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Stroke Medicine/General (Internal) Medicine ST4 23rd September 2026

Complete Guide to Stroke Medicine/General (Internal) Medicine ST4 Application and Recruitment (2026)

Written by Medibuddy. Last updated: September 2026.

If you’re planning your Stroke Medicine/General (Internal) Medicine ST4 Application for 2027, this guide will provide you with everything you need to know. Stroke Medicine/GIM ST4 is a Group 1 route with single accreditation in General (Internal) Medicine with a dedicated Stroke Medicine sub-specialty year, completed over three years after Internal Medicine Training Stage 1. Here we’ll cover how national selection works, eligibility, how the self-assessment and portfolio are scored, and the recruitment timeline, with practical steps to strengthen your application.

Key Facts at a Glance

  • Competition ratio (2025): 4.5:1 (145 applications, 32 posts)
  • Training length: Three years after IMT (two GIM, one Stroke)
  • Entry requirement: IMT Stage 1 completed; full MRCP(UK) by offer
  • Recruitment platform: Oriel; national lead: NHS England Thames Valley (PHST)
  • 2026 evidence upload (guide): 19–25 January 2026 (2027 dates to follow)
  • 2026 interviews (guide): 10–11 March 2026 (2027 dates to follow)

Table of Contents

Stroke Medicine/General (Internal) Medicine ST4 Curriculum

Training follows GMC‑approved curricula delivered through the JRCPTB. It’s capabilities‑based: you’ll collect portfolio evidence against Generic Professional Capabilities and specialty‑specific Capabilities in Practice for both GIM and Stroke Medicine, with progress judged through workplace‑based assessments, multi‑source feedback and ARCP outcomes in the JRCPTB e‑portfolio. Stroke content spans the whole pathway: hyperacute and acute stroke care, TIA and secondary prevention, rehabilitation, service leadership, teaching and quality improvement.

Regional programmes deliver the same outcomes but differ in how they get you there. Rotations vary in the balance between hyperacute stroke units, thrombectomy‑referring centres, community stroke rehabilitation and general medicine. Some regions schedule the concentrated stroke year in the middle of the programme; others place it at the end. Exposure to thrombolysis decision‑making, tele‑stroke, thrombectomy pathways, and out‑of‑hours cover also varies with local service configuration. Many programmes embed academic time, simulation and regional teaching; check local adverts to see how these elements are incorporated.

You’re expected to demonstrate increasing independence across GIM and stroke CiPs, contribute to teaching (ideally with feedback), lead QI that changes practice, and evidence leadership experience. The curricula build on what you covered in Internal Medicine Training, but expect you to lead the acute take while managing complex stroke pathways safely.

Note: This summary reflects the current GMC‑approved Internal Medicine and 2022 Stroke Medicine sub-specialty curricula; if they change for 2027, we’ll update this page.

Stroke Medicine/General (Internal) Medicine ST4 Eligibility Criteria and Entry Requirements

If you’re applying for Stroke Medicine/General (Internal) Medicine ST4 in 2027, here’s what you need to be eligible:

  • Primary medical qualification: MBBS or equivalent acceptable for General Medical Council (GMC) registration.
  • GMC status: Full GMC registration with a current licence to practise at the point of application. This also evidences English language proficiency, for example through IELTS or OET accepted by the GMC.
  • Postgraduate exam: MRCP(UK) Part 1 must be passed by application submission, with the full MRCP(UK) diploma in place by the offer deadline.
  • Prior training and competence sign-off: Completion of Internal Medicine Training (IMT) Stage 1 (three years) with ARCP Outcome 1 and all IMT Stage 1 capabilities signed off by the post start date. Stroke Medicine/GIM is a Group 1 route; PHST confirms IMT Stage 1 completion is required and alternative training routes are not accepted.
  • Right to work: You must have the legal right to work in the UK by your start date. NHS employers can sponsor Skilled Worker visas, but you need full GMC registration to be appointed.

Note: 2027 eligibility documents have not yet been published. The information above reflects the 2026 NHS England person specification and PHST specialty page and are a reliable guide for planning. We’ll update this page when the 2027 person specification is released.

Most applicants will have progressed through the Foundation Programme into Internal Medicine Training. If you’re still in IMT, plan your MRCP(UK) timeline so you can complete Part 2 Written and PACES in time for offers.

How to Apply for Stroke Medicine/General (Internal) Medicine ST4 National Recruitment

Although the 2027 timetable hasn’t been published yet, the 2026 PHST (Physician Higher Specialty Training) timeline is a good planning guide for your 2027 application. We’ll update this page when the 2027 dates are released.

