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Genitourinary Medicine ST4 8th July 2026

Complete Guide to Genitourinary Medicine ST4 Application and Recruitment (2026)

If you’re putting together your Genitourinary Medicine ST4 application for 2026, you’re aiming for one of the most rewarding higher specialty routes in UK medicine: a four-year dual-accreditation programme with Internal Medicine, entered after IMT1–3 and recruited nationally through Oriel and the Physician Higher Specialty Training (PHST) office. We’ve written this guide to walk you through the whole recruitment side of things: eligibility, the person specification, self-assessment scoring, portfolio evidence and the application mechanics (including a reported five-application cap being introduced across specialties for 2026). A note on caveats: recruitment rules and dates shift year to year, so always cross-check what follows against the current NHS England GUM ST4 person specification and PHST applicant handbook before submitting. We won’t repeat that reminder in every section. The interview itself is covered in depth on our Genitourinary Medicine ST4 Interview Question Bank page, so we’ll only summarise it here. Let’s start with the headline facts.

Key Facts at a Glance

  • Competition ratio (2025): 1.02:1 (46 applications, 45 posts)
  • Training length: 4 years, dual CCT in GUM and Internal Medicine
  • Entry level: ST4, after Internal Medicine Training
  • Key requirement: Full MRCP(UK) by offer date, GMC registration
  • Recruitment platform: Oriel, coordinated by PHST recruitment
  • 2026 interview date (England): 18 March 2026 (NIMDTA: 5 February 2026)

Table of Contents

What Is Genitourinary Medicine ST4 Higher Specialty Training?

Genitourinary Medicine (GUM) is a higher specialty training programme entered at ST4, after you’ve completed Foundation training and Internal Medicine Training stage 1 (IMT1–3) with full MRCP(UK). Since August 2022, all new higher specialty trainees follow the updated 2022 curriculum and dual-accredit in Genitourinary Medicine and Internal Medicine, so you’ll build GUM, HIV and sexual health expertise while maintaining acute general medical competencies throughout.

The programme runs ST4–ST7, typically four years, with roughly 12 months full-time equivalent in Internal Medicine spread across the four years (about three months per year). The curriculum is set by the Joint Royal Colleges of Physicians Training Board (JRCPTB) on behalf of the Federation of Royal Colleges of Physicians, and it’s structured around Capabilities in Practice (CiPs), split into generic and specialty-specific, assessed through workplace-based assessments and annual ARCPs against the JRCPTB decision aid.

Recruitment is coordinated nationally through Oriel and the Physician Higher Specialty Training (PHST) recruitment office, and the same person specification applies across England, Northern Ireland, Scotland and Wales. What varies is local delivery: deaneries such as London, West Midlands, Severn and Yorkshire & Humber run their own rotation patterns and regional teaching days, and HIV volume and urban versus district general case mix can differ noticeably.

At the end of ST7, you’ll be awarded a dual CCT in Genitourinary Medicine and Internal Medicine, giving you entry to the GMC Specialist Register in both. Most trainees also collect the Diploma in GUM, Diploma in HIV Medicine and often the DFSRH along the way, opening doors into HIV, SRH, genital dermatology, psychosexual medicine and academic pathways after CCT.

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

If competition is your first worry, GUM ST4 is one of the least contested higher specialty routes in UK medicine. The 2025 round had 46 applicants for 45 posts, a ratio of roughly 1.02:1 (community-source figure from specialty-applications.co.uk, cross-referenced with NHS England data). For context, the related Community Sexual and Reproductive Health ST1 route sat at around 98.5:1 the same year, so if sexual health is your interest, the ST4 GUM pathway is by far the more accessible door.

Lifestyle. GUM has long been known for a favourable work–life balance, and that’s still broadly true. Clinics are predominantly outpatient, and pure GUM/HIV on-call is light. The important caveat since August 2022 is that all higher trainees dual accredit with Internal Medicine, so you’ll spend around three months of each training year on GIM placements, contributing to the acute medical take. That’s where most of your antisocial hours will come from. Less-than-full-time training is well supported and extends the four-year programme pro rata.

