The Complete Guide to Respiratory Medicine ST4 Applications

Part I: an overview of the specialty

If you are aiming for a Respiratory Medicine Specialty Training Year 4 (ST4) position and want clear, practical advice that reflects how national selection actually works, you are in the right place.

This complete guide walks you through the full application journey, including the eligibility criteria, Oriel process, scoring framework, evidence requirements and the interview format used in the 2025/26 recruitment cycle. You’ll also find detailed insights into what Respiratory Medicine training involves, the skills expected at entry, and the kind of portfolio evidence that consistently convinces assessors.

Along the way, we highlight how to prepare efficiently using Medset’s Respiratory ST4 Interview Course so that you can approach the process in a calm, organised and prepared fashion.

What Respiratory Medicine training involves

Respiratory Medicine sits at the intersection of acute care, chronic disease management, diagnostics and procedural practice. At ST4, trainees begin higher specialty training in a specialty that has become increasingly central to the National Health Service due to rising respiratory disease prevalence, complex inpatient needs, and the expansion of subspecialty services such as interstitial lung disease (ILD), lung cancer pathways, advanced ventilation and pleural medicine.

The scope of practice is broad. Respiratory trainees manage severe pneumonia, COPD exacerbations, asthma, interstitial lung diseases, bronchiectasis, pleural effusions, sleep-related breathing disorders, tuberculosis (region-dependent), and complex hypoxia. They work closely with radiology, oncology, critical care, physiologists, specialist nurses and palliative care teams, particularly in lung cancer/ILD services where multidisciplinary decision-making is essential.

Procedural skills are a defining part of training. These include chest drain insertion, pleural aspiration, pleural ultrasound, bronchoscopy, bronchial lavage and, in many centres, endobronchial ultrasound (EBUS) and medical thoracoscopy. Early in training, pleural procedures are a priority, with bronchoscopy and subspecialty techniques developing progressively as exposure increases.

A typical ST4 week includes inpatient respiratory ward work, general internal medicine on-calls, specialist clinics (e.g., ILD, asthma/COPD, lung cancer, bronchiectasis or TB), bronchoscopy and pleural lists, lung cancer multidisciplinary team (MDT) meetings, quality improvement work and teaching activity.

Most deaneries deliver Respiratory Medicine as a dual-accredited programme with General Internal Medicine (GIM). Trainees continue to contribute to acute medical take, requiring confidence in managing hypoxia, sepsis, acute asthma, NIV decisions, and complex comorbidity. Higher specialty years (ST4–ST7) incorporate rotations through ILD services, cancer pathways, sleep and ventilation units, bronchoscopy theatres and infection teams, depending on local availability. Completion of training leads to a Certificate of Completion of Training (CCT) in Respiratory Medicine (and usually GIM), preparing trainees for consultant roles across district general hospitals, tertiary centres and academic units.

Why consider Respiratory Medicine

Respiratory Medicine attracts doctors who enjoy a specialty combining acute decision-making, procedural skill, diagnostic reasoning and long-term patient relationships. It has become one of the most dynamic areas in internal medicine, offering clinical breadth, intellectual challenge and strong service needs.

Several features consistently draw applicants toward Respiratory Medicine:

A specialty with genuine breadth

Few medical specialties cover such a broad range of clinical presentations — from acute respiratory compromise to chronic progressive diseases such as IPF or bronchiectasis. This variety suits trainees who enjoy a mix of rapid-decision acute work and thoughtful outpatient medicine.

Procedural opportunities throughout training

Respiratory Medicine provides structured development in pleural procedures, bronchoscopy and, in appropriate centres, advanced interventional techniques such as EBUS, intercostal pleural catheter (IPC) insertion or medical thoracoscopy. Many applicants are drawn to the balance of hands-on skill and clinical reasoning.

Strong consultant job prospects

Respiratory Medicine continues to face significant workforce shortages in many regions, creating excellent long-term job security. Expansion in airways diseases, ILD, pleural medicine, lung cancer pathways and home ventilation services means newly appointed consultants often find clear opportunities to lead and innovate.

A specialty central to acute medical care

Respiratory issues drive a large proportion of acute admissions. Trainees who enjoy acute general medicine often thrive in respiratory units, where they develop refined decision-making in managing hypoxia, respiratory acidosis, NIV, complex infection and escalation to critical care.

