How I bagged my top choice IMT London Training Job
Introducing the Brownie Points Contest – also known as the Application Scoring Table
Training applications are a nuisance. It is akin to a comical contest where doctors must skate through this course and slide onto that project collecting as many brownie points as possible. Whether or not this charade directly contributes to your clinical skills as a doctor is up for debate. However, what is indisputable is that this ‘brownie points contest’ or the ‘Application Scoring Table’ as it is known on the IMT website is the crux of your application. It is your stepping-stone on to your medical journey. To make matters it worse, it is competitive. Very competitive. And it appears to have become harder and harder each year.
I applied for Internal Medical Training (IMT) in the year 2021. A whopping 3,512 candidates applied that year which rose from 2,714 the year before and 2,105 the year before that. And what about the number of posts? Those all stayed the same constant at approximately 1600. Re-iterates my point about competition becoming tougher. Being competitive does not automatically mean it needs to be hard. Far from it. You just have to be tactical and smart by doing things which have the greatest yield.
I had just started my Foundation Year 2 (FY2) doctor when I applied for IMT. I never planned on going straight to training. I was fully gearing up for a #gapyaahhh F3 year but thanks to COVID that was an uncertain option. I was a bit lost as to what was the next step. Maybe I could do that global health degree I always wanted to do; maybe I could locum and feebly attempt to save up for a house deposit. In the end, I decided to give the unfashionable option of applying to a training post a go and getting on with the “career thing.”
It is very easy to convince yourself you will be rubbish at something if you put your mind to it. I had concocted a long series of reasons why I wouldn’t have a strong IMT application. Firstly, I jumped on the ‘the brownie points contest’ bandwagon very late. 3 months before the application deadline I had no idea I was going to be applying. Needless to say, I hadn’t even checked what the IMT scores consisted of at that point. Secondly, I was only a F2 and my F3/4 colleagues had more clinical years behind them to collect more of these brownie points. Lastly, I had far too good a time in medical school – so it was all play and minimal work. Neither were my university grades phenomenal, nor did I venture close to a posters or publications as a medical student. So how did I manage top 3% on my application score to bag my top choice London training post?
3 golden tips in achieving a top quality IMT application
- Be VERY familiar with the IMT application scoring table
- Use time effectively, not efficiently
- Choose the right projects, drop the clutter
#1: “The Brownie Points table” commonly known as “The Application Scoring table”
I can’t stress this enough. You need to know the IMT application scoring table off the back of your hand. Like really know it. There are 8 sections – Undergraduate degrees, Postgrad degrees, Additional Achievements, Presentations, Publications, Teaching, Quality improvement and Leadership. Reading what is required in each section is easy, but scratching the surface and dissecting the wording to really check if what you have done fits the bill is a completely different thing. I would have dropped a lot of valuable points if I didn’t go back on the letters I had as proof of evidence and go back to issuing hospital or organisation who to revise their wordings and format.
You must pay close attention to the wordings of the points table. For example, in the teaching experience section, the points table asks for you to have “designed and organised” and “contributed regularly over three months” to a teaching project in addition to receiving “formal feedback” teaching project. The chances are that if you had organised a teaching session, you most likely had a role in designing it, contributing to it regularly and would have acquired feedback along the way. However, all these things need to be explicitly mentioned in the evidence later to give them no reason to slash your points. I know some of our CST colleagues applying in my year also had points docked because there was “inadequate evidence of feedback.” It wasn’t just enough for the letter to mention the teaching course received positive feedback – so I attached all the feedback I received, whether it be spreadsheets from google forms, scanned paper feedback forms, email feedback and the thank your letters I received. Probably an overkill, but it got me full marks so I guess it worked. The other common pitfall section was Leadership. Most people will have a letter outlining the leadership role they have held but it would not mention the positive impact that role has had. Every leadership role will have a positive impact, so we need to ensure the evidence letter spells that out.
The other reason why evidence letters weren’t accepted was because of its format. Whether it’s a taster session, QI project, teaching or leadership make sure your hospital or charity or whoever is issuing you the letter have included their logo, company address and a date. I had to go back to the charity I worked with for my leadership letter to revise the letter, so it included all three things. The chances are that consultants or education centres providing you with the letter are not aware of the specific format or wording required. Most organisations would want to equip you with something that is appropriate for your use so I would go back and ask them to revise it if necessary. These minutiae wouldn’t make a difference to the issuing person/authority bit could all the difference to your points.
#2: Use time effectively, not efficiently
Efficiently working through an extra audit or delivering another teaching session is not necessarily going to help. It is very easy to get caught in the idea that the more you do, the better your application is going to be – but that isn’t necessarily true. Once I started focussing on the application scoring table, the more I realised I had been doing things which may help me with life in general but were not immediately useful to my application. For example, I was working on two different audits – one on sepsis and the other on troponins. That brownie points table doesn’t really care how may audits you do, but it does care about how many cycles of the same audit you do. So, I decided to prioritise completing the third cycle of my sepsis audit and left my troponin audit on the backburner for a later date. In retrospect this should have been obvious, but it’s easy to lose the bird’s eye view when you are the person going through the application.
Therefore, use time effectively, where everything you do is helping to push you up the next box in the table. I wish I had made life easier for myself. You don’t need to go through a million things frantically albeit efficiently. Drop the clutter and leisurely go through the targeted right projects.
