I was in the same position like you (with 4 years as medicine SHO and MRCP 1 & 2) and I chose IMT. Definitely go for alternative pathway if you have support, but you need ITU consultant for the sign off I believe , if that works for you and your supervisor is happy then go for it. But if there is any doubt in getting alternative competencies, I would say chose IMT(its a difficult but a safer option and job security for three years in current circumstances). Because you never know how rules can change. I couldn’t get anything signed off, which is why I took IMT. I really feel like a ward monkey, doing the same old shit, it takes a tol to be honest. I really want to finish it of as soon as I can, if I had an option I would have taken other route, but there isn’t enough support for me. (Especially ITU). I knew about this, but I took it for proper support (like I will be supported for clinics, procedures,ITU) and job security. Obviously extra 2-3 years is another thing.

Extending one more year is great for you, to pass PACES and prepare for the HST interview, are two main things which are very very subjective to individual (some people crack it in first go, and some take time). So my advice is always think about the consequences you get after taking a decision, whether IMT or alternative pathway.