A Simplified Guide into Emergency Medicine - UK – International Emergency Medicine Education Project

The great thing about going into emergency medicine (EM) is that it allows entry into the program at various points of your career. So whether you know right off the bat following your two foundations years or whether it takes you a couple of years to make a choice, there is a straight pathway into the speciality (give or take a bit more competition!).

Acute care common stem (ACCS)

The most common entry route into emergency medicine from your foundation years is through the Acute care common stem (ACCS). This will be a 3-year training program and so becomes your CT1-3 years. This will comprise four six-month rotations in Intensive care medicine (ICM), emergency medicine (EM), anesthesia, and acute medicine (AM). Following this, there will be a one-year focus on EM and pediatric emergency medicine (PEM). In terms of examinations, the major ones that need to be completed are the MCEM Part A before the CT3 year and the MCEM Parts B and C before progressing to higher specialty training (ST4).

Defined route of entry into EM training (DRE-EM)

If one doesn’t do the ACCS and decides they want to enter EM in their ST3 year, this can be done view the DRE-EM. For the two years before entry into the DRE-EM at ST3, you need to have a minimum of 2 years of experience in substantive EM posts (which exclude any done during your foundation years). In addition, one of these posts needs to have been in the UK in the previous four years. Examples of such posts could be a core trainee level in an ACCS specialty (anesthesia, EM, ICM, AM), which at the end of the pathway would give you a Certificate of Completion of Training (CCT), or in core surgical training, which would give you a Certificate of Eligibility for Specialist Registration by the combined program route (CESR CP). Your ST3 year following acceptance into the DRE-EM can take 18 to 24 months, depending on how quickly competencies are met to enter ST4.

Before entry into their ST4 years, trainees will be required to have completed the EM specialty-specific examinations before progressing into ST4:

• MCEM Part A or MRCS (Latter for DRE-EM trainees only)

• MCEM Parts B and C

At the end of this training, all trainees will be required to complete the FCEM exit example before their awarded their CCT.

Higher Specialty training (HST) in EM

This is one of the pathways into EM that can be taken following CT3/ST3. Entry at this point is by a selection through a national recruitment process. From this point, HST trainees can also apply for subspecialty training posts, such as PEM or prehospital emergency medicine. This training post doesn’t have to be full-time (i.e., done over two years instead of one year).

This simplified pathway can be seen in the figure below.

However, your route into EM isn’t always straightforward; you might be considering taking a detour, so it’s important to remember that there are backways into EM as well, and not everything will have been covered here! So make sure to check out the ACCS 2021 curriculum guide or the RCEM website for more details.