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Stroke Medicine/General (Internal) Medicine ST4 15th July 2026

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

A Stroke Medicine/General (Internal) Medicine ST4 application for the 2026 UK recruitment round is what this guide is built around. Entry sits at ST4 after Internal Medicine Training stage 1 and MRCP(UK), with national recruitment coordinated by Physician Higher Specialty Training (PHST) on Oriel and Stroke Medicine delivered as a GMC-approved sub-specialty alongside a Group 1 parent specialty that dual-accredits with GIM.

We’ll walk you through eligibility, the application process, self-assessment scoring, portfolio evidence, and how the new five-application Round 1 cap changes your strategy. The interview itself is summarised briefly here and covered station-by-station on the Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank page. First, here’s the shape of it at a glance.

Key Facts at a Glance

  • Competition ratio (2025): 4.53:1 (145 applications, 32 posts, NHS England)
  • Training length: 3 years run-through (2 years GIM + 1 year stroke)
  • Entry point: ST4, after completion of Internal Medicine Training (IMT) Stage 1
  • Key exam requirement: Full MRCP(UK) diploma by offer deadline
  • Recruitment platform: Physician Higher Specialty Training (PHST) via Oriel
  • Interview window (2026): 10–11 March 2026 (Round 1 interviews)

Table of Contents

What Is Stroke Medicine/General (Internal) Medicine ST4 Higher Specialty Training?

Stroke Medicine with General (Internal) Medicine ST4 is a UK higher specialty training programme that leads to dual accreditation as a stroke physician and a general physician. You enter at ST4 after completing Internal Medicine Training stage 1 (IMT1–3) and MRCP(UK), then complete a three-year run-through, typically two years of GIM plus one dedicated year of stroke medicine, culminating in a Certificate of Completion of Training (CCT) and entry onto the GMC Specialist Register in both specialties.

The programme is overseen by the Joint Royal Colleges of Physicians Training Board (JRCPTB) through the Federation of Royal Colleges of Physicians, with the GMC approving the curriculum and NHS England (and equivalent bodies in Scotland, Wales and Northern Ireland) quality-managing local delivery. Recruitment is coordinated nationally through Physician Higher Specialty Training (PHST) on the Oriel platform.

One recent shift matters here: following a 2024 pilot, direct ST4 entry into stroke medicine coupled with single-accreditation GIM is now an established route. Previously, stroke was only accessible as a sub-specialty tagged onto another Group 1 physician programme (such as geriatric medicine, neurology or acute internal medicine). Both routes still exist, so it’s worth checking the current PHST guidance for the 2026 round before you apply.

Training follows the 2022 GIM (Internal Medicine Stage 2) curriculum alongside the 2022 Stroke Medicine sub-specialty curriculum. Both are capabilities-based, structured around Generic Professional Capabilities and Capabilities in Practice, and assessed through workplace-based assessments, multi-source feedback and the annual ARCP. The stroke component spans the whole pathway: hyperacute care, thrombolysis and thrombectomy pathways, rehabilitation and secondary prevention, plus service development, teaching and research.

Is Stroke Medicine/General (Internal) Medicine ST4 Competitive and What Is the Lifestyle Like?

Stroke Medicine/General (Internal) Medicine ST4 sits in the moderately competitive band for medical higher training. The 2025 round saw a ratio of around 4.53:1 (145 applications for 32 posts, per NHS England competition data), which is a step up on many parent physician specialties but well below the tightest medical bottlenecks. The pathway is also relatively new: it lets doctors who’ve completed IMT Stage 1 enter a three-year run to dual CCT in Stroke Medicine and GIM, rather than achieving stroke as a sub-specialty on top of a Group 1 parent specialty.

Day-to-day life is unmistakably acute-medicine-flavoured. You’ll be a medical registrar carrying the unselected acute take alongside hyperacute stroke unit (HASU) work: thrombolysis and thrombectomy decision-making, TIA clinics, ward rounds and MDT meetings with neurology, radiology and rehab colleagues. Based on broader acute medicine data rather than stroke-specific surveys, rotas involve 24/7 hyperacute stroke cover on top of GIM on-call, sitting within the 48-hour EWTD average and the 2016 resident doctor contract safeguards. LTFT is available at a minimum of 50% full-time, with training extended pro rata. Note that no published data specifically describes lifestyle or work-life balance for UK Stroke Medicine/GIM ST4 trainees, so treat these as reasonable expectations rather than a specialty-specific survey result.

