Emergency Medicine is a specialty in which doctors use their knowledge and skills to recognise and treat the acute, urgent, and emergency aspects of illness and injury affecting patients of all age groups. A lot of international Medical Graduates (IMGs) working in the UK are interested to know how the training in emergency medicine is structured and what are the opportunities to work in this field. Royal College of Emergency Medicine (RCEM) is the body who maintains the training and their website would be the primary source of information and guidelines.

Related Sub-specialties

The pathways to obtain Certificate of Completion of Training (CCT) in emergency medicine in the UK, is not as straight forward as many medical specialties. Before we go into the in-depth discussion, I would like to mention the following sub-specialties which are related to the main EM training.

  • Paediatric Emergency Medicine
  • Pre-hospital Emergency Medicine
  • Intensive Care Medicine (Dual accreditation along with EM)

There are a number of other recently developed (and developing) options for special interests that can be included in emergency medicine training. These include

  • Academic EM,
  • Geriatric EM,
  • Ambulatory Care and and a number of other allied specialties.

Some Emergency Physicians also work as General Practitioners or have an interest in almost anything you can think of, including Toxicology, Infectious Diseases, Sexual Health, Wilderness Medicine, Retrieval Medicine… the list goes on and on!

Let’s have some look at the statistics

The statistics below are for the Round 1 fill-up rate for the CT1/ST1 specialties. We can clearly see a few important points:

  • The number of available posts for training in ACCS -EM (The CT1/ST1 equivalent for EM training) is very small compared to other specialties (325 in 2018, 323 in 2019) like GP, Internal medicine training even core surgical training. This small number makes this training competitive.
  • And as you can see almost 87% posts got accepted in 2019, that means the acceptance rate is moderately high among doctors who got the offer of training.

Pathway of Emergency Medicine training in the UK

Depending on your level of clinical work experience before, Emergency Medicine (EM) training offers you entry into the training pathway at three levels:

  1. ACCS-EM (3 years)
  2. DRE-EM (start from ST3 to ST6)
  3. Higher Specialty Training (ST4-ST6) (if you have obtained equivalent competencies of lower level trainnig already)

Acute Care Common Stem (ACCS) – EM

Acute Care Common Stem (ACCS) is a core level training programme. ACCS-EM is the only core training programme for trainees wishing to enter higher specialty training in Emergency Medicine in the UK.

It is a three year programme (CT1 – 3). The first two years are spent rotating through Emergency Medicine (EM), Acute Internal Medicine (AIM), Anaesthetics and Intensive Care Medicine (ICM). The third year is spent providing training that will ensure the trainee meets the minimum requirements for entry into Emergency Medicine Specialty Training at ST4 level.

The expected duration of this training programme is three years subject to satisfactory progression. The actual duration may depend on the circumstances of individual trainees. In 2020 applicants have the opportunity to accept a post as a run through training (RTT) post or a core training post. That means, if the trainee choose an RTT post – the progression to Higher training of EM is streamlined where in the other case they have the option to choose something different if they want to.

Run-through Training (RTT)

As we all know the specialties are mainly divided into uncoupled and run-through on the basis of how the higher specialty training follows the core level training – for EM a trainee has the option to choose.

If they choose to be on a RTT pathway they begin at ST1 (ACCS-EM) and continue, dependent on satisfactory ARCPs (yearly evaluation) , to ST6 without the need to re-apply for Higher Specialty Training (ST4-6).

If they choose otherwise (choose ACCS-EM to be a core training only), then they will have to go through recruitment again for HST. Some might prefer this over RTT, as they have the option to change their specialty after finishing their core level training to keep their options open.

Core Training

ACCS-EM is the core training for Emergency Medicine.

Read in detail about ACCS from the official documentation – ACCS website.

Direct Route of Entry to EM (DRE-EM) & EM ST3

DRE-EM is an entry point to ST3 for trainees who have a background in Core Surgical Training or a background in non-training posts in Emergency Depts .

We have written an article regarding this – DRE-EM for Emergency Medicine.

Higher Specialty Training

Higher Specialty Training in Emergency Medicine (EM) is the years ST4 to ST6. Trainees at this level assume the EM Registrar posts and work their way to become a consultant.