Academic, teaching and leadership opportunities

Respiratory teams regularly lead national audits, participate in major clinical trials (particularly in ILD and severe asthma), develop regional care pathways and deliver high-impact teaching programmes. For trainees interested in service transformation, research or education, Respiratory Medicine offers substantial scope for involvement.

If this combination of acute care, procedural skill, diagnostics and long-term management appeals to you, the next step is understanding the eligibility requirements and how to apply.

Eligibility checklist

Before opening Oriel, ensure you meet the national person specification for Respiratory Medicine ST4. Entry requirements are tightly defined by the Physician Higher Specialty Training (PHST) recruitment team to ensure that all successful applicants have the appropriate clinical and academic foundation.

Core medical training requirements

Applicants must have completed one of the following by the training start date (usually August 2026 or February 2027):

• Internal Medicine Training (IMT) Stage 1, with successful ARCP
• Acute Care Common Stem – Acute Medicine (ACCS-AM), provided IMT Stage 1 capabilities are fully achieved
• Equivalent international training, mapped clearly to IMT outcomes

If your ARCP is pending at the time of application, you may still apply — but completion must be confirmed before starting the post.

Membership of the Royal Colleges of Physicians (MRCP)

Full MRCP is required, including:

• MRCP Part 1
• MRCP Part 2 Written
• PACES

You may apply before all components are completed, but all must be passed before the CCT programme start date. Candidates without confirmed PACES passes by this point cannot take up the post.

Evidence of clinical competence

Competence at IMT Stage 1 level must be demonstrated through:

• ARCP outcomes
• supervisor reports
• ePortfolio evidence
• procedural documentation (pleural procedures, NIV exposure, acute medical work)

IMG applicants must map their competencies clearly to IMT outcomes, using structured evidence.

Fitness to practise and professional requirements

Applicants must have:

• full GMC registration
• right to work in the UK
• no unresolved fitness-to-practise issues
• satisfactory references
• clean declarations on probity and health

Commitment to specialty

This is a major part of scoring and interview performance. Strong evidence includes:

• taster weeks in respiratory units
• attendance at lung cancer or ILD MDTs
• QI projects in pleural safety, NIV, COPD and asthma pathways, or lung cancer standards
• respiratory-focused teaching
• involvement in respiratory research or audit
• shadowing bronchoscopy or pleural clinics

Commitment is judged across the written application, portfolio evidence and interview questions.

Dual training applicants

Applicants interested in dual Respiratory–Intensive Care Medicine (ICM) must meet entry requirements for both specialties. Availability of dual posts varies by deanery.

Part II the application process: How to apply on Oriel

The Respiratory Medicine ST4 application is submitted through Oriel, the national online recruitment portal used across UK postgraduate medical training. Although the system is straightforward, the quality of what you upload — and how clearly you present your evidence — has a direct impact on your shortlisting score and, ultimately, your invitation to interview.

You will need to create or sign into your Oriel account, search for the “Respiratory Medicine ST4” vacancy within Physician Higher Specialty Training (PHST), and complete the online application form. The form includes demographic details, declarations, employment history, qualifications and the self-assessment section.

The self-assessment section is one of the most important components. Here, you are required to score yourself against set criteria relating to publications, audits, teaching, leadership, quality improvement, presentations and commitment to specialty. The scoring guidance is strict, and claims must be supported by documentary evidence at the upload stage. Panels will later validate your score, and over-claiming leads to score reduction or, in serious cases, application rejection.

Once the application is submitted, Oriel will auto-generate deadlines for evidence submission and provide updates on longlisting outcomes, interview scheduling and offers. Email alerts are also sent, but applicants are strongly advised to log into Oriel frequently during recruitment windows to avoid missing time-sensitive tasks.

Remember: Oriel does not allow late submissions. Applications, evidence uploads and slot bookings must be completed by the exact deadlines listed in the window. Missing a single step removes you from the recruitment process for that cycle.

2025/26 recruitment timeline

The Respiratory Medicine ST4 timeline follows the national PHST recruitment schedule, running through late 2025 and early 2026 for August 2026 start dates. The exact dates are published by PHST, but the structure is consistent each year.