  1. Map your timeline. See the Eligibility section first, then plan around last round’s dates: Round 1 applications opened on 20 November 2025 and closed on 11 December 2025, with the evidence upload window from 19–25 January 2026. A smaller Round 2 also ran in 2026; see the Timeline section below.
  2. Complete your application on Oriel. On Oriel you’ll complete standard sections including personal details and eligibility, employment and training history (including Internal Medicine Training), fitness to practise, referees, the PHST self-assessment (supporting information), and programme preferencing (released later in the cycle).
  3. Plan your MRCP(UK) timing. See Eligibility for MRCP(UK) timing and ensure you plan accordingly.
  4. Complete the PHST self‑assessment honestly. Shortlisting is by verified self-assessment. Score yourself against the published domains, give precise claims, and don’t overstate. Your application score can go up or down at verification.
  5. Upload supporting documents. After applications close you’ll upload evidence electronically. Use PHST evidence pro formas where required, include formal feedback for teaching/QI where relevant, and provide certified translations for non‑English documents. Achievements gained up to the evidence‑upload deadline can be scored.
  6. Preference programmes. When preferencing opens, rank regions and posts you’re willing to accept. Be realistic: you can’t be offered something you don’t rank, and a tight preference list risks no offer.
  7. Interviews and offers. Invitations go to the highest verified scores. For 2026 Round 1, interviews ran 10–11 March 2026 and first offers were expected by 31 March 2026. You can usually hold and upgrade within PHST rules if a higher‑ranked post becomes available.
  8. If you need to reapply. You can apply again in round 2 or a future year if you remain eligible; each cycle is a fresh application with new evidence upload and scoring. Previous claims don’t carry over, but you can reuse the same documents if they still meet the rules.

Stroke Medicine/General (Internal) Medicine ST4 Recruitment Timeline and Key Dates (2027)

The Stroke Medicine/GIM ST4 application process followed the timeline set out below for Round 1:

Stage Date
Applications open (Oriel) 20 November 2025 at 10am
Applications close 11 December 2025 at 4pm
Evidence upload window 19–25 January 2026
Interview window (Stroke Medicine/GIM ST4) 10–11 March 2026
Initial offers released By 31 March 2026

Note: Although the 2027 recruitment dates have not yet been published, the 2026 (Round 1) dates are a useful guide when planning your 2027 application. We’ll update this page when the 2027 dates are released.

The specialty is also in Round 2 of 2026: evidence upload ran 21–28 August 2026, with interviews scheduled for 14 October 2026 and very few posts available.

How Competitive Is Stroke Medicine/General (Internal) Medicine ST4?

Here are the most recent official figures to help you gauge competitiveness and plan your preferences.

Round Year Applications Posts Competition ratio
Round 1 2025 145 32 4.5:1
Round 2 2024 75 30 2.3:1

Figures are from the PHST Stroke Medicine/GIM specialty page. We’ll update this section when the next set of figures is released.

What these figures mean for you

  • Small national post numbers amplify the effect of preferencing. Be as geographically flexible as you reasonably can.
  • England’s 2025 fill rate was 77.4% (24 accepts for 31 posts), so some regions did not fully fill. If you’re open to a wider spread of programmes, you may improve your chances.
  • Post numbers can rise during a round; PHST notes increases of around 20–40% after initial offers, so keep your application active and preferences updated if you’re on the reserve list.
  • Round 2 also ran in 2026 (see timeline above), but places are very limited (often 0–1 per region). Treat Round 2 as a bonus opportunity, not a primary plan.

How Stroke Medicine/General (Internal) Medicine ST4 Applications Are Scored (2027)

Scoring framework and weighting

Stroke Medicine/General (Internal) Medicine ST4 runs through Physician Higher Specialty Training (PHST) with a formal scoring framework. You self-assess your achievements on the application form; that score is then verified against uploaded evidence before shortlisting. There’s no separate “commitment to specialty” shortlisting screen for this pathway; shortlisting is based on the verified self-assessment alone, and that same application score also carries forward into the final ranking.

Your final total is out of 100:

  • Interview contributes 80 (weighted)
  • Application (self-assessment) contributes 20, by taking your application score out of 40 and multiplying by 0.5

This 80/20 split is set out on the PHST Stroke Medicine/GIM specialty page. We summarise how the self-assessment feeds into this below; the detailed descriptors and evidence tips are in the Self-Assessment & Portfolio section.

Self-assessment domains (overview)

PHST scores nine domains for Stroke Medicine/GIM ST4. The domain maxima below reflect the 2026 PHST scoring matrix used across higher medical specialties; they’ll be updated here if PHST changes them for 2027.