Salary. At ST4 you sit at nodal point 4 on the 2025/26 resident doctor scales: basic pay around £65,048, rising to about £73,992 at nodal point 5 (ST6+). Additional hours, on-call supplements and London weighting sit on top.

Career trajectory. You’ll CCT as a dual consultant physician in GUM and GIM, with strong workforce demand driven by rising STI rates. Sub-specialty interests (HIV, complex STIs, adolescent sexual health, contraception) are actively encouraged, and many consultants combine clinical work with public health, teaching or research roles.

Genitourinary Medicine ST4 Eligibility Criteria and Entry Requirements

Eligibility for Genitourinary Medicine ST4 is set out in the nationally agreed person specification published by NHS England, and it applies across all four UK nations. Since August 2022 the programme has been dual-accredited with Internal Medicine, so the entry criteria are built around completing IMT and holding the full MRCP diploma, not just a Part 1 pass as at some other ST4 entry points. This is the document to anchor everything else to: if you take one action away from this guide, it’s downloading and working through the current version line by line.

To be eligible for the 2026 round, you’ll need to meet the following:

  • Primary medical qualification: MBBS or equivalent, with an acceptable postgraduate qualification route recognised by the GMC for overseas graduates.
  • Registration: Full GMC registration with a licence to practise by the post start date, and full registration at the point of application.
  • Postgraduate exams: MRCP(UK) Part 1 at application, with the full MRCP(UK) diploma by the offer date. Equivalent routes include eligibility for the specialist register in General Internal Medicine, or completion of Irish Basic Specialty Training with full MRCPI. Our MRCP guide covers timing strategy if you’re still working towards it.
  • Prior training: Completion of Internal Medicine Training stage 1 (IMY1–3). From August 2024 onwards, IMY3 (the 3-year IMT) is required. The older 2-year CMT is no longer sufficient.
  • Competence sign-off: Foundation competences achieved, plus evidence of the IMT stage 1 outcomes required for ST4 progression. IMGs must map overseas experience to at least 36 months in medical specialties with equivalence to IMT.
  • English language: Evidenced via GMC-accepted routes (IELTS, OET, or an exemption through an English-medium primary medical qualification).
  • Right to work: Valid immigration status verified through Oriel. From 2026, the Medical Training (Prioritisation) Bill also affects how offers are ordered by immigration status.

There’s no formal cap on post-foundation experience at ST4 level, so more experienced applicants remain eligible.

How to Apply for Genitourinary Medicine ST4 National Recruitment

Applications for Genitourinary Medicine ST4 run through a single national round coordinated by the Physician Higher Specialty Training (PHST) Recruitment Office, with the Midlands region long/shortlisting on behalf of the UK.

Here’s the mechanical walkthrough for the 2026 round:

  1. Register on Oriel. All UK Specialty Registrar applications go through Oriel, the national recruitment portal. There’s no application fee. Create your account well before the window opens so you’re not fighting with password resets on day one.
  2. Check you meet the person specification. You need GMC registration with a licence to practise, MRCP(UK) Part 1 by the application deadline, and the full MRCP(UK) diploma by the offer date. You’ll also need to evidence completion (or imminent completion) of Internal Medicine Stage 1 or ACCS-IM. If your Foundation or Core stage is still in progress, our Foundation Programme guide sets out the wider training pathway.
  3. Open your application within the window. For the 2026 intake, Round 1 opened at 10:00 on 23 October 2025 and closed at 16:00 on 20 November 2025. A further HST window runs 28 July to 13 August 2026 for remaining August posts.
  4. Complete the form sections. You’ll enter personal details, qualifications, employment history, fitness-to-practise declarations, and, crucially, the self-assessment/self-score against the published domains. This score drives shortlisting, so treat it as the heart of the application.
  5. Rank your programme preferences. You’ll rank deaneries within GUM. A five-application cap across specialties has been reported for 2026: confirm the current limit against the applicant handbook before submitting, and if it applies, choose deliberately.
  6. Declare any previous training programme history. If you’ve previously resigned from or been removed from a specialty training programme, you must declare it and obtain a Support for Reapplication from your previous Postgraduate Dean before you can reapply.
  7. Submit, then wait for shortlisting. Applications are shortlisted on verified self-assessment score, with claims cross-checked against your uploaded portfolio evidence. Supporting documents (passport, GMC certificate, MRCP evidence) are verified at eligibility checks; references are only requested via Oriel after you accept an offer, not at submission.
  8. If unsuccessful, you can reapply. There’s no cap on the number of reapplication attempts, and PHST operates a formal complaints and appeals route where the panel’s decision is final.

