The Complete Guide to Respiratory Medicine ST4 Applications (2027 Entry)

Part I: an overview of the specialty

If you are aiming for a Respiratory Medicine Specialty Training Year 4 (ST4) position in the 2027 recruitment round 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 most recent published round (2026). 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 combines acute care with the long-term management of chronic disease, and that includes 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.

All Respiratory Medicine programmes dual specialise with General Internal Medicine (GIM), according to PHST. Trainees continue to contribute to acute medical take, requiring confidence in managing hypoxia, sepsis, acute asthma, NIV decisions, and complex comorbidity. The higher specialty years 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 General Internal Medicine. PHST notes that most, but not all, consultant appointments are in respiratory medicine with some general internal medicine.

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 offers clinical breadth, intellectual challenge and a mix of acute and chronic care.

Several features consistently draw applicants towards Respiratory Medicine:

A specialty with genuine breadth

PHST describes a huge number of different respiratory conditions, among them pulmonary infection, airways disease, cancer, interstitial lung disease, autoimmune diseases, sleep-related breathing disorders and pleural disease. 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.

Consultant careers

PHST says a sound training in general internal medicine is vital, because most (but not all) consultant appointments are in respiratory medicine with some general internal medicine.

A specialty central to acute medical care

PHST describes the respiratory specialist as being at the forefront of hospital acute services, including intensive care. Trainees who enjoy acute general medicine can develop refined decision-making in managing hypoxia, respiratory acidosis, NIV, complex infection and escalation to critical care.

Academic, teaching and leadership opportunities

PHST says respiratory medicine attracts a high level of research opportunities, that research during training is encouraged, and that many trainees obtain higher degrees such as an MD or PhD. For trainees interested in service transformation, research or education, the specialty offers 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 (2027). Entry requirements are tightly defined by NHS England and the Physician Higher Specialty Training (PHST) recruitment team to ensure that all successful applicants have the appropriate clinical and academic foundation.

Internal Medicine training requirements

You must show the Internal Medicine Stage 1 capabilities. The person specification accepts any one of the following by the advertised post start date (posts in the national ST3/ST4 round start between August and December 2027):

• Internal Medicine Training (IMT) Stage 1, UK ACCS (Internal Medicine) or UK Broad Based Training (medicine route), with successful completion by the start date
• A JRCPTB internationally level 3 accredited equivalent Internal Medicine Stage 1 programme
• UK Core Medical Training or ACCS (Acute Medicine) plus a further standalone third year (IMY3)
• UK ST3 in General Internal Medicine with satisfactory ARCP
• An accepted version of the Alternative Certificate to Enter Group 1 Higher Physician Specialty Training, submitted with your application

If you are still in training when you apply, you may apply if your programme will be completed by the advertised start date. If you have already completed it, your satisfactory ARCP must be submitted with your application.

Membership of the Royal Colleges of Physicians (MRCP)

You need MRCP (UK) Part 1 at the time of application, and the full MRCP (UK) diploma by the offer date. The full diploma means:

• MRCP Part 1
• MRCP Part 2 Written
• PACES

Eligibility for the GMC specialist register in general internal medicine, or Irish Basic Specialty Training plus the full MRCPI diploma by the offer date, are accepted alternatives. A candidate who cannot show the full diploma by the offer date does not meet the person specification.

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 at the time of application, and a licence to practise when the post starts
• right to work in the UK
• no unresolved fitness-to-practise issues
• satisfactory references
• clean declarations on probity and health

Commitment to specialty

In the 2026 round PHST did not assess commitment to specialty at shortlisting for Respiratory Medicine: applications were scored on the self-assessment framework alone, and commitment was assessed at interview. Check the PHST Respiratory Medicine page to see whether that is unchanged for 2027. Strong evidence of commitment 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 at interview, through your answers and your portfolio. PHST asks you not to upload evidence of courses you cite under commitment to specialty unless they relate to a scored option.