Domain Max score
MRCP(UK) exam status 8
Publications 8
Presentations/posters 6
Teaching experience 5
Postgraduate degrees and qualifications 4
Quality improvement (QI) 4
Leadership and management 4
Additional achievements 3
Training in teaching 3

Note: These are the 2026 PHST maxima; we’ll update this page if they change for 2027.

For the evidence rules and upload process, see the Self-Assessment & Portfolio section.

Stroke Medicine/General (Internal) Medicine ST4 Self-Assessment and Portfolio: How to Maximise Your Score

Your verified self-assessment drives shortlisting and contributes to your final ranking (the application score is weighted to 20 of the 100-point total). As mentioned above, the PHST’s 2026 application-scoring guidance sets out nine portfolio domains with clear maxima for Stroke Medicine/GIM: MRCP(UK) up to 8; Publications 8; Presentations 6; Teaching experience 5; Postgraduate degrees 4; Quality improvement 4; Leadership and management 4; Additional achievements 3; Training in teaching 3. There is no scored procedural logbook for this specialty.

Evidence and verification

After you submit the form, you upload evidence for every claim. PHST verifies it before shortlisting and your self-assessment can go up or down. For guidance on the verification window timescales, see the Stroke Medicine/General (Internal) Medicine ST4 Recruitment Timeline and Key Dates (2027) section.

How to score in each domain

  • MRCP(UK) (max 8): Full diploma (Part 2 Written and PACES) scores highest; PACES-only scores less. MRCP(UK) Part 1 is an eligibility requirement and does not score here.
  • Publications (max 8): Aim for PubMed-cited work as first, joint-first or corresponding author, as these score highest. Case reports and letters can help if accepted and citable.
  • Presentations (max 6): National/international oral as first or second author scores highest; posters and local talks score less.
  • Teaching experience (max 5): Organise a regular programme with feedback and attendance records; ad hoc sessions score lower.
  • Training in teaching (max 3): A PG Cert/Dip in medical education scores the maximum. PHST also awards 1 point for a live “Teach the Teacher” style course lasting at least six hours.
  • Postgraduate degrees (max 4): PhD/MD highest; master’s next. Intercalated degrees do not score here.
  • Quality improvement (max 4): Lead a completed, multi-cycle QI with measured impact; present or publish it to strengthen your case.
  • Leadership and management (max 4): Hold a defined role for 6+ months (e.g. rota lead, trainee rep) with demonstrable outcomes.
  • Additional achievements (max 3): Honours or distinction in your primary medical degree (top 18%), national or international medical prizes, or prizes for parts of the course (top 20%). Your medical school may need to confirm your percentile in writing.

Common pitfalls: do and don’t

  • Do use PHST pro formas where requested; don’t rely on a CV line alone.
  • Do upload acceptance emails, certificates and author-order proof; don’t omit first/second authorship where it matters for top marks.
  • Do evidence regular teaching with timetables and feedback; don’t claim occasional sessions as a programme.
  • Do ensure QI is closed-loop and you led it; don’t submit single-cycle audits for maximum points.
  • Do include certified translations; don’t upload non-English documents without them.
  • Do pick a live 6+ hour teaching course; don’t assume brief e-learning will score in Training in teaching.

Actions to take now

  • Book remaining MRCP(UK) components if needed, then document confirmation as soon as results land.
  • Target one national oral presentation as first/second author; convert an ongoing project into a poster if timelines are tight.
  • Close the loop on a QI you lead, write it up, and submit to a meeting or journal.
  • Set up a regular teaching series with feedback; complete a live Teach the Teacher course (6+ hours).
  • Take on a 6–12 month leadership role and keep minutes/emails evidencing outcomes.
  • Build your evidence pack early, including the right PHST pro formas, so upload week isn’t a scramble.

The Stroke Medicine/General (Internal) Medicine ST4 Interview: A Brief Overview

Once you’re shortlisted, you’ll complete a structured PHST interview. For the full breakdown, as well as preparation materials, head to our dedicated page: Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank.

Stroke Medicine/General (Internal) Medicine ST4 Offers, Preferencing and What Happens Next

Here’s how the offer mechanism works for Stroke Medicine/GIM ST4 and what to do at each stage.

