IMT / CST / Specialty Training

Overview

Once you start thinking beyond your first NHS job, the next big step is usually formal specialty training.

This page explains how UK training pathways actually work — without the usual confusion.

What is Specialty Training in the UK?

Specialty training is the structured pathway that eventually leads to becoming a consultant.

Most specialties follow this pattern:

  • Entry via national application
  • Several years of structured training
  • Regular assessments (ARCP)
  • Exams during training
  • Completion of training (CCT)
  • Consultant eligibility

It is competitive, but achievable with planning.

IMT (Internal Medicine Training)

IMT is the most common pathway for doctors aiming for medical specialties like:

  • Gastroenterology
  • Cardiology
  • Respiratory
  • Neurology
  • Endocrinology
  • Infectious Diseases

Structure:

  • IMT1–IMT3 (3 years)
  • MRCP usually required during IMT
  • Mandatory rotations including acute medicine and ICU
  • After IMT3 → apply for higher specialty training (ST4)

IMT focuses heavily on:

  • Managing acutely unwell patients
  • Medical take
  • Leadership on the wards

CST (Core Surgical Training)

CST is for those pursuing surgical careers.

Structure:

  • CT1–CT2 (2 years)
  • Rotations across surgical specialties
  • Portfolio heavily focused on:
    • Logbook
    • Courses
    • Teaching
    • Audits
    • MRCS

After CST, you apply for higher surgical training (ST3+).

Surgery is more portfolio-driven and competitive than many medical specialties.

Run-Through Training (Some Specialties)

Some specialties allow you to enter training once and continue through to consultant without reapplying.

Examples include:

  • GP Training
  • Paediatrics
  • Obstetrics & Gynaecology
  • Radiology
  • Psychiatry

These pathways still require:

  • Portfolio evidence
  • Exams
  • ARCP progression

But the structure feels more stable.

How Competitive Is It Really?

Competition varies widely by specialty.

Examples (roughly):

  • GP → Less competitive
  • IMT → Moderate
  • Radiology → Highly competitive
  • Surgery → Highly competitive
  • Dermatology → Extremely competitive

The key point:

Competition is influenced by strategy and preparation, not just intelligence.

What Do Applications Actually Assess?

Selection is based on:

  • Portfolio evidence
  • Commitment to specialty
  • Teaching experience
  • Audit / QIP
  • Courses and exams
  • Leadership
  • Communication skills
  • Interview performance

Your day-to-day job title matters far less than your evidence.

Reality Check

You do not need to apply immediately.
Many doctors take time to:

  • Gain NHS confidence
  • Strengthen portfolio
  • Pass exams
  • Explore specialties

Delaying application can be a smart strategy, not a failure.

Reassurance

IMGs successfully enter UK training every year across all specialties. With consistency and planning, this pathway is realistic — even if it feels distant at first.