Dual training applicants

The 2027 person specification also lets current Intensive Care Medicine (ICM) trainees who intend to dual train apply. You must show completion of UK Core Medical Training or ACCS (Acute Medicine), successful completion of ST3 in ICM by the advertised start date, and satisfactory ARCP progress. The 2027 person specification keeps this rule: ICM trainees applying to dual train must not be beyond the end of ST5 in ICM at the time of interview, and PHST describes these as transitional arrangements.

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 qualifications, publications, presentations, teaching, quality improvement and leadership. 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.

You do not upload your scoring evidence with the application. After applications close, PHST contacts you with login details for a separate evidence system. Oriel itself is used for interview booking, programme preferences and offers. Email alerts are sent, but you 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.

2026/27 recruitment timeline

The Respiratory Medicine ST4 timeline follows the national Physician Higher Specialty Training (PHST) recruitment schedule, running from November 2026 into spring 2027 for posts starting from August 2027. The national dates are confirmed. Respiratory Medicine’s own evidence upload and interview dates are to be confirmed by PHST, so we show last cycle’s dates for context.

PHST publishes the anticipated evidence upload and interview dates for each specialty in the Interview dates & posts section of its specialty page. Use the table to plan portfolio completion, evidence gathering and interview preparation, and check the PHST Respiratory Medicine page for the exact dates. A second, smaller PHST round took applications from 28 July to 13 August 2026.

What is new for 2027: prioritisation and the five-application limit

Two changes affect everyone applying in the 2027 round.

• Five applications per round. NHS England says applicants can submit a maximum of five applications per recruitment round in 2027.
• Prioritisation. The Medical Training (Prioritisation) Act 2026 applies at two stages: the offer of an interview and the offer of a training place. Applicants are placed in a priority group or not, based on the country of their primary medical qualification, their immigration status and whether they have completed or are on a relevant qualifying UK programme. For ST3 and ST4 posts those programmes include the UK Foundation Programme and a relevant UK training programme that is an entry route for the specialty, such as IMT for Respiratory Medicine. Your status is shown in Oriel the day after the application deadline.

PHST says it is not yet possible to say what the effect on higher specialty recruitment will be. Read the criteria on the NHS England prioritisation page and check your own status before you decide where to apply.

Competition ratios

Applications for Respiratory Medicine ST4 have risen since 2023. The figures below are from the NHS England Medical Hub.

PHST’s own Respiratory page shows 108 posts for 2025 (3.8 : 1), because it counts posts at the end of the round. The 2026 figures have not been published yet. PHST also publishes shortlist scores, total scores and post fill rates for each specialty back to 2013, linked from its Respiratory Medicine page, so you can see how scores were distributed in past rounds.

Factors that may be contributing to the rise include:

• IMT bottlenecks: more IMT Stage 1 doctors may be 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.
• 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 application score and is a major gatekeeper for receiving an interview invitation. Respiratory ST4 uses the national PHST scoring framework. In the 2026 round the application score had 38 points from the self-assessment domains plus 2 marks for well-organised evidence, so it was out of 40. It is later halved and added to your interview score. The 2027 framework has not been published yet.

PHST’s 2026 scoring page lists these domains:

• Postgraduate degrees and qualifications
• Additional achievements (e.g. honours and prizes)
• Presentations and posters
• Publications
• Teaching experience and training in teaching
• Quality improvement (QI) and audit
• Leadership and management
• MRCP (UK) results beyond Part 1 (Part 2 Written and PACES), worth up to 8 points in 2026.

Commitment to specialty was not a scored shortlisting domain for Respiratory Medicine in 2026. Check the PHST scoring page for the options and points that apply to you before you score yourself.

Each domain presents a set of options with fixed point values. You must select the one that best describes your highest achievement in that domain and then upload evidence to prove it. Assessors 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

The next section gives a detailed breakdown of what to upload, including templates and examples.

Evidence upload: what impresses and what to avoid

After applications close, PHST will contact you 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 can only score what they can verify, so aim for evidence that is:

Clear and well organised
Keep each domain’s evidence short, clearly named and attached to the right domain. In 2026 PHST accepted PDF or image files up to 5MB each, and asked for an evidence pro forma for postgraduate qualifications, presentations and posters, publications, teaching experience and quality improvement.

