What is DRE-EM?

Defined Route of Entry into Emergency Medicine

This is a run through 5-year training program in EM, which may be suitable for those who have done core training in other specialties such as core surgical training, or who have done a minimum of one year of EM experience with/without some ACCS competencies.

The Defined Route of Entry to Emergency Medicine (DRE-EM) allows entry to ST3 Training via 2 routes:

Route 1 : from Surgical Training

One route is to enter into Emergency Medicine specialty training, having successfully completed two years of a UK core surgical training program or two years of a run through surgical training program in the UK.

Entry via this route leads to a Certificate of Completion of Training (CCT) in Emergency Medicine.

Route 2 : from ACCS specialties

The other route is to enter into Emergency Medicine specialty training is with evidence of a minimum of 24 months at core trainee level (not including time spent within a Foundation program or equivalent like internship/house-job) in any ACCS specialties (Anaesthesia, Emergency Medicine, Intensive Care Medicine, or Acute Medicine), of which at least 12 months must be in Emergency Medicine, with at least 6 months of this worked within an Emergency Medicine environment similar to that seen in the UK and at least 12 months worked in the UK as a fully registered medical practitioner.

OR

Completion of the equivalent of core surgical training with evidence of achievement of CT/ST1 competencies in surgery at the time of application and CT/ST2 competencies in surgery by the time of appointment.

This route leads to a Certificate of Eligibility for Specialist Registration – Combined Programme (CESR CP) in Emergency Medicine.

Route 2a – from approved ACCS programs

Some trainees may have applied and been selected on the DRE-EM route having switched from other specialties within approved ACCS programs. There might be options for trainees in this category to train to CCT or CESR-CP.

The ST3 ‘year’ will normally last for 18-24 months depending on the competencies each trainee still requires for entry to ST4.  ST4 requirements are the same for DRE-EM and non-DRE-EM trainees and include having full MRCEM. Trainees from CST who have the MRCS are exempt from sitting the MRCEM part A if they successfully complete Parts B & C within four years of passing MRCS.

So is this for me?

The vital question.

If yes, then after getting GMC registered and working in the UK for a year, you can apply for this route to directly be an ST3 Trainee in EM upon getting your ACCS EM competencies signed from your home country.

Or, if you are already in the UK working in the aforementioned specialties, and willing to change your career to the EM, then it is for you too.

It’s always better if you have a look at the Person Specifications for ST3 DRE-EM.

Frequently Asked Questions

At what level will I be appointed?

You will be offered an appointment to a ‘ST3 Emergency Medicine’ post. Prior to your starting, a review will be conducted by the College of Emergency Medicine, in conjunction with the local training program, to understand what competencies can be transferred, and establish future requirements. A decision will be made as to the additional time/competencies required before to moving to ST4. You will usually undertake a minimum of one year of Emergency Medicine, plus additional time as needed in Acute Medicine, Anesthesia, Intensive Care, Medicine, etc. You’ll typically require between 12 months and 24 months at ST3 prior to progressing to ST4.

Does DRE-EM provide uncoupled or run through training?

DRE-EM provides run through training; you will progress through ST3, ST4, ST5 and ST6 automatically, subject to meeting all curriculum requirements and College exams.

If I am appointed to DRE-EM ST3 Emergency Medicine, do I need to take and pass the MRCEM examination before ST4?

Yes, you are required to pass the MRCEM exam, and all other ACCS/core EM competencies before moving to ST4 training.

Are applicants from a surgical training background- either from a UK approved program or an equivalent program- required to have cleared the MRCS?

If you are applying via the CCT route, you’re required to have completed MRCS.
If you are applying via the CESR CP route (equivalent surgical training), you are not required to have completed MRCS.

What is a CESR CP?

The Certificate of Eligibility for Specialist Registration – Combined Program (CESR CP) route allows applicants to be appointed above ST1/CT1 level to a LETB/Deanery and GMC approved training program. They are awarded a National Training Number (NTN), but when they start, they have previous training that has not been prospectively approved by the GMC to count.

The certificate does not replace the Certificate of Completion of Training (CCT) and is not the same thing as a CESR. Trainees who are awarded the CESR (CP) will be recommended to the GMC for Specialist Registration in the same manner as a trainee on the CCT route. Trainees will thus be able to work as substantive consultants in the UK.

Is there an upper experience/time limit for DRE-EM applicants?

No. The intention is to allow entry from a broad range of applicants, but you will have to demonstrate that your career progression is consistent with personal circumstances and that your achievements and performance is at par with your total period of training or experience.

How will the national recruitment process work?

The national recruitment process will be hosted by Health Education Yorkshire and the Humber. There is one national application form for DRE-EM Emergency Medicine ST3. Therefore, eligible candidates will apply and be interviewed under one process, irrespective of whether they are applying for the CESR CP route or CCT route.

Long-listing will take place in line with the person specification after the closing date. Short-listing will only be undertaken if required. You will be asked to rank all Units of Application within LETBs/Deaneries, although it is not yet certain whether all LETBs/Deaneries will have vacancies. If a candidate preferences a LETB/Deanery which does not have vacancies, the system will skip to the next preference on the candidate’s preference list, and so on.