Start strategizing based through this simple formula:
- Calculate your current score as it stands
- Identify your strong and weak sections
- Cross-off sections you don’t need to work on to streamline your attention. You can’t get or improve the score of your undergraduate degree so discard that section. If you have already maxed your points on another section, cross that off too. Working on it any further will be futile and your time is much better spent working on a different section.
- Review the sections you haven’t yet received top scores and evaluate if you can do any better in the given the time you have. This is the trickiest part and your area of work between now and leading up to the application.
#3: There is always time to maximise your points
It is a no brainer that the earlier you start accumulating your browning points, the more relaxed you will be and the better chances you will have with your application. But what is key to understand is that there are some sections, where you can get maximum points, quickly. Other sections need a few months so if you only have a month to your application, be wise on what you choose to do. Both QI and Publications have a maximum of 8 points – it is possible to do 3 cycles of QI in one months and get 8 points, but not quite possible to publish two first author papers.
Sections where you can easily improve your points is Quality improvement, Presentations and Teaching.
QI:
There is not really any big reason why one shouldn’t be getting maximum points in the QI section. You can do quick and easy audits such as checking if the Resus status is documented or cleanings stethoscopes/hands between each patient and re-audit after interventions. Your interventions could be something as simple of reminder posters and announcements in team board rounds. I did the dumb think of doing a very time-consuming audits where gathering data took weeks and months to complete which is not very feasible to re-audit unless you have a lot of time. Silver lining of that was possibly because it was time consuming, not many audits of that nature was done, and I managed to present it in an international conference which brings me on to the next point.
Presentations:
Don’t be scared to present. Full stop. Genuinely, before I had an international poster, I thought it was something that only super amazing, hardworking, and ridiculously out of the ordinary thing. But I was lucky I had a Consultant who considered it everything but difficult and she wouldn’t hear any of my excuses of it “not being good enough yet” or “there isn’t enough time”. So, on her orders, I did what I thought was a mediocre abstract. It couldn’t even be more than 300 or so words so it was very quick to do an lo and behold, it got accepted and I was very glad she didn’t allow me to shy away from it. Most hospital have local poster presentations, but if you have a few months until your application use any audit or QI you are doing and try giving national and international conferences a go. Worst case scenario is that you abstract get rejected for an International Conference and no harm is done as writing an abstract is not time consuming. But the best-case scenario is that you have acquired a lot of brownie points and your ranking is 200 or more spaces above what it would have been.
Teaching:
Talk to the undergraduate education team, your consultants, the F1s or students itself. There is always space for teaching. You could start up weekend revision courses, evening revision lectures, lunch time sessions, bedside mentoring courses, mock osces, skills workshop, bleep simulation workshops, anything really and get a signed letter. Top tip is that you need to do it regularly over three months, but you don’t have to do it an intense frequency. Depending on what your students want and what your commitments are like, instead of doing teaching multiple times a week, you can also do it fortnightly to make it manageable. The well-known Oxford Medical Teach the Teacher courses can earn you so easy points for a weekend’s worth of work, but you do have to pay up for those.
Sections where it is a bit more difficult to improve your points but still possible:
Postgraduate Degrees
I would argue it is fairly simple to get postgraduate degree points. With cOVID, Distance-Learning courses, PgCerts, Masters are offered by many universities. I personally enjoyed doing post graduate short course(on demand learning) by the University Aberdeen – these are modules contributing towards a full pgcert or masters but you can do jus parts of it if you are not ready for the full commitment yet. They can also very flexible, and you can do it over a period of time which works with your rota and time commitments. The biggest drawback is that they cost money unless you can magically get. Your hospital to fund it. I tried, but it didn’t work.
Publications:
We all know publications can take ages to publish. Honestly, keeping the issue of time aside I had a bit of a publication phobia – Where to begin, what to write, how to choose a topic and how to get it published? However, once you have a good guide and structure, publications will fall into place. I will be writing a blog post on blog post on “How to write a systematic review” where I will break down systematic review write-ups in manageable steps which anyone can follow.
You need to start early if you want publication points. It doesn’t have to be years in advance, but a couple months would do. And you need to choose sensibly. Time to publication in a good journal like Lancet or BMJ can also take months and years. So, choose a more accessible journal, but make sure it is PubMed indexed. I published mine in Cureus, which is peer reviewed but takes only a few weeks from submission to publication. Additionally, you are unlikely to get a Randomised Controlled trial published unless you have years at your disposal. RCTs also hugely rely on teamwork, experiments, and gruelling data collection. To get a publication published, rely on yourself. And choose something you can do from the comfort of your own home. For example, if you have any interesting patient cases you come across, offer to write a case report. Or ask your consultants if there are any interesting cases they want written up. To get the higher marks on the points table, you need something like a systematic review. Like case reports, you can do them from home in your time. You don’t need to spend time collecting data or running experiments. All the information you need is already online on Pubmed or Medline databases. You just need to formulate an interesting research question and use the articles already published to answer it.
Lastly, be humble of what you’ve published. These are tips on how to publish fast which would not necessarily equate to something with a high impact factor and the rest.
Leadership:
Leadership projects are not hard to come by. Talk to your rota coordinator to see if they need a hand with the rota, become a BMA Rep, join a charity. But the reason it takes a long time is that you must do it for a minimum of 6 months to use it in your application.
You really don’t need to run in this IMT race, you can walk through it, leisurely but SMARTLY and do just fine!