running from 5 January to 10 April 2026, though some other sources cite an earlier 23 October opening, so verify on the current PHST page before planning. The specialty is currently recruiting in Wessex, West Midlands, Yorkshire & Humber and Scotland, each with its own interview date inside that window, published on the PHST Palliative Medicine specialty page.

Here are the key 2026 Round 1 dates at a glance:

Stage	Date (2026 Round 1)
Applications open (Oriel)	10am, 20 November 2025
Applications close	4pm, 11 December 2025
Evidence upload window	Week commencing 22 December 2025
Shortlisting outcomes	No later than 7 days before your interview
Interview window	16–18 March 2026
First offers deadline	~14 April 2026
Offer holding deadline	~22 April 2026
Offer upgrade deadline	~23 April 2026
Post start date	August 2026

A few practical notes. Offers come through Oriel with a 48-hour response window each time, and you can only hold one offer at a time while waiting on a higher preference. Evidence upload dates sit separately from the application window and vary by region, so check the “Interview dates & posts” section on the PHST Palliative Medicine page as soon as it’s updated for your region. If Round 1 isn’t successful, a Round 2 typically opens for applications in late summer. Dates can shift year on year, so confirm against the PHST timeline before locking in your plan.

Palliative Medicine ST4 Competition Ratios and Application Trends

Palliative Medicine at ST4 has historically been one of the calmer corners of higher specialty recruitment, but that picture is changing fast. According to NHS England’s Medical Hub competition ratio data, the specialty has gone from being broadly one-applicant-per-post to genuinely competitive in just three cycles.

Here’s how the last few rounds compare:

Year	Applications	Posts	Competition ratio
2022	53	51	1.04:1
2024	101	65	1.55:1
2025	136	58	2.34:1

That’s more than a doubling of the ratio since 2022, driven by a sharp rise in applicants alongside a slight contraction in posts. Several factors are likely playing in: the dual-accreditation pathway with Internal Medicine has widened the appeal, and the IMT pipeline now feeds a larger cohort towards ST4 entry points across the medical specialties.

One nuance worth knowing: despite more applicants than posts, the 2025 England fill-rate data shows 40 accepts against 51 advertised posts (around 78%), so not every post was filled. Parliamentary written evidence has noted Palliative Medicine historically recruits close to 100%, so the 2025 dip is notable. Regional competitiveness isn’t published in a granular way, though larger deaneries like London tend to attract more applicants.

The headline for you: treat this as a competitive specialty in 2026, plan your evidence accordingly, and don’t assume the older “almost everyone gets in” reputation still holds.

How Palliative Medicine ST4 Applications Are Scored (2026)

Palliative Medicine ST4 recruitment runs through Physician Higher Specialty Training (PHST), and the scoring framework is published openly, which is genuinely helpful when you’re planning where to put your effort. There’s no separate written exam in the recruitment process itself (MRCP is an eligibility requirement, not a scored domain), so your final ranking comes down to two things: your self-assessment on the application form, and your interview.

The headline weighting

According to the PHST Palliative Medicine specialty page, the total score is out of 100, split as follows:

Component	Raw score	Weighting	Contribution to total
Interview, scored across 8 marks (2 stations × 2 questions, each scored 1–5 by 2 interviewers)	/40 raw, scaled to /50	×1.6	80 points
Application self-assessment	/40	×0.5	20 points
Total			/100

So the interview carries roughly four times the weight of the application form. That said, the self-assessment isn’t a side-show. It’s the gateway to shortlisting in the first place, and in a year with 136 applications for 58 English posts (2025 figures from NHS England), those 20 points decide who gets ranked highly enough for an offer once interview scores are close.

Appointability thresholds

Even with a strong combined score, you have to clear PHST’s appointability bar at interview:

• A Ranking Interview Score currently cited as at least 30 for Palliative Medicine ST4 (verify against the current PHST specialty page, as thresholds can change year to year and the general PHST page has previously cited 24)
• No single station scored 1 out of 5
• No more than two stations scored 2 out of 5

Miss any of these and you’re not ranked for offers, regardless of how good your application form was.

How the self-assessment feeds in

The self-assessment is a structured form where you award yourself points across defined domains (additional degrees, publications, presentations, teaching, quality improvement, leadership and commitment to specialty) with documentary evidence for every claim. Anything you can’t evidence at interview gets struck out and rescored, which can pull your total down meaningfully. We’ve broken down each domain, the evidence rules and where Palliative Medicine candidates typically lose easy points in the next section. The full station-level interview detail sits on the dedicated Palliative Medicine ST4 Interview Question Bank page.