Below is a table in the same style as the Vascular ST3 guide — clean, clear and centred on the applicant’s perspective:

These dates may shift slightly when PHST publishes final documentation, but the sequence remains consistent. Applicants should plan portfolio completion, evidence gathering and interview preparation around this timetable to avoid bottlenecks later in the cycle.

Competition ratios

Respiratory Medicine traditionally sits in the mid–upper range of competition within higher medical specialties. However, ratios have gradually risen over the past several recruitment cycles due to increased interest, bottlenecks at Internal Medicine Training (IMT) exit, and a rise in applicants seeking specialties with a strong balance of both acute and chronic care.

Recent years have seen many deaneries receive more applicants than available ST4 posts, particularly in London, the West Midlands and Scotland. The British Thoracic Society and PHST have noted increasing interest among IMT doctors who value respiratory’s combination of procedures, diagnostics, and involvement in acute medicine.

In the 2024/25 cycle, competition ratios varied by region but remained higher in metropolitan areas with tertiary respiratory units. Although exact 2025/26 figures will not be published until later in the year, all indicators suggest ratios will again reflect strong national demand.

Several factors explain the increasing pressure:

• IMT bottlenecks: More IMT Stage 1 doctors are eligible than there are ST4 posts.
• Subspecialty expansion: Growth in ILD, airways diseases, pleural medicine and lung cancer services has increased the specialty’s visibility.
• Predictable consultant demand: Hospitals continue to face respiratory workforce shortages.
• Strong procedural identity: Applicants who want to work in a specialty combining hands-on procedures with broad medical practice are increasingly choosing respiratory.

While competition ratios help applicants understand the overall landscape, they do not predict individual success — a point reinforced later in this guide. Strong evidence, clear communication, and structured interview performance remain the real differentiators.

Self-assessment guide with scoring logic and evidence

The self-assessment section determines your shortlisting score and is a major gatekeeper for receiving an interview invitation. Respiratory ST4 uses the national PHST scoring framework, which assesses your achievements across several domains:

• Quality Improvement (QI) and audit
• Teaching experience
• Leadership and management
• Research, publications and presentations
• Commitment to specialty
• Additional achievements (e.g. prizes, qualifications)

Each domain presents a set of criteria with fixed point values. You must select the level that best describes your achievements and then upload evidence to prove it. Panels will validate your claims strictly and will reduce scores where evidence is incomplete, ambiguous or inconsistent.

How the scoring logic works

The scoring model rewards:

• sustained involvement rather than single events
• completed cycles for audits and QI
• teaching roles with evaluation rather than ad hoc sessions
• peer-reviewed publications over local newsletters
• oral presentations over posters
• specialty-specific engagement over generic IMT activity

For example, a QI project that demonstrates problem identification, data collection, intervention, re-measurement and dissemination is scored more highly than participation in a single-cycle audit. Similarly, publications indexed on PubMed or presented at recognised respiratory conferences carry more weight than local-level activities.

What strong evidence looks like

Evidence should be:

• concise
• clearly labelled
• combined into logical PDFs
• cross-referenced to the scoring domain
• dated, signed or independently verifiable

Panels will disregard unclear evidence, so applicants must present information professionally and logically.

What to avoid

Common pitfalls include:

• over-claiming without sufficient proof
• listing planned audits as “completed”
• uploading teaching slides without feedback forms
• submitting abstracts not accepted for presentation
• providing evidence with mismatched dates
• relying solely on respiratory taster weeks without broader commitment

A later section of this guide (“Evidence upload: what impresses and what to avoid”) gives a detailed breakdown using the same structure as your Vascular ST3 article, including templates and examples.

Evidence upload: what impresses and what to avoid

Once your self-assessment is submitted, you will be required to upload documentary evidence for each claimed domain. This step is critical: the verification team may downgrade or remove any claim that is not supported by clear, valid, or complete evidence. Strong applicants treat this stage with the same importance as the interview itself.

What impresses assessors

Assessors consistently reward evidence that is:

Clear and well organised
Use one PDF per domain, with a brief index page outlining each item and where it can be found.

Directly matched to the claim
If the domain refers to a completed QI cycle, the evidence should include baseline data, intervention, re-measurement, and outcome.

Fully dated and attributable
Dates must align exactly with your application. All documents must clearly show your name.