Interviews for GUM ST4 2026 run from 5 January to 10 April 2026, with Round 1 offers expected by 31 March 2026.

Genitourinary Medicine ST4 Recruitment Timeline and Key Dates (2026)

Genitourinary Medicine ST4 recruitment sits within the Physician Higher Specialty Training (PHST) national process, coordinated centrally and run through Oriel. There are two rounds each year: Round 1 in the spring for the main August intake, and a smaller Round 2 in the autumn for August–December start dates. Since August 2022, all GUM higher trainees dual accredit with Internal Medicine, so the timeline sits alongside the wider physician specialties.

Here are the key Round 1 dates for the 2026 intake:

Milestone Date (2026 Round 1)
Application window (Oriel) Opens late autumn 2025, closes ahead of shortlisting
Evidence upload Within the main Oriel application window (no separate portal)
Shortlisting outcomes No later than 7 days before the interview date
GUM ST4 interview (NHS England) 18 March 2026
GUM ST4 interview (NIMDTA, Northern Ireland) 5 February 2026
First offers released By 31 March 2026
First offers deadline 5pm, Tuesday 14 April 2026
Offer holding deadline 1pm, Wednesday 22 April 2026
Offer upgrade deadline 4pm, Thursday 23 April 2026

A few practical points worth flagging. All self-assessment evidence must be uploaded through Oriel within the main application window. There is no separate portfolio upload portal opening later, and late evidence uploads are not accepted, so give yourself several days of buffer before the close. If posts remain unfilled after Round 1, GUM participates in Round 2, with the PHST timeline showing a summer application window (28 July to 13 August 2026) for August start dates. Devolved nations (Scotland, Northern Ireland) publish their own hold and upgrade deadlines that can differ by a week or two, so if you’re applying regionally, check your deanery page.

Genitourinary Medicine (GUM) sits at the less competitive end of higher specialty training, and the numbers have stayed that way for years. In the 2025 round, NHS England recorded 46 applications for 45 advertised posts, giving a competition ratio of 1.02:1, essentially one applicant per post. The fill rate tells the more striking story: only 17 of 41 posts were accepted, a fill rate of around 41%.

Cycle Applications Posts Ratio Notes
2025 46 45 1.02:1 ~41% fill rate (17 accepts / 41 posts)
2024 27 51 0.53:1 More posts than applicants
2019 (ST3, pre-reform) — — 0.43:1 Historically undersubscribed

Two things are worth flagging. First, NHS England’s competition ratios table and fill-rate table give slightly different post counts for 2025 (45 vs 41), which reflects different snapshots during the cycle rather than a data error. Second, since August 2022, GUM training has moved to dual accreditation with Internal Medicine, which changes the shape of the training programme but hasn’t materially shifted applicant volumes.

The practical takeaway: if you’re eligible and your portfolio and Internal Medicine Training evidence are in order, you have a genuinely realistic shot at a post. Regional variation isn’t published, so it’s worth thinking carefully about your deanery preferences. Undersubscribed specialties often mean some regions fill while others don’t.

