Prepare for the 2026 Stroke Medicine/General (Internal) Medicine ST4 Interview with Structured, Specialty-Specific Practice Questions

Stroke Medicine/General (Internal) Medicine ST4 Interview Questions built for doctors preparing for the 2026 PHST selection interview. The bank covers every station in the national Stroke Medicine/GIM ST4 interview, from the clinical scenario through to portfolio and reflective discussion, and it’s written by high-scoring registrars who recently sat and passed the interview themselves.

“I was successful at interview and the scenarios were very similar to those on the Medibuddy website. The information on Medibuddy was really useful for interview preparation.”

“I wanted to say thank you for your wonderful site. I got my top ranked post and I scored highly in all stations.”

Updated for 2026

What to Expect from the Stroke Medicine/General (Internal) Medicine ST4 Interview

Stroke Medicine/GIM ST4 is competitive. In the 2025 round, NHS England reported 145 applications for 32 posts, a ratio of 4.53:1, and the interview carries the majority of the final score. Recruitment runs through the national Physician Higher Specialty Training (PHST) process, coordinated on Oriel, with Round 1 2026 interviews scheduled for 10-11 March 2026 and Round 2 on 14 October 2026.

The interview is delivered as a structured two-station panel, roughly 35-40 minutes in total including the transition between stations. Each station lasts around 15 minutes and is scored by its own pair of interviewers, typically consultants involved in physician higher specialty training. PHST has not published the video-conferencing platform on the Stroke Medicine/GIM specialty page, so confirm the delivery details on Oriel once shortlisted.

Across the two stations, five assessment areas are scored, each on a 1-5 scale. Station 1 covers the Clinical Scenario, Medical Registrar Suitability and Communication. Station 2 covers Ethics, Professionalism and Governance, then Application and Training/Suitability and Commitment. Station-level detail below reflects the PHST Stroke Medicine/GIM specialty page and sibling PHST specialty guidance.

Clinical Scenario

You’re given a short written stem with 3-5 minutes’ reading time and then talked through it by the panel. Expect hyperacute stroke decision-making (thrombolysis and thrombectomy eligibility, pathway navigation), stroke mimics, secondary prevention and rehabilitation or MDT judgement. Scored on clinical reasoning, prioritisation, safety and awareness of the stroke and Internal Medicine curricula.

Medical Registrar Suitability

A scenario placing you as the on-call medical registrar. The panel is testing prioritisation across competing acute demands, delegation, escalation and situational awareness. This domain is common to all ST4 specialties dual-training with GIM and carries real weight for Stroke/GIM candidates.

Communication

Assessed as an integrated verbal domain rather than an actor-led role-play. You’re asked to talk through how you’d handle a communication challenge, such as consenting for thrombolysis, breaking bad news about a disabling stroke, or a DNACPR conversation. Scored on structure, empathy, checking understanding and adapting language.

Ethics, Professionalism and Governance

A scenario probing your handling of an ethical or professional dilemma, for example a colleague performance concern, capacity and best-interests decisions, or a governance issue on the stroke unit. Scored on your reasoning, use of GMC Good Medical Practice and appropriate escalation.

Application and Training/Suitability and Commitment

Explores why stroke medicine and GIM, and what you’ve done to demonstrate that commitment: taster experience, audit and QI, teaching, research and career plans. Answers are cross-checked against the evidence in your application self-assessment.

What the Panel Is Looking For

Each of the twelve interview scores is judged against an expected level of performance, with 3/5 the appointable standard. To be appointable you need no 1/5 scores, no more than two 2/5 scores and a Ranked Interview Score of at least 36. Panels reward specificity, safe prioritisation as the medical registrar, structured communication and evidence-backed commitment to stroke medicine and GIM.

The Medibuddy 2026 Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank

We’ve built the question bank around the exact two-station format used by PHST for Stroke Medicine/GIM ST4, so every scenario reflects what you’ll actually face on the day. Coverage spans both stations in full: clinical scenarios rooted in acute stroke and GIM decision-making, ethics, professionalism and governance hypotheticals anchored in GMC Good Medical Practice, portfolio-style questions, and reflective discussion of adverse events using Gibbs’ cycle. The bank is written by trainees who scored highly at their own ST4 interview and is refreshed each year using feedback from the most recent cohort of candidates.

What’s Included in the Stroke Medicine/General (Internal) Medicine ST4 Interview Question Bank

How to Prepare for the Stroke Medicine/GIM ST4 Interview

Stroke Medicine/GIM ST4 preparation is different from IMT or CT-level interviews. You’re being assessed as a future medical registrar with a stroke sub-specialty interest, across a compressed two-station PHST format with tight reading windows. Here’s how we recommend you build that preparation.

Understand the format before you start practising

Before you rehearse a single answer, get the shape of the day fixed in your head. PHST runs Stroke Medicine/GIM ST4 as two structured stations of roughly 15 minutes each, with about 35-40 minutes total including transition. Reading time inside each station is typically 3-5 minutes, not longer. That’s a very specific constraint: you need to read a stroke or acute medical scenario, structure a response, and deliver it in a window measured in minutes. Practising open-ended, untimed answers won’t prepare you for that. The delivery format for the 2026 round should be confirmed via Oriel once you’re shortlisted.