Pay at ST4 sits at nodal point 4 of the resident doctor scale: basic salary is around £65,048 in 2025/26, rising to roughly £67,325 in 2026/27 (NHS England pay circulars), before London weighting and out-of-hours enhancements.

Career trajectory: three years to dual CCT, then consultant posts in stroke medicine with a general medical commitment, typically in HASU-hosting district generals or tertiary centres, with strong research, service-development and teaching opportunities threaded through the role.

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

Eligibility for Stroke Medicine and General (Internal) Medicine ST4 is set out in the annual Person Specification published by NHS England (Workforce, Training and Education), covering England, Scotland, Wales and Northern Ireland. Because criteria can shift year to year, always cross-check the 2026 Person Specification before you submit. The summary below reflects what’s currently required.

Here’s what you’ll need in place by application:

  • Medical degree: MBBS or an equivalent primary medical qualification recognised by the GMC.
  • Registration: Full GMC registration with a licence to practise at the time of application. Overseas graduates typically reach this via PLAB/UKMLA or an accepted postgraduate qualification.
  • Postgraduate exam: MRCP(UK) Part 1 passed by the application deadline, with the full MRCP(UK) diploma by the offer deadline. Full MRCPI (Irish route) is accepted as an alternative, as is existing eligibility for the GIM specialist register.
  • Prior training: Completion of the three-year Internal Medicine Training (IMT) Stage 1 programme, or ACCS-Internal Medicine equivalent, with all required IMT capabilities signed off before the post start date.
  • Competence sign-off: UK trainees evidence this through their IMT ARCP outcome and Stage 1 completion. International medical graduates without UK training almost always need a Certificate of Readiness to Enter Specialty Training (CREST) completed by a UK-recognised supervisor, which usually means a period of NHS clinical work first.
  • English language: IELTS Academic overall 7.5 (7.0 in each component) or OET Grade B/350+ across all four sections, unless you meet the GMC’s alternative evidence route.
  • LAT experience cap: Applicants coming via Locum Appointment for Training posts must have no more than 24 months of LAT experience in the specialty.

One important nuance: direct ST4 entry into GIM alone is unusual. Most trainees enter GIM in parallel with a Group 1 parent specialty (geriatric medicine, acute internal medicine, cardiology, respiratory), and stroke medicine is normally accessed as a sub-specialty once you hold an NTN in a relevant parent specialty. It’s worth clarifying which route your intended programme sits under before you apply.

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

Applications for Stroke Medicine/General (Internal) Medicine ST4 are coordinated by Physician Higher Specialty Training (PHST) recruitment on behalf of NHS England and submitted via Oriel, the national platform. Always cross-check specifics against the 2026 PHST applicant handbook before you submit. This walkthrough gives you the shape of the process.

One thing worth flagging up front: direct entry to GIM at ST4 is uncommon. Most trainees reach GIM (and stroke as a sub-specialty) via a Group 1 physician specialty that dual-accredits, so check the person specification carefully to confirm this is the right route for you.

Here’s the step-by-step:

  1. Check eligibility against the 2026 person specification. You’ll need full GMC registration, completion of Internal Medicine Training stage 1 (or equivalent), and MRCP(UK) Part 1 by the application deadline. The full MRCP(UK) diploma must be in hand by the offer deadline (historically mid-April).
  2. Register on Oriel. There is no application fee, but you’ll need a verified Oriel account before the window opens.
  3. Submit within the Round 1 window. For 2026 entry, applications opened at 10:00 on 20 November 2025 and closed at 16:00 on 11 December 2025. A Round 2 window runs 28 July to 13 August 2026 for any unfilled posts.
  4. Complete the application form. Expect sections on personal details, employment history (Part 2), qualifications, evidence of eligibility, and the structured self-assessment against the published domains (postgraduate qualifications, achievements, research, audit/QI, publications, presentations and teaching).
  5. Attach supporting documents. You’re evidencing the person specification (MBBS, MRCP progress, GMC registration, IMT completion), rather than uploading traditional written references. Referee details are requested later, typically around offer stage.
  6. Mind the five-application cap. It is understood that for 2026, Round 1 applicants are limited to a maximum of five specialties across the cycle. Confirm this against current NHS England and PHST guidance before applying, as the BMA states the cap while some NHS England pages still describe unlimited applications. Within Stroke Medicine/GIM ST4 you can still rank multiple regional programme preferences on Oriel.
  7. Reapplication requirements. If you’ve previously held or left a UK training programme, you’ll need a signed Support for Reapplication form from your Training Programme Director. There’s no lifetime cap on reapplying, though the five-specialty rule applies each cycle.

