Internal Medicine Training (IMT) offers for 2027 are made to appointable candidates in rank order of their weighted interview score out of 96, matched against the programme preferences they submit after interview. NHS England's Round 1 timeline sets initial offers by 5pm on Tuesday 6 April 2027, a hold deadline of 9am on Friday 9 April and an upgrade deadline of 4pm on Wednesday 14 April 2027.
You have 48 hours to accept, hold or reject each offer.
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.
Key takeaways
- Ranking comes from the interview alone: the weighted score out of 96, with the self-assessment playing no part.
- You preference individual programmes, not regions; in Round 1 of 2025 there were 1,528 options, and no preferences means no offer.
- Offers go to the highest scorer first; declined programmes are re-offered to the next ranked candidate in contention.
- You have 48 hours, excluding weekends, to accept, hold or reject; no response withdraws the application.
- Opting in to upgrades keeps you in contention for higher-ranked preferences until the upgrade deadline.
- National 2027 deadlines: initial offers by 6 April, hold by 9 April, upgrades by 14 April. IMT's own 2027 dates are due in autumn 2026; in 2026 they were 24 March, 2 April and 8 April.
When are IMT offers made in 2027?
IMT initial offers for 2027 are due by 5pm on Tuesday 6 April 2027 under NHS England's national Round 1 timeline. The IMT recruitment office's own 2027 dates are published in autumn 2026, and in 2026 IMT made its offers by 24 March.
| Stage | National Round 1 2027 (confirmed) | IMT 2026 round (for reference) |
|---|---|---|
| Interviews | 11 January to 2 April 2027 | 12 January to 13 February 2026 |
| Rankings released | Not yet published | Tuesday 24 February 2026 |
| Programme preferences window | Not yet published | 24 February to Monday 16 March 2026 |
| Initial offers | By 5pm, Tuesday 6 April 2027 | By Tuesday 24 March 2026 |
| Hold deadline | 9am, Friday 9 April 2027 | 1pm, Thursday 2 April 2026 |
| Upgrade deadline | 4pm, Wednesday 14 April 2027 | 4pm, Wednesday 8 April 2026 |
| Scoresheet feedback | Not yet published | Thursday 2 April 2026 |
| Posts start | Not yet published | Wednesday 5 August 2026 |
The IMT recruitment office states that most programmes start in early August but "can start as late as April" of the following year, and the start date is shown when you preference.
How is the IMT ranking calculated?
The IMT ranking is calculated from the weighted interview score alone: seven areas marked 1 to 5 by two interviewers, weighted to a maximum of 96, with appointable candidates ranked highest score first.
Appointability is the gate before ranking: no score of 1, no more than two scores of 2, and a raw score of 42 or above out of 70. The IMT recruitment office states that candidates found not appointable "are not given a ranking".
The self-assessment score you used to be shortlisted does not count. The full weighting is in our IMT interview 2027 guide.
How does IMT programme preferencing work?
IMT programme preferencing asks you to rank individual programmes across every region you applied to, moving each from a "not wanted" list into your ranked order; the IMT recruitment office states that "if you do not give any preferences, you cannot receive a post offer".
In Round 1 of 2025 there were 1,528 options to choose from, covering both IMT and ACCS-IM programmes. There is no maximum number of preferences.
Towards the end of the interview period you are invited to preference, and in 2026 the window ran from 24 February to 16 March. Rank everything you would accept, in the order you would accept it.
That said, leave out anything you would decline: rejecting an offer ends your round.
How are IMT offers made?
IMT offers are made by considering appointable candidates in rank order and assigning each their highest available preference. The IMT recruitment office states that "the first offer will be made to the highest-scoring candidate, the next to the second-highest and so on".
After the first pass, programmes that are declined are "re-offered to the next ranked candidate in contention for that programme". Candidates whose preferences all went to higher-ranked applicants sit on the reserve list.
The office adds that if you are not offered a post initially, "there will be short periods during the offering period where you will be able to reconsider your preferences".
What are accept, hold and reject in the IMT offers process?
Accept, hold and reject are the three responses to an IMT offer, and you must choose one within 48 hours. The IMT recruitment office states that the 48 hours "does not include weekends" but does include bank holidays, and that no response withdraws your application.
| Response | What happens | Upgrade possible? |
|---|---|---|
| Accept | The post is yours; you will not receive another offer in this round | Yes, if you opt in |
| Hold | Keeps the offer open until the hold deadline while you await other specialties | Yes, if you opt in |
| Reject | Ends your IMT application for the round; no further offer | No |
| No response in 48 hours | Application withdrawn; no further offers | No |
Holding is the option for candidates who have applied to more than one specialty and are waiting on another outcome. The hold deadline for 2027 is 9am on Friday 9 April.
How does the IMT upgrade process work?
The IMT upgrade process lets a candidate who has accepted or held an offer opt in to be considered for any programme they ranked higher than the one offered, until the upgrade deadline of 4pm on Wednesday 14 April 2027.
The IMT recruitment office states that only programmes ranked higher than your current offer qualify, and that upgrades run "until a fixed deadline".
In practice, that means your preference order at the deadline is a genuine order, not a wish list. Rank above your offer only what you would rather have.
What is the IMT reserve list?
The IMT reserve list holds appointable candidates who have not yet received an offer because every programme they preferenced went to a higher-ranked candidate. The office states that reserve-list candidates "will be kept up to date with the progress of offers" after the upgrade deadline passes.
Offers continue as accepted candidates upgrade or withdraw, so a reserve-list candidate can receive an offer weeks after the initial round. Widening your preferences during the reconsideration windows is the lever you control.
What feedback do you get after the IMT interview?
After the IMT interview you receive your appointability status and rank, your score in each area with the raw and overall totals, a published distribution graph of all candidates' scores, and your interviewers' comments by email.
The IMT recruitment office describes three forms of feedback, and in 2026 the scoresheets were released on 2 April. The distribution graph shows average scores and the proportion found appointable.
The internalmedicineinterview bank marks spoken practice against the same seven areas, so a candidate preparing for a second attempt can work on the exact area their feedback names.
What if you are not appointable or not offered an IMT post?
If you are not appointable you receive no ranking and no offer in that round; if you are appointable but unplaced you stay on the reserve list and can widen your preferences during the reconsideration windows.
- Read the area scores. A single 1 or a third 2 explains a not-appointable outcome more often than the total does.
- Keep the interviewer comments; they are the most specific feedback you will get.
- Check whether a Round 2 or a later start date is advertised on the IMT recruitment office's dates and posts page.
- Start the next cycle's spoken practice early. internalmedicineinterview's 361 questions and AI-marked practice cost £97 to the interview week, and the free samples at /Question-Bank/Sample-Questions cover every station.
The application side of the next round, dates, eligibility and the self-assessment, is in our IMT application 2027 guide.