  1. Preferencing. On Oriel, rank all programmes you’d genuinely accept, in your true order. You can reorder during the preferencing window; offers are made against this list.
  2. Initial offers. Offers are released in strict rank order by final recruitment score, matching you to your highest available preference. If nothing is available, you may be placed on a reserve list.
  3. Your choices. When an offer arrives you can accept, decline, or hold. During the hold-down period, you may hold one offer while remaining eligible for an upgrade to a higher-ranked preference.
  4. Upgrades. NHS England’s national rules apply: if you opt in to upgrades, Oriel will automatically upgrade you to any higher preference that becomes available, without prior contact. You can opt out to lock your accepted post.
  5. Reallocation and reserve. As others decline or are upgraded, posts recycle. If you’re appointable on the reserve list, you can receive an offer later in the cycle.
  6. If you’re not offered. Round 2 sometimes runs; see the Timeline section.
  7. Pre-employment and start. Once you accept (with or without upgrades), the employer will complete checks and issue your contract ahead of your start date.

Note: Timings for offers, upgrades and the hold-down period are set nationally each round; processes have been consistent in recent cycles and we’ll update this page with any 2027 changes.

Frequently Asked Questions About Stroke Medicine/General (Internal) Medicine ST4 Application

Is Stroke Medicine/GIM ST4 hard to get into?

Competition is moderate (4.5:1 in Round 1 2025). We’ll update this section when multi‑year figures are published. Round 2 sometimes runs; see the Timeline section.

What are the eligibility requirements for Stroke Medicine/GIM ST4?

You need MBBS or equivalent, full GMC registration, completion of Internal Medicine Training (IMT) Stage 1 (three years or equivalent) and MRCP(UK) Part 1 at application with the full MRCP(UK) diploma by the offer deadline. NHS England publishes the person specification annually for this route; PHST runs national recruitment via Oriel.

What exams do I need for Stroke Medicine/GIM ST4?

You must have MRCP(UK) Part 1 at the time you apply and the full MRCP(UK) diploma (both Written and PACES) by the offer deadline. PHST also recognises Irish Basic Specialty Training with the MRCPI, or eligibility for the GMC specialist register in GIM, in place of MRCP(UK); check the person specification if either applies to you. Most candidates progress via MRCP(UK).

How is shortlisting done for Stroke Medicine/GIM ST4?

Shortlisting uses your verified self-assessment score. You self-score across the PHST domains, then upload evidence; assessors review it before shortlisting and your score can go up or down. Achievements gained before the evidence-upload deadline can count. Supplying no evidence for a claimed domain risks not being shortlisted. Stroke Medicine/GIM does not use a separate “commitment to specialty” shortlisting step.

What scores well on the Stroke Medicine/GIM ST4 self-assessment?

High-yield areas include: MRCP(UK) (up to 8), publications (up to 8), national/international oral presentations (up to 6), teaching (up to 5), postgraduate degrees (up to 4), QI (up to 4), leadership (up to 4), additional achievements (up to 3), and training in teaching (up to 3). A live teaching course of at least six hours scores 1 point under Training in teaching. Your application score contributes 20% of the final /100 total.

When are applications and evidence upload for Stroke Medicine/GIM ST4?

Timings follow the PHST national timeline. In Round 1 2026, evidence upload ran 19–25 January and interviews were 10–11 March. Round 2 also ran in 2026; see the Timeline section for dates. We’ll update this page when the 2027 dates are released.

How do offers, preferencing and upgrades work?

On Oriel, you preference programmes. Offers are released in rank order using your total score. If you accept or hold an offer and opt in to upgrades, Oriel will automatically upgrade you to a higher-ranked preference if it becomes available, without prior contact. You can opt out of upgrades if you want to keep a specific post.

Can I reapply if I’m unsuccessful for Stroke Medicine/GIM ST4?

Yes. You can reapply in a future round provided you meet eligibility at the time. Use any Oriel feedback to target improvements, and build your self-assessment evidence (for example, presentations, QI, leadership, or training in teaching) before the next window. Stroke Medicine/GIM sometimes runs Round 2, which can offer another chance within the same year.

Stroke Medicine/General (Internal) Medicine ST4 Useful Resources

Conclusion

In this guide, we’ve covered what scores in the PHST self-assessment, how your evidence is uploaded and verified before shortlisting, and how the application score then carries into your final ranking. From here, focus on mapping each achievement to the scoring domains, lining up the right evidence (including any required pro formas), and giving yourself enough time so nothing is a scramble.

When you’re ready to prepare for the interview, work through the Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank for scenario questions with model answers, written by recent high-scoring trainees.

Stroke / General Internal Medicine ST4

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Stroke / General Internal Medicine ST4 is a competitive higher speciality training route recruited through national selection. Our question bank gives you structured, speciality-specific practice across the interview stations, written by high-scoring trainees who recently sat the round.

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