Focus on knowledge and delivery equally

Strong candidates at ST4 already have the clinical knowledge: MRCP(UK) full diploma is an entry requirement, and you’re coming from a Group 1 parent specialty like geriatric medicine, neurology or acute internal medicine. What separates offer-holders from the shortlist is delivery: structured answers, a clear diagnostic and management framework under time pressure, and the ability to sound like a registrar rather than a senior SHO. Knowledge without structure loses marks. We recommend pairing clinical revision (hyperacute stroke, thrombolysis and thrombectomy pathways, secondary prevention, stroke mimics, TIA governance) with deliberate practice of how you say it.

Build preparation around each station

Station 1 centres on a clinical scenario, medical registrar suitability and a communication component. Prepare stroke and acute medicine scenarios you’d realistically be called to as the med reg: thrombolysis decisions, deteriorating patients, escalation, complex discharge, capacity. For the communication mark, rehearse breaking difficult news, discussing prognosis after major stroke, and handling family conflict about ceilings of care.

Station 2 brings an ethical or professionalism scenario alongside further suitability and commitment-to-specialty questions. Work through consent in patients with communication impairment post-stroke, best-interests decisions, DoLS, raising concerns, and probity. Have a clear, personal narrative for why stroke medicine specifically, evidenced by what you’ve done: audit, teaching, courses, thrombectomy exposure, research.

Practise under timed conditions

The 15-minute station and 3-5 minute reading window are the constraint that catches candidates out. Set a timer. Read the scenario in the actual window you’ll have. Answer aloud, not in your head. Record yourself if you can bear to. Do this with a colleague acting as the panel wherever possible, because the pressure of speaking to another person is different from rehearsing alone. Most candidates significantly overrun in early practice sessions; the fix is repetition against the clock, not longer answers.

Start earlier than you think

With Round 1 interviews on 10-11 March 2026, we recommend starting structured interview preparation 8-10 weeks out, not the fortnight after shortlisting. Stroke ST4 candidates are typically working full clinical jobs, often as med reg on-call, so realistic practice time is 3-4 hours a week. That’s enough if you start early and enough is compounding; it isn’t enough if you cram.

Practising with the question bank

The Stroke Medicine/GIM ST4 question bank is built around the two-station PHST format described above, so you can practise the exact scenario types and time windows you’ll face. Work through it station by station rather than at random: run Station 1 clinical and communication questions in a block, then Station 2 ethics and suitability questions. The point is repetition against the real format until structured, registrar-level answers become your default.

Frequently Asked Questions

What does the Stroke Medicine/GIM ST4 interview involve?

The PHST national interview is a structured, two-station format lasting roughly 35-40 minutes in total, with each station around 15 minutes and scored by its own pair of interviewers. Station 1 covers a clinical scenario, medical registrar suitability and communication. Station 2 covers an ethical, professionalism and governance scenario, plus suitability and commitment to specialty.

How competitive is Stroke Medicine/GIM ST4 recruitment?

In the 2025 round, NHS England reported 145 applications for 32 posts, a competition ratio of 4.53:1. Direct ST4 entry into this dual programme is relatively uncommon, with many trainees reaching stroke medicine as a sub-specialty via a Group 1 parent specialty. Numbers for the 2026 round have not yet been published at time of writing.

What topics come up in the Stroke Medicine/GIM ST4 interview?

Expect acute medical and stroke-focused clinical scenarios (thrombolysis and thrombectomy decisions, hyperacute stroke pathways, complex GIM take), medical registrar suitability under pressure, an ethical or governance dilemma, and questions on your commitment to stroke as a sub-specialty. Reflection on adverse events, M&M cases and quality improvement work is frequently woven through the clinical and professionalism questions.

Does the question bank cover every station in the interview?

Yes. The bank is built around the PHST two-station format for Stroke Medicine/GIM ST4, so you’ll find practice material for the clinical scenario, medical registrar suitability, communication, ethical and governance scenarios, and suitability and commitment to specialty. Coverage is intentionally comprehensive rather than weighted to a single station, because both stations carry marks.

When should I start preparing for the Stroke Medicine/GIM ST4 interview?

We recommend starting six to eight weeks before your interview date. Round 1 2026 interviews sit on 10-11 March 2026, with Round 2 on 14 October 2026. That window gives you time to work through the clinical, ethical and registrar-suitability content, rehearse under timed conditions matching the 15-minute stations, and refine delivery based on feedback.

Start Preparing for the Stroke Medicine/General (Internal) Medicine ST4 Interview

Most candidates prepare by reading broadly across stroke guidelines and general medicine topics. Strong candidates prepare differently: they rehearse against the exact station formats, refine their delivery under time pressure, and align their answers to how the ST4 panel actually scores them.