Supported by independent verification
Certificates, supervisor letters, emails from organisers, and official acceptance notifications all carry strong weight.

Specialty-relevant where possible
Respiratory cases, pleural pathways, lung cancer MDT involvement, ventilation audits or ILD and airways disease QI projects tend to stand out positively.

Clean, legible and professionally presented
Evidence that is simple to follow helps assessors quickly validate your claim without ambiguity.

What to avoid

Several common pitfalls consistently lead to downgrading:

• Missing dates
• Evidence that appears copied, redacted excessively, or altered
• Certificates without signatures or issuer details
• Audit reports without re-measurement
• Slides without feedback
• Conference abstracts without acceptance confirmation
• Email screenshots with no identifiers
• Over-claiming — an immediate red flag
• Claiming planned work (“in progress”) as completed

Remember: If assessors cannot verify it, they cannot score it.

Clear, complete, well-structured evidence makes the verification process straightforward and greatly reduces the risk of losing points.

Interview format and timing

Respiratory Medicine ST4 interviews are delivered online and follow a structured national format used across Physician Higher Specialty Training (PHST).

You will complete two stations, each containing two scored questions. Interviews typically last between 25 and 35 minutes.

Station 1 — Clinical & Professional Scenarios

This station assesses your ability to manage acute respiratory problems safely and structure your clinical reasoning. You will receive a short scenario to read before the discussion begins.

Typical themes include:

• acute asthma, eosinophilic pulmonary diseases
• COPD exacerbation
• pneumonia and sepsis
• pulmonary embolism assessment
• hypoxia and oxygen delivery, sleep apnea
• non-invasive ventilation (NIV) decisions
• pleural effusion pathways
• pneumothorax management
• interpreting chest imaging or blood gases

You are assessed on:

• early recognition of severity
• safe prioritisation and escalation
• structured management plans
• use of evidence-based pathways
• clarity and clinical reasoning
• communication under pressure

The professional/ethical question may involve:

• mental capacity and consent
• team conflict or handover concerns
• patient safety incidents
• professionalism issues
• difficult conversations
• prioritising during system pressure

Station 2 — Commitment & Portfolio Discussion

This station explores your background, commitment to respiratory medicine, and depth of understanding of your portfolio evidence.

Common questions include:

• “What motivates you to pursue Respiratory Medicine?”
• “What experience confirmed this choice?”
• “Which respiratory topics or pathways interest you the most?”
• “Tell us about one of your QI projects and what you learned.”
• “Explain your contribution to this teaching programme/publication.”
• “How have you prepared for ST4 training?”

Panels look for genuine engagement, reflective insight, and clarity.

Station-by-station preparation

To perform well, you must prepare deliberately for each station. The interview is highly structured, and candidates who practise with purpose tend to score significantly higher.

Station 1 — Clinical Scenario Preparation

Use structured frameworks. Assessors prefer a consistent, safe pattern over fragmented or overly detailed answers.

For acute presentations, use:

Identify → Assess → Act → Escalate

or a respiratory-adjusted ABCDE for deteriorating patients.

Key revision areas include:

• asthma severity assessment
• COPD pH/CO₂ interpretation and escalation to NIV
• pneumonia severity and sepsis pathways
• pleural disease decision-making
• indications for chest drain vs aspiration
• pulmonary embolism risk stratification
• oxygen delivery methods (including HFNO)
• recognising when to involve critical care early

Practise interpreting simple imaging: CXRs showing consolidation, pneumothorax, large effusion, spirometry and ABG interpretation, hyperinflation or mass lesions.

Station 1 — Professionalism/Ethics Preparation

Use structured models such as:

SPIES (Situation – Problem – Intervention – Escalation – Support)
Four Principles (autonomy, beneficence, non-maleficence, justice)
GMC Good Medical Practice

Scenarios often require:

• calm handling of conflict
• prioritising patient safety
• recognising personal limits
• clear escalation to senior clinicians
• thorough documentation and follow-up

Station 2 — Commitment to Specialty Preparation

Reflect deeply on:

why respiratory
your key learning moments
MDT exposure (cancer, ILD, ventilation)
procedural experiences
any taster weeks
respiratory-specific QI or teaching
cases that shaped your career interest

Show authenticity, not memorisation.

