IMT Ethics, Professionalism and Governance Scenarios (2027)

The Internal Medicine Training (IMT) ethics, professionalism and governance scenario is the final part of Station 1, lasting up to five minutes and scored 1 to 5 by each of two interviewers at a weighting of 1.2, a maximum of 12 of the 96 marks. Five scenario families cover most of what is asked: mental capacity, confidentiality, the struggling colleague, the duty of candour, and DNACPR decisions.

Reviewed and updated 11 September 2026. Every date, score and price below carries the year it belongs to, and the 2027 IMT pages are due from the Physician Specialty Recruitment Office in autumn 2026.

The timing and weighting below are the 2026 position published by the IMT recruitment office, which expects the 2027 process to be "largely unchanged" and will publish the 2027 detail in autumn 2026.

Key takeaways

• The ethics scenario is up to five minutes at the end of Station 1, scored by both interviewers at 1.2: 12 of the 96 marks, or 13%.
• Communication is marked across the whole of Station 1 at 1.6, so the way you reason through the scenario is worth more than the verdict.
• One framework covers every scenario: facts, principles, patient interest, escalation, documentation and reflection.
• The five families to prepare are capacity, confidentiality, the struggling colleague, candour and DNACPR, each anchored to a named GMC or statutory source.
• A 1 from either interviewer, in this area or any other, makes you not appointable.
• Interviewers mark reasoning, not agreement: saying when you would seek senior help is a strength.

What is the IMT ethics, professionalism and governance scenario?

The IMT ethics, professionalism and governance scenario is a short case put to you by the Station 1 interviewers, typically a dilemma on a ward, and you have up to five minutes to talk through what you would do and why.

Clinical governance is the framework through which NHS organisations are accountable for the quality and safety of care: incident reporting, audit, guidelines, training and raising concerns.

The IMT recruitment office lists the area as "ethical, professionalism and governance" and gives no further syllabus. Good medical practice (2024) is the reference the questions are written against.

How is the IMT ethics scenario scored?

The ethics scenario is scored 1 to 5 by each of two interviewers and weighted 1.2, for a maximum of 12 weighted marks. Communication across Station 1 is scored separately at 1.6, so the scenario influences up to 28 marks.

A 3 is satisfactory at the competent-F2 level. In practice, a 5 goes to the candidate who names the principle, the source and the safety net, in that order, without being asked.

What framework should you use for IMT ethics questions?

Use one six-step framework for every ethics scenario: establish the facts, identify the competing principles, act in the patient's interest, escalate to the right person, document, and reflect.

1. Facts: what do you know, what do you need to know, and who else is involved?
2. Principles: autonomy, beneficence, non-maleficence and justice, plus the specific duty in Good medical practice.
3. Patient first: the immediate action that keeps the patient safe.
4. Escalation: registrar, consultant, the Caldicott guardian, the medical director, or the GMC, as the case demands.
5. Documentation: what you write, and that you write it contemporaneously.
6. Reflection: what you would learn, and how the system should change.

That said, do not recite the framework. Use it as the spine of an answer that sounds like a doctor talking, not a checklist.

How do you handle a capacity scenario at the IMT interview?

Handle a capacity scenario by assuming capacity, assessing it against the two-stage test in the Mental Capacity Act 2005, and acting in the patient's best interests if it is absent, with the least restrictive option.

The two-stage capacity test is an impairment of the mind or brain, and an inability to understand, retain, weigh or communicate a decision because of it. It is decision-specific and time-specific.

A typical scenario: a patient with delirium wants to self-discharge. Say that you assess capacity for that decision, involve the family and the senior team, consider the least restrictive way to keep them safe, and document the assessment.

The IMT recruitment office marks reasoning, so name the Act and the test rather than the outcome.

How do you handle a confidentiality scenario at the IMT interview?

Handle a confidentiality scenario by stating the duty of confidence, checking whether the patient consents to disclosure, and identifying the narrow grounds on which disclosure without consent is justified: a legal requirement or a serious risk to others.

The GMC's confidentiality guidance sits under Good medical practice and sets out that disclosures should be the minimum necessary and, where possible, made with the patient's knowledge.

A typical scenario: a relative on the phone asks for results. Say you would confirm the patient's wishes, offer to speak to the relative with the patient, and never confirm details to an unverified caller.

Then escalate: the Caldicott guardian exists for exactly the cases that are not clear.

How do you handle the struggling colleague scenario at the IMT interview?

Handle the struggling colleague scenario by putting patient safety first, speaking to the colleague with concern rather than accusation, and escalating to a senior or the educational supervisor if patients are at risk.

Good medical practice (2024) requires doctors to act promptly if patient safety may be compromised, and to support colleagues who are unwell or under pressure.

A typical scenario: an F1 smells of alcohol on a night shift. Say that you would remove them from clinical duties now, involve the registrar or consultant on call, and ensure the F1 is supported, not only reported.

In practice, the candidates who score well hold both duties at once: the patient and the colleague.

How do you handle a duty of candour scenario at the IMT interview?

Handle a candour scenario by telling the patient what happened, apologising, explaining what will be done to put it right, and reporting the incident through the trust's system.

The duty of candour is the professional duty, set out jointly by the GMC and the Nursing and Midwifery Council, to be open and honest with patients when something goes wrong, and the statutory duty on NHS organisations for notifiable safety incidents.

A typical scenario: a drug dose was given tenfold. Say you would assess and treat the patient first, inform the senior team, tell the patient and family, apologise, complete an incident report, and take part in the review.

An apology is not an admission of liability, and the interviewers will listen for you to say so.

How do you handle a DNACPR scenario at the IMT interview?

Handle a DNACPR scenario by explaining that a DNACPR decision is a clinical decision made by the senior clinician in consultation with the patient, or those close to a patient who lacks capacity, and that it never means no other treatment.

The joint BMA, Resuscitation Council UK and Royal College of Nursing guidance sets out that patients should be involved in the decision wherever possible and that a decision to withhold CPR must be communicated and documented.

A typical scenario: a family demands CPR for a dying patient with a DNACPR in place. Say you would listen, explain the reasoning, involve the consultant, and offer a second opinion if disagreement persists.

What do the interviewers listen for, and what loses marks?

The interviewers listen for a structured answer that names the principle and the source, keeps the patient safe first, escalates appropriately, and shows the candidate knows the limits of their own role.

• Rushing to a verdict: the mark is for reasoning, not for landing on the interviewers' answer.
• Never escalating: an F2 who resolves everything alone is marked down, not up.
• Ignoring the human side: acknowledge the patient or colleague before the procedure.
• Vague sources: "GMC guidance says" scores less than "Good medical practice requires".
• Silence: communication across Station 1 is weighted 1.6.

The internalmedicineinterview bank holds 8 ethics scenarios and 33 questions across these families within its 361, with model answers and AI-marked spoken practice at £97 to the interview week; the free samples at /Question-Bank/Sample-Questions show the format.

How should you practise IMT ethics scenarios?

Practise ethics scenarios by answering one aloud each day in under four minutes, using the six-step framework, and naming the source for each principle you use.

1. Write a one-line source card for each family: the Mental Capacity Act, the GMC confidentiality guidance, Good medical practice on colleagues, the duty of candour, the DNACPR guidance.
2. Take a scenario, speak the answer to a timer, and stop at four minutes.
3. Check that you named the principle, the safety action, the escalation and the documentation.
4. Rehearse with a colleague who plays the relative or the struggling F1.

The rest of Station 1 is covered in the internalmedicineinterview presentation and suitability guide, and the full mark scheme in the IMT interview 2027 guide.