If your self-assessment scores you into the shortlist, you’ll be invited to interview via Oriel. Feedback after the round is generally limited to a score breakdown, and PHST’s complaints and appeals process covers procedural issues rather than scoring disagreements.

Stroke Medicine/General (Internal) Medicine ST4 Recruitment Timeline and Key Dates (2026)

Stroke Medicine/General (Internal) Medicine ST4 is now a fully-fledged single-accreditation ST4 programme following its 2024 pilot, recruited nationally through Physician Higher Specialty Training (PHST) via Oriel. The 2026 round sits in Round 1, which means initial offers are due out before the end of March 2026 for August 2026 start dates.

Here’s how the key dates line up for the 2026 cycle:

Stage Date (2026 cycle)
Applications open (Oriel) 10:00, 20 November 2025
Applications close 16:00, 11 December 2025
Evidence / self-assessment upload window January 2026 (sibling Group 1 specialties such as Neurology ST4 use 8–15 January 2026)
Shortlisting outcomes issued via Oriel December 2025 – early January 2026
Interview window (Round 1) Scheduled for 10–11 March 2026; confirm on PHST/Oriel
Initial offers released By 31 March 2026
Post start dates August–December 2026

One practical tip: the evidence upload window is short and separate from the main application. Have your self-assessment evidence, MRCP(UK) confirmation and pro formas ready to go the moment applications close, so the January upload isn’t a scramble.

Stroke Medicine with General (Internal) Medicine is a dual-CCT training programme, and direct ST4 entry is relatively uncommon. Most physicians accessing GIM training do so in parallel via a Group 1 specialty. That context matters when you read the numbers below, because the post count is deliberately small.

For the most recent completed round, NHS England’s 2025 competition ratios show 145 applications for 32 posts, a ratio of approximately 4.53:1.

Worth noting: the sibling direct GIM ST4 route is significantly more competitive than the Stroke/GIM dual pathway, based on PHST data, and PHST Recruitment publishes regional fill-rate breakdowns showing that competitiveness varies meaningfully by deanery. Some regions historically fill well below 100%, which can shape where you rank preferences.

How Stroke Medicine/General (Internal) Medicine ST4 Applications Are Scored (2026)

Recruitment for Stroke Medicine/General (Internal) Medicine ST4 runs through Physician Higher Specialty Training (PHST) via Oriel, and it uses a formal, published scored framework rather than a subjective read of your CV. Understanding the architecture matters because it tells you where your time actually pays off.

The overall scoring model

According to PHST’s published scoring pages for Group 1 medical specialties (including Stroke Medicine/GIM), the final score is out of 100 and combines two components:

Component Raw score Weighted contribution
Interview (clinical scenario, medical registrar suitability, communication, ethics, suitability and commitment) /50 /80
Application self-assessment (portfolio-style domains on the form) /40 (×0.5) /20
Total /100

So the interview is doing roughly 80% of the heavy lifting in the final ranking, and the self-assessment about 20%. That said, don’t underestimate the self-assessment. It’s what gets you shortlisted to interview in the first place, and with a national ratio of 4.53:1 in 2025 (145 applications for 32 posts, per NHS England), you can’t afford to leave easy points on the table.

How the self-assessment feeds scoring

The self-assessment is a set of scored domains you complete on Oriel, with roughly 38 points available across the categories PHST publishes for higher physician recruitment. The scored domains for Stroke Medicine/General (Internal) Medicine ST4 include:

  • Postgraduate degrees and qualifications (PhD/MD by research scoring highest, Masters-level lower)
  • Publications (tiered by first vs co-authorship and peer-reviewed status)
  • Presentations and posters (tiered by local vs national/international, oral vs poster)
  • Teaching experience (with extra credit for formal teaching qualifications)
  • Quality improvement and audit (top marks generally require completed cycles with measurable impact)
  • Leadership, management and professionalism/governance

Note that for Stroke Medicine/GIM ST4 specifically, commitment to specialty is not scored at shortlisting. It’s assessed at interview instead. Each self-assessment domain is individually capped before the ×0.5 weighting is applied, so you can’t rescue a weak area by piling points into a single strong one. Everything you claim must be evidenced at verification; unsupported points are removed, sometimes with referral consequences.