Station 2 — Portfolio Discussion Preparation

Panels may pick any item you uploaded.

Prepare concise 60–90 second summaries for:

• QI projects
• audits, research
• teaching roles
• publications/presentations
• leadership roles
• major achievements

Focus on:

your role,
what you did,
what changed,
what you learned.

Part III Interview specifics: Point-scoring Mark-earning habits at interview

High-scoring candidates consistently demonstrate the following behaviours:

1. Structured answers every time

Structured = safer. Scattered answers score poorly. Use repeatable frameworks under pressure.

2. Early, appropriate escalation

Respiratory medicine deals with physiological instability. Panels reward candidates who escalate:

• early
• clearly
• to the right person
• with a rationale

3. Clear prioritisation

Tell the panel what you will do in the next 10 minutes rather than listing every possible intervention.

4. Calm, professional tone

Confidence is not volume — it is clarity. Speak steadily, pause briefly to structure your answer, and avoid filler speech.

5. Evidence-based thinking

Demonstrate familiarity with:

• BTS guidelines
• local pleural pathways
• NIV criteria
• sepsis management
• oxygen safety principles

You are not expected to quote numbers, but you must show aligned reasoning.

6. Reflection and insight

Especially in Station 2. Panels score highly for:

• “What I learned was…”
• “Looking back, I would have…”
• “This changed how I approach…”

7. Ownership of your portfolio

Know your evidence deeply. Weak understanding creates doubt and reduces trust in your self-assessment claims.

Building a strong portfolio

A well-structured portfolio is one of the most influential components in Respiratory Medicine ST4 selection. It supports your self-assessment claims, shapes your discussion during the interview and signals your commitment to higher specialty training. The strongest portfolios are built over time and demonstrate both breadth and depth across the core domains.

Quality Improvement (QI) and Audit

Respiratory services offer rich opportunities for impactful QI work due to structured pathways and safety-critical processes. High-scoring applicants typically present projects involving:

• pleural safety bundles
• NIV governance and escalation pathways
• COPD discharge bundles
• lung cancer referral standards
• pneumothorax pathway optimisation
• oxygen prescription audits

Your evidence should clearly outline:

• project aim
• your specific role
• baseline data
• intervention
• re-measurement
• measurable improvement
• dissemination (local or regional)

Closed-loop projects with documented patient-level benefit score most strongly.

Teaching Experience

Respiratory Medicine places value on structured, regular teaching. Strong evidence includes:

• designing or coordinating teaching programmes
• simulation-based respiratory teaching
• teaching IMT or FY cohorts
• delivering sessions on asthma, COPD, NIV, pleural disease or CXR interpretation
• collated feedback demonstrating improvement

Formal teaching qualifications strengthen this domain further.

Research and Academic Activity

Respiratory training is evidence-driven, and assessors expect some engagement with academic activity. Achievements may include:

• posters (regional, national or international)
• oral presentations
• co-author or first-author publications
• involvement in ILD, cancer or asthma clinical research
• assisting with data collection for trials

All research evidence must be cited accurately and include your contribution.

Leadership and Management

This domain rewards evidence of responsibility and initiative, such as:

• rota coordination
• organising teaching timetables
• leading QI groups
• service development contributions
• involvement in guideline or policy updates

Show clear outcomes — for example, “Improved NIV documentation compliance from 45% to 78%”.

Commitment to Specialty

This is one of the most scrutinised domains for Respiratory Medicine. High-quality evidence includes:

• pleural clinics or procedure lists
• bronchoscopy exposure
• lung cancer MDT attendance
• ILD, ventilation or sleep medicine experience
• respiratory teaching delivered or attended
• reflective learning entries from taster weeks
• involvement in respiratory QI

Commitment must be genuine and demonstrated through sustained experience.

Tried and tested resources

Successful applicants prepare using a blend of clinical revision, interview practice and specialty-relevant tools. The following categories consistently prove valuable.

Clinical Knowledge and Pathways

Respiratory interview scenarios frequently align with established national guidelines. Ensure familiarity with:

• British Thoracic Society (BTS) pleural guidelines
• BTS asthma and COPD guidelines
• NIV protocols
• oxygen therapy and safety guidance
• national lung cancer optimum pathways
• ILD multidisciplinary management principles

Local trust protocols for pleural disease, escalation pathways and ventilation are also extremely helpful.