In order to apply for HST at ST4 level, you need to:

  1. Completed MRCEM (before 2018) or have FRCEM Intermediate certificate by the time of appointment.
  2. Evidence of achievement of foundation competencies.
  3. Have evidence of achievement of ACCS-EM or equivalent competencies by working in the relevant fields.

Find more info at Person Specification of ST4 EM here.

Sub-Specialty Training

As mentioned already above, the related sub-specialties to the main EM training are:

  • Paediatric EM
  • Pre-hospital EM
  • Intensive Care Medicine

During your higher specialty training (HST) if you are interested in any of these sub-speciaities then you can choose to take these routes.

PEM (Paediatric Emergency Medicine) will be an extra 12 months of training during your HST in order to gain a sub-specialty accreditation with your EM CCT. Six months Paeds/PEM training is part of the EM curriculum during the CT/ST3 year. This six months training cannot count towards the twelve months training at sub-specialty level.

PHEM (Pre-Hospital Emergency Medicine) is a new sub-specialty area of medical practice focusing on the specialist provision of on-scene and in-transit critical care. Unlike paediatric EM, PHEM doesn’t extend your EM training rather the trainees take a blended training (mixing base specialty with PHEM training) which most closely reflects future working patterns and gives trainees sufficient time to consolidate information.

Intensive Care Medicine (ICM) is a specialty in it’s own right which is available for EM trainees to specialize in as well. Unlike PEM and PHEM, which are sub-specialties – ICM is it’s own specialty – thus you have to take the training in ICM to obtain dual CCT in EM and ICM. This in terms will make the entire training longer by 2 or 2.5 years. More official info about dual CCTs in ICM and EM can be found here.

FRCEM Examination

Fellowship of Royal College of Emergency Medicine (FRCEM) is one of the pre-requisite to complete your EM training in the UK successfully. The different components of this fellowship exam are divided into various stages of your training – which will be highlighted in the infographic below.

The Fellowship examination consists of the following components:

  • FRCEM Primary Examination 
  • FRCEM Intermediate Certificate:
    • Short Answer Question Paper 
    • Situational Judgement Paper
  • FRCEM Final Examination:
    • Critical Appraisal (Short Answer Question Paper)
    • Quality Improvement Project (QIP)
    • Clinical Short Answer Question Paper 
    • Objective Structured Clinical Examination (OSCE)

Previously (circa 2012) there was a separate Membership Examination (MRCEM) with three parts (A,B,C). But that has been absolved into the fellowship examination. You can obtain a Membership of the Royal College of EM is you have done any of the below:

  • FRCEM Primary (or MRCEM Part A between 1 August 2012 and 1 August 2016 or granted exemption)
  • FRCEM Intermediate SAQ (or MRCEM Part B between 1 August 2012 and 1 August 2016) 
  • MRCEM OSCE (previously called Part C.  Passed after 1 August 2012)  

Info-graphic on Emergency Medicine Training in the UK

How can an International Medical Graduate (IMG) join EM training?

Obtain GMC registration with a license to practice

Before joining any approved training programme in the UK, you have to have GMC registration with a license to practice first.

Please read this article on order to know which pathway to choose for GMC registration – How to get registered with GMC (UK).

Getting the CREST form signed

If you already have obtained Full GMC registration, the next step for you to be eligible to apply for ACCS-EM (CT1/ST1) level training is to obtain equivalent Foundation Competencies. There is a form called Certificate of Readiness to Enter Specialty Training (CREST) which serves the purpose.

Click the photo below to take the FREE course by RoadToUK Academy related to getting your CREST form signed.

Click the photo to take the FREE Course!

Gaining experience in working in Emergency Medicine

Taking a trust grade job (non-training job) in Emergency Medicine is always a good idea if you want to make a career out of it in the long term. You can aim to get your CREST form signed working there as well as gain enough experience to build a solid portfolio for your training application.

Read our experience about – Working in Accidents & Emergency (A&E) in the NHS as a junior doctor.

Apply for training when the rounds open

Training applications happen in rounds and in order to effectively plan, you need to know when this rounds open. Like all other specialty training, the process is entirely online and the posts are advertised in ORIEL and applied through that system as well.