How Genitourinary Medicine ST4 Applications Are Scored (2026)

Genitourinary Medicine ST4 recruitment is run through Physician Higher Specialty Training (PHST), and unlike some specialties where interview does most of the heavy lifting, GUM uses a structured self-assessment application score alongside the interview. Getting to grips with how those two pieces combine is worth doing early, because it changes where you invest your time in the months before applications open.

The two components that make up your score

Selection has two scored stages plus eligibility gateways:

  1. Self-assessment application form, scored by PHST against defined domains, with points only awarded where you upload the specified supporting evidence.
  2. Interview / selection centre, used to shortlist rank and produce your Rank Index Score (RIS), reported by PHST as each domain scored 1–5 across roughly ten items, giving a RIS between 10 and 50.
  3. Eligibility gateways: full MRCP(UK) diploma and Internal Medicine (IMT) competences. These are pass/fail, not scored, but without them you don’t progress at all. Remember GUM has dual-accredited with Internal Medicine since August 2022, so IM competencies are non-negotiable.

Self-assessment domains and weighting

PHST generic guidance indicates around 38 points are available across the self-assessment domains on the application form. Confirm the exact total in the current GUM ST4 scoring guidance for your recruitment year. The domains map to the GUM ST4 2026 person specification and cover the areas below. We’ve kept this at a summary level here; the next section unpacks what each domain actually wants and where candidates lose easy marks.

Self-assessment domain What it covers
Qualifications MBBS, MRCP(UK), any additional degrees
Career progression & commitment to specialty GUM-relevant posts, tasters, courses
Clinical skills & experience Breadth relevant to GUM and IM
Quality improvement QI project with recognised methodology, ideally completed cycle
Audit Clinical audit activity and outcomes
Teaching experience Sessions or programmes delivered, with formal feedback
Training in teaching Formal teaching qualifications or courses
Presentations Local vs national vs international; oral vs poster
Publications First vs co-authorship; peer-reviewed vs not
Leadership & management Roles held and impact demonstrated

One honest caveat on weighting: PHST publishes the domain structure and the RIS range, but doesn’t publish an explicit percentage split between the application score and interview score in the final combined ranking for GUM ST4. A community source suggests a roughly 50/50 split for ST3/ST4 medical specialties broadly, but this is unconfirmed for GUM ST4 specifically. The PHST GUM applicant handbook is the definitive source. Either way, both halves matter: a strong self-assessment gets you shortlisted and starts you higher up the ranking, and the interview then decides where you land.

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

GUM ST4 shortlisting is run through Physician Higher Specialty Training (PHST), and it works differently from many surgical or GP applications. There’s no operative logbook, no case numbers to count. Instead, you self-score against a set of defined domains, upload evidence for every claim through Oriel, and your verified score produces a Rank Index Score (reported as roughly 10–50) that decides whether you’re shortlisted for interview. The self-assessment has typically totalled around 38 points across the domains below in recent rounds. Check the current PHST GUM scoring guidance for the exact rubric in your recruitment year.

The domains that carry the points

  • Postgraduate qualifications. Full MRCP(UK) is required by the offer date given the dual GUM/Internal Medicine accreditation introduced in August 2022. Additional degrees (MSc, MD, PhD) score in their own domain: the higher and more relevant, the better.
  • Publications. PubMed-indexed original research scores highest. First-author beats co-author; case reports and letters score lower than original papers.
  • Presentations. International oral presentations sit at the top of the scale; regional posters at the bottom. GUM/HIV-relevant topics strengthen the “commitment to specialty” narrative even if the domain itself is topic-neutral.
  • Teaching. Sustained, structured teaching with feedback outscores ad hoc bedside sessions. A PGCert in Medical Education or an accredited “training the trainers” course typically scores higher than short courses, though no formal qualification is mandatory.
  • Quality improvement and audit. Completed cycles with a second loop and a measurable change score well above one-off data collection projects.
  • Leadership and management. Formal roles (rota lead, BMA rep, committee membership) with evidence of impact are what score, not vague “team player” claims.