Investigation Interpretation

Frequently examined areas include:

• chest X-rays (consolidation, pneumothorax, effusion, ILD changes)
• CT thorax patterns (large pulmonary emboli with right heart strain)
• blood gas and spirometry interpretation
• oxygen delivery devices and flow-rate reasoning

Panels reward clarity rather than technical jargon.

Communication Frameworks

Structured communication improves performance across all stations.

Practice using:

• SBAR (Situation–Background–Assessment–Recommendation)
• SPIES (Situation–Problem–Intervention–Escalation–Support)
• IM SAFE (fatigue, limitations, stress, etc.) for professionalism reflections
• basic GMC Good Medical Practice principles

Interview Practice

The most effective candidates practise:

• timed answers
• simulated online interviews
• clinical scenario walk-throughs
• portfolio discussions out loud
• mock interviews with respiratory trainees or consultants

Honest, structured feedback is more valuable than large volumes of unfocused revision.

Common pitfalls and how to avoid them

Despite strong clinical backgrounds, applicants frequently lose marks due to avoidable errors. Being aware of these pitfalls allows you to prepare strategically.

1. Lack of structure in clinical answers

Unstructured, rambling responses score poorly even if the medical knowledge is strong.
Use a consistent clinical framework every time.

2. Over-explaining instead of prioritising

Panels do not expect textbook detail. They expect:

• immediate priorities
• safe escalation
• rationale for decisions
• recognition of risk

Focus on what you would do within the next 10 minutes.

3. Weak understanding of portfolio evidence

If you cannot articulately fluently explain a QI project or teaching role, assessors may doubt the validity of your claim. Prepare concise summaries in advance.

4. Missing or unclear evidence in verification

Common issues include:

• no dates
• no signature
• no indication of your contribution
• screenshots with missing identifiers
• incomplete audit cycles

If evidence is unclear, assume it may be downgraded.

5. Generic commitment-to-specialty answers

Statements such as “I enjoy respiratory medicine because it is varied” will not score highly.
Instead, reflect on specific experiences, for example:

• observing a bronchoscopy
• participating in an ILD/lung MDT
• supporting NIV decisions on take
• a STROKE/TIA overlap clinic involving respiratory complications like pulmonary arteriovenous malformations

6. Underestimating timing and pressure

Online interviews move quickly. Practise concise, structured answers under time pressure to improve fluency.

Guidance for International Medical Graduates (IMGs)

Respiratory Medicine attracts a significant number of International Medical Graduates (IMGs) each year. Many bring excellent acute care experience, strong procedural backgrounds and extensive exposure to high-acuity medicine — all of which can strengthen interview performance.

However, IMGs often face additional challenges that require strategic preparation.

GMC Registration and MRCP

Before starting training, you must have:

• full GMC registration with licence to practise
• completed all components of MRCP (Part 1, Part 2 Written, PACES)

You may apply before receiving final MRCP results, but all components must be passed before the training start date.

Demonstrating IMT Equivalence

To meet eligibility criteria, IMG applicants must evidence competence equivalent to Internal Medicine Training (IMT) Stage 1. This may include:

• mapped curriculum documents
• supervisor letters
• workplace-based assessments
• procedural logs

Clarity and structure here are essential.

Understanding United Kingdom Systems

IMG candidates often benefit from:

• taster weeks in respiratory departments
• joining pleural clinics or bronchoscopy lists
• attending lung cancer MDT meetings
• observing NIV and escalation pathways
• learning United Kingdom norms for capacity, consent and safeguarding

These experiences help bridge differences between healthcare systems and improve confidence during interview scenarios.

Strengthening Portfolio Evidence

Evidence from overseas roles must be:

• dated
• clearly attributable
• translated where necessary
• mapped appropriately to PHST requirements

For QI/audit, ensure documentation reflects the United Kingdom model of:

baseline → intervention → re-measurement → outcome.

Interview Preparation

IMGs often benefit from extra practice in:

• United Kingdom-style communication frameworks
• structuring answers
• explaining rationale succinctly
• discussing ethical or professionalism scenarios

Mock interviews with individuals familiar with PHST interviews can make a substantial difference.