For all DRE-EM applicants, the interview format will be a multi-station selection process. Thorough checks will be carried out by Consultant faculty to confirm eligibility. Whilst the station questions will be the same for those applying under the two routes, there will inevitably be some differences in terms of supplementary questions, as a result of the differing backgrounds of the two routes. A comprehensive scoring matrix will be used to ensure that all applicants from both routes are equitably assessed and are on a ‘level playing field’.

DRE-EM applicants will be ranked on one list, and offers will be made based on this single list, with the top candidate being offered their preferred post (subject to available vacancies).

Where do I find out further information– such as how to apply, where the interviews are happening, timeline for when applications open/close, etc?

For more information, check out the recruitment page. The applicant handbook may also be of help.


To conclude, DRE-EM is giving you the opportunity to change your career to EM in you mid-career in any of the ACCS specialties. The doctors with the background of working in those specialties are also going to be helped with this route as this is additional path of national recruitment to ST3 training in the UK.

14 thoughts on “DRE-EM Program for Emergency Medicine”

  1. Thank you for this post. I just received full GMC registration and I’m about to start my first job working for the NHS. I have 2 years of experience working as a medical officer (equivalent to UK SHO) in my home country. I have the full MRCP, and will be doing MRCEM primary this year. Do you think I am eligible to apply for st3 training via the DRE-EM route?

  2. If I do have a MRCS qualification and worked in the NHS hospitals for 2 years in A&E as a clinical fellow, would I go under the CCT or CESR CP?
    Because its mentioned if surgical core trainee + MRCS = CCT
    And to be honest does CCT or CESR even make a difference?

    1. Clinical fellow is not a training job.
      To say plainly, in the UK there is traing before and after MRCS. If you do both type of TRAINING in the UK then you are on your route to CCT if you do one (mostly after MRCS), then you will get CESR-CP, if none then you have to take CESR.
      So, a doctor in the UK can also apply for CESR, if they never got into any formal training job. After MRCS you have to join a training for a specific surgical specialty (or EM training if you wish), that will be your route to get CESR-CP (Combined programme) not CCT.
      It doesn’t matter in the UK. Some foreign medical regulatory boards maynot accept your specialist registration via CESR or CESR-CP, CCTs are more accepted.

    1. You still switch to EM and apply for ST3 EM, if you had achieved EM competencies. But to proceed from ST3 to ST4 you need to pass FRCEM Intermediate exam.

  3. Thank you for your well organized explicitly discussed post on this topic.
    I am a doctor from Bangladesh. Completed MRCS and cleared OET recently.Currently enrolled in the MS (Neurosurgery) residency program. I am planning to shift to UK and pursue my career in EM. I have one and half year experience of working in the accident and emergency department ( Here we don’t have any specific faculty as EMERGENCY MEDICINE), 3 months in ICU, 3 months in Anaesthesia, 6 months in Neuroemergency as part of the MS residency curriculum. WILL THESE EXPERIENCES BE COUNTED THERE? HOW CAN I GET MY ACCS EM SIGNED OFF?
    I have completed diploma in medical ultrasound and a post graduate certificate course in echocardiogram. I attended workshops on mechanical ventilation, ABG sampling, chest drain, ECG and imagings, Basic surgical skills and ATLS in my home country. Would these help me to get into a training program in EM there?
    Moreover, I have several other questions. Would you please run through these if you are free;
    1.What can be the best possible first job to pursue career in emergency medicine? (Keeping in mind if it is necessary to sign off the alternative foundation training certificate and alternative core competence certificate)
    2. What are the trainings and courses (eg USG, mechanical ventilation etc) I can do beforehand in Bangladesh before switching to UK?
    3. Should I appear in FRCEM intermediary (if I have the chance) before switching to UK?
    4. What are the certificates (eg alternative core competence, foundation training??) I need to get signed before I apply for DRE EM?
    Please feel free to suggest anything else if you have in mind for me.
    With thanks
    Dr Nafiz Imtiaz

    1. Hello, nice to meet you.
      1. It is always better to start as an SHO level job first and then move onto registrar level jobs.
      2. If the courses aren’t accredited by royal colleges, you will have to do them again regardless. But definitely knowing your way around things helps you in your work. You can use those course certificates in your application but accredited courses weigh much higher.
      3. I would suggest working in the UK first before appearing in FRCEM primary. Once you start working in A&E, the questions become very relatable to your work. It makes them easier.
      4. Have a look here : what is Core competences?

  4. I am dr aminul from bangladesh.Thank you for your excellent post.I have 2 year working experience in ICU at a multidisciplinary corporate hospital in Bangladesh. If I completed MRCS from Bangladesh,can I enter into EM training post in UK? Do I need UK core surgical training to enter into EM training post after completion of MRCS from Bangladesh? I want to be a EM specialist in future.
    Please Answer.
    Thank You

  5. I have more than 5 years training & experience in surgical field outside UK but I don’t have MRCS.
    Is there any chance to get DRE EM program in Uk?

    1. As mentioned in the post:
      “If candidates are applying via the CCT route, they are required to have achieved MRCS.
      If candidates are applying via the CESR CP route (equivalent surgical training), they are not required to have achieved MRCS.”
      To know further about CESR-CP, this might help:
      https://www.gmc-uk.org/registration-and-licensing/join-the-register/registration-applications/specialist-application-guides/combined-programme-application—cesr-cp

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