To know about the recruitment timeline please keep an eye on the responsible deaneries websites:

  1. ACCS-EM, the recruitment is co-ordinated by the London Postgraduate Medical and Dental Education.
  2. ST3 DRE-EM, it is handled by Health Education of Yorkshire & Humber.
  3. Higher Specialty Training (ST4). it is also Health Education of Yorkshire & Humber

SAS (Specialist & Associate Specialist) Grade

The term ‘SAS doctor’ includes staff grade, associate specialist and specialty doctors with at least four years of postgraduate training, two of which are in a relevant specialty.

Now-a-days all of these grade are termed as Specialty Doctor which are non-training posts which usually offer the opportunity to focus predominantly on providing direct patient care and less on the other clinical and non-clinical responsibilities required of a consultant or trainee . Many doctors choose this role as a long term or short term option and work their way for specialist registration via CESR or CESR-CP.

Specialist Registration via CESR or CESR-SP

If you want to get GMC registration as a specialist without having to go through a GMC-approved training programme your pathways can include obtaining CESR (Certificate of eligibility of Specialist Registration) or CESR-CP (Combined Programme).

Rules of CCT, CESR and CESR-CP are changing and thus the best place to track the current rule is the official Royal College Website.

Frequently Asked Questions

Still have questions?

Check out a day in the life of an A&E consultant with this interview:

Need further explanation?

Tap the photo to book a one-to-one guidance session with Ibreez and Ibrahim!

14 thoughts on “Emergency Medicine Training in the UK”

  1. I just finish family medicine at Saudi Arabia, and I want to joint acute care medicine is that possible
    Thank you

    1. Do you want to start at ST3 level training in EM? Find the required person specifications and see what is needed to get selected.

  2. hi if i pass MRCEM Primary should i need plab to get into uk training or can i get GMC registration if i pass just part 1 of mrcem ? which is better plab or mrcem ?

    1. You have to either complete PLAB or complete MRCEM in order to apply for GMC registration. Both will get you the same GMC registration – so in that terms one is not better than the other. Now it’s upto you to decide how quickly and how much you want to invest on getting GMC registration.



  4. I have completed 6 years of EM training in my home country (Hong Kong). What is the available path to continue to work as an emergency physician in UK? It sounds the only feasible way is I need to pass PLAB first in order to get GMC registration, followed by joining the EM training programme from the beginning. Is there any way that I can bypass the junior training and start working as a mid-level or specialist emergency physician in A&Es in UK?

    1. If you want to bypass the junior training you have to collect evidences and proof from your EM training in Hong Kong that you have done all the training requirements of that level already. You can find the ACCS-EM Curriculum here.
      Otherwise you can complete MRCS and prove that you have Certificate of Readiness to enter Higher Surgical Training (by same way of collecting evidences from your previous work) and apply for DRE-EM ST3 post.
      If you can’t prove your competencies in any of these ways, you will have start your training from the beginning. It’s all about having the clinical experience and competemcies according to the set curriculum to bypass a training.

  5. My partner has completed his UG in 2016 and been working as resident medical officers.For the past one year he is working in an emergency medicine department in a tertiary care and now on covid duty (ICU medical officer).So he has 5 yearsof experience, what should we do?should we directly apply for the training jobs after gmc registration?Or should we work there and apply after a while?

    1. Getting into a training job without any NHS experience:
      1) is technically difficult as you will have to prove you competencies from back home.
      2) is not suggested as it is natural to take a bit of time to get used to a new healthcare system and you don’t want to be in a career impacting commitment during that time.
      So it’s always better to get your feet yet with a non-training jobs first and then try for training.

  6. I have obtained full GMC registration and I’m eligible for F2 post after completing one-year of internship in my home country. My question is, do we need full 12 months of F2 experience before we apply for core training, or is there a chance to get accepted into CT before completing 12 months? I am aware that in some cases, supervising consultants can sign CREST forms after spending 3 months in the F2 post.
    Thanks in advance!

    1. Internal Medicine and GP training – both requires you to have worked 12 months in total after your F1 equivalent year. This duration can be UK and/or Non-UK combined. For other core level trainings please check the entry criteria in the person specifications.

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