We’ll unpack each of these domains, and the evidence that actually holds up, in the next section.

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

Shortlisting for Stroke Medicine/General (Internal) Medicine ST4 is driven almost entirely by your verified self-assessment score on the Physician Higher Specialty Training (PHST) application form. Around 38 points are available across the scored domains, and, importantly for this specialty, *commitment to specialty is not scored at shortlisting*. PHST assesses that at interview instead. That makes the portfolio evidence you upload with your Oriel form the single biggest lever you have for getting shortlisted.

What the self-assessment actually scores

Based on the PHST framework and the published 2024–2026 Stroke/GIM shortlist score distributions, the scored domains centre on:

  • Postgraduate degrees and qualifications (MDs, PhDs, MScs relevant to medicine)
  • Publications (PubMed-indexed, first-author weighted higher)
  • Presentations and posters (national and international scoring above regional)
  • Teaching experience and teaching qualifications: a PGCert, PGDip or Masters in Medical Education sits at the top tier
  • Quality improvement / audit with completed cycles
  • Prizes and distinctions

There is no procedural logbook score at ST4. Clinical competence is assumed via Internal Medicine Training Stage 1 completion and MRCP, and verified through your ARCP rather than counted here.

How evidence is verified

Every claim needs a PDF upload against a PHST evidence pro forma (the 2026 Presentations/Posters pro forma is a good example of the format). Certificates, acceptance emails, published abstracts and supervisor-signed verification forms are the standard proofs. Unsupported or ambiguous claims get downgraded at verification: scores can move both up and down against your self-assessment.

Where candidates lose easy points

Don’t:

  • Claim a national presentation without an acceptance email naming the conference and abstract
  • Bundle multiple audits into one PDF; verifiers score what they can clearly see
  • List a “Teach the Teacher” day as equivalent to a PGCert; the tiers are distinct
  • Leave publication evidence as a screenshot; PubMed IDs and full citations verify cleanly

Do:

  • Complete a second audit cycle before applications open; closed loops score above open ones
  • Get PGCert enrolment underway early if you want the top teaching band
  • Save conference certificates the day you receive them into a labelled folder
  • Focus stroke-specific audit, QI and publications into your academic and QI domains; these strengthen your scored evidence, even though commitment to specialty itself only scores at interview

Candidates cluster tightly on score, so one well-evidenced first-author publication or a completed teaching qualification genuinely shifts your rank. Build the evidence now, not in January.

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

Once you’re shortlisted, selection moves to a structured interview run through Physician Higher Specialty Training (PHST). For the 2026 cycle, Round 1 interviews are scheduled for 10–11 March 2026, with a second round on 14 October 2026 for any remaining posts. Confirm the specific dates on PHST and Oriel once you’re invited.

The format follows the standard PHST multi-station model used across physician specialties: two short stations, each scored by a separate pair of interviewers on different domains, with brief scenario reading time built in. Total interview time is in the region of 35–40 minutes. PHST hasn’t confirmed the delivery mode (remote or in person) in advance, so keep an eye on Oriel once you’re invited.

We’ve kept this section deliberately short because the station-by-station breakdown deserves its own space.

Preparing for the interview? The Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank has the full station breakdown, scenario questions and model answers written by high-scoring trainees.

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

Once interviews are over, offers for Stroke Medicine and General (Internal) Medicine ST4 are released through Oriel, the single national platform used by Physician Higher Specialty Training (PHST) Recruitment. Here’s how the offer stage generally runs from interview to your first day as an ST4:

  1. Rank list published. PHST ranks all appointable candidates nationally on interview score.
  2. Preferencing window opens on Oriel. You rank programmes (regions and, where offered, single-accreditation GIM with stroke sub-specialty vs dual pathways) in your true order of preference. Rank honestly, because Oriel matches your position on the national list to your highest available preference.
  3. Initial offer released. You’ll have a fixed hold-down period (typically around 48 hours) to accept, hold, or decline. Holding lets you keep the offer live while waiting to see if a higher preference becomes available.
  4. Automatic upgrades. If you opt in (the default), Oriel will automatically move you to a higher-ranked preference if one frees up later in the cycle. No separate contact is made before the upgrade applies.
  5. Pre-employment checks and start date. Posts commence between August and December 2026, depending on the region.