How evidence is verified

Every scored item needs documentary proof uploaded during the Oriel window (in 2025 this ran 15–29 May). PHST provides pro formas in its Document Library for publications, presentations, teaching and QI. You must use these where required. Certificates, acceptance emails and supervisor sign-off letters go in as PDFs. Anything unverifiable, or submitted without the correct pro forma, is not scored. This is where candidates most commonly lose easy points.

Do and don’t

  • Do download the PHST GUM shortlist score distribution (2013–2025) to benchmark yourself against previous cohorts.
  • Do get supervisor sign-off letters drafted and signed months in advance, not the week of application.
  • Don’t claim a QI project without a completed second cycle documented.
  • Don’t rely on screenshots of emails. Use the official pro forma every time.

One final point worth holding in mind: with GUM ST4 running at roughly 1.02:1 in 2025, the self-assessment mostly functions as a gate to interview. Once you’re through, the interview does the heavy lifting, and that’s covered in depth in the Genitourinary Medicine ST4 Interview Question Bank.

The Genitourinary Medicine ST4 Interview: A Brief Overview

If you’re shortlisted, the Genitourinary Medicine ST4 selection process moves on to a structured online interview run through the Physician Higher Specialty Training (PHST) recruitment route. According to the official PHST recruitment page, it’s split across two stations of around 20 minutes each, giving roughly 50 minutes in total including the transition between them. Across the two stations you’ll face four questions of about 10 minutes each, covering areas like clinical scenarios, ethical scenarios and presentations, with communication skills assessed throughout. Each station is staffed by a separate pair of interviewers, and your weighted interview score is combined with your application score to produce the total ranking score.

We’ve kept this deliberately brief because the full station-by-station breakdown, scoring detail and practice material sit on a dedicated page.

Preparing for the interview? Work through the Genitourinary Medicine ST4 Interview Question Bank for scenario questions with model answers written by high-scoring trainees.

Genitourinary Medicine ST4 Offers, Preferencing and What Happens Next

Once interviews are done, offers for Genitourinary Medicine ST4 are made through Oriel and coordinated nationally by PHST Recruitment. Here’s how the sequence generally works from interview to start date:

  1. Rank order list published. Candidates who meet the shortlisting and interview threshold are ranked nationally against the number of GUM ST4 posts available that round (45 posts in 2025, against 46 applications).
  2. Preferencing your posts. Before offers are released, you rank the deanery/region posts in your order of preference on Oriel. Do this thoughtfully: geography, rotation structure and HIV/sexual health case mix vary meaningfully between programmes.
  3. Initial offer. Oriel matches your rank position against your preference list and issues one offer at the highest preference still available.
  4. Hold-down period. You have a fixed window (typically 48 hours, confirmed each round in the applicant handbook) to accept, accept with upgrades, decline, or hold. “Accept with upgrades” is usually the sensible move: you keep the offer while remaining eligible for anything higher on your list.
  5. Upgrades cascade. As higher-ranked candidates decline, posts free up and offers automatically upgrade to your highest available preference until upgrades close.
  6. Pre-employment checks and start date. Once you commit, the appointing deanery handles occupational health, DBS and contract paperwork ahead of the standard August start.

There’s no fast-track for prior GUM experience. Everyone enters at ST4 into the four-year dual GUM/GIM programme set by the JRCPTB.

Frequently Asked Questions About Genitourinary Medicine ST4 Application

How competitive is Genitourinary Medicine ST4?

Genitourinary Medicine ST4 has historically been one of the less competitive higher physician specialties. NHS England’s 2025 data recorded 46 applications for 45 posts, a ratio of just 1.02:1, with a fill rate around 41%. That said, undersubscription doesn’t guarantee an offer. You still need to meet every essential criterion on the person specification and score well at interview.