Medset’s Respiratory ST4 Interview Course

Preparing for the Respiratory Medicine ST4 interview requires more than clinical knowledge alone — it requires structure, clarity under time pressure and familiarity with the scoring anchors used by the Physician Higher Specialty Training (PHST) recruitment team. Many strong clinicians lose marks simply because they are not used to the online, highly structured interview format.

The Respiratory ST4 Interview Course, delivered by Medset, is designed around the exact national interview structure and focuses on the skills that consistently separate successful candidates from the rest.

You can explore and book the course here:
Respiratory ST4 Interview Course

What the course covers

The course provides targeted preparation across the full interview spectrum:

• structured approaches to acute respiratory scenarios
• safe interpretation of gas exchange, imaging and ventilation decisions
• communication frameworks for ethical and professionalism stations
• high-quality responses to commitment-to-specialty questions
• portfolio discussion practice with reflective, concise and accurate answers
• personalised feedback on pacing, clarity, escalation and scenario reasoning

Why it helps

Candidates who practise in a timed, realistic environment demonstrate:

• greater fluency during clinical scenarios
• clearer prioritisation and escalation
• improved confidence when discussing portfolio evidence
• more polished reflective answers
• reduced hesitation in commitment-to-specialty questions

Trainees frequently report that the mock-station format mirrors the real interview closely, helping them understand where points are won and lost.

Frequently asked questions (FAQ)

Do I need to complete all parts of MRCP before applying?

You may apply before receiving the final result, but MRCP Part 1, Part 2 Written and PACES must all be completed before the training start date for Respiratory Medicine ST4.

Is Respiratory Medicine offered as a dual training programme?

Yes. Most regions offer dual accreditation with General Internal Medicine (GIM). Some deaneries also offer combined training with Intensive Care Medicine (ICM), depending on regional capacity.

How competitive is Respiratory Medicine ST4?

Competition varies by year and region. London and major tertiary centres tend to be the most competitive. Smaller deaneries often have more stable ratios, but post numbers can fluctuate. Demand has increased due to rising IMT output.

What does the interview focus on?

The two-station interview assesses:

• clinical reasoning
• communication and professionalism
• interpretation of investigations
• ethical or situational judgement
• commitment to specialty
• portfolio evidence clarification

Structured answers score most strongly.

How can I strengthen my commitment-to-specialty evidence?

Meaningful experiences may include:

• attending lung cancer, ILD and TB MDT meetings
• shadowing bronchoscopy or pleural lists
• participating in respiratory QI (NIV audits, pleural bundles, COPD projects)
• attending BTS, ERS and Royal College educational events
• observing ventilation decisions or sleep clinics
• reflective entries linked to respiratory exposure

Do I need hands-on bronchoscopy or pleural experience before applying?

Technical procedural experience is helpful but not required. Awareness of indications, risks and pathways is more important at ST4 level.

What happens if my evidence is downgraded at verification?

Downgrading can significantly reduce your ranking position. You cannot add new evidence after the verification window, so all uploaded documents must be clear, dated, attributable and relevant to the domain claimed.

Should I attend a preparation course?

Most applicants who score highly at interview undertake structured practice. A specialty-specific course, such as the Respiratory ST4 Interview Course, can help you understand the interview style, refine structured responses and practise under realistic timed conditions.

Final thoughts

Respiratory Medicine offers a uniquely rich combination of acute care, chronic disease management, procedural work and interdisciplinary collaboration. It is fast-paced, intellectually stimulating and consistently evolving — from ILD therapies and oncology advances to ventilation pathways and pleural medicine innovation.

The pathway to Respiratory Medicine ST4 is competitive, but competition ratios do not determine success — preparation does.

Applicants who do the following consistently achieve the strongest results:

• build a well-evidenced, structured portfolio
• practise timed, structured interview answers
• reflect sincerely on their specialty motivation
• understand respiratory pathways, escalation and safe decision-making
• prepare early rather than compressing effort close to interview season

The 2025/26 cycle brings a stable timetable, steady growth in applicant interest and rising expectations around interview performance. With deliberate preparation, authentic specialty engagement and clear communication, you can demonstrate readiness for higher specialty training and secure an offer.

If you want focused, specialty-specific preparation, the Respiratory ST4 Interview Course
provides structured mock stations, frameworks and feedback aligned directly to the national interview format.