One caveat worth flagging: from 2026, the Medical Training (Prioritisation) Bill introduces prioritisation at the offer stage, which may affect how ST4 posts are allocated. Check the PHST stroke medicine page for the current cycle’s exact hold-down timings before your window opens.

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

How competitive is Stroke Medicine and GIM ST4?

In the 2025 round, NHS England reported 145 applications for 32 posts, giving a competition ratio of around 4.53:1. The corresponding fill rate page showed 24 accepts against 31 posts (77.4%). Broader UK specialty training applications have risen sharply since 2019, so you should prepare on the assumption that competition remains firm rather than easing.

Who is eligible to apply for Stroke Medicine/GIM ST4 in 2026?

You need MBBS or equivalent, full GMC registration with a licence to practise, and completion of Internal Medicine Training (IMT) Stage 1 (or an accepted equivalent such as ACCS-Internal Medicine) with capabilities signed off before the post start date. Full eligibility, including alternative routes via Irish BST/MRCPI or GIM specialist-register eligibility, is set out in the NHS England 2026 person specification.

What exams do I need before applying?

You must hold MRCP(UK) Part 1 at the point of application and the full MRCP(UK) diploma by the offer deadline. Accepted alternatives include completion of Irish Basic Specialty Training with MRCPI, or existing eligibility for the GMC specialist register in General (Internal) Medicine.

How does the application process actually work?

Recruitment is coordinated nationally by Physician Higher Specialty Training (PHST) on behalf of England, Scotland, Wales and Northern Ireland, and applications are submitted through the Oriel portal. The 2026 round opens on 20 November 2025. You complete a long-form application including a scored self-assessment, evidence is verified, and the highest-scoring candidates are invited to interview in the Round 1 window (provisionally 10–11 March 2026).

What scores well on the self-assessment?

For Stroke Medicine/GIM ST4, commitment to specialty is assessed at interview, not at shortlisting. The shortlisting self-assessment focuses on qualifications, quality improvement, teaching, publications and presentations. Around 38 points are available across those scored domains. A PGCert, PGDip or Masters in medical education typically attracts the top teaching score; completed audit cycles, stroke-relevant QI, and first-author peer-reviewed publications and presentations strengthen the academic and QI domains. Save your commitment-to-specialty evidence (tasters, stroke-focused audit, courses) for the interview.

How many training posts are available each year?

For 2025, 32 posts were advertised nationally across the four UK nations, with 31 confirmed on the fill rate table. Post numbers vary year to year and by deanery. PHST publishes the vacancy breakdown on its Stroke Medicine/GIM specialty page once vacancies are confirmed for the current round.

What happens if I’m not successful, can I reapply?

Yes. Reapplication is common and there’s no cap on the number of attempts, provided you remain within the eligibility window and still meet the person specification. Use the year to strengthen your self-assessment (stroke-focused audit or QI, further publications, a teaching qualification) and to complete any outstanding IMT capabilities or MRCP components.

How does the offer and upgrade process work?

Offers are released through Oriel and ranked to your preferences. If you accept or hold an offer and a higher-preferenced post later becomes available, Oriel upgrades you automatically unless you’ve opted out. You won’t be contacted before the upgrade if you’ve opted in, so rank your preferences carefully at the point of submission.

Stroke Medicine/General (Internal) Medicine ST4 Useful Resources

We’ve pulled together the sources we’d send any applicant to for this route. It’s a small, recently formalised programme, so official pages carry more weight than commercial reading lists.

Official recruitment and person specification

Curriculum and clinical reference

Peer discussion

  • The r/doctorsUK annual applications megathreads are the closest active community for cycle chatter; there’s no dedicated Stroke/GIM ST4 forum yet.

Medibuddy resources

Applying for Stroke Medicine and General (Internal) Medicine ST4 is a big step, but it’s a very manageable one when you break it down. Get your MRCP(UK) squared away, map your evidence against the PHST self-assessment domains early, and make sure your portfolio reflects the single-accreditation Stroke/GIM pathway you’re actually applying to. Do that groundwork, and you’ll walk into the interview with far less to worry about.

When you’re ready for the next stage, work through the Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank for scenario questions and model answers from high-scoring trainees. You’ve got this.

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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