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

Common pitfalls that can 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 using Qpercom Recruit and follow a structured national format used across Physician Higher Specialty Training (PHST). The structure is the same for every candidate in the specialty.

This is the latest published format (2026). PHST has said it will publish the 2027 format when it updates its website for the new round. In 2026 you completed two stations of 16 minutes each, about 40 minutes including changeovers, with a different pair of interviewers in each station. There were four questions of 6 to 10 minutes each and six scored areas, including a communication mark in each station.

Station 1: Clinical Scenario and Application & Training

The first question (about 10 minutes) assesses your ability to manage acute respiratory problems safely and structure your clinical reasoning. You will receive a short scenario of two or three sentences and a little time to review it before the discussion begins. The second question (about 6 minutes) reviews your application form and training to date: your career, achievements and engagement with learning. A third mark scores your communication throughout the station.

Typical clinical themes (Medset’s examples, not an official list) include:

• acute asthma, eosinophilic pulmonary diseases
• COPD exacerbation
• pneumonia and sepsis
• pulmonary embolism assessment
• hypoxia and oxygen delivery, sleep apnoea
• 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

Station 2: Medical Registrar Suitability and Suitability & Commitment

Station 2 opens with a one-minute presentation, with no slides, summarising your experience managing the acute unselected medical take as the medical registrar. The question explores the non-clinical side of being a medical registrar, drawing on two Internal Medicine Stage 1 capabilities in practice: managing an acute unselected take, and managing a multidisciplinary team including effective discharge planning. It lasts about 10 minutes. A second question of about 6 minutes explores your suitability for and commitment to the specialty and lets you expand on your application. A final mark scores your communication.

Examples of what the registrar question may draw on (Medset’s examples) include:

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

For the suitability and commitment question, common prompts include:

• “What motivates you to pursue Respiratory Medicine?”
• “What experience confirmed this choice?”
• “Which respiratory topics or pathways interest you the most?”
• “How have you prepared for ST4 training?”

For the application and training question, expect questions such as “Tell us about one of your QI projects and what you learned” or “Explain your contribution to this teaching programme or publication.” Panels look for genuine engagement, reflective insight, and clarity.

How you are scored and ranked

In 2026, each scored area was marked from 1 to 5 by each of two interviewers, where 3 means the level expected of a core-level trainee applying to the specialty. Your total score of 100 combined the interview, weighted to 80, and your application score, halved to 20. To be appointable you needed all three of the following:

• none of your twelve interview scores was 1 out of 5
• no more than two of your twelve scores were 2 out of 5
• a raw interview score of 36 or above (the raw score runs from 12 to 60)

Appointable candidates are ranked by total score and offered the highest-ranked programme on their preference list that is still available. The 2027 weightings and thresholds have not been published yet.

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.

The ground rules apply to every station: notes must be on paper, AI tools and real-time transcription are not permitted, and you must not share detailed information about the questions you were asked.

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 2: The One-Minute Medical Registrar Presentation

PHST asks you to start with a one-minute summary of your experience managing the acute unselected medical take as the medical registrar. It should cover:

• the roles and duration you have undertaken in this capacity
• the level of responsibility you have held, and how closely you were supervised
• the size and profile of the multidisciplinary teams you have managed
• the number of patients you were directly and indirectly responsible for
• the non-clinical duties you performed

You will be stopped at one minute. You may not use slides or share your screen, but you may use notes for your own use. Practise it out loud with a timer, giving headlines and brief descriptions. Expect follow-up questions asking you to expand on your experience, then examples of how you have managed different situations.

Station 2: Professionalism and Escalation 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: Suitability & Commitment 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 1: Application & Training (Portfolio Discussion) Preparation

Interviewers may pick any item from your application. Scores are not only about achievements, because those are already scored through the application form: interviewers also consider your answers, the breadth and quality of your achievements and your career progression.