What are the eligibility requirements for GUM ST4 in 2026?

You need MBBS (or equivalent) with GMC registration, foundation competences signed off, and MRCP(UK) Part 1 at the time of application with the full MRCP(UK) diploma by the offer date. Alternative routes include specialist register eligibility in General Internal Medicine or Irish Basic Specialty Training plus MRCPI. The 2026 person specification is published by NHS England and applies across all four UK nations.

How do you apply for Genitourinary Medicine ST4?

Applications are made through the Oriel portal in a single centralised national process, coordinated by the JRCPTB Recruitment Office via PHST Recruitment. You apply once against the UK-wide person specification, complete a verified self-assessment, and, if shortlisted, attend interview. Northern Ireland runs its own parallel process through NIMDTA but uses the same person specification.

When does the GUM ST4 interview window open in 2026?

For 2026 Round 1, the NHS England interview schedule lists the national Genitourinary Medicine ST4 interview date as 18 March 2026. NIMDTA is running its Northern Ireland GUM ST4 interview earlier, on 5 February 2026. First offers across Round 1 specialties are expected by 31 March 2026. GUM also participates in Round 2 later in the year for any remaining posts.

How does shortlisting work for GUM ST4?

Shortlisting is driven by your verified self-assessment score entered on the Oriel application form, benchmarked against the ST4 person specification. The highest-scoring applicants are invited to interview, and self-assessment claims are cross-checked against your uploaded portfolio evidence. Any claim you can’t evidence gets removed, which can drop you below the shortlisting threshold, so be conservative and accurate.

Do you need a PGCert in Medical Education to apply?

No. The 2026 GUM ST4 person specification asks for evidence of teaching experience and/or training in teaching, but a formal postgraduate qualification isn’t mandatory. A short accredited “training the trainers” course meets the essential criterion. Where teaching is scored, more substantial qualifications (PGCert or PGDip in Medical Education) typically score above ad hoc teaching experience, though exact bands aren’t published.

How long is Genitourinary Medicine training?

Higher specialty training in GUM is a 4-year programme entered at ST4, leading to a CCT. Since August 2022 it’s delivered as a dual-accreditation programme with Internal Medicine, so you’ll spend roughly 12 months full-time equivalent in internal medicine spread across the four years (about 3 months per year), with the remainder in GUM.

What happens if you’re offered a lower-preference post?

You can accept and “hold with upgrades”. If a post you ranked higher becomes available later in the offers cycle, it’s automatically allocated to you and replaces your accepted offer. Upgrades continue running until the process closes or you decline further upgrades. This is standard across physician higher specialty training coordinated by PHST Recruitment.

Genitourinary Medicine ST4 Useful Resources

When you’re pulling your application together, we recommend anchoring everything to the official sources first and using community material as a supplement. Here’s where to look.

Official recruitment and person specification

Curriculum, clinical standards and specialty networks

Medibuddy guides

  • Genitourinary Medicine ST4 Interview Question Bank: scenario questions with model answers from high-scoring trainees.
  • Foundation Programme guide: the wider UK training pathway leading up to ST4.
  • MRCP guide: timing strategy and preparation advice for the essential ST4 gateway exam.

Applying for Genitourinary Medicine ST4 is a big step, but with dual GUM and Internal Medicine accreditation, full MRCP(UK), a well-organised self-assessment and a portfolio that maps cleanly to the PHST scoring domains, you’re giving yourself the best possible start. Get your evidence together early, cross-check everything against the current NHS England person specification, and treat the self-assessment as the scorable exercise it is.

When you’re ready to prepare for interview day itself, the Genitourinary Medicine ST4 Interview Question Bank has scenario questions with model answers, put together by high-scoring trainees. Good luck. You’ve got this.

Genitourinary Medicine ST4 Interview Question Bank

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