IMT Interview – top tips

Dear Friend,

I hope you’re all having a great weekend. This Sunday, I find myself working a 13-hour shift in the ICU. In fact, it’s one of my last shifts in this department—just two more before my placement comes to an end. It’s one of the oddities of medicine: just as you start to feel like you’re getting the hang of things and improving in your role, it’s time to pack up and move on to a new specialty. Next up for me is cardiology, which will be my final rotation of Internal Medicine Training (IMT).

This week, interviews are taking place for those applying for IMT. Unlike many other specialties, where the final ranking is determined by a combination of factors—such as exams (e.g., MSRA), portfolio, and interview—IMT is unique. In this case, your rank is solely determined by your interview score. This means that a 20-minute interview will essentially dictate your placement for the next 2-3 years.

Given that, I wanted to take the opportunity this week to share some tips on how to excel in your IMT interview.

The IMT Interview

The IMT interview consists of three main sections:

1. Commitment to Medicine & Portfolio
2. Clinical Scenario
3. Ethics Scenario

There will be two panelists who will assess you across six criteria, including communication skills, presentation, and ethics. Your final score will be the sum of both panelists’ assessments. Given the competitiveness of IMT, every mark counts. For instance, when I scored 75.4 out of 80, my rank was around 500. This placed me on the borderline for securing a London IMT position.

It’s worth noting that some may argue the system isn’t entirely perfect. Candidates may be interviewed by different panels, and the clinical or ethics scenarios they face may vary in difficulty. Some interviewers may be more lenient, or you might receive a “easier” scenario. While this may seem frustrating, it’s important to accept the process as it is.

With that in mind, here are my top tips for performing well in your IMT interview:

1. Rehearse Your Opening Presentation

The first question in the IMT interview is a two-minute speech where you’ll need to discuss why you’re suited for IMT. There’s really no excuse not to practice this beforehand, especially under timed conditions. Remember, this isn’t just a list of what you’ve done—your answer should directly address the question. Start with a strong introduction, then wrap up by linking everything back to the core point, finishing with something like: “This is why I am well-suited for IMT.”

2. Avoid Specialty-Specific Answers

A common mistake is tailoring your answers too specifically to one specialty. The interviewers are looking for candidates who can become the medical registrars of tomorrow. They want to hear about your ability to thrive under pressure, handle complex differential diagnoses, and manage a broad range of cases. Imagine the best medical registrar you’ve seen on a night shift and model your answers around that person’s characteristics—calm, clear-headed, and solution-focused.

3. Read the Medical Interviewers Book

It feels a bit odd recommending a book that’s not my own, but trust me—Medical Interviewers (photo above) was a lifesaver for my IMT interviews. It’s an excellent resource for practicing both clinical and ethics-based scenarios. If you dedicate time to working through it, you’ll feel a lot more confident if something similar pops up in your interview.

4. Don’t Overcomplicate the Clinical Scenario

The clinical scenario is designed to assess whether you’re safe to work at an SHO (Senior House Officer) level, not a registrar level. Stick to a clear, structured approach using your A-E assessment, and don’t forget to escalate to senior help early if necessary. When I practiced, I tended to overcomplicate my responses—listing things like “if the BP is low, I’d do this, and if the sats are low, I’d do that.” Keep it simple: just explain what you’d do, and the interviewers will provide the observations for you. You can then explain your actions based on that information.

5. Smile and Be Approachable

At the end of the day, an interview is still a personal interaction. Make a good first impression by being friendly and approachable—this will increase the likelihood of receiving higher marks. Don’t expect the interviewers to smile back; they are often briefed to maintain a neutral, poker-faced expression. Personally, I thought my interviewers disliked me and that I had failed, but try not to read too much into their facial expressions.

Best of luck to everyone interviewing this week! I hope you all manage to secure your IMT positions. And if you don’t, remember there are silver linings—at least you won’t be spending your Sunday working another 13-hour shift!

Drug of the week

Brinzolamide

Brinzolamide is a carbonic anhydrase inhibitor used to lower intraocular pressure in patients with open-angle glaucoma or ocular hypertension.

Inhibition of carbonic anhydrase in the ciliary processes of the eye decreases aqueous humor secretion and thus lowers the intraocular pressure in the anterior chamber, presumably by reducing the rate of formation of bicarbonate ions with subsequent reduction in sodium and fluid transport; this may alleviate the effects of open-angle glaucoma.

A Brain Teaser

A 73-year-old female presents to her GP with left shoulder and arm pain which came on quite suddenly a week ago and has been worsening. The pain is now unmanageable with regular co-codamol. The GP also notes that the patient’s left pupil is smaller than the other side and the eyelid is lagging slightly. 

Which question would most likely aid in diagnosing this lady?

A: Exposure to pathogens 

B: Exercise history

C: Smoking history

D: Alcohol history

E: Recent flu-like illness