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

Training in teaching has its own domain. In 2026 a higher qualification such as a PG Cert or PG Diploma scored the most (3 points). Training in teaching methods below that level scored 1 point if it was specifically focused on teaching, was additional to your medical degree and included at least six hours of live (synchronous) teaching time. You need a certificate and a course outline showing the duration and how it was delivered. Medset’s Train the Trainers course runs in two formats. The live virtual classroom includes six hours of live teaching plus online modules, so it fits the 2026 rule. The self-paced online course has no live teaching time, so it did not meet the rule. PHST has not yet published its 2027 wording, so check the scoring page before you choose a format.

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

Commitment to specialty is assessed at interview and is one of the most scrutinised themes 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.

Useful resources

A blend of clinical revision, interview practice and specialty-relevant tools is a sensible way to prepare. The following categories are worth covering.

Clinical Knowledge and Pathways

Respiratory scenarios can draw on established national guidelines. It helps to be familiar 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

Areas worth practising 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)

If you trained overseas, some parts of the process need extra preparation. From the 2027 round the Medical Training (Prioritisation) Act 2026 applies at the interview and offer stages, so check the priority criteria on the NHS England Medical Hub before you apply.

GMC Registration and MRCP

To apply and to start training, you must have:

• full GMC registration at the time of application, and a licence to practise when the post starts
• MRCP (UK) Part 1 at the time of application, and the full MRCP (UK) diploma (Part 2 Written and PACES as well) by the offer date

You must hold Part 1 when you apply and the full diploma by the offer 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 online, highly structured interview format. The Respiratory ST4 Interview Course is an online course created by Dr Sonay Beyatli, a respiratory specialist registrar.

What the course covers

The course page lists modules on:

• the application process, eligibility, competition, timeline, interview structure and how to prepare
• communication, practice and managing nerves, and common pitfalls
• clinical scenarios, with the ABCDE approach and hot topics such as sepsis, oxygen prescription, CURB-65, the Wells score, chest drains and NIV
• medical registrar suitability, with model frameworks and scenarios such as capacity, consent, incident reporting and concerns about a colleague
• suitability and commitment, including why respiratory medicine

Medset also lists a mock interview option on the course page; dates are posted there once they are confirmed.

Why practising to time helps

Practising out loud and to time helps with fluency, prioritisation and confidence when discussing your portfolio, whichever resources you use.

Frequently asked questions (FAQ)

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

No. You need MRCP (UK) Part 1 at the time of application and the full diploma (Part 2 Written and PACES as well) by the offer date for Respiratory Medicine ST4.

Is Respiratory Medicine offered as a dual training programme?

Yes. According to PHST, all Respiratory Medicine programmes dual specialise 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?

NHS England figures show 413 applications for 104 posts in 2025 (4.0 to 1), up from 367 applications for 109 posts in 2024 (3.4 to 1). PHST publishes indicative post numbers by region, and they can change as the round goes on. The 2026 figures are not yet published.

When are the Respiratory Medicine ST4 interviews in 2027?

Applications run from 19 November to 10 December 2026, and interviews fall within the national window of 11 January to 9 April 2027. Respiratory Medicine’s own dates are not yet published. In 2026 they were 2, 3 and 4 March.

How many applications can I make?

NHS England says a maximum of five applications per recruitment round in 2027.

What does the interview focus on?

In 2026 the two-station interview assessed:

• clinical reasoning in an acute scenario
• your application form and training to date
• your suitability to be a medical registrar, including a one-minute presentation
• suitability for and commitment to the specialty
• communication in each station

Structured answers score most strongly. PHST will confirm the 2027 format.

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?

Structured practice helps with timing and structure. A specialty-specific course, such as the Respiratory ST4 Interview Course, covers the interview format, frameworks and practice stations.

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.

A sensible approach is to:

• 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
• watch the PHST Respiratory Medicine page for the 2027 evidence upload and interview dates

The 2027 round has a confirmed national timetable, and applicant numbers have risen from 3.1 per post in 2023 to 4.0 in 2025. With deliberate preparation, authentic specialty engagement and clear communication, you can show readiness for higher specialty training and give yourself the best chance of an offer.

If you want focused, specialty-specific preparation, the Respiratory ST4 Interview Course
provides frameworks and guided practice stations for the interview.