Palliative Medicine ST4 Self-Assessment and Portfolio: How to Maximise Your Score

Palliative Medicine ST4 shortlisting runs through Physician Higher Specialty Training (PHST) recruitment on Oriel, and your application score is built almost entirely from a self-assessment matrix. You tick the highest band you can honestly claim in each domain, then upload documentary evidence to back it up. There’s no procedural logbook here. Unlike surgical specialties, clinical volume isn’t counted. What matters is the quality of evidence you can produce against each specific domain.

The domains you’re actually scored on

The PHST self-assessment for Palliative Medicine ST4 has, in recent years, covered the following areas. Tier values are based on the published PHST self-assessment framework, which should be verified against the current year’s scoring matrix on the PHST Document Library:

• Additional qualifications: intercalated degrees, MSc/MD/PhD. Higher degrees typically score higher; certificates required.
• Publications: PubMed-indexed first-author papers sit at the top; case reports and non-indexed pieces score lower.
• Presentations and posters: international oral > national oral > regional > local. Verified via the PHST Presentations/Posters pro forma signed by a senior author.
• Teaching experience and training in teaching: a “Train the Trainer” course sits at the lower end; based on the published framework, a PGCert, PGDip or Masters in Medical Education typically scores higher (confirm exact point values in the current scoring matrix).
• Quality improvement and audit: full cycles with personal leadership beat single-loop participation. Audit reports and supervisor sign-off are the usual evidence.
• Leadership and management: formal roles (rota lead, committee member, trainee rep) with evidence of impact.
• Commitment to specialty: palliative-specific tasters, hospice placements, APM membership, conferences, relevant courses. Per PHST guidance, this domain is worth roughly 20% of the application score, and it’s where palliative applicants genuinely differentiate themselves.

Where candidates lose easy points

The recurring pitfalls are administrative rather than clinical. Common ones:

• Don’t claim a publication band you can’t evidence with a PubMed ID or acceptance email dated before the Oriel closing date.
• Don’t list a poster without the signed PHST pro forma. Unverified claims are downgraded.
• Don’t assume your Internal Medicine Stage 1 ARCP outcome will “just appear”; have the certificate (or Alternative Certificate) ready at submission.
• Do complete every achievement before the application closing date. Anything finished afterwards doesn’t count.
• Do keep teaching feedback forms with dates, audience numbers and your role specified.

Building evidence before applications open

If you’re a year out, the highest-yield moves for palliative specifically are: arrange a hospice or hospital palliative care taster, complete a full audit cycle on a palliative-relevant topic (symptom control, advance care planning, end-of-life prescribing), and book onto a recognised teaching qualification if you’re targeting that domain. A first-author case report or service evaluation in a palliative journal is achievable in months and lifts your publications score meaningfully. You can also browse our wider Medibuddy blog for portfolio-building advice across UK specialty training.

The Palliative Medicine ST4 Interview: A Brief Overview

If you’re shortlisted, the Palliative Medicine ST4 interview is a structured, multi-station selection coordinated nationally through the Physician Higher Specialty Training (PHST) recruitment process and scheduled centrally by NHS England. Current PHST guidance describes a two-station format, with each station scored by a separate pair of interviewers covering different domains drawn from the person specification. The NHS interview schedule lists Palliative Medicine ST4 interviews on 16–18 March 2026, the specialty-specific date within the broader Round 1 window of 5 January to 10 April 2026.

We’ve kept this section deliberately short because the full station-by-station breakdown, the domains assessed, scoring weightings and practice scenarios all live on our dedicated interview page.

For the full breakdown, scoring detail and scenario questions with model answers written by high-scoring Palliative Medicine trainees, head to the Palliative Medicine ST4 Interview Question Bank.

Palliative Medicine ST4 Offers, Preferencing and What Happens Next

Once interviews are done, the Physician Higher Specialty Training (PHST) office, coordinating on behalf of the JRCPTB, releases offers through Oriel in national rank order. Here’s roughly how the journey from interview to start date plays out:

1. Interview scoring is collated nationally and candidates are ranked across all Palliative Medicine ST4 applicants in the UK.
2. You preference posts on Oriel in your true order of preference. Don’t game it. The algorithm matches your highest-ranked available preference to your national rank.
3. Offers are released in rounds. You’ll have a fixed window (generally around 48 hours) to accept, hold or decline.
4. Opt in to the upgrade (“hold-down”) process when you respond. If a higher-preferenced post opens up because a better-ranked candidate declines or moves, your offer is automatically upgraded to your highest available preference, and your previous post cascades down to the next person.
5. Pre-employment checks with your allocated deanery follow: references, occupational health, DBS, right-to-work.
6. You start ST4 in August, joining a four-year programme dual-accrediting with Internal Medicine Stage 2.

A practical note: because the Palliative Medicine ST4 programme is dual-CCT with GIM, post location affects which hospitals you’ll rotate through for the medicine component too, so weigh that when ranking. Reserve-list and upgrade activity has historically continued well into the preferencing window, so don’t panic if your first offer isn’t your top choice.

Frequently Asked Questions About Palliative Medicine ST4 Application

How competitive is Palliative Medicine ST4?

Competition has risen sharply. NHS England’s Medical Hub data show the ratio climbing from around 1.04 in 2022 (53 applications for 51 posts) to 1.55 in 2024 (101 for 65), and 2.34 in 2025 (136 for 58). Interestingly, the 2025 fill-rate data showed only 40 of 51 advertised posts accepted, so rising applicant numbers haven’t yet translated into every post being filled.

Who is eligible to apply for Palliative Medicine ST4?

You’ll need MBBS (or equivalent), full GMC registration with a licence to practise, and MRCP(UK) by the time of post start. You also need to have completed the Foundation Programme plus a core training stage delivering Internal Medicine Training (IMT) stage 1 competences, typically IMT, core medical training, or ACCS (Acute Care Common Stem) acute medicine. The full essential and desirable criteria sit in the NHS England Palliative Medicine ST4 2026 Person Specification.

Do I need to sit the MSRA for Palliative Medicine ST4?

No. Palliative Medicine ST4 doesn’t use the MSRA. Shortlisting is based on a self-assessment scored against the published person specification, with your claims verified against uploaded portfolio evidence. MRCP(UK) is the exam requirement that matters for eligibility, not a written sift exam.

How do I apply for Palliative Medicine ST4?

Applications go through a single national process coordinated by the Physician Higher Specialty Training (PHST) Recruitment Office, with the form submitted via the Oriel online portal. You apply to the specialty nationally and preference regions within the same application. For the 2026 cycle, Round 1 applications opened on 20 November 2025 and closed at 4pm on 11 December 2025 (check the current PHST page, as some sources cite an earlier opening date).

When are Palliative Medicine ST4 interviews held in 2026?

The national PHST Round 1 interview window runs from 5 January to 10 April 2026. Specialty-specific dates are published on the PHST Palliative Medicine page, and the NHS interview schedule lists Palliative Medicine ST4 interviews on 16–18 March 2026. For 2026, the recruiting regions are Wessex, West Midlands, Yorkshire & Humber and Scotland, each running interviews within that overall window.

How long is Palliative Medicine higher specialty training?

Higher specialty training is typically four years full-time (ST4–ST7), delivered as a dual programme alongside Internal Medicine stage 2. You exit with a dual CCT in Palliative Medicine and Internal Medicine. The programme includes 12 months of acute unselected take across the four years.

Do teaching qualifications score points on the self-assessment?

Yes. Based on the published PHST self-assessment framework (verify against the current year’s scoring matrix), the Teaching and Training in Teaching domain rewards accredited “Train the Trainer” or “Teach the Teacher” courses at the lower end, with higher points typically awarded for a PGCert, PGDip or Masters in Medical Education from a recognised university. You need to hold the qualification (or have documented evidence of completion) at the point of application to claim the points.

What happens if I’m offered a lower-preferenced post, can I upgrade?

Yes. When you respond to your Oriel offer, you can opt in to the upgrade process. If a post higher up your preference list becomes available because a higher-ranked candidate declines, your offer is automatically upgraded to the highest available preference, and your previous post is released back to the next candidate.

Palliative Medicine ST4 Useful Resources

When you’re pulling your application together, it helps to work from the official sources first and then layer on specialty-specific guidance. Here’s where we’d send you.

Official recruitment and eligibility

• NHS England Person Specification: Palliative Medicine ST4 2026: the definitive eligibility document.
• PHST Recruitment: Palliative Medicine: the JRCPTB-run national recruitment office, with timelines and the applicant handbook.
• PHST Application Scoring guidance: sets out how the self-assessment domains are scored.

Specialty and curriculum guidance

• Association for Palliative Medicine: Getting into Pall Med and the APM Trainee Resources hub.
• GMC End of Life Care guidance: core reading for ethics scenarios.
• London/KSS Dual Trainee Handbook: practical detail on dual training with Internal Medicine.

Peer networks

• APM Juniors and APM Trainees Facebook groups, plus the r/doctorsUK community for current-cycle chatter.

Medibuddy resources

• Palliative Medicine ST4 Interview Question Bank for scenario questions with model answers.
• Foundation Programme guide for wider specialty training context.

Putting together a strong Palliative Medicine ST4 application takes time, but it’s very doable when you break it down. Keep coming back to the NHS England person specification, score yourself honestly against the PHST self-assessment domains, and gather your evidence (publications, QI, teaching, commitment to specialty) well before the form opens. Small margins matter at this stage, so every well-evidenced point counts.

When you’re ready to turn your attention to the interview, the Palliative Medicine ST4 Interview Question Bank has scenario questions with model answers written by high-scoring trainees. We’re rooting for you.